By Roxanne Jacobs a*, Marguerite Schneider a and Nicolas Farina b
aAlan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; bCentre for Dementia Studies, Brighton & Sussex Medical School, Brighton, United Kingdom
*Corresponding author: Roxanne Jacobs, email at Roxanne.jacobs@uct.ac.za
Elder abuse is a global public health concern that is believed to affect 1 in 6 people 60 years and over. Vulnerability to abuse increases for people who rely on care and support from others, with an estimated 2 out of 3 people living with dementia said to have experienced some form of abuse, including emotional, physical, sexual and financial abuse.
This post provides an overview of elder abuse in South Africa as part of ongoing PhD work nested within the STRiDE project (i.e. Strengthening responses to dementia in developing countries). Initial findings of a situational analysis on care and support provisions in South Africa shows that elder abuse is significantly under-researched with no known prevalence or reliable reporting and monitoring (see this video for a presentation of preliminary findings https://youtu.be/GmH70AOhvWU) . Under-reporting in South Africa is a serious problem while older persons’ vulnerability to crime, violence and exploitation is deepened in a context of widespread poverty, inequality, and unemployment.
The COVID-19 pandemic has not affected all people in South Africa equally and has exacerbated existing socio-economic divides along age, gender and historically disenfranchised population groups. Measures to control and prevent infection saw a growth in family hardships as a rise in unemployment and food insecurity hit families that depend on informal jobs with no-work-no-pay employment norms, the hardest. These mounting pressures within households and communities, place older people at greater risk of exploitation, insecurity and especially financial abuse when their pensions are often the only stable source of income during this time of great insecurity.
Long-term care facilities are largely reserved for those who can afford them, while the majority of older people in South Africa needing care live at home and are typically cared for by a female family member. The medical vulnerability of older people to COVID-19 and a slow roll-out of vaccinations across the country, has further restricted access to their usual sources of support and largely confined mobility to their homes. Therefore, older people who live alone and those with care needs living with families were cut off from their social networks and community- and faith-based services, as hard lockdown measures left them socially isolated and generally unsupported. These realities raise family stress and caregiver burden concerns and therefore increase risk of older persons’ exposure to neglect, mistreatment, and abuse.
As elder abuse ranges from neglect to extreme forms of violence, so too varies the required responses as not all perpetrators are the same. However, there are very few mechanisms to obtain justice for older people suffering from abuse in South Africa. There is currently no national helpline or dedicated non-profit organisation for elder abuse, with reports to police or social development sectors often being the last port of call for anyone who needs support, and victims often do not know how to access these services.
Older people are also known to hide the abuse out of fear of retaliation, feeling ashamed or helpless, not being able to disclose due to cognitive impairment, or because they do not recognise their situation as an abusive one. While testing the suitability of two elder abuse screening tools for the STRiDE project (see presentation of STRiDE’s approach to cross-cultural adaptation, ADI conference, Dec 2020: https://www.youtube.com/watch?v=sEHa8P6d9bE, timestamp: 33:33), we found that there is a great need to understand the complexities of elder abuse and how it manifests differently across cultures in South Africa. Access to justice in the form of health care, social care and support as well as judicial recourse when needed, are critical gaps in South Africa. Developing a strong long-term care system would also assist in providing support for carers caring for older people at home. Special attention is needed to develop targeted and culturally appropriate responses to local manifestations of abuse while strengthening access to justice for older people.
Acknowledgements
The information offered here is based on ongoing work in both the STRiDE project and Roxanne Jacob’s doctoral research (nested within STRiDE) describing the landscape of elder abuse in South Africa. The first two papers are planned for publication in 2021 and will include (1) a situational analysis on the care and support provisions for older people in South Africa; and (2) the cross-cultural adaptation of two screening tools for elder abuse. We hereby gratefully acknowledge the support of the STRiDE project and funding from the UK Research and Innovation’s Global Challenges Research Fund, through the Economic and Social Research Council, (grant number ES/P010938/1).