Elderly Abuse in Malaysia

The official visit by the undergraduate students and their lecturers from Tzu Chi University from Taiwan ended a week ago.
 
During that visit, I talked about elderly care and abuse, particularly within the Malaysian context because I feel this is one area which is not very much talked about, not easily detected, and in fact, what we know is probably the tip of the iceberg only. This forum would also provide a space for our students to interact with the Taiwanese students as Taiwan has a good legal provision for the elderly, although Professor Hanson Huang (extreme right in front row, pic) from this team of Tzu Chi university said that the problem still remains a concern as the issue is not the law, but the implementation of the law.

In Malaysia, elderly is defined as one who is “60 years and over”  (adapted from: United Nations World Assembly on Ageing, Vienna, 1982). Some would further divide them into the  “young old”, aged 55-75 years old, and the “old old”, aged above 75 years old.

Unfortunately, many of us as healthcare professionals have narrow perception on what health is. We often define health as an “absence of disease” as defined by Sidell (1995).

On the other hand, the World Health Organization (WHO) gives a more wholistic definition of health:

“the state of complete physical, mental and social well-being” (World Health Organization,1995)

The elderly population in Malaysia has increased from 5.9% in 1991 to 6.5% in 2000. And it is expected that the proportion of people age 60 years and above in 2020 would increase further to 9.5% (Sherina et al, 2005). The life expectancy of Malaysian men and women in 1957 was 55.8 years and 58.2 years respectively, but today, it is 71 for men and 74 for women.

Contrary to what many believe, elderly abuse is not only confined to physical abuse, but, may also be sexual, or emotional abuse or neglect

WHO defines elderly abuse 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" (World Report on Violence and Health, World Health Organization, 2002)

As mentioned, elderly abuse can be:

• Physical abuse
• Sexual abuse
• Emotional and psychological abuse
• Financial exploitation
• Neglect
• Abandonment

Many believe that elderly abuse only occurs in nursing homes. But the truth is, more often than not, the abuser is a close relative – 80% being spouses and children of the victims or a close relative.
Another common myth is that elderly abuse would not happen in rich families although in actuality, elderly affects all ethnic groups and cuts across all socio-economic and religious lines. Those at risk are most likely to be female, widowed, frail, cognitively impaired, and chronically ill.

According to the 4th Malaysian Population and Family Survey, by the National Population and Family Development Board (LPPKN) 2011, one in three Malaysian elderly (33%) aged 60 and above are abandoned and do not receive financial support from their children. Click here and here to read further.

The main problem is that unlike child abuse (where there is the Malaysia Child Act 2001 to provide a protective legal environment for children), elderly abuse per se is not an offence in Malaysia as there is no law to explicitly deal with this. The only way is to charge any perpetrator under the Penal Code or Domestic Violence Act for physical abuse.

Under the Malaysian Domestic Violence Act 1994 (Act 521), domestic violence means the commission of any of the following acts:

willfully or knowingly placing, or attempting to place, the victim in fear of physical injury;

causing physical injury to the victim by such act which is known or ought to have been known would result in physical injury; 

compelling the victim by force or threat to engage in any conduct or act, sexual or otherwise, from which the victim has a right to abstain; 

confining or detaining the victim against the victim's will; or 

causing mischief or destruction or damage to property with intent to cause or knowing that it is likely to cause distress or annoyance to the victim

by a person against—

    his or her spouse;
    his or her former spouse;
    a child;
    an incapacitated adult
    any other member of the family. 

Under the domestic violence act 1994, the main issue of course is the fact that many of the more subtle forms of abuse such as emotional abuse, neglect and financial exploitation would be difficult to be legally charged.

Questions:
From your experience is elderly abuse? Why or why not?
What steps can you contribute to combat this society ill?


References:
Sidell, M. (1995) Health in Old Age: Myth, Mystery and Management, Buckingham: Open University Press.
Sherina M, Sidik Rampal L, Aini M, Norhidayati MH. The prevalence of depression among elderly in an urban area of Selangor, Malaysia. Int Med J. 2005;4(2):57-63.