Elder abuse through a prism of perceptions : perspectives of potential witnesses

The overall aim of this thesis was to deepen understanding of elder abuse (EA) by exploring and comparing perceptions held by experts, older persons, representatives of potential support organizations, and family members. Experts’ perspectives (I) were examined through risk indicators and screening questions (a) located in EA literature and (b) selected by an international Delphi panel. Risk indicators most commonly found in the literature or selected by the panel were compiled into consensus lists. There were differences between risk indicators and questions in the two lists. In papers II and III participants were interviewed in focus groups about their perceptions of EA. Older persons (II) considered EA to be due to changing society and family systems where children are not brought up to respect older persons. EA was mainly conceptualized as ageism, criminal actions, mistreatment in residential care, and societal abuse. The abuser was perceived as a stranger or a healthcare worker. Fear was discussed as a major consequence of EA; especially fear among women. Abused persons were described as carrying the responsibility to seek help. Witnesses were described as hesitant to get involved. Improvements in society such as educating children and healthcare workers were considered ways to cope with EA. Besides family and friends there were few spontaneous suggestions for where to seek help and support in society. These suggestions included healthcare, police, church, and volunteer organizations. Representatives of these suggested organizations were interviewed in focus groups about their perceptions of EA (III). Perceptions of both causes and conceptions of EA were very similar to perceptions of older persons (II). Four themes emerged in the data; good intentions in abusive situations, older generation’s responsibility for EA, failing to report abuse, and prevention of abuse. Participants (III) also expressed ageist attitudes themselves and findings included victim blaming and tolerance for EA. Participants perceived that anyone could be provoked to abuse, and that abusers can be considered victims in abusive situations. Confidentiality was discussed as a barrier to reporting and the need for educating children to show respect for older persons was identified. Interviews with an adult family member (IV) explored her experiences of witnessing abuse situations between her uncle and his wife. In her desire to protect and remain loyal to her family she felt powerless and tolerated abuse. She longed for support she could trust but was locked into passivity by her feelings of shame. Synthesis of findings (I – IV) revealed issues of isolation, autonomy, vulnerability, victim blaming, perceiving the abuser as a victim of circumstances, ageism, tolerating EA, shame, and power as essential elements in EA. Based on the findings, alternative descriptions of EA are offered as a challenge to existing EA definitions. Findings suggest that a key to unlocking EA is compassion, understood as the ability to see a situation as if we were in it ourselves, experiencing the potential for disrespect, shame and unworthiness inherent in abusive acts