Abstract

Background: With the improvement in quality of life and increased birth rates, the elderly population has grown in most societies. This rise may be accompanied by harmful social phenomena such as ageism and elder abuse, which necessitate immediate planning and intervention.
Objective: The purpose of this brief review is to raise awareness about ageism and elder abuse, as well as the factors that contribute to their prevalence.
Results: Findings from previous studies indicate that ageism and elder abuse often overlap, manifesting at social, individual, and organizational levels, and can occur in both covert and overt forms. Their occurrence can be mitigated through social support, education, legal interventions, and by keeping the elderly active.
Conclusion: Ageism is a pervasive social pandemic that encompasses various forms of elder abuse, both covert and overt. It appears that three key factors—active and healthy aging, extensive social support, and legal interventions—can significantly contribute to the prevention and reduction of these detrimental phenomena among the elderly.

Keywords:Ageism; Elderly Abuse; Overcoming factor

Introduction

Today, the increase in the elderly population has become a global phenomenon and is sometimes referred to as the “aging tsunami” [1]. The elderly are more vulnerable and exposed to risks due to physiological and anatomical changes caused by increasing biological age, retirement, reduced social activities, the death of relatives and friends, and separation from children due to marriage, work, or migration [2]. One of the significant risk factors for the elderly is elder abuse, which is a form of violence within the family [3]. While many experts express deep concern about the increase in violence in the streets and public places, unfortunately, the likelihood of individuals being subjected to violence within the family is much higher than outside the home [4]. On the other hand, one of the main challenges faced by the elderly is ageism. Ageism refers to providing services to people based on their age [5]. Given that today’s societies have changed significantly and the socialization process is very different from the past, society’s view of the elderly has shifted, and to some extent, the attitude of people is negative, often referring to the elderly as a consumer group [6]. These perceptions may have a detrimental effect on hospital care for the elderly, job opportunities, social participation, and other services [7]. There appears to be a broad overlap between ageism and elder abuse; the higher the level of ageism, the more likely it is that the elderly will be excluded from society, which can lead to social isolation and the possibility of elder abuse [8]. In this study, we aim to clarify the concepts of ageism and elder abuse and provide preventive strategies..

Ageism

Ageism is usually defined as “stereotyping and discrimination against individuals or age groups because of their age,” and it can affect both young and old people; however, it seems to be more of a problem for older individuals than for younger ones [9]. Ageism manifests itself in various ways, including prejudiced attitudes toward older people, aging, and disability, as well as the persistence of discriminatory practices against older individuals through flawed institutional practices and policies [10]. Age discrimination leads to behaviors that hinder the elderly from receiving adequate care and services [11]. This is often due to caregivers not being sufficiently aware of their own discriminatory behaviors towards the elderly. Therefore, it is necessary to explain and clarify the concept of age discrimination [12].

“Ageism, or discrimination against individuals based on age, is an increasing international concern with significant health implications [8]. The noticeable and growing number of studies indicates that the average age in many countries is rising, and this issue is expected to escalate with the increasing population of older adults worldwide [13]. Moreover, convincing findings have emerged that show negative attitudes towards aging pose a significant risk to health and well-being in the coming years. These widespread negative perceptions of aging are associated with an increased risk of mortality, poor functional health, and slower recovery from illness. Additionally, having negative perceptions of aging also predicts poor mental health [14]. Not only do widespread attitudes and stereotypes about aging contribute to negative health outcomes, but age discrimination among healthcare professionals can also lead to practices that put older individuals at risk [15].

“Ageism can have adverse effects on the elderly. For example, consider a situation where caregivers regard symptoms of depression in the elderly as normal and do not take therapeutic action, believing it to be age-related, or the stereotype that the elderly have fulfilled their roles and responsibilities, making spending on medical treatment seem futile, which leads to avoidance of interpreting clinical tests, para-clinical tests, and necessary medical interventions [16]. Ageism is one of the major social problems affecting the elderly, harboring many harmful social issues and creating conditions for their expansion, including elder abuse, social anxiety, and social isolation, necessitating preventive measures [9]. One of the serious consequences of ageism is elder abuse, which we have elaborated on.”

