By Andonis Vassiliades
The elderly woman fell off her wheelchair. Three residential home carers were sitting in the office just opposite chatting and smoking in a strictly no smoking environment.
Another carer came out of the kitchen, walked past the woman and proceeded to clean the veranda. The woman was wailing for someone to help her out. In desperation she started pushing herself on the floor, crawling toward another elderly and infirmed man. He sat motionless and droopy in a wheelchair opposite her. Though he was unable to speak or move, as he was ravaged by a massive stroke, he was visibly shaken. He had tears in his eyes. The woman was now surging forward and closing in on this elderly and hapless man by calling out his name time and again.
Elsewhere, another elderly woman was at pains to attract attention. ‘Nurse…nurse…nurse…’ ‘Nurse…please nurse…somebody…nurse. Please…nurse…’ She needed to be taken to the toilet. Various members of staff passed her by without paying attention. She continued calling for assistance regardless. One hour later, a carer finally stopped and told her: ‘Just do it on you…I will clean you later’. She then walked away to carry out other practical tasks.
The first case above took place in a residential nursing home for the elderly in Cyprus three years ago. It was a personal and traumatic experience. For the woman and man in question were my mother and father.
The second case happened two thousand miles away in a London residential home. This was a woman in her seventies with the onset of dementia. The setting was one of many which were the subject of a three-year externally funded research study that I, and my research team, had carried out in the period. This involved a barrage of research methods including 24-hour video recordings of all interactions between the subjects and their carers in three settings: residential, community and family.
The above two examples of neglect and abuse of elders are a common occurrence. Last December, the case of an elderly man left on the floor for hours and who later died made front page news in Cyprus.
Neglect and abuse of the elderly is not just a case of maltreatment in residential establishments. In a statement by the Cyprus Third Age Observatory, to mark World Elderly Abuse Awareness Day on June 15, the group pointed to a worrying rise in the number of such cases. Maltreatment of the elderly, it stated, though mostly invisible (i.e. taking place away from the public eye) manifests itself in both the family and within residential establishments.
Ageing is closely associated with incapacitation. In lay terms, and unfortunately in many medical and psychological models, ageing has been seen and understood as a process of decay, impacting both physically and mentally on those affected. The notion of ‘senility’, which has been misused and abused by the professions, has often been conveniently deployed as an explanation for the various types of incapacitation; has promoted stereotypes about the inevitability of ageing; an attitude that once decay has set in, there is not a lot one can do; and that offering medical and psychological interventions and provision of services for older people is a waste of money, labour resources and time.
Although things have changed dramatically in the last 20 years and the professions have adopted a more positive perspective toward the elderly, in practice elders are still seen as naturally going through a process of decline and reaching the end of a life-cycle. This perception of elders, and the notion of their ‘rocking-chair lifestyle’ and idleness, plays a significant part in the way in which they are treated. This is particularly evident in residential establishments as these are more visible and prone to observation and inspection. Elders are basically left to sit still or ‘rocking on their chairs’ for hours on end, expected to appreciate their ‘peace’ and ‘quiet’ but starved of direct interaction and communication.
One common form of neglect is the lack of social engagement with elders. Intergenerational interaction and communication are so lacking that elders go through what has been characterised as ‘linquistic depersonalisation’. Communication starvation undermines the social status of elders by potentially down-casting them and reinforcing the stereotype that they are idle and non-productive. Where there is communication, this is often based on the utilisation of ‘baby-talk’. This bears little association to the actual level of cognitive functioning of older people. The use of baby-talk reduces elders’ intellectual capacities and functioning to a level below that of others and as such it reinforces the false belief that elders are no more than infants requiring basic practical care. The use of such spoken language is accompanied by similarly negative non-verbal communication – gaze, facial expression, posture and lack of proximity.
Another consistent research finding is the low level of activity and stimulation offered to elders. Elders live largely in social seclusion and isolation. Irrespective of perceived ability or disability, elders spend much of their time in a state of social isolation, exclusion and inactivity. Even where there is some social contact and attempts at communication, only a fraction (around five per cent of encounters) can be deemed positive while over half of encounters are sharply negative and restrictive.
The care of elders is far more task-oriented rather than person-oriented. Carers are happier buzzing around practical tasks than stopping to chat, answer pleas for help or carry out the demanding chores of social engagement. In residential establishments in particular, there is in force a pervasive practice which I have termed ‘carer traffic’. Carers are observed, when videoed, moving in and out of elders’ zone and space like vehicles zooming in and out of traffic; or like lines of shoppers rushing forward and backward in busy shopping streets. Elders in these instances are just part of the furniture, physical fixtures and fittings. In the absence of human contact, the only noises heard are the background sound of a television or radio set punctuated by the occasional odd scream, a telephone ringing, the noise made by the legs of a table or chair being pushed and the tapping of the shoes of the carers as they walk in and out of sight.
The potentially harmful effects of social isolation, lack of communication and loneliness on health are well documented in the literature. These effects, though harsh on all ages, are particularly severe among elders. There is credible evidence that isolation and loneliness, lack of stimuli, companionship and participation in normal social exchanges lead to a compromised immune system, disrupted sleep, depression, increased risk of coronary heart disease, blood pressure, stroke, accelerated cognitive decline, higher rates of mortality and the onset of dementia.
Three naked truths exist in life. We are born, we die and in-between we grow older. At a blink of an eye we are all, without exception, the new elders. Making elders the subject of neglect and abuse as though they have passed, like products, their expiry-date says more about the quality of care and the society we live in than it does about elders themselves.
Dr Andonis Vassiliades is professor emeritus of social science at Middlesex University