Introduction

The socio-economic and technological changes in the world have placed old people in misery. Not only have the younger generation shifted from a joint-family system to a nuclear one, but also they have waved goodbye to their cultural values and tradition in relation to care given to elderly parents. As part of adopting a new culture, they have been prepared to abandon their old parents who once took all kinds of trouble to selflessly feed and care for them.

Gone are the days of the belief that ‘old is gold’. There was a time when an elderly member of the family was vested with all authority and decision-making powers. So important was the consent of the family’s older members that not for any reason would younger ones in dare to take independent decisions without consulting them. Now everything is changing, and so are people. In their race to reap material wealth, people often treat their old parents as a burden. It is in these instances that young people try to get rid of such a burden by means like neglect, abuse and abandonment. Old people are frequently put under house arrest, with their freedom of movement restricted, too. It is often believed that a person is safe within the four walls of his/her house. But this notion has received a major blow with the cases of abused and neglected elderly people increasing day by day. Ageing of the population coupled with increased longevity are the root causes at this juncture.

Neglect is the refusal to fulfil a care-giving obligation (WHO 2002), whereas abandonment of elderly people is the desertion of them by an individual who has physical custody or otherwise has assumed responsibility for providing care for them (Gorbien and Eisenstein 2005). Elder abuse is different from both neglect and abandonment, though it may include such acts. As per WHO (2017), elder abuse can be defined as ‘a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person’. In Kerala, 3% of people fall victim to abuse after the age of 60 (UNFPA 2011).

The dwindling of the joint family, the rise of dual-career families, a possible shift in filial piety values, the increasing life expectancy with greater chances of a prolonged old age characterized by poverty, degeneration, more empty-nest years, and dependency, have all added to the seriousness of the problem and made the elderly more susceptible than ever to abusive treatment (Jamuna 2003). It is found that fewer members in the household reduces the chance of abuse while having a greater number of children increases the chance of abuse (Vegard and James 2014).

Under the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, a senior citizens (including parents) who is unable to provide maintenance for himself/herself from his/her own earning or out of the property owned by him/her shall be entitled to get support from his/her children because, as per this Act, the obligation of the children to maintain their parent extends to the needs of such a parent (either father or mother or both, as the case may be) so that such a parent may lead a normal life (Ministry of Law and Justice 2007).

The share of elderly population in Kerala’s total population is more than 12%, and 58.90% of households have no elderly person (Census 2011). In India, Kerala has the largest number of old-age homes, with the number increasing. Old-age homes, which used to be the last resort, are now the first choice of the new generation (Sreeraj 2016). In many cases, though old people are not willing, children forcefully dump them in old-age homes. In some other cases, old parents prefer to stay in old-age homes rather than suffer at the hands of their children. Some 0.3% of elderly people prefer staying in old-age homes to staying with family members (UNFPA 2011).

In such a scenario, this chapter tries to examine the risk factors leading to elder neglect and abuse within the family. Attempts are made to discover the relationship of the abuser with the abused elderly person. Different forms of elder abuse within the family are studied, as are the consequences of elder abuse by a family member.

Focus of the Study, Data and Methodology

There have been many newspaper reports of elderly people suffering neglect and abuse in Kerala. Seniors’ living patterns are important for understanding the relationship between the abuser and the abused. Among those who live with a son, 56.4% are females and 56.2% are males. By contrast, the proportion of elderly females living alone is 4.3 and 1.2% elderly males (Rajan et al. 2017). Understanding such living arrangements is particularly crucial because abuse nowadays often comes also from those people who are supposed to take care of the elderly during their twilight years. This highlights the fact that elderly people are not safe even within the four walls of their own homes.

Unlike other topics, it is very difficult to find data on elderly neglect and abuse as these are the cases which cannot be expressed purely in numbers. Also, many people are afraid to reveal the exploitative situations they face in life. This happens especially when the culprits are their own children. Only reported cases are known. There are many unreported cases which are many times more frequent than the reported ones. Even in the case of reported instances, a single number cannot express the type of traumatic and painful experiences which old people have gone through. Thus, to capture the sufferings of elderly people due to abuse and neglect within the family, we conducted case studies in and around the district of Thiruvananthapuram. Observation and semi-structured interviews were also used here. The samples in the study include 20 old people falling in the age group of 60–90. Both males and females were covered in this study (see Table 6.1).