Elderly Abuse As the world’s population ages, the number of elderly individuals is increasing. It is predicted that the population of people over 60 years of age will rise from 900 million in 2015 to about 2 billion by 2050 [17]. Consequently, paying attention to elder abuse and combating it is considered a serious matter. Elder abuse is defined as behavior that is consciously or unconsciously committed by a person or persons caring for an elderly individual, which results in a decrease in the quality of life of the elderly person [18].

Overuse or underuse of medication, failure to care for the elderly person’s wounds, neglecting healthy food and vitamin intake, and failing to attend to personal and mental health are among the instances of elder abuse. Sexual abuse of the elderly, which is reported only once in every 24 cases, is also considered a type of elder abuse. Elder abuse can cause physical injuries ranging from minor scrapes and bruises to broken bones, inflicting irreparable harm on the elderly [19]. It can also lead to depression and anxiety if the injuries are emotional and psychological. Even relatively minor injuries can result in serious harm and death. Studies show that victims of elder abuse are twice as likely to die prematurely compared to other elderly individuals. It is predicted that as the number of elderly people increases and resources become limited, their needs may not be fully met, leading to a rise in the number of individuals subjected to elder abuse.

Risk Factors Risk factors that may increase the potential for elder abuse are identified at the individual, kinship relationship, social, and sociocultural levels.

Individual

Risks at the individual level include poor physical and emotional health, mental disorders, and alcohol and drug abuse. Other individual factors, such as the victim’s gender and marital status, also increase the likelihood of abuse. While the same risks that threaten women also threaten men, in some cultures, women’s social status is secondary, making them vulnerable to neglect and financial abuse when widowed [20].

Kinship Relationship

It may not seem apparent, but unfortunately, there is a risk of elder abuse in cohabitation. It is often unclear who the perpetrator is - the spouse or the children. The dependence of the victim on the elder abuser increases the risk of abuse, which is usually financial. In some cases, a long history of poor family relationships can also amplify the psychological stress of caring for an elderly person. As more women enter the workforce, they have fewer opportunities to care for the elderly, placing additional pressure on them and increasing the possibility of elder abuse [21].

Sociocultural

isolation of caregivers and older adults, along with the resulting lack of social support, is a risk factor for elder abuse by caregivers. Many older adults become isolated due to the loss of physical or mental abilities, loss of friends and family members, and the phenomenon of retirement [18].

Sociocultural Other factors that increase the risk of elder abuse include:

a) Ageist stereotypes that portray older people as weak and dependent
b) Eroding family ties
c) Inheritance and property distribution systems that affect power dynamics within the family
d) The migration of young couples and the abandonment of parents in societies where children traditionally care for their parents
e) A lack of funding for care costs

In institutions for the elderly, abuse is also more likely to occur in the following situations:

a) Low standards of healthcare, welfare services, and care facilities
b) Poorly trained staff, low salaries, and long working hours
c) Poor physical environments and policies that serve the interests of the organization rather than those of the older person [18].

The Connection Between Ageism and Elder Abuse Ageism creates a negative climate that lends itself to the abuse of older people, likely increasing the levels of abuse experienced by this demographic. While not all acts of abuse are explicitly motivated by ageism, it is important to recognize that ageism perpetuates the social attitudes that devalue older individuals; it underpins much of their experiences of abuse. When older people are perceived as having “low value or being unworthy,” others may feel more empowered to mistreat them with little accountability or inhibition. Unfortunately, studies have shown that elderly individuals in care and social care centers are often subjected to severe forms of abuse.

Ageism manifests in “rudeness, dismissal, indifference, disregard, objectification, condescension, intrusion, restriction, and labeling” directed towards older people within health and social care settings [22]. Such attitudes allow for behaviors that, while not necessarily seen as overtly abusive, are nevertheless extremely harmful to older individuals, denying them their basic human rights.

