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Elderly abuse has been prevalent in our society and it has not been discussed frequently as compared to other issues in our society and not much research has been done on elder abuse in Singapore. Due to such limitations present in the study of elderly abuse, this creates an impression that elderly abuse is a rare occurrence and is not a potential threat to our society. With the reports on real life elderly abuse cases, it is evident that elderly abuse does exist and is not a rare occurrence in Singapore as most of the time, such incidences go underreported. Furthermore, it is often difficult to detect elderly abuse as in the first place, there is a lack of awareness as to what actually comprises elderly abuse. Dr Vivian Balakrishnan, minister for community youth and sports, at the annual family violence symposium in the year 2009, cautioned that as Singapore comprises one of the fastest ageing populations in the world, we have to be prepared and expect an increase in the number of cases involving elder abuse. ( straits Times). What is more worrying that majority of the elders suffer abuse under the hands of their own children due to the stress induced on them from care giving. Hence, elderly abuse has become one of the most important compelling social issues which have to be addressed due to the nature of Singapore’s demographic trends which consists an increasing proportion of elderly. Thus, in this paper, the social issue of my focus would be elderly abuse in Singapore.
A common problem faced with regards to the discussion of elderly abuse would be the issue about what exactly constitutes elder abuse. As a result, many cases of elder abuse go unreported. ( pg 28, say no to elder abuse).The Golden Life Workgroup on Elder Abuse Prevention formed in Singapore in the year, 2002, adheres to the World Health Organization (WHO)’s definition of elder abuse. It defines elder abuse in its report presented to the government as
“A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust or duty of care, which causes harm or distress to an older person.” (Golden life workgroup on elder abuse, 2004 PG 16, World Health Organization 2002) CITE PROPERLY
The Ministry of Community Youth and Sports (MCYS) categorises elderly abuse into 5 main groups such as financial, neglect, abandonment, physical and psychological abuse. (Understanding Elder Abuse and Neglect pg 8 check year 2004?).
The ageing trends of Singapore suggests that with increase in life expectancy, the elderly would now require more long term care than before and there will be an increasing level of dependency on their children to support them. With declining birth rates, there would be fewer care givers in the family. This creates ample opportunity for elderly abuse to take place. (UN Secretary-General’s Report, March 2002). The percentage of elderly who are aged above 65, in 2009 was 8.80% and the projected percentage of elderly in the year 2030 is expected to rise to 18.7%. (Statistical Indicators on the Elderly, MCYS) .The United Nations uses the dependency ratio as a marker of the potential dependency burden to predict the amount of burden which has to be carried by the working population. (Source: Population Division, Department of Economic and Social Affairs, United Nations Secretariat 2007 http://www.un.org/ageing/popageing.html). In the case of Singapore, as the old-age dependency ratio is increasing each year whereby in the year 2008 it was 11.9 per 100 and in the year 2010 it increased to 12.2 per 100. (Department of Statistics, 2011). This has serious implications for Singapore, as the working population has to shoulder the burden of care giving and financial support. Now, it becomes even more challenging with the rising number of singles and married couples choosing not to have any children or just having one child . Such situations have serious repercussions as the future trend will be such that care giving on the elderly will be solely shouldered by the only child and this creates an increasing amount of stress and pressure on the sole caregiver which in return causes them to abuse the elderly. It was reported in the Straits times that each year a total of about 178 cases of elderly abuse were being reported and out these 178 cases reported about 120 cases of the elderly were abused by their own children. (Theresa Tan, The Straits Times (Singapore) October 22, 2009 Thursday).
There are various theories to explain the reasons for the occurrence of elderly abuse. The social exchange theory seeks to further explain the reasons for elderly to experience violence from their perpetrators using the concept of social resources such as power, financial stability and status. ( Quote : social work textbook pg 324), Pillemer, 1989 refer to no eldlerly abuse book behind). Increasing level of dependency on children creates a potential environment for abuse to take place, as the elderly authority is now diminished due to lack of power and necessary resources which the potential caregiver has. Hence, such a power dimension with regards to the availability of resources creates imbalance and strain in the relationship between the elderly and the caregiver. Another instance whereby an elderly abuse can take place can be explained through another theory known as the ecological theory, is when the caregiver of the elderly themselves might be undergoing several problems for instance they themselves might have financial difficulties or could be suffering from some health conditions. Thus, looking after an elderly may induce stress on the caregiver whereby in some situations, as a form of coping mechanism they might vent out their frustrations on the elderly under their care through verbal and physical abuse and this causes the elderly to be in a greater exposure to abuse. (MCYS , booklet). An example to illustrate such a case which was cited in a Straits times article will be about an unmarried son who was in his forties who had to give up his job to look after his mother who was bedridden and suffering from dementia. Not being able to handle the stress that he was going through, he used to hit his mother frequently. (Theresa Tan, The Straits Times (Singapore October 22, 2009 Thursday). Most of the times , the victims of elderly abuse tend to be elderly who are completely dependent on their children in terms of financial and healthcare aspects and therefore the perpetrators of elderly abuse are usually their children or someone they dependent on.( Quote: The Pattern of Elderly Abuse Presenting to an Emergency Department, G W M Cham, E Seow, 2004, pg 571).
Although, the number of elderly abuse and neglect cases are less than 200, it should not be taken at face value that the elderly abuse is a rare phenomenon. Coming from an Asian society, especially in a region whereby Confucian values are prevailing, since most of the perpetrators are their own children, the elderly seldom report about them being abused as they do not want to be embarrassed or do not want to be judged upon, looked down for raising children who are abusive. ( Penhale 1993, british journal of social work, 23,2) . For other elderly, they might choose to suffer under the hands of their children rather than reporting them as they are increasingly dependent on their children to fulfil their basic needs, they fear of losing them or they fear of the future consequences such as intensified level of abuse from the perpetrator when they resort to reporting them.(Lee and Pang, 2003, pang 2000). Due to such underreporting and the denial of being abused further heightens this social issue as the elderly tend to suffer in silence.
The social issue of elderly abuse should be viewed in terms of a micro and macro level. (social work)From the examples cited in this paper, it can be seen that most of the Elderly abuse which is one form of family violence was initially seen to be a private affair which was confined to and occurred usually in the family sphere which is the micro level. When the issue of the elder abuse is also being experienced by majority of the citizens in Singapore as well, with the increasing number of cases of elder abuse being cited in the newspapers and with the fast paced ageing population in Singapore, this issue of elder abuse now becomes a public and national issue which the state has to address. (textboo) For instance, in the earlier years when it came to issues about abuse more attention had been given to child and spousal abuse but not elderly abuse.(say no elderl abuse) Currently as more cases of elderly abuses are coming to the limelight, it is an issue which is worthy of concern. Therefore, elderly abuse and neglect is a social issue which not only affects the elderly but it also the rest of the population who now have to shoulder the responsibility of supporting the elderly.
There are many perspectives with regards to the issue of elderly abuse and how it should be tackled. Firstly from the state’s point of view, it strictly adopts a non-welfare approach .The state believes that various social safety nets such as the community, social services and non-profit organizations have to come together to tackle the social issue of elderly abuse. The state mainly uses the legal approach and tertiary intervention in the form of laws to tackle elder abuse and neglect. For example the Women’s charter seeks to deal with family violence and protect family members including the elderly who are being abused. The financial neglect of elderly is being handled under the Maintenance of Parents Act which allows the parents to demand financial support from their children through the Tribunal court. ( say no to elder). The Maintenance of Parents Act although allows parents to demand for financial provison from their children. This solution can help the elderly to seek financial support from their reluctant children especially when they have no one to turn to. Unfortutantely, this is only a temporary solution as the law only address the financial neglect aspect and does not address the emotional aspect of the elderly. It is because the law cannot mandate children to be loving towards their parents .This present solution posses certain shortfalls, for instance, ,many parents may not want use this maintenance act in order not cause further trouble for their children. Another problem with this solution is that many of the elderly are not even aware about the existence of such legal framework.