Table 6.1 Brief details of the cases studied
Full size table

The study is explorative in nature. Elderly people living with their family members form one group of the sample. Seniors living in old-age homes are also included in the study to portray the real picture of the nature of miseries they faced at home because of mistreatment from family members. Snowball sampling is used in this study. Insights drawn from case studies are rich in instances of abuse, neglect and hidden sufferings of elderly people. Since many of the samples in this study are still worried about the future of their children, children-in-law and grandchildren, they do not want their names to be disclosed. Narrative style is used to comprehend the miseries of the elderly as this method is best suited to unveil the kind of oppression and exploitation suffered by them in their sunset years.

Findings of the Study

Risk Factors Leading to Elder Neglect and Abuse Within the Family

A risk factor is any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury (WHO 2017). Risk factors make elderly people vulnerable to neglect and abuse. Failing health and aching bodies demand somebody to take care of them. Thus, it is important to devote time, effort and money to provide for full care of seniors. It is the working-age group, sandwiched between the demands of their old parents and their children, who confront challenges because of stress in multiple areas such as home, office and others. It is primarily this anger that is vented on old people in the form of neglect, abuse, and sometimes abandonment. Adding fuel to the fire, old people have a high chance of developing many diseases, making this period of life worse than any other.

Risk factors operate at multiple levels. WHO (2017) has identified risk factors functioning at four levels: individual level, community level, relationship level and socio-cultural level. Risk factors can be looked at from two different angles, one related to the functional impairments of elderly people and the other to the difficulties and stress of the care-giver in looking after elderly people in the family. Many studies have proved that the chances of disability increase as one reaches old age. Disability can be single, double or multiple, at times related to vision, sight, movement, etc. As per the findings of the Kerala Aging Survey (2013), the share of elderly people suffering from difficulties related to vision, chewing, hearing and walking are 79, 44.3, 23.6 and 34% respectively. Chances of other health problems like heart diseases, arthritis, urinary infections, etc. cannot be neglected in old age. Adding insult to injury, another headache at this point is life-style diseases such as diabetes, obesity, anaemia, etc. All these make elderly people vulnerable to problems such as abuse, neglect or even abandonment by family members at a time when they require greater care and attention. It is also found that elderly people who are bedridden are the ones who suffer most.

Below we narrate the experience shared by a 77-year-old man.

Since he was not educated, it was impossible for him to get a well-paid permanent job. So, he worked on other people’s paddy fields. When it was off season he was employed by rich people to help them take care of their estates. He never wanted his children to inherit his job. So, he sent them to the nearby school. Giving no food to his own belly, he gave his children enough food. Now, both his son and daughter-in-law are doctors. After the death of his wife, they told him to sell off his property and go with them. He did so but now they do not want him, addressing him as good for nothing. Now he is suffering from kidney failure. So, they have abandoned him. They are running after money. Though his children are financially well off, they do not have time for him. He complains about his fate.

Here, lack of adequate education and the death of his wife act as risk factors, making his children feel that nobody could question their acts. Adding to his misery, he is a kidney-patient.

Another danger to which elderly people fall prey is falls. As per the findings of the Kerala Aging Survey (2004), 33.6% of seniors have not recovered fully from the outcomes of falls. Falls among elderly people in most cases lead to disability. Locomotive disability is the worst of all because a single fall can lead to an active old person becoming bedridden, making his or her life hellish. In many cases, a fall may lead to death after months or years of suffering. Thus, these types of falls are called terminal falls. Since old people have less calcium content in their body, even a trivial fall can lead to fracture.

When conditions like disability or memory loss prevail, more care is required from the care-giver. If the care-giver should manage household responsibilities, too, this may create over-strain released in the form of abusive behaviour against the elderly person in the family. Such a situation is exacerbated when coupled with financial dependency of the elderly person.

In the early theoretical models, the level of stress of caregivers was a risk factor linking elder abuse with care of an elderly relative (Eastman 1994; Steinmetz 1988). In many cases, striking a balance between household duties and work pressure appears to be a Herculean task for many of the nuclear-family members where both husband and wife are employers. In such a scenario, though not deliberately, they vent their anger on the old people at home, without even remembering that it was these old people who strived to help them to become what they are today. At times, such abusive behaviour is momentary. But one cannot take back words that are already spoken and stones that are already thrown because one cannot take back somebody’s pain which has already been suffered and tears which have already been shed.

