By: Christine Chan
Christine Chan holds an MPH in Epidemiology, is a Seniors Support Consultant at the York Fairbank Centre for Seniors, and a PhD Candidate at the Institute of Health Policy, Management and Evaluation at the University of Toronto.
When people ask me what I do for work, they usually have a strong reaction. I tell them I work with older adults who are abused, exploited or neglected. I am a Senior’s Support Consultant at a busy senior’s centre in Toronto. I help older adults and their significant others facing situations of exploitation, abuse and neglect. It’s hard to explain how I landed in this line of work after 20 years of working in community health and hospital environments and pursuing public health training. A lot of the reason I am here has to do with luck, but also where my heart has taken me.
People typically struggle to make a mental connection of how elder abuse might fit with public health. They frown, asking me: “But what is it that you really do to help elder abuse?” Typically, people think elder abuse is a problem affecting only a few families, a rare problem the worst families have or a rare situation affecting a neglected older person.
The truth is: elder abuse is pervasive, and it is public health. According to the World Health Organization, elder abuse is “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person”. This harm can include physical, sexual, psychological and emotional abuse; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect.
The problem is that much of the population— you, me, our friends and family included— does not yet acknowledge the full extent of the problem. Unless you’re working in the field or have personal or professional encounters with an abusive or exploitation situation, you may have a limited recognition of elder abuse. The elder abuse stories we hear about often take place in nursing homes. People will share about how ‘this happened to that family’ as if the affected families are somewhere out there, not here and definitely not where they live. This is “othering”. My experiences have taught me that elder abuse is often othered in that people think “it’s a thing happening to others out there, but not to me or people like me, no, not in our circles I don’t think.”
Typically, people don’t see elder exploitation or neglect as a problem for their own community, their own families, or for people we know and meet regularly. Unfortunately, if we take a closer look at our family relationships and friendships, the ugly head of elder exploitation and neglect is readily revealed as the thin veneer of civility in some relationships is peeled back. The world rate of elder abuse among adults over 60 years of age is 16%. Expressed another way, 1 in 6 adults over 60 report having been subjected to some form of elder abuse in the past year.
Elder abuse is our problem: it’s in our families and it’s in our neighbourhoods. It’s not out there in some distant nursing home and it’s not a problem that only affects the poorest or richest neighbourhoods. It can happen to your mother, your uncle, your grandfather, your neighbour, your friend’s aunty, your doctor, your bus driver, your public librarian, your caregiver, your professor. Choices can be, and very well are, being made for them by caregivers, advisors, professionals that may not have an older person’s best interests in mind and may be far from what they would choose for themselves. Granted, most of the time people are trustworthy, people are caring, people are responsible with lives and assets entrusted to them; however, abuse of control and power is much more common that people realize. Psychological manipulation is happening. Verbal abuse is more common than we know. Money is being taken. Possessions are being transferred. Legal documents being signed in order to give others power over older people. Pre-emptive-estate conflict is taking place with impact on the living conditions for the older person. Sadly, for some, even basic needs like food, water, medication, and let’s not forget, vital companionship and social stimulation, go unmet. Let’s face it: when people manipulate you, they don’t care about your needs. They neglect you— which is why I consider neglect “the sibling of all abuses.”
The time has come to own elder abuse in the same way that we acknowledge child abuse and sexual violence. The “Me Too” movement needs to be accompanied by the “We Too” movement. Many silent seniors would say “We Too” if only someone would notice their suffering and help them imagine what hope and improvement could be like.
Indeed, life can be better for older persons and that’s why I love my job. We can help seniors re-design their lives and habits, so that harm from their treasured, yet previously abusive, relationships can be reduced. In a world that is often about fear and fascination over elder abuse, what we can be left with is a paralyzed shock response when what is needed is empathy and compassionate action. Fear and fascination with a problem leaves us stuck in a state of wonderment. As a society, we need to move away from this and better define the problems associated with elder abuse, familiarize ourselves with the risk factors and work in a coordinated fashion across the levels and sectors in society to solve this wicked problem.
Due to the limited understanding of elder abuse, few in our society have experience with the steps involved in identifying and carefully responding to an abuse or exploitation situation. We are basically not taught this in school. As a result, few know how to help a person in this situation, and even fewer can imagine the hope of living through and after elder abuse. Fortunately, most situations can be worked at, and I have seen plenty of survivors continuing to live their sunset years in the sun rather than in the shadows.
When someone experiences, as a grown adult, exploitation and aggression from people they love and perhaps even parented, it is a special type of suffering. It is the most private grief, deepest disappointment, a choking anxiety – yet these individuals still love the ones doing the abusing and want the best for the people harming them or the ‘perpetrators’ for those who work in criminal justice. This is the beauty of the elder abuse “victims” who I work with: they still want the best for everyone and most of all, they want peace.
I should note that very few of my elder abuse seniors would ever identify with being a victim or as someone who has experienced elder abuse for that matter. These labels (‘victim’, ‘perpetrators’) are not helpful as they are often not recognized by the people experiencing the violence, neglect or exploitation. The ‘victims’ often don’t identify with the term ‘elder abuse.’ They view it as a relationship gone very wrong and struggle to understand how it turned out that way. Elder abuse is a term coined by professionals and carers, since historically and still today, elder abuse is largely professionally driven, rather than victim- or survivor-driven. We professionals are the ones to tell seniors that they are being abused and that it needs to stop, rather than ‘victims’ seeking help. Many cases of elder abuse come to light because someone else – a daughter, a son, a neighbour, a niece, a grandchild – cared. We know this from the calls we get at the centre where I work and the referrals we get from hospitals, police, and the general public: People who cared about an older person bothered to do something about it on their behalf.
Once people start talking to me about elder abuse, they will inevitably mention the law or the police, as if criminal justice will solve these problems. This is consistent with what we have been taught as children or young adults: call the police, get a lawyer, the government should help.
But these solutions don’t work for most elder abuse cases. The criminal justice system may provide some legal remedies but it will not be able to heal relationships. Most older adults still need and, often, still want to be in a relationship with their abusive family or friends. These older adults cannot be easily extricated from trust agreements upheld by the law or developed from the heart. They are not like younger individuals. They can’t just leave relationships and start again somewhere new and fresh. Making new friends is much more difficult, physically getting around may be harder, and when financial difficulties are present as well, you can understand why some older adults will isolate. They are overwhelmed. They can’t just get a job and recover lost money. They can’t just go for a trauma webinar and come out a new person.
Who can understand the pain of neglect and abuse? Where are the victims’ voices since they are not out protesting or leading civic action? Once their abuse or neglectful situation has been worked on and they are able to have peace, hope, and (I always pray for) joy, then the last thing they want to do in their golden years is publicly campaign to end elder abuse. They want rest, good friends and company for the rest of their days. They certainly do not want to publicise the dirty laundry of their lives. This is why I think we will never see a public movement by survivors of elder abuse.
The problems of betrayal – betrayal of trust and disappointment with the limitations of love and what you expected that people might do for you when you are getting older – these are problems that cut deep. Problems of deep betrayal never heal solely by pursuing the law which condemns, divides and scars. And yet, healing is what we need. Ultimately, we use softer and better tools, such as communicating with all people involved in an exploitation and neglect situation to understand priorities and interests. We use community mediation, persuasion by professionals and influential friends or family members, explanation and clarification of the fiduciary duties that adult children or trusted parties have for older adults and where they might get in trouble with the law. We urge moral responsibility since legal endeavors may prove to be unsuccessful. We urge grace and forgiveness, and we urge help for all. Most elder abuse problems are inherently family problems; therefore, help is needed for all family members, even and especially for the person doing the abusing (if they will accept help). For the few unremorseful and continuingly exploitative friends or relatives, seeking criminal or civil remedies through the courts may be necessary.
Elder abuse response work is hard and long and requires a balance of tenacious toughness and tender-heartedness. The betrayal of trust suffered by our older adults is a chronic public health problem, presenting in acute ways at times, a problem hidden in plain sight. It’s time we owned the problem as a society, in our neighbourhoods and in our families. It’s our problem and we need to work on it together.
The Public Health Corner 
Leave a comment