Roxanne Jacobs (Centre for Public Mental Health at the University of Cape Town, STRIDE)

Due to underreporting, elder abuse is considered a hidden problem globally.   Only 4% of cases are believed to be reported and as many as 1 in 6 persons 60 years and older are said to have experienced some form of abuse. Persons with significant health concerns, cognitive impairment and who are frail are more vulnerable to abuse, where 2 out of 3 older persons living with dementia have been said to have experienced abuse.  The majority of research done on elder abuse globally are based in high-income countries, with not enough research investigating the culturally specific forms of abuse against older persons in low- and middle income contexts. 

In South Africa, research on elder abuse is limited with no nationally representative studies, with abuse of specifically older persons living with dementia being hidden and largely unknown.   South African policies, such as the Older Person’s Act (no.13 of 2006) adopt an ‘active ageing’ philosophy that promotes the active participation of older persons in their communities and decision-making, and acknowledges the need for multi-disciplinary responses to provide care and protection for persons vulnerable to elder abuse.  Despite these policy provisions, South Africa is plagued by widespread poverty, unemployment and inequality were the majority of people (76%) are living in poverty.  Necessitated migrant labour practices of adult children poses social and economic hardships for older persons as their roles shift to assuming caregiving roles for grandchildren, and also lead to older persons being left behind in rural areas, vulnerable to neglect and social isolation.  Older persons are also deemed more vulnerable to financial exploitation and hardships, as their state pensions are often the main (or only) source of household income, often sustaining entire families.  Therefore, social disorder, dysfunctional family life and a lack of income for economically viable youth in South Africa has led to older persons becoming targets for abuse and exploitation.  The effects of poverty and dysfunction has been linked to increased family- and caregiver stress and subsequent risk for elder abuse, especially in the context of care-dependent relationships. 

The impact of COVID-19 raises concerns for the exacerbation of existing social and economic hardships on families (e.g. hard lockdown effects on informal employment and no work-no-pay working norms), and is believed to amplify risk for exploitation and abuse of older persons in South Africa.  There are no official reports available on the status of elder abuse during the COVID-19 pandemic, however early reports on domestic- and family violence have indicated significant spikes in reported cases since the start of lockdown on 27 March 2020. 

Increases in caregiver burden and stress amongst formal caregivers at long-term care facilities is also a concern as LTCFs have made provisions for staff to stay-in at facilities as a measure of containing and managing the spread of COVID-19 during lockdown.  Staff who are working long hours, away from their own families, without adequate channels for debriefing and relief of duty, are believed to be vulnerable to stress and high levels of caregiver burden – a known risk for elder abuse.  Support- and debriefing of caregivers, especially during lockdown periods are critical to manage vulnerabilities and dignified support provisions for older persons in need of care in South Africa. 

South Africa has serious gaps in research on the nature and prevalence of elder abuse, determinants and risks specific to its context, and evidence-based practices for the prevention and treatment of elder abuse (i.e. including understandings of culturally specific forms of abuse, barriers and facilitators for intervention, and the effectiveness of protection services including rehabilitation and reintegration).   There is a need for timely, targeted responses for the provision of care and support for older persons vulnerable to elder abuse in South Africa, especially during the COVID-19 pandemic; that include the ‘unmasking’ of this hidden public health concern in culturally appropriate manner that restores dignity, respect and integrity to older persons living in South Africa.  Detection and protective services need to take current lockdown restrictions into account, and guide communities and stakeholders alike, to respond to risk of elder abuse during this time.   

For more information on the current health and long-term care and support provisions in South Africa, please consult the report on the COVID-19 Long-Term Care situation in South Africa: