Like the rest of the world, Malaysia is rapidly ageing. Older adults – defined as those aged 60 or over – are projected to comprise approximately 10% of total Malaysian population by 2025, and 17% of Malaysian population by 2040. The oldest-old group (80 years and over) on the other hand, is expected to quadruple between 2010 and 2050. This booming of senior citizens has begun to draw attention and concerns, for several reasons. First, population aging is likely to be accompanied by an upsurge of non-communicable diseases and rising health care expenses. Second, it exerts greater pressure on the pension and social security system, as well as existing social services. Third, the increase of older adults amidst rapid industrialization renders these individuals vulnerable to exploitation, neglect and social isolation. And fourth, continuous population aging with decreasing fertility rates will worsen the dependency ratio (less working population, more dependants).
Among the problems that stems from this ‘greying phenomenon’ – which is occurring against a backdrop of urbanization and changes in social fabric – is abuse and neglect. The World Health Organization (WHO) has recognized elder abuse and neglect (EAN) as one of the major public health issues, and defined it as ‘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’. Generally, EAN is categorized into five types: physical abuse, emotional abuse, financial abuse, sexual abuse and neglect. Some researchers and organizations have attempted to expand the classification of EAN by including social abuse and institutional abuse, but the common five subtypes are still more widely used.
EAN results from a combination of multiple factors. At the contextual level, rapid urbanization and westernization of developing countries are said to have changed societal norms, social structures and family dynamics. Subsequently, many elders lose the traditional structural support that they used to enjoy. The ‘sandwich generation’ trend – which describes the struggle of an adult child having to care for his family (wife and younger children) and provide for his old parents at the same time – with the economic stresses of the modern world, further predisposes older adults to abuse and abandonment. At the individual level, risk factors for EAN include cognitive impairment, poor physical health, sex (female), shared living households, mental disorders or substance abuse (by caregiver), family disharmony and many more.
Research shows that while the worldwide prevalence of EAN is 15.7%, almost one in ten (10%) older adults in Malaysia experience some forms of abuse in late life. Interestingly, there seems to be a consensus that actual figures of EAN are way higher, because for every reported case, there are five to ten unreported cases. In Malaysia, the most common form of EAN is financial abuse, followed by emotional (psychological) abuse. Like child abuse and domestic violence, the repercussions of EAN are severe. Besides the monetary loss (from financial exploitation), EAN is shown to cause multiple health consequences such as premature mortality, depression, anxiety, sleeping problems, suicidal ideation and acts, gastrointestinal symptoms, urinary incontinence, musculoskeletal pain, and others.
Addressing EAN requires a multi-level approach. Apart from empowering older individuals through education and training, caregiver support should be adequately provided. This is to avoid abuse due to caregiver stress, lack of skills (to provide care) or unintentional neglect. Healthcare providers such as primary care physicians, family medicine specialists, geriatricians, nurses and medical assistants need to receive continuous training on the subject of EAN in order to facilitate detection and appropriate management of victims. Other interventions include family mediation, community-based services, criminal justice response and changes at the policy level. To this day, Malaysia does not have a specific act to protect older adults from abuse and exploitation. EAN cases often fall either under the penal code or the Domestic Violence Act (DVA 1994). Experts argued that these acts are not sufficient to safeguard the welfare and safety of older adults, and that formulation of a new, specific act or legislation is the way forward.
Dr. Raudah Mohd Yunus,
DrPH Candidate & Researcher for Prevent Elder Abuse and Neglect (PEACE) study
University of Malaya