Looking At Elderly Abuse In Developed Countries Social Work Essay

Published Date: 23 Mar 2015

As the population continues to age, it is becoming increasingly important to focus on policies and practices that support and enhance the wellbeing of the older population in later life. One sad reality for many seniors in later life and an increasing cause for concern is elder abuse. Elder abuse is one of the most disturbing and rapidly growing areas of crime throughout the global. It is extremely difficult to exactly quantify the extent of elder abuse because many such cases go undetected and under-reported.

The World Health Organization reported that it is generally agreed that abuse of older people is either an act of commission or of omission or neglect, and it may either be intentional or unintentional (Krug et al., 2002). It results in unnecessary suffering, injury, the loss of violation of human rights, and a decreased quality of life for the older person. Like any other form of domestic violence, abuse of the elderly initially remained as a private matter hidden from public view. It was initially seen as a social welfare issue and latter on a problem of ageing, but now has developed into a significant public health and criminal justice concern. The value of loving family institution has been tarnished by greed, position-struggle and impatience.

Despite elder abuse is not entirely a new issue; it is time to find out the prevention ways to be implemented and effective interventions to emerge. There are a few welfare needs that will be highlighted after so that the young generation have a strong sense of love and care towards the senior citizen.

Elderly

Nowadays, Malaysians are living longer; they are on an average of 74 years for men and 78 years for women. In others words, their life expectancy has increase. With the advances in medical care and better nutrition, older people are living longer, they are more visible, more active and more independent than ever before and they are in better health. Therefore there is a growing concern regarding the global phenomenon of aging. A decline in the birth as well as death rates has resulted in an increase in the elderly population. Given that the elderly population is on the rise, it is of paramount importance to examine the care of the older persons.

2005

(%)

2010

(%)

Total Population

26.75 m

28.96 m

65 and above

1.15 m

4.3%

1.36 m

4.7 % This table shows that the total population and the aged of 65 years or above in Malaysia between the year of 2005 and 2010. In 2005, the total population of Malaysia was 26.75 million, and which 1.15 million or 4.3% was aged 65 years and above. Moreover, in 2010, Malaysia currently has a population of approximately 29 million, and aged 65 years and above has increased to 1.36 million or 4.7%. With the projected population growth of 2% annually, it expected that the total population in 2020 will rise to 34 million, of which 3.2 million or 9.5% will be the age of 65 years and above. In the year 2035, the country is expected to have a total population of about 46 million of which 6.9 million or 15% will be the aged 65 years and above. This is evident that Malaysia's demographic ageing pattern is emerging. Based on the figure showed in this table, the real numbers of older person have increased lately, which also means that the number of elderly will continue to grow over the coming year. As the populations of older Malaysian grows, so there has a hidden problem of elder abuse. Further, the number of elderly with chronic illness is likely to increase. This can pose an increased burden on their caregivers such as family members, and it could lead to a higher risk of elderly abuse.

Elder abuse

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 (Action on Elder Abuse 1995). The "wilful infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm or pain or mental anguish, or the wilful deprivation by a caretaker of goods or services which are necessary to avoid physical harm, mental anguish or mental illness" (1985 Elder Abuse Prevention, Identification & Treatment Act). According to the Swanson (1999), elder abuse refers to the mistreatment of older people by those in a position of trust, power or responsibility for their care. This is a global problem that is likely to intensify in view of the increasing number of older people and the changing socio-economic and environmental conditions worldwide (Randel et al. 1999). Further, Hazzard (1995) described elder abuse as cruel and inhumane treatment of the elderly. Kapur (1997) defines it as a kind of harassment or an injustice done to the elderly by the family members themselves. In fact, there is too many definition of elder abuse but despite this, most would agree with this definition "an action or inaction by someone in a position of trust; often a family member or unrelated caregiver". Normally, more than two-thirds of the abusers are their family members and are typically giving their basic needs or care support such as food, shelter, personal care or transportation. In others word, someone who commits elder abuse usually has control or influence over the older person. The older persons often know and trust the abusers. Some victims of elder abuse depend on the people who hurt them, sometimes for food, shelter, personal care, or transportation. Therefore, the abusers could be their family members, friend; someone the older people relies on for basic needs or staff in group residential settings such as care homes or in long term health care facilities.

