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Article Type: Guest editorial From: The Journal of Adult Protection, Volume 16, Issue 5
Elder mistreatment matters
Ever since the first report of Granny Battering in the early 1970s (Burston, 1975), increasing attention has been paid to the mistreatment of elders. Considerable work has been done to define what elder mistreatment means, to estimate its prevalence across societies, and to determine its risk factors and impact, as well as efforts to prevent new and intervene with existing cases.
There is now a general consensus on the definition of elder mistreatment. The WHO (2008) defines elder mistreatment 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". According to the National Research Council (2003), elder mistreatment refers to "(a) intentional actions that cause harm or create a serious risk of harm, whether or not intended, to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder, or (b) failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm" (p. 40). Despite the different wordings, common elements in these definition are, first, a trusting relationship that involves an older person and another party; second, actions or lack of actions by the other party, that results in, third, harm or distress experienced by the older person. Elder mistreatment can take various forms such as physical, psychological, and sexual abuse, financial exploitation, abandonment, as well as active or passive neglect.
The impact of elder mistreatment on the victims, their families and society at large must not be underestimated. Apart from the bodily injuries and emotional distress, mistreated elders have also been found to have greater mortality risk than their intact counterparts (Dong et al., 2009). Elder mistreatment is not only devastating for the victims and their families, but also affects our health care, social welfare, justice and financial systems. For example, study of urban emergency room utilization in the USA found that mistreated elders who were identified through adult protection services programs were more likely to go to an emergency room for assessment and treatment (Lachs et al., 1997). Elder mistreatment is also a compelling predictor of nursing home placement (Lachs et al., 2002). Few would argue against the fact that elder mistreatment poses an important threat to the social and health care systems of society.
Elder mistreatment in Chinese populations matters
Chinese populations, whether in People's Republic of China, Hong Kong, Macau, Taiwan, or in USA, Canada, or other others as immigrants, represent one of the fastest aging population in the world. The People's Republic of China alone contains one-fifth of the world's population (United Nations, 2013). Currently, the number of Chinese aged 60 years is expected to rise to at least 31 per cent by 2050 (United Nations, 2013).
Rooted in the Confucian principle of filial piety, it was once assumed that older Chinese enjoyed prestigious status in their families, were respected and were well taken care of by their family members.
Confucian teachings of filial piety prescribes that adult children provide care, respect, financial support, and show obedience to their parents (Cheng and Chan, 2006). Research findings have shown that older people continue to have high filial expectations of the younger generation (Tang et al., 2009). However, given the social changes and the shift in individual values, it can no longer be taken for granted that older Chinese continue to enjoy prestigious status within the family. A more recent study found that young people are likely to interpret filial duty differently from their parents. While most viewed filial piety as following cultural traditions and reciprocating parent's love and care, many suggested that actually practicing filial piety would depend on future circumstances (Tsai et al., 2008).
Research has increasingly confirmed that older Chinese are equally, if not more, likely to fall victims of elder abuse as their non-Chinese counterparts across the world. Depending on the sample characteristics, sampling methods and measurement criteria, estimates for the prevalence of abuse in Chinese population range from 4.5-36 per cent in population surveys (Lai, 2011; Wu et al., 2012) to 27.5-35 per cent in convenience samples (Dong et al., 2007; Yan and Tang, 2004), to as high as 62 per cent in clinical sample (Yan and Kwok, 2011).
This special issue on elder abuse in Chinese populations
While sharing considerable similarity, in terms of their cultural heritage including customs, practices, language and values, Chinese populations living across the world also show many differences. For instance, Chinese people originating from different part of China each have their own dialects, customs and practices. The variation is particularly complex when one considers native Chinese who emigrated to different parts of the world bringing their own culture and traditions which then interacted with local ones. It is thus important to understand elder abuse from different perspectives in these related and yet diverse populations.
This special issue contains a collection of papers that examines elder abuse in Chinese populations from diverse perspectives. Included in this issue are data from community dwelling older Chinese in the People's Republic of China, family caregivers of post-stroke survivors in Hong Kong, frontline professionals in elder care in Macau, Chinese immigrants in the greater Chicago area and in Canada. Authors contributing to this special issue examine elder abuse through very different lenses and the papers range from empirical research using qualitative and quantitative research methods, to theoretical discussion paper, to policy commentary.
In their survey of 453 community-dwelling older Chinese in Kunming, Qin and Yan reported that 57 and 13 per cent of the sample reported fear of common crime and domestic violence respectively, while 56 and 5 per cent reported that they had been victims thereof in the past year. Neighborhood disorder, direct and indirect victimization experience, as well as perceived risk of victimization were salient predictors for fear of common crime and domestic violence in their study.
Tiwari and Chan's study of family caregivers, caring for community dwelling stroke survivors sheds light on elder abuse prevention. Their qualitative interviews with 29 family caregivers identified physical and psychological health, financial hardship, cultural expectations and an unfriendly environment as major stressors. Whilst a strong sense of resilience may buffer the effects of these stressors, adequate peer support and tailor made programmes also achieve this goal. Various unmet needs identified by family caregivers, included education and training, loopholes in existing services, etc, thereby informing elder abuse preventive efforts.
Yu and his colleagues point out the fact that elder mistreatment is largely under-reported in Macao. They review the existing elder care policy in Macau and discuss its implication for elder abuse detection and intervention. The team proposes a collaborative governance model to replace to exist public-private partnership (PPP) for the delivery of social services.
Guided by the community based participatory research approach, Dong and his colleagues inquire into the barriers to, and facilitators of help seeking in their focus group study of US-Chinese older adults. The team identified cultural, social and structural barriers for help seeking and suggested that increased education and awareness, strengthened social support, and interdisciplinary team would facilitate help seeking behaviours among US-Chinese older adults.
Drawing on his previous work on elder abuse in Canadian older Chinese, Lai critically reviews the socio-cultural context of elder abuse in Canadian older Chinese. Echoeing with the arguments proposed by Dong et al., Lai highlights the importance of having culturally competent services in managing elder abuse among the Chinese population in non-Chinese speaking communities.
Elder abuse in the Chinese population is a complex topic. While the papers contained herein may not be all encompassing, we hope that they will provide an outline for researchers, policy makers, frontline professionals, and stakeholders concerned about elder abuse in Chinese population and facilitate further research and discussion on this important topic.
Dr Elsie Yan is an Assistant Professor, based at Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Hong Kong.
1.While terms including elder mistreatment, elder maltreatment, elder abuse and neglect frequently appear in the literature and are sometimes used interchangeably, we use the term elder mistreatment to include both elder abuse and neglect in the present discussion.
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