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ss nucleus - autumn 2001,  Elder Abuse - Chipping the Old Block

Elder Abuse - Chipping the Old Block

Mark Cheesman calls for Christians to make a compassionate, active response to elder abuse.

At first sight it might seem incredible that anyone would want to hurt or damage an old person. Pictures of old people with facial bruising from an assault, or stories of intimidation by a younger person make us feel aroused and angry. Clearly, anyone who behaved in that way would have to be unlike us, and would probably be sick. No-one in their right minds could behave like that. Even though our culture does not value older people very much, and views them more as a problem than a resource, surely no-one would sink so low. And, needless to say, it could never happen in the Christian community. Sadly, not even the last is true. When it comes to child abuse, abuse of marriage partners, or abuse of older people, the Christian world’s hands are not clean. It has become apparent in the last few years that physical, emotional and sexual abuse of children is common rather than rare and some Christian children have suffered in this way. Many church leadership teams will tell you that they are aware of Christian couples who have experienced emotional, physical or sexual violence within their relationship: no-one knows how many - the survey has never been done. ‘Wonderful Christians’ can sometimes turn out to be angry, spiteful people to their nearest and dearest.

Back to the Scriptures

Let’s pause. Is it as bad as all that? Is there no advantage in being Christian when it comes to evil in relationships? Most surely there is. Christians are ruins in the process of being re-made by the grace of God, ordinary people with an extraordinary Heavenly Father. A Father who is in the business of forgiveness, cleansing, renewal and mercy.[1] A Father with amazing patience, whose love never gives up.[2]

The Bible, as always, is immensely realistic about human beings and their weaknesses. It insists that we respect and honour old people;[3,4] carry their burdens; listen to their advice;[5,6] serve them as we would serve the Lord himself. It paints pictures of saintly old age (such as Simeon, Moses and Anna) - and some pictures of less-than-loveable older age in people the Bible is nonetheless happy o call its heroes of faith. The Bible’s heroes and heroines are not untouchable holy paragons - but real people with real problems, hang-ups and sins, who nonetheless trusted God - and therefore God was able to do much with them. God is finished with none of us yet.

Jacob (aka Israel) was cynical and manipulating in his old age.[7] Sarah, Abraham’s wife, laughed in unbelief at God’s promise of a son.[8] The great King David died with vengeful words on his lips,[9] and his son, Solomon, who thought too much for his own good, came out with a very bleak description of old age without God.[10] Eli the priest would not restrain his wicked sons in Israel’s priesthood, and died a blind and broken-hearted man.[11] The fact is, neither old age nor old people are necessarily nice. Even Christians can get it badly wrong.

But the Bible also shows us pictures of old age touched with the gentleness of faith and endurance in the service of God. Simeon and Anna[12] were both old people when God brought them, by his Spirit, into the temple to see the new-born Messiah. Moses was a worship leader and preacher to the last.[13] No, old age doesn’t have to be ugly or contemptible. It can be filled with the presence and fellowship of God. The Bible goes out of its way to promise us God’s faithfulness and love all our days, right down to our grey hairs.[14] He promises never to leave us nor forsake us.[15] And when we leave this world, we do so in his arms, to be with him for ever. Not even death can separate us from the love of God.[16] Neither what we do to ourselves, nor what others may do to us endure for ever; but God’s love and favour are for ever[17] - everything that he does is for ever.[18]

What is elder abuse?

Elder abuse is destructive behaviour in the context of a close relationship with an elderly person, which may take the form of emotional, physical, financial, sexual or spiritual exploitation or damage. It is assumed in this definition that the one perpetrating the abuse has the capacity to act differently.

Emotional abuse might take the form of belittling, name-calling, treating the old person like a child, or obstructing the old person’s needs in terms of feelings and wishes. Physical abuse might include any form of hitting, burning, exposure to risks and discomforts, or denial of bodily needs. Financial abuse means inappropriate use of the old person’s funds and assets for other than their needs. It might seem impossible that old people might be subjected to unwanted sexual advances of any degree, but it does happen. Spiritual abuse is about crushing of someone’s soul by cruelty and malevolence.