The Prevalence of Elderly Abuse in Five Developed Countries

Country

Prevalence (%)

USA

3.2

Canada

4.0

Finland

5.4

Netherlands

5.6

United Kingdom

5.0

The accepted prevalence rates of abuse of older people are drawn from five community surveys carried out in developed countries, which are USA, Canada, Finland, Netherlands and United Kingdom. The prevalence of the elderly abuse in USA with percentage is 3.2%, in Canada is 4.0%, in Finland is 5.4%, in Netherlands is 5.6% and United Kingdom is 5.0%.

But in Malaysia, the information and data of elderly abuse is scarce. There are no reported cases of elder abuse to the Department of Social Welfare as well as no agency keeps proper records of the incidence of elder abuse in this country. Although this 'epidemic' is virtually unheard of in Malaysia, we are challenged to be aware of the many faces of elder abuse in our own society and this issue is much more common than societies admit.

Types of elder abuse

Elder abuse referred to an inappropriate action that causes harms or distress to an elderly which the older person has expectation trust onto the person. Elder abuse can take in several forms. Elder abuse may take form in physical, psychological, financial, sexual abuse, neglect and abandonment that cause distress to a person who is past retirement age.

Physical Abuse

Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injuries, or impairment (Ellen, Tina, Jeanne, 2008). This abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement. The physical acts of violence commonly include slapping, hitting, and striking with objects. Indicators of potential physical abuse are broken bones, sprains, or dislocations, unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two side of the body, signs of being restrained, such as rope marks on wrists (Elder Abuse.com, 2009). Diagnosis may be difficult even at autopsy as findings may be subtle and invariably some chronic or debilitating disease would be present. The case of an elderly lady from a nursing home referred to the police for suspected physical abuse. Investigations showed that osteomalacia and spontaneous fractures could have accounted for her injuries. However, recognition of physical abuse may not be straightforward, as injuries may be secondary to falls to which the frail elderly are more prone.

Emotional abuse

Emotional abuse is defined as the infliction of anguish, pain, or distress of elderly. Emotional abuse also referred as an act with the intention that causing emotional pain or injury which often accompanies physical abuse. This abuse may be happens in verbal or nonverbal acts. Verbal forms are included humiliation and ridicule, intimidation through yelling or threats and habitual blaming or scapegoating. Nonverbal emotional elder abuse can take the form of ignoring the elderly person, isolating an elder from friends or activities and terrorizing or menacing the elderly person (Ellen, Tina, Jeanne, 2008). Therefore, an elderly person who shows fear, passive, withdrawn, low self esteem, reluctance to talk openly, insomnia, fatigue and listlessness or behave mimics dementia, such as rocking, sucking, or mumbling to oneself may be abused in the form of emotional abuse.

Financial Abuse

Exploitation of the elderly is also considered as an abuse which includes acts of material or financial exploitation. Financial or material exploitation is defined as the illegal or improper use of an elder's funds, property, or assets (Elder Abuse.com, 2009). Elder financial abuse is one of the most difficult types of elder abuse to recognize due to its lack of obvious symptoms. Some of these include misuse an elder's personal checks, credit cards, or accounts, steal elder's cash, income checks, or household goods. Most common example case is the announcements of a "prize" that the elderly person has won but they need to pay money to claim (Ellen, Tina, Jeanne, 2008). Besides that, theft of pension checks, threats to enforce the signing or changing of wills or other legal documents, and coercion involving any financial matters also consider as the example of the financial abuse. Indicators of potential financial abuse may include unusual bank account activity, sudden changes in the elder's financial condition, or worsening medical conditions due to lack of follow up or unfilled drug prescriptions. Exploitation may also occur in the form of fraud schemes; someone may persuade the elderly person to withdraw their life savings in a "get rich quick" scheme, or 'contractors' convincing the elderly that the house needs repairs which in reality might be unnecessary. Financial abuse is one of the most difficult types of elder abuse to diagnose as the victim may not be aware of its occurrence or may not know how to seek help.

