Introduction
The twenty-first century is marked with the aging of populations in almost all countries, but more so in the developing countries of Asia, where China, India, Indonesia, and Thailand in particular occupy a significant place with their larger aging populations. With the aging population growing at a faster pace in many of Asia's developing countries than those in the developed countries of the Americas and Europe, growing incidence and prevalence of elder abuse is a matter of great concern attracting societal responses in dealing with the issue. Since the late 1990s, elder abuse as a concern has been receiving marked attention from the academic community, civil society members, as well as governments in many of the Asian countries, where policies for older people are being developed in line with the demographic and socioeconomic challenges being faced by these countries. There is growing interest in generating valid statistics, systematic collection of facts, and documentation of elder abuse cases, even though abuse and neglect of older people is under-reported and still unrecognized, in general, by family members and older persons in many Asian countries. Nonetheless, there is a serious attempt to develop conceptual and definitional clarity on abuse, neglect, abandonment, and exploitation of older people in society. The 1980s, 1990s, and even the early part of 2000 were marked by a taboo on discussing the subject of elder abuse and the denial by family members, older persons, and governments that abuse, neglect, violence against older people occur in their country, homes, and public places. However, for the last few years, we have seen an acknowledgment of the incidence and prevalence of elder abuse and neglect, as exemplified by a greater media coverage, reporting and recording of cases with the police, legislative reforms, revision of policies and programs to address issues of elder abuse and neglect, including abandonment, violence against older people, mistreatment, and marginalization of older people, which are on the rise. Many of the Asian countries, for instance China, Hong Kong, India, Philippines, Singapore, and Thailand, are making continuous progress in dealing with the concern, though national data on the extent of elder abuse and neglect are still missing. It is significant that various civil society groups and even governments in these countries, since 2006, have started to observe annually the World Elder Abuse Awareness Day (WEAAD), an initiative of the International Network for the Prevention of Elder Abuse (INPEA), with chapters in different parts of the world.
A decade or more of progress in selected Asian countries
In 2002, the Second World Assembly on Ageing was an important event, which brought international and national attention to aging issues, including incidence and prevalence of elder abuse. The Madrid International Plan of Action on Ageing (MIPAA) and the political declaration adopted by the UN member countries at the Second World Assembly on Ageing stated: “Governments be encouraged to develop and fund a National comprehensive strategy and Agenda to prevent, detect and intervene in elder abuse” (United Nations, 2002). Since then, many countries in their national agenda emphasized that the concern for elder abuse and neglect requires immediate attention, policy response, and societal interventions to reduce abusive environments and adoption of combating strategies from the perspective of older people and those involved with their care. In tune with the third issue of the MIPAA document, which outlines the objectives of eliminating all forms of neglect, abuse, and violence toward older persons and creating support services to address elder abuse, many of the Asian countries have progressed with treating elder abuse as a social issue and relevant to public health concerns and legal response. Gradually, efforts are being devoted to tackling the underlying causes of abuse and developing appropriate interventions.
No doubt, some countries have progressed faster than others in societal response to address the issue of elder abuse (United Nations, 2008). In Singapore (Chiang, Reference Chiang2002), there are provisions in the penal code that pertain to protecting elderly people from financial, physical, and sexual abuse. Also, the amended Women's Charter, besides dealing with family violence, has expanded its scope to include older adults and protects them against psychological or emotional as well as physical abuse (ESCAP, 2007). In addition, older people who suffer financial neglect have some form of redress through the Maintenance of Parents Act of 1996, which provides for parents to file a complaint against their children for maintenance (Shankardass, Reference Shankardass2010a). Nonetheless, a Medline search from 1966 to 1999 for local data in Singapore revealed no studies on elder abuse (Cham and Seow, Reference Cham and Seow2000). As Singaporean geriatrician Pang (Reference Pang2000) observes: “Elder abuse is seldom reported, and even less so in an Asian society where filial piety and respect for the elderly is traditionally highly regarded, . . . the relatively low figure of 17 cases of elder abuse out of 62,826 elderly attendances at the Emergency Department is likely to be the tip of the iceberg.”
In Philippines, Carlos (Reference Carlos1999) notes the occurrence of abuse committed against the elderly people in homes and institutions as a critical issue. In the same year, national statistics in Philippines revealed 12 homes for the aged operated by both the government and other charitable or private institutions, catering to the abandoned, needy, neglected, or unattached elderly people (Carlos, Reference Carlos1999). The Philippine Plan of Action for Older Persons 1999–2004 may be seen as a timely response of the government to respond to various key issues related to population aging, including addressing abuse, neglect, and marginalization of older people (ESCAP, 2007). In Philippines, the enactment into law of the “Senior Citizens Center Act” is recognition of elderly people's right to have access to facilities and opportunities to achieve a productive, wholesome, and satisfying life. The Act has been amended as the “Expanded Senior Citizens Act of 2009,” to maximize the contribution of elderly people to nation building, grant benefits, special privileges, and for other purposes including reducing elder abuse and neglect (Shankardass, Reference Shankardass2010a).
Similarly, in China (http://english.gov.cn/chinatoday), since the adoption of MIPAA, increasing numbers of policies have been related to improving the quality of life of older people and implicit in this approach is the prevention of elder abuse and neglect (Shankardass, Reference Shankardass2011). Besides strengthening the work on aging at the state-level departments and among the committees established right from central government to grassroots levels, the Chinese government pays attention, first to ensuring that older people have basic living allowance, second to improving their quality of life through construction and expansion of social security, and third to establishing a uniform basic old age insurance system in urban areas and a social aid system in rural areas. Also, various programs in both rural and urban areas encourage and support older people to integrate in society and maintain an active and healthy independent lifestyle (ESCAP, 2007). There is emphasis on developing community services, such as mobile services for day care, emergency, housekeeping, recreational activities, and improving supportive environments for home care (Chang, Reference Chang2010). The Chinese government has also enacted the law for the protection of the rights and interests of the elderly, which forbids mistreatment of the elderly people and stipulates punishment for the accused under the relevant provisions of the Regulations on Administrative Penalties for Public Security (China National Committee on Ageing, 2007). In China, the people's court takes the handling of cases of mistreatment, abandonment, and harm of elderly people very seriously. “Senior's tribunals,” the grassroots people's courts, are set up in rural and urban areas to handle civil cases, including those involving elder abuse (Shankardass, Reference Shankardass2011).
Hong Kong (http://www.info.gov.hk/swd) and Thailand (2001) have also initiated aging policies, certain age-friendly legislations, and programs as part of the strategy to develop and strengthen legal measures and social protection structures, including health and pensions, which attempt to address the needs of older people and reduce the risk of abuse in later years (Shankardass, Reference Shankardass2011). In Thailand, the “Act on Older Persons,” in force since 1 January 2004, covers significant issues on elderly people's rights, a national mechanism on the elderly people, tax privileges for children who take care of their parents, and the elderly fund. These initiatives serve as an incentive for children to look after their parents and parents-in-law and also promote healthiness of older people (ESCAP, 2007). The outline of the “Minimum Standard of Housing and Environment for Older Persons” is also a progressive step in reducing abuse and neglect of older persons (Shankardass, Reference Shankardass2011). Similarly, in Hong Kong, the release of statistics of elder abuse cases for the last few years by the Secretary for Health and Welfare at the Legislative Council is a positive development in raising awareness on elder abuse. It is noteworthy that the Social Welfare Department in 2002 launched a project on elder abuse research and protocol. This project includes research to understand the phenomenon of elder abuse, a multi-professional protocol for related parties in handling elder abuse cases, an elder abuse registry with a computerized database system, and related briefings and trainings (Hong Kong Christian Service, 2004).
Progress in India in addressing elder abuse concerns
In India, as in other Asian countries, elder abuse is gaining attention as a social, public health, legal, human rights, and gender issue, cutting across socioeconomic groups, rural–urban divide, and educational levels. There is accumulating evidence from surveys done by non-governmental organizations (NGOs), media coverage, crime records, hospital statistics, and other documented sources that the incidence and prevalence of elder abuse is on the rise and is gaining visibility in many new forms (Shankardass, Reference Shankardass, Johnson and Rajan2010b). Testimony to its occurrence in some form or the other has always been there, be it through films made from time to time to reflect social reality, or literary stories, or some published autobiographical accounts (Shankardass, Reference Shankardass2008). It has also been an increasing focus of academicians and researchers, though much greater interest was generated 2002 onward, when there is policy response toward the well-being of older people in some form or other. In addition, the growing concern at various levels such as a rapidly aging population, along with the occurrence of fast socioeconomic changes, migration, urbanization, resulting in the nuclearization of families and individuation, as well as prevailing poverty as witnessed in the last few years, are inevitably leading to an increase in the magnitude of elder abuse.
Like most countries in Asia, India does not have specific legislation to deal with elder abuse or its mandatory reporting, indicating a lack of strong political commitment to eradicate the problem. Nonetheless, there are many provisions in the criminal law or in laws dealing with civil rights, property rights, family violence, or mental health that deal with particular aspects of abuse. Six years ago, India enacted The Maintenance and Welfare of Parents and Senior Citizens Act 2007, which provides for more effective provisions for ensuring financial, emotional, and social security to the “uncared” senior citizens by their families. It especially reaches out to those deprived of shelter, maintenance, and protection. While all the 28 states and 7 union territories of India are recommended to notify the Act, frame rules for the Act, and appoint maintenance and appellate tribunals as well as appoint maintenance officers, so far only five states in the country have taken all the steps. Eleven states have taken most of the steps; for instance Delhi has taken four necessary steps, but has yet to constitute appellate tribunals. While most of the states and the union territories have notified the Act, other steps have not been taken for the effective implementation of the Act, despite the efforts of the Ministry of Social Justice and Empowerment, the nodal agency under the central government to look after the affairs of older persons in the country.
As in Europe, America, and a few Asian countries, where domestic violence legislation brings in its fold redress to older people, in India the legislation “The Protection of Women from Domestic Violence Act 2005” recognizes violence toward older persons, which occurs in the context of a breakdown in social relations between persons and his or her family. While this legislation stands out as an important adult protection law it, nonetheless, loses out as an enforcement mechanism, thus limiting its utility as an intervention into adult abuse cases. The growing cases of older people being framed by their young daughters-in-law for demanding “dowry” under the “Anti-dowry Act” without being able to protect themselves and get a hearing in the courts to defend themselves are a case in point. Quite like many countries, as Brownell (Reference Brownell, Mellor and Brownell2006) points out, adult protective service programs have conflicting mandates and definitions, which limit the effective coordination among protective service systems, thus failing to give relief to older people from abuse.
In India, the Eleventh Five-Year Plan (2007–2011) brought emphasis on the marginalization of older persons and recommended a specific health care plan for the elderly people, which could reduce their neglect and abuse in society. The lack of healthcare provisions makes older people vulnerable to neglect, mistreatment, and abuse. However, more important is the recognition that healthcare professionals through their practice are able to detect and assess abuse and neglect among older adults. Also, a growing concern is to recognize the burden of caregiving for elderly people, especially when family members are the desired and effectively in practice in the forefront as caregivers and the need to develop services as support to stressed caregivers. Respite care and day care centers that especially recognize the problem in care of older adults suffering from dementia and Alzheimer's disease are being encouraged by the government. In India, the Ministry of Social Justice and Empowerment has started supporting such initiatives of NGOs across the country. Programs for training in self-care for older persons and enhancing social contacts in the community are being initiated by senior citizens associations, along with programs to become less dependent on the carer and family members. These programs involve skills training, financial and health counseling, and encourage participation in support groups. “Helpline” and Internet connectivity set up by members of the civil society offer a wide range of information and counseling by trained manpower for problems related to elder abuse.
Consultations through such mechanisms on a range of aging issues are seen to have an impact in reducing the problem of abuse. However, despite many new initiatives, what is generally lacking is building a system for detection, treatment, and monitoring of abusive cases. There are limited specialized agencies and professionals from the social, legal, and health fields for dealing with elder abuse concerns. Police departments in various states in the country have set up senior citizens cells for registering elder abuse cases in all forms and types. However, in general, these bring greater emphasis on reconciliation among family members than seeking criminal procedures against perpetrators. A key concern, as is in many more countries across the world, is in addressing elder abuse by strengthening practice response. The question of whether there should be an integration of service systems for elder abuse victims and their perpetrators becomes pertinent. Addressing elder abuse from a social work perspective is challenging as interdisciplinary collaboration is often essential for effective intervention (Brownell, Reference Brownell, Mellor and Brownell2006). Moreover, in developing countries such as India, where geriatrics and gerontology is still in infancy, the availability of qualified professionals to deal with problems related to elder abuse is a moot point. Respective countries need to work on enhancing the justice system's response to elder abuse (Heisler and Steigel, Reference Heisler and Steigel2002) as well as dealing with concerns from the perspectives of the victim and the perpetrator. In most cases, prosecutions are long-drawn affairs and cause pain and agony to victims rather than quick relief from abusive situations.