Would people really do such things? Sadly, sometimes they do, out of sheer evil and spitefulness. But often these things happen when basically good people reach the end of their tether and lash out in frustration - and are then horrified at what they have just done. How do you go and ask for help to look after your rather cantankerous old mother when you have just ‘lost it’ with her and slapped her hard? How do you go through a financial assessment for extra care for her when you know you’ve been siphoning off some of her pension to keep yourself financially afloat? Can you really look the staff of a residential home in the eye and ask them to take particular care of her emotional needs when you’ve not bothered with them yourself?

Some aspects of elder abuse are predictable: people with a family or personal history of violence, who have substance abuse problems, or limited emotional coping mechanisms, or who are left alone to struggle with demanding old people, are more likely to resort to verbal or emotional violence than others. It is possible to target help to such people, if they can be identified at an early stage. Often, when a violent situation involving an old person flares, the fault is shared by others who could have helped and did not.

Detecting elder abuse

The fact of the matter is that old people rarely disclose abuse, and almost never volunteer the information. The main reason for this is that the abuser is usually a close family member, often a son or daughter of the person. Old people will put up with great difficulty to preserve what relationship is left. Many of them will consider their lives nearly over, and cannot bring themselves to expose their offspring to the shame and guilt of a public accusation. Some are scared of being seriously harmed, or dumped in a bad nursing home.

Abuse may come to light when a person is brought to a hospital or doctor (or day centre) and injuries or signs of neglect are seen. It can be difficult to decide if the bumps and bruises that old people get from time to time (especially if they’re not too steady on their feet) are consistent with the story given. Certainly, multiple injuries of different ages, or multiple trips to an A&E Department should make people stop and consider. In a sense, physical abuse is the easiest to spot, despite all the difficulties in judgement involved.

Becoming aware that all is not well emotionally in an old person is much more difficult. Behavioural changes such as emotional withdrawal, low mood and failure to thrive can have many causes. Only by getting to know the old person and finding out how things have changed and are now can one begin to understand and evaluate such situations. For those who have eyes to see, the interaction between a ‘carer’ and the elderly person can speak volumes, should one get the chance to be an observer. And medical students may have more time to sit and talk than many other healthcare workers, so keep your ears open!

Sometimes the awareness that a carer is becoming increasingly distressed and upset starts alarm bells ringing. Looking out for high-risk caring relationships should be part of good supportive care (be it from community ervices or churches). An educational and supportive approach at an early stage may prevent a situation descending into breakdown. Most carers genuinely want to look after their charges well: only a few are evil through and through.

Managing elder abuse

What do you do when you suspect an old person is being abused? Something! Walking away and trying not to notice is complicity at best, and serious dereliction of duty at worst. The fact is, few situations are irremediable, and many can be made wholesome. But this will not happen without intervention. Usually this would mean contacting either the GP or Social Services Department and setting out what you have seen (preferably with chapter and verse) in some detail. The more factually and less emotionally this can be done, the better. Unfortunately, the law in this area is a mess. Elder abuse is far more like partner abuse than child abuse: that is, it concerns two adults with unequal power. For the law to get involved one of them has to make a complaint, or a third party has to notice damage so obvious that it is clear a criminal offence has been committed. As we have seen, such information is rarely volunteered: and often the only way to gather information is to admit the old person to hospital.

It is not usually difficult to find an excuse to admit an old person to hospital... it has been said that a normal elderly person is simply someone you haven’t examined properly! Nor is such an admission usually obstructed by any of the parties. It does provide an opportunity to carefully review (clinically and by X-ray) the extent of any injuries or harm, and also to observe the old person’s mood and behaviour. One can often observe the old person’s reaction when their carer visits. It provides some time to get statutory services involved with the situation, and perhaps visit the home. It may be possible to talk frankly with the carer about the stresses and strains of it all; maybe even to openly discuss areas of concern. And one can organise supporting services (and, if necessary, surveillance) when the person is discharged.