Relationship of the Abuser with the Abused

In the context of the erosion of joint families and the simultaneous rise of nuclear families, the presence of elderly people in the family is not encouraged. In many cases reported in the study, abusive behaviour towards seniors in the family came especially from the victims’ own children, children-in-law and grandchildren. The sandwiched generation tries to get rid of the elderly people from their house, deliberately forgetting the care and support they once received from those hands which are now old, weak and frail.

The experience of a 90-year-old woman is narrated below:

She suffered a lot. Her daughter-in-law tried all her means to drive her away from home, using abusive language and never letting the old woman talk to her son, who came home only once a month. On many occasions she asked the old lady to commit suicide if she could not die normally. She used to hit the old lady on the head. Food was not given on time. She withheld all medicines to hasten this frail old woman’s death. Though this old woman had seven children (six daughters and one son), none of them was ready to take care of her. One day, her daughter-in-law drove her away from home. The old widow touched her feet telling her not to abandon her. When her son came, the daughter-in-law told him that it was the old woman who had tried to leave home, shifting all blame. It was on that visit home that her son put her in an old-age home. All the residents of this new home have had similar experiences.

Though elderly people dance to the tune of their grandchildren, nobody can predict what is going to happen in future. The story of an 86-year-old lady is narrated below:

Her grandchildren left her after locking her house, taking all the furniture with them. She was 80 by then. They pulled her out of the house and drove her away. After spending weeks on the streets, she is now in an old-age home. She suffered a lot. She was shivering under rain in the open air at night, with no roof over her and no walls to protect her. They treated her like this because she was opposed to their wish to sell her property before her death. She had four children: three sons and one daughter. Now her sons are no more.

Siblings, members of the extended family or even a spouse can also be culprits of elder abuse. In most of these cases, the reason would be financial. The role of marital status is thus important when it comes to determining whether an elderly person receives adequate care and attention because this also deals with the living arrangement of the elderly. As per the findings of the Kerala Aging Survey (2013), out of the total unmarried elderly people, 38.7% were living alone whereas in the case of widowed elderly people, 47.5% were living with their son. Some 42.9% of the married elderly were living with their spouse.

Occasionally, shocking events related to servants harming and killing elders for money also happen in Kerala. Because of both out-migration and emigration increasing in Kerala, people are now more likely to leave behind their old parents. Since women also migrate to other areas in search of work, it is the paid servants who extend a helping hand to the elderly at home in many such cases. A 69-year-old woman has lot to say about how she suffered at the cruel hands of her servant:

She was left alone in a big house by the children when they moved to Canada. They also made all the necessary arrangements for a paid servant-cum-home nurse to take care of all the needs of their mother. But the servant was driven by her greed for money which was evident from her behaviour. She, in the name of dusting and cleaning, tried many times to steal money and gold ornaments. She never bothered to care for the old woman. She never gave the old woman food and medicines on time. There were many unreasonable withdrawals from the elderly woman’s bank account. When this old woman tried to question her, she reacted violently by pushing the old lady to make her fall.

Types of Elder Abuse

Elder abuse may take various forms ranging from mere verbal abuse to physical and mental torture and exploitation. In most of the cases reported in Kerala, financial matters are a factor. Since the older generation has no other option but to suffer silently, they try their level best to tolerate these kinds of behaviour from their family members.

Verbal abuse ranges from ordinary scolding to the use of rude and offensive language. Expressions like ‘remember that you are old’ and ‘stop doing that’ are certain commands which are used by young people to restrict old people from engaging in some activities which give the latter pleasure. Shouting, yelling and making insulting or disrespectful comments to elderly people are also instances of verbal abuse.

Physical abuse and exploitation include beating, punching, deliberate pushing to make elderly people fall, and use of weapons. These, in many instances, lead to disability. In extreme cases, they can even lead to death. Instances of putting elderly people in chains, accommodating them in cattle stalls or a bathroom, or under house arrest have even been reported in Kerala.

Financial abuse and exploitation of elderly people is very common in Kerala. Elderly people who live alone are vulnerable to crimes such as attack (and, in extreme cases, murder), while resisting robbery.

We narrate one old man’s experience below:

His children are away in the city, living with their family who are very keen on education of their children. He is alone in his home. He is a heart-patient too. Since there is a chance of being robbed, he is afraid. Two instances of robbery have happened at his home. On one occasion, he got injured. Everyone knows that he is alone there.

Since people are driven by financial motives, they try all means to acquire wealth. In such instances they do not care whether their acts create problems for their old parents.