The bigger issue is what kind of response and to what extent it is most appropriate and adequate to address elder abuse concerns which are generally seen in the form of physical abuse, including elder domestic violence, homicide and sexual assault, verbal or psychological/emotional abuse, financial abuse, neglect, abandonment as well as the violation of basic human rights, including abduction and mistreatment. These forms of abuse are manifested in many different ways across communities. They require a response in the form of either service, treatment, compensation, rehabilitation, or justice from different sectors as per requirements and the specific mandate of different sectors, namely from law enforcement agencies, social service providers, legal setups such as courts, police, and healthcare providers, etc., with a professional and humanistic perspective. At times, it is not simply one agency or service provider, there may be two or more, but unfortunately as things go these may not be properly coordinated or be fragmented, of varying quality, and may not be suitable to the needs of the victims who have to be served, quite like the problem in many other countries (Nerenberg, Reference Nerenberg, Mellor and Brownell2006).
As a critique of “The Maintenance and Welfare of Parents and Senior Citizens Act 2007,” voices are rising against the suitability of the legal framework to address issues of neglect as the Act does not go beyond maintenance and does not tackle the underlying issue of uncaring attitudes of family violence nor does it protect elderly people as consumers of care services. The Act does mandate states to build old age homes, but is silent about the possibility of institutional abuse and how to deal with it if it exists. However, an often unrecognized legal provision in the country exists in the form of the liability of those who organize and run institutions/old age homes with an obligation to care for the residents. The Indian Contract Act 1872 and the law of torts protect against any mistreatment and failure in caring. What most old people and their family members are generally unaware is that a civil suit can be filed against the management of the institution for the breach in contract to care, even though there might not be a written contract and damages can be claimed for the wrong done (Bakshi, Reference Bakshi and Bhatla2000). Institutions catering to meeting the needs of older persons have not so far been brought under legal purview in order to alleviate elder abuse, but there is a need to take seriously the provision in the Indian Penal Code, under which breach of contract may attract criminal liability (Shankardass, Reference Shankardass2008; Reference Shankardass, Johnson and Rajan2010b). Incidentally, the evidence of growing prevalence of elder abuse is often estimated by increases in old age homes and demand for institutional care and care providers/givers from outside the family (Shankardass, Reference Shankardass2003). However, governments are also encouraging “home-bound care,” which means serious thinking on interventions to reduce and eliminate abusive circumstances and situations at different levels. To combat elder abuse, there has to be community response to abuse and laws have to be strengthened, professionals mandated or encouraged to report abuse, and professional service providers organized to assess and provide training, have community outreach programs, and service coordination and effective implementable policies.
Concluding comments
Across the world, age-friendly and enabling environments are being built and developed as policy and legislative initiatives to minimize vulnerabilities of older people. Compared with India, certain countries such as China, Hong Kong, Philippines, Singapore, and Thailand have taken concrete steps in their response to tackle elder abuse. While these countries have taken many civil and criminal justice system responses, they have also streamlined budgetary allocations for initiating, maintaining, and monitoring programs and services, besides going in for skill development to generate appropriate responses. It is important that elder abuse concerns in India, and as elsewhere in the world, be combated with comprehensive, effective multiple system responses along with addressing “systemic” issues to enable adequate and timely health and social services with emphasis on reducing vulnerabilities to abuse and neglect and realization of rights of older persons.
Finally, while there must be pressure on governments for interventions, prevention, and protection, there must be a call for national surveys, statistics, disaggregated data, systematizing anecdotal evidence, developing appropriate methodology, encourage program evaluation studies, regulations of services, training programs for recognizing, detecting, addressing elder abuse for comprehensive societal dealing with the issue of elder abuse.
Conflict of interest
None.