Getting an older person to disclose abuse is difficult. And reticence has to be respected. One has to convince the older person that things will be better for themselves and for their abuser if things come out in the open. That is by no means easy, and sometimes it’s only on a subsequent hospital admission that an older person feels it’s right to say something. However, simply letting the perpetrator know (however obliquely) that you know what’s going on and will be watching in the future can be a useful deterrent, at least for serious physical abuse.

Nursing homes and standards of care

In the last 10 to 15 years the NHS has systematically disposed of most of its long-stay beds for elderly people, and moved their care into mixtures of publicly and privately-run residential and nursing homes. This led to a ‘boom’ market for a while, with some providers only in the sector for the money. The bubble has burst, and the number of homes is falling. Some homes have high standards: many others have indifferent or poor ones, with low levels of staffing and low ratios of qualified to non-qualified nursing staff. There are areas of very good practice... but also over-sedation of confused patients because staff lack either the skills or the resources to care for them well. Is this abuse? Sometimes it is. But even here, responding in a supportive and educational way may reap much better rewards than a confrontational stance. Being an advocate for the powerless is a thoroughly Christian thing to do, although it may not endear us to people! Speaking the truth in humility and gentleness, but speaking the truth anyway, is the thing to do.

Christian culture and elder abuse

Even some aspects of Christian culture are less than helpful when Christians are involved as participants in such relationships. We have a way of reacting to each other in the church as righteous saints, rather than the sinners saved by the grace of God that we really are. We rarely, if ever, confess our sins to each other. Admitting that we need help ought not to be so difficult. We are placed together in fellowships to care for each other, and not to judge. Why is it so difficult for a Christian to say to his or her brethren that he or she is struggling with their duties and emotions and needs help right now?

It is naturally assumed that children will look after their aged parents. Unfortunately, in British culture this often means a lone daughter trying to do everything for a disabled parent and feeling terrible if they need assistance, or cannot manage and the parent needs a residential home. But that is not what the Bible says. The Bible says we are to honour and esteem old people - it does not say single Christians are to destroy themselves by trying to cope alone with burdens that the wider community (and particularly Christian community) should be sharing. The command to honour the elderly is one made to the Church as a whole. Local churches could do much to alleviate these burdens, and to prevent explosive situations arising.

How should we regard old people?

The revealed will of God is that we honour and esteem elderly people, care for them and listen to them. The Scriptures do not hold them up as infallible, and are honest about the besetting sins and faults of old age. But they also see them as given to the younger people for their profit, just as the younger ones are given to the older folks.

It is a stark fact that many non-Christian communities esteem their elderly people far more than does the Western church. Our churches, by and large, have middle-aged leadership teams. Few specifically include really old people, to garner their wisdom. Yet this would be the biblical pattern.

We should main-stream the older people in our churches: honour and make space for their input, and seek their prayers and wisdom. We should make many fewer mistakes if we did! And old people would feel much better about themselves, and be spurred on to greater things rather than just feeling a waste of space amongst God’s people.

So how about it?

  1. Ps 103:8-12
  2. Ps 106:1
  3. Lv 19:32
  4. Pr 20:29
  5. Pr 23:22-23
  6. Jb 32:6-9
  7. Gn 42:35-38
  8. Gn 18:10-15
  9. 1 Ki 2:5-9
  10. Ec 12:1-8
  11. 1 Sa 3:11-18; 1 Sa 4:15-18
  12. Lk 2:25-38
  13. Dt 29:2 - 31:8
  14. Is 46:3-4
  15. Heb 13:5
  16. Rom 8:38
  17. Ps 103:17
  18. Ec 3:14
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