Abandonment and Neglect

Abandonment is defined as the desertion of an elderly person by an individual who had physical custody or otherwise had assumed responsibility for providing care for an elder. It also referred to the action of withdrawing a person or a thing entirely; putting aside all care for him or it. Neglect of the elderly is also a form of abuse and is often referred to the refusal or failure to fulfil any part of a person's obligations or duties to an elder. This may be intentional or unintentional neglect. Active neglect is the intentional withholding of basic necessities or care, while passive neglect is not providing basic necessities and care because of a lack of experience, information or ability. Another area to consider is self-neglect where older adults, by choice or ignorance, live in ways that disregard health or safety needs, sometimes to the extent that the disregard also poses a hazard to others. For example, the caregiver may be unable to perform care giving duties such as bathing or changing an incontinent elderly person. Therefore, an elderly person with unusual poor hygiene, loss in weight, poor nutrition, skin breakdown, unsuitable clothing, unsafe and unclean living conditions such as no heat or running water, faulty electrical wiring, other fire hazards and smelling of urine may be neglected either intentionally or unintentionally.

Sexual Abuse

Sexual abuse is defined as non-consensual and unwilling sexual contact of any kind. This includes all unwanted sexual activity, such as verbal or suggestive behaviour, fondling, sexual intercourse or a lack of personal privacy. Besides that, activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse. Indicators of potential physical abuse are unexplained venereal disease or genital infections, bruises around breasts or genitals, unexplained vaginal or anal bleeding and torn, stained, or bloody underclothing (Ellen, Tina, Jeanne, 2008). Sexual abuse usually implies a physical sexual relationship with an elderly person without that person's informed consent, though this is not restricted to sexual intercourse but includes other forms of intimate sexual contact. It is often difficult to establish whether sexual abuse has occurred, unless the individual has cognitive impairment.

Signs and symptoms of elder abuse

Signs and symptoms of elder abuse should be taken seriously. It is vital that we are alert to the possible indicators of abuse. In assessing any situation, it is important to realize that an indicator may be present for reasons other than abuse or neglect. However, if a combination of the following indicators is present there is a need to further explore why those indicators are present. Increase awareness of abuse signs and symptoms as well as monitor the progress in suspected cases of abuse. Home care community nurses can play a critical role in detecting suspected cases of elder abuse. However, in Malaysia, we do not as yet have a health care system in place for such purposes, although these types of services are only now slowly emerging. Hence the only opportunity for detecting abuse is when the older adult visits a primary care setting or an emergency department.

Characteristics of the Abused Elder

Most victims of elder abuse are mentally competent and able to make decisions for them. Most of them able to taking care of their own health needs and do not need constant care. Although some victims of elder abuse are generally dependent on their abuser in some way, their dependency is not necessarily because they are mentally incapable or physically frail (Al Loney, 2006). However, if the older people who having mental or physical disability, they may be more vulnerable to be abused. Those at risk are most likely to be female, widowed, frail, cognitively impaired, and chronically ill. The older adults who poor in physical health, highly dependence on the abuser, functional or cognitive impairment and a living arrangement shared with the abuser are consider as risk factors for elder abuse. Normally, older women are more vulnerable to abuse than older men and are burdened with a lifetime of experiences and beliefs that may increase their susceptibility. In most instances, violence and abuse against older women can be sexual, physical or psychological and also can include material or financial abuse and neglect. It can occur in the home, in institutions or as a result of harmful cultural practices that specifically target older women (Breatheinspirit, 2006).

There are various studies have looked at factors associated with elder abuse. In the NEAIS report, females and those aged 80 and above were more likely to suffer abuse, family members were the most likely perpetrators and victims of self-neglect were usually depressed, confused or extremely frail. Other studies have similarly reported vulnerable elderly as those with physical and mental weaknesses, advanced age, women, those with previous abusive relationships in the family, financial strain and caregiver stress and burnt out.