A 78-year-old woman reveals her suffering:

She and her husband were living in their home. Since their children had migrated for the convenience of work and studies of their children, these elderly parents were left behind. After her husband’s death, she was taken to her son’s home on one condition. He and his wife asked this old woman to transfer her house and property to their name. It was almost at the same time that her daughter also asked her for the same. She never wanted her children to fight each other. So, she told them that it is for their children that parents acquire all wealth. This was considered by them as an act of refusal on her part. From then onwards, days passed like decades for her. She came across all kinds of verbal abuse from her children. At times, they even dared to hit her and punch her. She was not taken to a doctor when she was unwell. She understood that she appeared a burden to them. She came to recognize that they were not waiting for an opportunity to take care of her but they were in a tug of war for her assets. She was convinced that if she became unwell and bedridden no-one would take care of her. So, she decided to transfer her house to her daughter and property to her Son. She had never wanted to create problems for her children. So, she herself decided to come to an old-age home. Now, she is happy. She is not alone here. Now, she can make sure that when she dies, at least there are some people who will be moved to tears.

Another instance of financial abuse concerns a 78-year-old man:

When he and his wife came to Kerala, he was 23. They had no inherited assets. The only thing they had was a determination to work hard. They could thus reap gold on earth, turning their blood to sweat. They raised their children, treating them as the apple of their eye. They had four children. They gave their children a good education and they are now in the USA. Each has a family. This elderly couple now have money, fame and everything. But though they wish to live with their children they know that this is just a dream which cannot be made a reality. After the death of his wife, his children took away his property saying that they would take him with them. But nothing happened after the transfer of property. Now he is in a destitute home.

Many elderly people who stay with their children or grandchildren or other relatives are not free from similar sufferings. Denying the older person access to his or her own assets or home, fraud, taking money under false promises, counterfeit, theft, forced property transfers, use of false signatures to deal with financial matters, improper use of legal agreements which contain the name or signature of the elderly etc. are some of the ways elderly people are financially abused and exploited. Thus, all illegal use of an elderly person’s assets without his/her permission fall under the category of financial abuse.

Though elderly people can tolerate all these, they wish to stay with their family because they do not want to be neglected. Neglect, in one instance or the other is a part of life. This is true especially for an elderly person. He/she, on many occasions, is not allowed to appear in front of guests. In many situations, even when the whole family leave the home for a leisure-trip they deliberately avoid the elderly member in the family, finding some excuses like ‘there is no space in the car’. Elderly people in the family, especially those who are bedridden, should be provided with food, water, medicine and clean clothes. Timely care is essential here to support them emotionally. Family care-givers may inadvertently neglect their older relatives because of their own lack of knowledge, resources, or maturity, although this is a less frequent form of abuse (American Psychological Association 2012). In many areas, elderly people are living alone. Even if they die, it is only after 2 or 3 days that others come to know this news.

Abandonment is the most extreme and common form of elder abuse found in Kerala. There have been instances of seniors being abandoned at public places, and police registering cases against people for failing to take care of their parents (Philip 2013). This type of desertion happens without seeking the consent of the elderly people. Even their own children dare to abandon their old parents for the sake of a stress-free life. They consciously and purposefully forget that what they are now is because of their parents’ sweat. Kerala has a lot to say about abandoned old people. Railway stations, bus stands, government hospitals, crowded temples, etc. are the main places where seniors are abandoned.

An 88-year-old woman reveals her experience of being abandoned”

She came with her son, daughter-in-law and grandchild to take part in festival celebration in the temple. They abandoned her in the crowd. Pointing to a tree, they told her to go and sit under it for shade to avoid tiredness so that they could go and get her something to eat. They told her that they would come back soon. She waited for hours but they did not come to take her with them. She was wandering in search of them. She pleaded with many people to help her. Somebody asked for her son’s phone number. But she had no idea about it. She heard some people murmuring that her son had intentionally avoided her. She could not resist her tears. But later, she realized the truth when nobody came in search of her. From that it can be seen that they had planned to abandon her. Now she is happy in an old-age home.

All these types of behaviour, whether intentional or unintentional, can lead to the most disastrous form of abuse, which is called emotional abuse. Unlike all other forms of abuse, this is something which has enduring effects because the trauma of all the abusive experiences mentioned above can have harmful impacts on the mind of the elderly victim rather than their body. Though the wounds created on the body disappear with time, the wounds formed in the mind will stay with elderly people till their end.