Practitioners may make assumptions about an older person’s ability to make decisions. Based on these assumptions, older individuals may be denied their right to self-determination. Self-determination (the right to make one’s own decisions) is critical to emotional and mental well-being, and an older person’s emotional health is likely to suffer when they are denied the right to make decisions about their own care and support needs. Health and social care practitioners may also act in ways that are well-intentioned but ultimately harmful to older individuals because they are rooted in ageist attitudes and assumptions [23].

The term “compassionate ageism” is sometimes used to refer to actions motivated by goodwill but arising from feelings of sympathy or pity towards an older person. Ageism can also increase tolerance towards the abuse of older individuals, meaning that others are less likely to intervene to support them. Studies thus far have shown that ageism strongly underpins elder abuse in both hidden and overt ways. It can occur in homes, hospitals, nursing homes, and employment institutions, with harmful effects on the elderly. It is crucial for national policymakers to plan preventive and intervention-oriented programs to prevent the situation from worsening. The research question is: how can we combat ageism and elder abuse?

Strategies to Combat Elder abuse can occur in many forms, and its causes may stem from the elderly themselves (in the form of neglect), society, and institutions, especially health and medical centers where ageism exacerbates the effects of elder abuse.

Therefore, to combat this phenomenon, action must be taken at three levels: individual, societal, and institutional. The following measures seem effective in reducing this issue.

Types of Strategies

a) Develop and implement active and healthy aging programs at the national level.
b) Awareness: Increasing public awareness about the rights and needs of older individuals through educational campaigns and media can help reduce negative stereotypes. Continuous education for families, caregivers, and the community on how to treat and respect older people is important.
c) Legal support: Developing and implementing laws and regulations that protect older individuals can help prevent abuse. These laws should include mechanisms to address abuse and neglect, allowing older individuals to defend their rights.
d) Caregiver support: Training and support for caregivers of older individuals is crucial. Caregivers should be well-trained and have access to resources and support services to reduce the psychological and physical stress that can lead to violence or abuse.
e) Reporting and monitoring: Establishing effective reporting and monitoring systems to identify and address cases of elder abuse is important. These systems should be designed to allow older individuals and their families to easily report problems.
f) Encourage social participation: Older individuals should be encouraged to participate in social activities and community partnerships. Strong social relationships can help reduce loneliness and vulnerability, preventing abuse.

Strategies to Combat Ageism in the Elderly

Ageism has a multifaceted structure and is influenced by many factors. Some studies have shown that it occurs at both individual and organizational levels and has cognitive, emotional, and behavioral dimensions. The following strategies may be useful in improving this phenomenon.

Types of Strategies at the Individual Level

Chronic diseases and multiple disabilities have led many elderly individuals to consider themselves old and disabled, inhibiting their initiative to engage in various activities; in other words, they exhibit ageism against themselves. Therefore, it is beneficial to prevent this negative attitude by initiating healthy and active aging education during middle and old age.

On the other hand, at the individual level, ageism can also be perpetuated by members of society against the elderly. For example, the lack of respect and dignity afforded to the elderly in public transportation services and parks is a concern. In this case, it is advisable to implement formal and continuous education in schools, in addition to academic education in universities. Intergenerational interventions can also help reduce both the severity of ageism and the generational gap at this stage [23].

At the Organizational Level

It seems that the greatest amount of ageism can be caused by institutions and organizations. For example, in the healthcare field, providers may limit or refrain from performing certain interventions and procedures based on the age of the elderly. Alternatively, they may not provide nursing and medical care comparable to that given to younger individuals, which is sometimes referred to as implicit ageism. Employment organizations may also impose strict age restrictions and mandatory retirement policies, often relegating the elderly to jobs such as watermen or gardeners, which is sometimes referred to as benevolent ageism, ignoring the abilities of older individuals. Employment laws should be made more flexible and reformed by policymakers.

Conclusion

Ageism is a widespread social pandemic that encompasses various forms of elder abuse, both covert and overt. It appears that three factors - active and healthy aging, broad social support, and legal interventions - can play a significant role in preventing and reducing these detrimental phenomena among the elderly.

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