Characteristics of the Abuser

The abuser is most likely the person with whom the elderly person stays with. More often, the abuser is a close relative; 80% being spouses and children of the victims, or a close relative. In some cases, elder abuse may be caused to abusers' over use of drug or alcohol, history of anti-social behaviour, or mental illness problems. Abuse is more likely to happen when the abuser is going through a period of high stress. It may be the stress of looking after the older person due to old age is a time of weak health, low income, meaningless role, or the death of loved ones (Al Loney, 2006). These problems may be creating great unhappiness for older people and then damage the relationships with their family. In extreme cases, this may lead to abuse.

Elder abuse often happens because of the abuser's power and fully control over an older person. Family members who depend on the elder for financial, housing, or other necessities have a higher risk of become an abuser. A caregiver's inexperience, a history of family violence, economic dependence on the elder or a blaming personality and unrealistic expectations often contribute to elderly abuse. The abuser may be lack involved in community activities, social services, and even contact with other family members. Besides that, they may lack of family support, facing marital conflict, overcrowding and the high burden of care placed on the caregiver. In most of elder abuse cases, the abuser may not allow people to visit or talk to the older person alone.

On the other hands, staff in long-term care homes, such as homes for the aged and charitable institutions, might involved in abuse the older people in physically or mentally. Abusers are more likely to be staff members who are not able to do their jobs properly (Al Loney, 2006). This may due to poor of training, low salary, over-work without pay, or under-staffing. Besides that, it also could be the staffs have personal problems that influence their services to older people which under their care. But, there is no excuse for abuse. The personal circumstances or problems of the caregiver can't be an excuse of elder abuse. These problems may be factors in the abuse, but they do not try to recognize it. It is unmoral because the older people are fully trusted and relies on the caregiver, but the caregiver misuse the trust of the older people to do something that threaten to the older people.

Common Reasons Elder Abuse Is Not Reported

The actual and prevalence of elder abuse is unknown and difficult to measure. Elderly abuse exists in our society but it is seldom reported, and perhaps even less so in an Asian society where filial piety and respect for the elderly is traditionally highly regarded. This problem often remains undetected because of poor public awareness and lack of knowledge among health care personnel. This is because it can cause some adverse effects on the health and quality of life of the elderly. Due to their mental capacity, they are unaware of the help available to them. Therefore, elder abuse is seldom reported. In most situations, elderly are unlikely to report that they are abused as they are fear of embarrassment and fear of losing care support. They are mostly completely under the control of the abuser and depend on the abusers for food, shelter, clothing and health care. Furthermore, they also fear of harm by the abuser. Some of them are lack of awareness; they are only suspect but uncertain that is abuse, therefore, the cases of elder abuse is hardly to report and also seldom reported.

Risk Factors for elder abuse

Abuse of older adults is such a complex issue with no single explanation. However, there are many factors seem to contribute to these critical issues and each case has its own unique mix of factors.

One of the most obvious factors is the family dynamics. The habits, values, emotional and coping skills are learned early in life and largely through family interaction. In other words, if unhealthy or violent behaviours go unchecked, abuse may continue when roles are reversed.  Therefore, if a child who was previously abused becomes a primary caregiver, there is a probability that the cycle of abuse will continue and be inflicted on a dependent parent.

Besides that, inability to cope with stress especially for those non professional caregiver such as spouses, adult children, other relatives and friends find taking care of an elder would caused many responsibilities. This may be extremely stressful to cope with the demands of elder care giving. As a result, the stress of elder care can lead to mental and physical heaths problems that caused caregivers impatient, burned out, and sometimes are unable to keep from lashing out against elders in their care.

Next, problem of elderly abuse may also happen in the nursing home when the staffs who worked are those lacks of experience and training. This is because even caregivers in institutional settings can experience stress at levels that can lead to elder abuse. The nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities and are unsuited to care giving, or they are work under poor conditions.