From the medical doctors and healthcare professionals’ perspective, there has been increasing concern with regards to elderly abuse and neglect. Hospitals now see an increasing number of care givers committing suicide due to not being able to handle the pressures of care giving and some even result to abusing their parents under their care not because of the intention of abusing them but because they do not know who to handle the situation.( srraits times) In a recent stratis time a doctor in the article mentioned that one of her patients’s daughter who was the sole care giver would force feed her until the patient had to be treated in hospital for malnutrition and despite continuously being admitted into the hospital, she was not told where to get help and the caregiver by chance found out that there is a centre which provides help in care giving. ( straits Times). From the health care professionals view, they feel that the state can come up with even more rigourous legal framework and the state could help in creating a strong network between hospitals and various caregiving centres so that the patients are able to get revelant help to cope with the demanding tasks of care giving. Furthermore, health care professionals can play a key role in detecting elderly abuse. The emergency department is one important place whereby elderly who are abused are being isolated and it can be the only appropriate situation to detect cases of elderly abuse. (W S Pang, 2000).The health care professionals face a dilemma when they encounter or suspect that their elderly patients might have been abused. It is because there are no specific laws addressing elderly abuse or neglect which results in not having a clear focus of what actually constititues an elderly abuse. (Quote pg 50). There are efforts to implement laws such as Maintenance of Parents Act by the state to protect elderly in some ways however, there is no laws which calls for mandatory reporting of elderly abuse cases. Hence this creates a predicament on part of the doctors as to whether or not to report cases of abuse. Due to the absence of a clear and proper framework or solution for the hospital professionals to strictly adhere to, such a situation causes an elderly to be trap in a vicious cycle of abuse. This has underlying consequences in the future as more cases of elderly abuse may become undetected.
From the social workers and policy makers perspective, they believe that more can be done in training healthcare professionals and social workers in terms of understanding and detecting elderly abuse. In addition, they believe that more care giving centers can be set up to reduce stress of the care givers and serve as an intervention for abuse cases. This solution is can be very useful in the long run as it helps to protect elderly and helps to consell and educating the stressed caregiver which eventually helps to prevent the elderly from being further abused. However, one area of concern would be that the availability and increasing number of caregiving centers and residential homes can also create a room for misuse whereby children of the elderly for their convenience and in order to discard their responsibility as they might use such places to dump their parents there. Thus, there has be stricter regulations with regards to the admission into the caregiving centers.
After considering all the different perspectives being offered pertaining to elderly abuse, in my view, I would support and favour health professionals, social workers and policy makers view especially with the view that the state has to adopt stricter and harsher laws when it comes to elderly abuse. The absence of mandotary reporting of elderly abuse, creates the main problem for allowing elderly abuse cases to go unreported. Furthermore with the absence of a clear framework of what actually constitutes elder abuse or how this social issue can be tackled it creates a form of helplessness on the part of the healthcare and social work professionals as they are not being able to intervene in elderly abuse cases promptly. In my view once the state has come up with a clear set of laws specifically addressing to elderly abuse and once there is an the implementation of mandatory reporting then it becomes easier for the healthcare professionals and social workers to be better equipped in intervening in elderly abuse cases.
In conclusion, as discussed in this paper, elderly abuse is one of the key social issues which the states has to constantly look into as elderly abuse requires lots of intervention programmes, training and education of the public and social work professionals. Elderly abuse can have serious consequences on the mental health of the elderly and they might lose their dignity in living as a normal human and their basic human rights such as the freedom to fight against any abuse and discrimination against them is being lost. Therefore it becomes a necessity to ensure that these group of elderly not just will have the proper healthcare facilities but it is also our society’s outermost duty to ensure that the elderly age with dignity and they spent their last years in a protected and non abusive family environment.
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