Effects of Elder Abuse

Elderly people who fall victims to abuse, neglect and abandonment not only suffer from the visible or audible form of pain but also carry a sense of mental distress with them. Some after-effects of elder abuse are quite intense and long-lasting effects. These are problems which cannot be cured with medicines. If a senior is a victim of continuous abuse, it can affect his or her mind forever and there is a strong chance that they will not be able to lead a normal life again.

Intense fear and anxiety are seen among the people who once fell prey to these kinds of experiences. Because of such experiences from their own children, who are meant to take care of them during their old age, there are high chances of developing mistrust towards others. Adding to this is the feeling of isolation. Old age is the time when a person goes back to his/her childhood days. Thus, this is the time when old people need more care from young people. Because of isolation, old people may develop a feeling of hatred towards their own life.

Also, the main cause leading to depression is the feeling of isolation. For elderly people, especially those who are bedridden and left alone in a room, devoid of any human company, their only relief may be a visit by the servant. Thus, they are forced to stay away from family and friends though they all are under the same roof. They do not have anyone to open their mind. Depression occurs as an after-effects of abuse, neglect and abandonment. The scale of depression among elderly people in Kerala is shown in the Kerala Aging Survey (2013); this shows 10.5% of seniors are vulnerable as they confront difficulties due to mental ill health because of depression.

Loss of hope is also seen among old people who are avoided by their children. Therefore, they do not wish to live any more. Thus, they live as if they are waiting for their last call. Though their children abandon them, till their last moment, they at times hope that their children at some time will realize their love for them.

A hopeless situation experienced by a 79-year-old person in an old-age home is described below:

He does not have any complaints. He does not have any regrets. He believes that his fate is to count his days there and his destiny is to spend his last days in a destitute home though he has children and other relatives who are financially affluent. Now he has no hopes and desires. Now he sees nothing else in his dreams but his death.

All these can cause fear, mental anguish, or emotional pain or distress. Suicidal tendencies increase among elderly people mainly due to feelings of isolation and resulting depression. These kinds of feelings come especially after facing the demise of a spouse. From then onwards the person is forced to live without much company. The only relief is old memories. Suicides are seen more among elderly people who live alone (Nair 2016). They commit suicide because they are suffering from multiple aliments and are sure that their children will not turn up to help them if they become bedridden. Among the elderly who have committed suicide, 78.43 and 17.98% have done so due to health problems and family problems respectively (National Crime Records Bureau 2014).

Loneliness causes unbearable pain for elderly people. Depression and suicide are the methods adopted by the mind to deal with the problems of isolation and suffering. Seniors are left with no option because many of them who stay with their children and face multiple kinds of abuse do not wish to share their experiences of hardship and suffering with others, mainly because they do not wish to defame their children.

Conclusion

Old age is the age of misery and pain due to multiple factors like deteriorating health, a tender body, low immunity, high chances of disability, etc. Thus, members of the older generation are treated as liabilities even by own children. The case studies included here also reveal that many of the residents in old-age homes have been driven out of their houses by their own children after had all their wealth snatched away. Old parents are made to sign documents of property-transfer through compulsion, threats and fraud. Once children realize that all the property has been transferred, they try, in many cases, to abandon their old parents. In many cases, the residents of old-age homes are in the state of widowhood. The strict implementation of the Maintenance and Welfare of Parents and Senior Citizens Act 2007 is thus the need of the hour.

There are many instances of elder abuse which go unreported due to the fear of being embarrassed or to the fear of further abuse and threats. The cost of these kinds of abuses cannot be calculated, especially when it comes from victims’ own children. During old age, most of the people are caged, tied to the rope of torture in the prison of sorrows. Many of them have transferred their assets and properties to their greedy children and now wander the streets. They have tearful stories to tell and each has unique experiences to share.

Another group of old people are blessed with all extravagances but are devoid of human company. Even if they have all the facilities they could wish for, living alone in old age is the worst situation. For many old people, living in an old-age home is better than living alone in the lap of a luxury.

Grandparents today are alien to children in the new generation. On the other side of the coin, old-age homes are mushrooming. It is not a bed of roses or cosy and luxurious living conditions that these old parents demand. All they need is just an ordinary life with their children and grandchildren around them. Though we have laws and policies, children have more responsibility for taking care of their parents than any law or government. We need day-care centres and relief centres for old people, but these should be the last option. Thus, it is high time to treat our old people with respect to save them from situations of misery and pain.