Social isolation can also conceal and perpetuate abuse or neglect. An older person may become isolated due to physical or mental illness, or through the loss of friends and family members. Therefore, isolation does not just conceal abuse and neglect; it perpetuates the problem.  The result of this isolation can make it easier for an abuser to exploit, neglect or abuse an older person. There is a significantly higher risk for elder abuse if without a caring support network.  In addition, if a caregiver imposes isolation to avoid uncovering the abuse, this is also a form of abuse.

In addition, sometimes caregivers who are unable to cope with the long term care giving may react to the stress of too many responsibilities in appropriate ways. These unusual releases way are such as abusing, neglecting the older adults in their care. Also, most of the caregiver's perception is that taking care of the elder is burdensome and without psychological reward. Thus, many of them choose to neglect the older adults.

The society's acceptance towards violence can also be a form of factors in contributing the elderly abuse. For example the Canadians see violence in the news, movie and television shows. This wide exposure often leads to a general acceptance or tolerance of violence as an acceptable way of venting frustration or anger. Thus, this tolerance creates an environment which can contribute to abuse and neglect of older adults.

The welfare needs of elderly

Welfare needs are necessary for elderly in order to stop the growing elder abuse issue. The government, law and legislation, mass media, school education, health care providers, family and also elderly have the responsibility to give support the rights of old persons.

The government

The National Service Program or Program Latihan Khidmat Negara (PLKN) was established since started in 2004 as a response to the Malaysian Government's desire to inculcate the spirit of patriotism in the hearts and minds of Malaysian youths. Besides to develop the spirit of patriotism, it instils a spirit of caring and volunteerism among members of society as well as to develop positive characteristics among younger generation through good values. The three-month program is aimed at shaping young people into disciplined, independent and resilient citizens capable of advancing the nation.

From this programme, the young generations could learn how to respect the elderly.

Welfare pension should be introduced in Malaysia. If elderly do not have the ability to claim maintenance from their financially-able children, they have the pension as a security. It is seen as a way to eradicate poverty. The senior citizens are still able to take care of themselves in spite of they are abandoned by their merciless children.

Abuse prevention programme could be introduced by Malaysian government as well. Its purpose is to provide and arrange for services to protect adults who are unable to protect themselves from abuse and provide older adults with information about their rights. For example, Abuse Prevention Programme (APP) in Australia which supports older adults who are being abused, or who are at risk of being abused, by someone with whom they are in a relationship of trust, such as family and friends. APP advocates work in consultation with the older adult, either directly, or with someone else the older person has chosen (their representative). APP can assist them to identify and understand the issues related to abuse of their rights as well as discuss information about options which they can implement to assert their rights. Besides, it suggests action they can take to stop abuse of their rights and give them with appropriate advocacy support that enables them to have their rights met.

In addition, the government can launch adult day care programme, which it enables the caregivers to get time off during the day. Adult day care is a planned program of activities designed to promote well-being though social and health related services. Adult day care centres operate during daytime hours, Monday through Friday, in a safe, supportive, cheerful environment. It not just provides older persons an opportunity to get out of the house and receive both mental and social stimulation but also gives caregivers a much-needed break in which to attend to personal needs, or simply rest and relax.

Law and legislation

Malaysia law and legislation also play a vital role in overcoming the elderly abuse problem. Malaysia law can establish a legislative "Elder Protective Act" which is warranted to protect our vulnerable elderly from untold suffering. They have the right to live with dignity and security. For example in all 50 US states have specific adult protection legislation within which issues related to elder abuse and/or neglect are addressed. This legislation is influenced by child welfare models, and is characterised by legal powers of investigation, intervention and mandatory reporting. In the absence of federal mandates, states have been developing their own responses to adult abuse, neglect and exploitation. Legislative "Elder Protective Act" should be implemented by the government to safeguard the rights of our vulnerable elderly.

Suggestion has been made for the government of Malaysia to adopt a law which allowing the elderly parents to claim maintenance from their financially-able children. This can be learned from the country of Singapore where the Maintenance of Parents Act enables parents above 60 years old who cannot support themselves to seek legal action forcing their children to provide maintenance for them.

The government of Malaysia should also tighten the law and can used country of India as an example. In India, children could be imprisoned or fined or be subjected to both if they abandon their elderly parents. The Tamil Nadu government is set to notify rules for the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, to help tribunals in each district decide on the order of maintenance for elderly citizens, who complain about being neglected by their children. Therefore, the government is committed to develop such services and formulate policies against elder abuse in Malaysia.

Malaysia, being one of a few countries that uphold Syariah Law has Islamic Law that governs the welfare of family matters including the ageing parents, following the case in which a couple sued their daughter for not providing sufficient maintenance as what they have agreed.

Elder abuse is a national problem with far reaching consequences for individuals, families, communities, and institutions. The state courts must play a critical role in addressing the needs of victims of elder abuse. The court's ability to assist older persons essentially determines whether individuals live their remaining years with respect and dignity, or are further alienated from the justice system with personal safety.

Mass Media

Mass media also plays a quite significant role in minimizing the problem of elderly abuse in Malaysia. The media was often blamed as one of the sources of the negative images of older adults in society. It was seen as important to work with the media to change these negative images, to raise awareness and to educate the population about elder abuse. They are able to inspire the public to be aware of this social issue by utilizing mass media such as televisions, radio networks, internet, newspaper, magazines, etc.

Nevertheless the problem often remains undetected because of poor public awareness and lack of knowledge among healthcare personnel. Therefore, the print as well as electronic media are to play active roles to increase the society's awareness of the elderly.

Media coverage of elder abuse cases can make the public knowledgeable about-and outraged against-abusive treatment in those settings. Due to most abuse occurs in the home by family members or caregivers, there needs to be a concerted effort to educate the public about the special needs and problems of the elderly and about the risk factors for abuse. Within mass media cultures, social issues such as elder abuse, have key reference points which can attract concentrated coverage of the topic and carry influential associations in public perceptions. For example, in USA, the Indochina Sino-American Community Centre formed a coalition called "Chinese Americans Restoring Elders", they used mass media to encourage the public to contact the Community Centre for matters related to elder abuse; provided some individual counselling sessions; and conducted a press conference and distributed brochures and flyers in Chinatown to commemorate World Elder Abuse Awareness Day.

The television networks always played the advertisements that have the influence on the public over the caring of the elderly. Like the PESTRONAS during religious or cultural holidays (namely Aidilfitri, Chinese New Year, Deepavali) are often accompanied by touching advertisement that convey the message to show love and care to our parents.

School Education

Education is the cornerstone of preventing elder abuse. This education needs to start very early, in primary school.

The students need to be educated to perceive to older adults more favourably as positive contributors to society. The elderly do not necessary mean burden to the family or society. With their wealth of knowledge and experience, they can still contribute to economic development and wealth creation. They have contributed to the development of the nation in their earlier years and they can still continue to be productive in their golden years. The students should consider senior citizens are an important and integral part of our society.

Students need to understand the interpersonal dynamic of care-giving. For example, they need to be award of the value placed on the dependency and inter-dependency in care-giving; role reversals in care-giving; and how unresolved emotions between the elderly and the care-giver influence the care-giving process.

The school curriculum is to include education on the family to enable the younger generation to understand and appreciate the elderly. They need to be encouraged to form closer relationships with older adults. The general population also needs to be aware that elder abuse happens and is a problem. Students need to understand the subtle difference between abuse, neglect and abandonment theoretically as well as operationally. The moral education teachers not just teach theoretically but also operationally. What is more, the schools should organise a numbers of the activities like visiting old folk's house to let students learn how to take care of the senior citizen.

For example, students could develop community support services for those caregivers or elderly, offer family counselling and assist caregivers to form self-help groups. This is able to enhance student's awareness on this issue. This awareness may facilitate the students to come up with innovative ways to assist caregivers or take care of the senior citizen to be effective and competent. This would provide valuable information, which in turn could be fed back into theory, thus making the theory more empirically grounded and comprehensible. This offers sound theory and rich practical field experiences, would enable the students to successfully face the challenges of taking care of the elderly.

