AGING IN AGONY

YOU REALLY SHOULD KNOW WHAT IT FEELS LIKE TO GROW OLD  

TREAT OLDER PEOPLE WITH EMPATHY AND KINDNESS

Sharing with you the following extracts from the articles, Titled Aging in Agony on Elder Abuse and What does it feel like to grow old?, by S Indramalar in Star2 on 11 March 2016.

With his shoulders slumped, head hanging low and chin resting on his chest, Bernard Matthews is a shell of the man he used to be.

Up until a few years ago, the 82-year-old retired teacher used to read and write. A strapping man – he used to play hockey in his youth – Bernard would walk to the neighbourhood coffee shop to discuss current affairs and exchange “war stories” with his friends.

These days, he doesn’t say much. He shuffles and mumbles, and prefers to stay in his room.

He was recently diagnosed with depression and dementia, but his well-being deteriorated rapidly because he has been mistreated at home.

The verbal and emotional abuse started four years ago.

After Bernard lost his wife, his son and family moved in with him. Bernard thought their company would be good in his golden years.

He didn’t expect to be bullied.

It was his house but Bernard was made to feel like he was invading “their” space. He was yelled at for every little thing: forgetting to turn the TV off, not folding his towel or even watching “too much” television. He was accused of being a “burden” even though most of his pension went towards household expenses, called a “nuisance” and was constantly belittled.

All this began to eat away at Bernard. Bit by bit, he became withdrawn and depressed. He stopped going for his walks.

A concerned neighbour alerted the police and two officers came to check on him in his house in Labu, Johor. After assessing the situation, one of them discreetly advised Bernard to file a report of abuse.

For the first time, Bernard felt he could do something about his situation. He called his daughter who lived in Kuala Lumpur and they went to the police station where Bernard shared about the abuse he’d been suffering.

The police said they’d help him get a protection order from the courts. But at the last minute, Bernard backed down.

“He is my son. I don’t know why he is like this but he’s my son,” Bernard told his daughter. He also refused to move in with her because he didn’t want to leave his own house.

Elder abuse is a growing problem in Malaysia’s fast-ageing society but it is a crime that is grossly under-reported. Just like domestic violence, most view it as a “family matter” that is best dealt within the family.

Elder abuse, as defined by the World Health Organisation, 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.

The country also needs to re-examine its laws to ensure the elderly are not vulnerable to abuse.

Thus far, the assumption is that the elderly will be well cared for in their golden years because filial piety is a trait most Malaysians are brought up with.

It is, however, not a value everyone subscribes to. The hard reality is that government health and social services must play their roles in protecting the elderly from abuse or mistreatment. Presently, there are no specific laws to ensure elderly care, what more protect the elderly from abuse. The welfare of elders comes under the purview of the Penal code and the Domestic Violence Act.

Doctors, social workers and other frontline responders now do not have clear guidelines on handling elder abuse.

“We found that most primary care doctors and nurses have had no training on handling elder abuse cases and rely on the guidelines that we have on child protection. Without any clear guidelines when it comes to elder abuse, most said they were just guessing and didn’t know what they should do,” says Universiti Malaya’s Department of Social and Preventive Medicine lecturer Assoc. Prof. Dr Noran Naqiah Hairi. She is leading an ongoing study – called the Prevent Elder Abuse and Neglect Initiative (Peace) – with her colleague Dr Clare Choo.

Consultant Geriatrician, Dr Rajbans Singh concurs, pointing out instances when social workers wanted to remove the elderly from an abusive environment but had nowhere to place them.

“So, what do doctors do? Do we call the police? We are not clear on the protocol related to elder abuse. When it comes to children, the SOPs are clear as we have the Child Act, but not so with elderly patients."

“At present, what we do is talk to the family members and try to counsel the caregivers and discuss problems they may face,” he says.

He stresses that while we may want to believe that as an Asian society we will look after our elderly, we need to accept our changing society and prepare for the future.

One of the contributing factors to elder abuse cases, says consultant geriatrician Dr Rajbans Singh, is a lack of awareness, knowledge and understanding about elderly care and support.

“In my 20 years as a geriatrician, I have come across many cases. A lot of the times, the abuse occurs not because the carers or family want to intentionally hurt or harm the older person but because they do not know how to care for the elderly."

“It’s different with children, where you are in charge and you can set the rules. With the elderly, they can make up their own minds. We have to remember that these older people were once ‘somebodies’ – they were the head of households, they were professionals or had jobs and were depended on for many things. But, the roles have now changed and that’s not an easy thing to deal with,” explains Dr Rajbans.

"Things get more challenging if the older person is no longer alert because of Alzheimer’s or dementia, diseases that correspond largely to ageing."

“Emotional and psychological abuse is very common especially if the patient (older person) has dementia. Many carers really don’t understand the nature of the disease and don’t know how to deal with someone with dementia,” says Dr Rajbans.

He shares his childhood experience of dealing with the elderly.

“My grandfather had dementia. At the time, I was quite young… I wasn’t a doctor yet. He would just walk out and talk about things that didn’t make sense to us. Sometimes, he would go to the road outside our house and take a leak. I remember my cousins would get very upset with him. They took his actions personally, as if the old man was out to make things difficult for them on purpose.

“What we didn’t understand at the time was that he was suffering from dementia. It was only years later when I became a doctor did I understand his behaviour at the time,” he shares.

"However, as important as it is for caregivers to empathise, it is also crucial for them to have a support system to lean on."

“Most families think about the welfare of the older person so much, they forget about the carer. In many families, the responsibility of caring for the older person falls on the shoulders of one child or one sibling."

“The others may contribute financially or occasionally, but the responsibility is largely on one person. It can take a heavy toll, especially if the elderly person is not well."

“The carer’s life now is centred around this older person. After some time, with no support or help, he or she may find it hard to cope and that is when the abuse starts – by taking out the stress on the elderly person,” says Dr Rajbans.

When it comes to caring for the elderly, families need to come together and support each other.

“If it gets too stressful, caregivers can hire private nursing help for a few hours every week just to allow them some time to do their own thing. Or, find suitable day-care facilities that are comfortable for the elder persons and allow them to meet and talk to their peers, while giving caregivers some time for themselves,” suggests Dr Rajbans

Presently, senior citizens (60 and above) make up 9% (2.77 million) of the country’s 30.49 million population. This figure is expected to shoot up to 15% by 2030.

The existing support services aren’t enough to cope with the current ageing population, let alone the surge in less than 15 years.

Something needs to be done, says Consultant Geriatrician, Dr Rajbans Singh.

“We currently have 20 geriatricians in the country. Singapore has a much smaller population and they have about 100. In many countries, geriatrics has become one of the largest (area of) specialisation as they know they are dealing with an aging population. We need to catch up,” he says.

“An ageing society is our reality. Everyone is busy with their careers or living abroad. We have to think of putting in place support services – community nursing homes and day-care centres, community nurses and so on. “It’s not too late, but we have to act quickly,” he says

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(Full Text – star2@thestar.com.my, 11 March 2016)