The research assignment
The Norwegian Directorate of Health asked the Norwegian Centre for Violence and
Traumatic Stress Studies (NKVTS) to conduct a qualitative study of abuse of elderly
people in Norway with a view to establishing the circumstances in which elder abuse
occurs, how the elderly perceive and deal with the situation, and what they do to
prevent and avoid abuse. The study reveals who abuses elderly people, the needs of the
elderly for help from the family, friends and acquaintances, from healthcare and social
services and the authorities, and their opinions of assistance provided. It was important
to establish variations in exposure to abuse for further studies of the same phenomenon.
Abuse
Abuse, according to the World Health Organization, is a general term for violence,
threats, intimidation and other behaviour resulting in harm, distress or suffering for
the victims. This understanding of the term is what informs the Government’s White
Paper on Future Care Challenges (Stortingsmelding 25 (2005-2006)).
Data and methodology
The data for this study were obtained by interviews of twenty-five women and five men
aged 62–95. Half had suffered abuse at the hands of adult children with substance
addiction and/or mental health problems; eight were abused by their spouse; four had
experience of abusive behaviour of neighbours or acquaintances; and in three cases, the
elderly had suffered what they experienced as improper and, on occasion, offensive
behaviour on the part of the care services (structural abuse).
Main findings
Compared with younger victims of physical abuse perpetrated by family members, the
elderly respondents in our sample were more likely to suffer abuse from adult children
than a partner/spouse.
The elderly are unwilling to call this behaviour abuse unless it involves actual physical
violence or threats. They do not see themselves as victims, because the abuse is perpetrated by members of the immediate family.
The adult children often had substance abuse or psychiatric problems dating from
childhood or adolescence. Relations with parents and peers had been difficult, and
there were problems in connection with life at school. Many of the abused old people
feel an urge to explain away their children’s unwanted behaviour by ascribing it to
circumstances outside latter’s control, such as inherited illnesses or predispositions.
Those who had experienced abuse by a partner, described their spouses as cantankerous
and aggressive. They were frequently at odds with other members of the family, colleagues at work, superiors and neighbours. Many of these partnerships/marriages were problematic from the start, and the abuse appears to have been part of a persistent pattern of negative behaviour. The «difficult» individuals were described as mentally ill. The exceptions were husbands or wives afflicted by dementia, which changed their character completely.
Like abused individuals in younger cohorts, the elderly did not attempt to leave the
abusive spouse or partner because they hoped the situation would improve, or because
the children were fond of both parents. They were also likely to pity the abuser, and feel
obliged to take care of the person, especially if it was one of their own children. The
elderly found it difficult to avoid contact because they felt sorry for the perpetrator. In
many cases, other siblings would intervene to protect their parents.
Several of the elderly respondents who had suffered abuse from neighbours and acquaintances, solved the problem either by avoiding the person or moving somewhere else. Victims of structural abuse, on the other hand, felt powerless in the face of the system/service. In many cases, these problems did appear to adversely affect the health of the elderly individual.
One of the most frequently stated reasons for approaching the health and social services
for help had to do with money, either because an adult child was constantly on at them
for money or because there were disputes with the person over financial dispositions.
The elderly had asked for help from GPs, mental health service, lawyers and the police.
These inquiries seldom led to changes before the eventual involvement of the Protective Services for the Elderly (PSE) or crisis centre. Both services have highly experienced
and qualified personnel in the field of abuse. It was their intervention that really brought
about improvements in the lives of the elderly concerned.
Many of the elderly who had been in touch with the ordinary care services in connection
with abuse, were far from happy with the help they were offered. A fortnight in an
institution is not much use for a person who has to return to the same place and
continue living with the person responsible for the abuse.
Some of our respondents wanted the public health and social services to accept greater
responsibility and do something about mentally ill individuals living at home, some of
whom neglect their personal hygiene, don’t take their medicine or follow the advice of
health workers.
Contact with the PSE and crisis centre was a turning point for many. Talking with
members of staff, being referred to other parts of the health and social services and
receiving practical assistance helped the elderly respondents achieve a better life.
Recommendations
To improve the lives of elderly victims of abuse, we would recommend setting up more
PSE centres, better supervision/aftercare of abusers, more facilities to prevent and
ameliorate social isolation, and better information on existing provisions.
Expand PSE services
The elderly participants of this study had all been helped by a PSE centre or crisis centre.
Both services have highly experienced and qualified staff to deal with violence in the
home and can help the abused elderly person get in touch with other parts of the health
and social services. Staff in both services are familiar with level of complexity of these
cases. Setting up PSE centres or creating an official position in the council administration
with competence in the field of elder abuse in other parts of the country – especially in
the most populous municipalities – should be undertaken. In addition, more could be
done to help the elderly understand that existing crisis centres are there to help the elderly as well. In 2001, only 2 per cent of people staying at a crisis centre were elderly, i.e. 60 and over, and only 2 per cent of all daytime visits were by people aged 60 and above.
We also recommend strengthening current services, training to staff to detect and help
elderly victims of abuse. In the case of small municipalities with small populations, it
would be a sensible idea for several municipalities to join forces to address cases of
abuse, possibly by creating a council position for people with the appropriate experience
and qualifications.
Closer supervision of abusers
In many cases, the abuser was an adult child suffering from substance addiction and/or
mental health problems. We recommend giving parents a greater role in the treatment
and aftercare of the adult child in the substance abuse and psychiatric services. Respondents want to see improvements in the aftercare of abusers discharged from a therapeutic institution or released from custody. The lack of inter-service coordination
creates problems for the abuser and the abused parents.
Elderly people in abusive marriages also would like to see the health and social services
get more involved. Our study indicates that local health service staff lack knowledge of
and qualifications for dealing with dementia, an illness often accompanied by severe
behavioural problems and depression. These shortfalls put too much strain on the
other spouse, with the risk of physical abuse increasing correspondingly.
More facilities to avoid social isolation of the elderly
Opportunities for contact and companionship with others are particularly important
for elderly victims of abuse. Steps should therefore be taken to widen the criteria on the
use of the TT card (free transport card) for people with mobility disabilities. At the
same time, it is important to stress the crucial role played by senior centres as social
meeting place for the elderly.
Raising awareness of provisions and services
The elderly are a heterogeneous group with an age span of about thirty years. They have
different ideas about themselves and about growing old. It is therefore important when
attempting to reach this target group to deploy a variety of approaches and strategies.
The elderly one is targeting through the different channels of information must be able
to identify themselves with the verbal descriptions and illustrations of elderly people
and their lives, depending on the type of information involved.
Looking ahead
Our findings offer a good starting point for further studies of the phenomenon of elder
abuse. But what we have learned so far is sufficient to initiate work on establishing new
provisions and services, and improving existing ones for elderly victims of abuse.
We believed to start with that the study would profit from a comprehensive prevalence
study of elder abuse. Our own review of prevalence studies conducted abroad revealed,
however, wide variations in response rates, and information provided by the different
countries is not necessarily comparable. For that reason, then, we would urge the
authorities to proceed with the issues raised in this study, rather than waiting for the
results of a prevalence study.