Through the education, the students would then understand significance of this topic and the need for social support and services for the elderly.

Parents

The parents play an essential role in family education as well. Just like with any relationship, building a positive relationship between parent and child is important to build a strong and caring relationship. Maintaining a close relationships and open communications helps to ensure parents and their children stay connected through all ages of their upbringing.

In the present Malaysian society, there are many instances where both the husband and wife are working. Parents have many responsibilities. These responsibilities could include their work-life, their social-life and their family-life. It is crucial for parents to know how to balance between the three. Parents need to realise that out of the three, their family-life is the most important to avoid their children from feeling neglected and unloved. Children at this very moment are different with those in the past. With so much influence from media and peers, they tend to follow their emotion rather than to think rationally with their mind. This is due to the lack of attention given by their parents, as money becomes more important than their own children. Parents must concern their children often while chasing after the materialistic life. Their children should be the first on their list of priorities.

Elder abuse can be considered that this phenomenon has its roots growing from the childhood memories, for instance, children were being abused by their parent or parents; physically, mentally or sexually. The nightmare experienced by the children has eroded the love and reliance that existed naturally and are replaced by hatred and vengeance resulting in growing intention to get rid of the parents whenever they can. Therefore, children should be educated to know what filial piety is since they are young. Filial piety means to take care of one's parents; not be rebellious; show love, care, respect and support; display courtesy. When parents have reached their old age, it is an obligation for the children to treat their parents with patience and love as what they have portrayed during childhood.

Moreover, parents are able to teach their faith as a religion based on morals to your children. Religion could be Islam, Buddhist, Hinduism, Christian, Sikhism, etc. For instance, according to Islamic Laws, it is a sin to abandon; neglect or abuse parents since parents hold a noble position in Islam. In spite of parents are abusive or rude, they still have the right to treated with love and care by their children. Thus, by educating children on Islamic morals, the children will appreciate their parents as it is a command addressed by Allah to all man-kind.

The rapid development of technology has enhanced the width of generation gap between the elders and the younger ones. Children reach out for independence at a young age, and parents can help to foster those decision-making skills by being supportive and even looking the other way on occasion. By respecting your children's choices, they will feel appreciated. They will not feel as though they are being looked down upon their parents. Therefore, they too will appreciate their parents.

Health Care Provider

With an ageing population, it is imperative that all health care professionals be aware of the problem of elder abuse. In particular, geriatricians, family physicians, nurses and community health care providers, particularly those in respite services and nursing homes need to be proactive in identifying potential cases of elder abuse. Doctors have an ethical responsibility to report and address abuse of residents in nursing homes whether by staff, visitors or other residents.

The emergency department is a key point of contact as elders who are mistreated are often isolated and an unexpected visit to the emergency department may be the only opportunity for detection of abuse. Emergency physicians have a responsibility to recognise, manage and when appropriate, report suspected cases of elder abuse. For instance, The American College of Emergency Physicians recommended in their policy statement the use of written protocols on recognition and treatment of elder abuse in emergency departments and for hospitals to have the necessary staff and resources to assess and assist individuals identified to be abused or neglected.

Family violence including elder abuse should be incorporated into and given eminence in the training of doctors and all health care professionals. This should include an awareness of the support services available. Besides, training is needed to the staff due to the problem of elderly abuse also occur in the nursing home when the staffs who worked are those lacks of experience and training, low salary, over-work without pay, or under-staffing. The nursing home must provide the enough training to the staffs. Hospital administration should come up with policies and systems to monitor the work of health workers to ensure that patients are handled well and to ascertain the staffs are working under good conditions.

Caregivers

In addition, care givers might occasionally find themselves so stressful to take care of elderly. Therefore, caregivers should find ways to relieve the stresses of being totally responsible for the care of a dependent elder.

Counselling for behavioural or personal problems in the family can play a significant role in helping people change lifelong patterns of behaviour or find solutions to problems emerging from current stresses. If there is a substance abuse problem in the family, treatment is the first step in preventing violence against the older family member.

Family counselling services are provided by the National Population and Family Development Board (NPFDB) so as to give knowledge and advice on overall aspects of marriage and family life, reproductive health, child and adolescent development. Hence, it will help people sort out the pressure of taking care of an elderly person. If a family member has a drug or alcohol problem, elder abuse is more likely to take place in the home. As a result, ensure them to find appropriate help from counsellors. Even in situations where it is difficult to tell whether abuse has really occurred, counselling can be helpful in alleviating stress. The Board carries out some campaigns and advocacy programs. Numerous activities are conducted from time to time to heighten awareness of the significance of living as a family unit and consolidation of the family institution.

It is essential for the children to be mentally and physically prepared so that they won't feel the burden to take care of their own parent as care own self first before taking care others. Children are urged to always ask for professional help when needed as it can save their own life from pressure. To be a good caregiver, one must sincere to carry their responsibility towards their parents.

If the caregivers are feeling overwhelmed, they might probably get some help from friends. Ask others to help care for the elder so that they can take breaks or have someone comes in their house for a few hours a week to make certain they get time off from taking care of an elder person.

In addition to the above, seeking out local respite care agencies for short breaks would be a wise choice for them. Respite care is any sort of help and support that enables a person to take a break from the responsibility of caring for somebody else. Caring for someone can be a full-time job and, like any job, caregivers sometimes need to take a break. It provides the much needed temporary break from the often exhausting challenges faced by the family caregiver. They may feel guilty or apprehensive about taking a break from the person you are looking after. However, it is important to remember that if they go too long without taking a proper break, they may become ill, anxious or depressed. This can make life more difficult for them and the person they are caring for.

Elderly

Senior citizens can take action to protect them from experiencing elder abuse. Hence, elderly might have to be careful themselves. Firstly, they must maintain and continue contacts with family and other important people in their life. Work out on a buddy system with other elders in the home is also a method to prevent elder abuse. Furthermore, develop and maintain new friendships outside of their family, for example, be active socially in an arts, religious or sports/recreational group; attend courses at their local recreation centre, be a volunteer at the local school or community centre. Friends and other relatives should be requested to visit the elder often. Do not be in isolation since isolation is strongly connected to the elder abuse.

Additionally, never sign anything unless it was reviewed by someone that they trust. Be careful about giving another person access to their finances for example, before arranging for someone else to have access their bank account and before lending their money or possessions. They must often coordinate so that their Employee Provident funds (EPF) or Social Security cheque is deposited directly to their bank account. Carefully consider all other options before deciding to accept support or care in exchange for sharing their home or relinquishing ownership of their assets.

Make a list of five people the elderly trust and can most rely on to support their best interests. Let the people they trust the most know about important decisions they have made in relation to their future. Lastly, protest and speak up if they are unhappy or not contented with the way their caregiver or other family member treats you. Tell somebody and remember that "there is nothing so terrible that you can't tell someone about it".

Conclusion

Certainly elder abuse will increase with an ageing population worldwide, especially if adequate caregiver support programmes and services are not developed in tandem. Elder abuse should be a growing concern issue in our society but it is preventable. This problem should be addressed on a national scale to prevent the untold suffering of the elderly who have a right to live out their lives with dignity and security. Since there is a lack of practice of elder abuse prevention in Malaysia, it is even more essential for community level efforts to recognize and encourage elder abuse awareness in a culturally sensitive context.

As a result elderly need more care and attention. The care and attention may help them remain free of abuse and it can be from their family members, relatives, friends and neighbours. Further, some of them also can be from their caregivers such as from the care home, or nursing home personnel. Each of us, as individuals, family members, in the community, as a society, government or nongovernmental agencies, school, mass media and so on must play our role, hand in hand to curb this problem. Understanding the magnitude of the problem, knowing and acting against its root causes will help to provide a healthier and safer society in this country and all over the world. Thus, these may prevent or stop the occurrence of the elder abuse. In short, we must also continue to create awareness, concern our loved ones care and protect them from becoming one of the victims. We are committed to develop such services and formulate policies against elder abuse in Malaysia.