One of the more commonly accepted definitions of elder abuse is ''a single 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.'' This definition has been adopted by the World Health Organization from a definition of elder abuse in the United Kingdom.
The core feature of this definition is that it focuses on harm where there is an ''expectation of trust'' of the older person toward the abuser. This includes harms by people the older person knows or with whom they have a relationship, such as a spouse, partner or a family member on whom the person relies. Many forms of elder abuse are recognized as types of domestic violence or family violence.
Filial piety means to take care of one's parents, show love, respect and support, display courtesy, wisely advice one's parents, show sorrow for their sickness and death, and carry out sacrifice after death. This value has been followed by many countries of the world such as China, Japan and India where filial piety or respect for older people was once taken for granted. In primal societies, elders were holders of wisdom. Their advice nourished the community and guided it. Society today prizes strength, progress and youth above elders who are gradually pushed aside. This is a huge loss.
Filial piety was a tradition and family value in the United States until quite recently (late 1950s and 1960s). Then more women were returning to work. More adult children moved longer distances away from their roots and parents' homes. There are changes in family values in that some adult children do not feel that they are responsible for the care of their elderly parents. On the other hand, many elders do not want to be a burden to their loved ones.
With advances in medicine and medical care, life expectancy has increased. The fastest growing segments of the US population are the old who are 85 years and up. These people are the most likely to need help from their children because of their growing frailty. The global economy, a highly technical society and advances in social services and medical provider systems have changed views on elder care. (Spotlight on Elder Abuse, 2008)
This is a massive problem and challenge for service providers, governments and individuals with interests in this area. Tackling the culture of the ''me first'' generation and the prevention of abandonment of the elderly is a big problem with no easy solutions. A multidisciplinary and multi-agency approach is necessary.
What are some of the reasons for estrangement or abandonment of elders within family systems? Children quote a breakdown of relationships as a reason for abandoning their parents. The effects of the abandonment of elderly parents may not be obvious to observers because social service systems may have assumed the responsibilities of elder care.
Some adult children believe they have deficient parents. Chronic mental illness or a disabling physical illness may have contributed to parental inadequacy. There is the story of the grandmother who struggles regularly with depression and with a family history of depression as well as having significant medical problems. The adult children tell mom that she is unable to care for her grandchildren when in fact with progress in treatment, grandma is quite functional. The stigma of mental illness impacts in this case scenario.
There are adult children who are living within alcoholic, addictive family systems. They have cared for their parents as children. These are very unhealthy family relationships. Boundaries are violated. Splits, alignments, blaming and guilt may occur and no one assumes responsibility for their parent.
There are controlling parents who fail to allow their children to assume their own responsibilities as they develop. These parents try to dominate their adult children because they fear being abandoned themselves. The adult children are made to feel guilty and disloyal to their parents if they make decisions and act independently. These children sometimes make decisions to cut off ties with parents in order to be free of parental control. There are case scenarios where the children are never allowed to leave the home and parental child care continues until death. The child could die before the parent or adult child could move to the nursing home with the parent.
There are abusive or neglectful parents. The abuse or neglect may have occurred early on within the family system. Adult children could hold grudges because they were traumatized and they do not have the emotional strengths to overcome the depressive thoughts and feelings of the events of their childhood. These events could be about parents who provided care but who were not emotionally caring, i.e., the parents who prioritize their selfish needs over the child's needs throughout the child's life. There is the horrid trauma of childhood physical and or sexual abuse. Without appropriate mental health counseling, these issues would be difficult to resolve. (When Children Abandon Parents, 2010)
Our society seems like a ''blame the parent'' culture. We need to remember that parents and children have different perspectives on what has occurred in their lives and within family systems. The elderly parent and child relationship can be a workable and delicate balancing act with each family system finding a workable solution. There is the special story of a family whose goal was for mom to live in her home as long as possible. A schedule for family members was developed with each member volunteering a number of hours each day and week for mom's near-24-hour care. This schedule continued on for at least four years and there was minimal family conflict. Mom did eventually move on to an assisted-living facility.
There are the fiercely independent parents who refuse the care or advice of their children as well as service providers. The story of a lady who is visually impaired with heart problems, diabetes and renal failure comes to mind. She is accomplishing her goal of living independently with minimal service provision in the home. She is more concerned about her children and grandchildren's well-being then her own. Her coping skills are determination and keeping busy. There is the story of a mom/grandma who recently had a fall and fracture. After rehab, her children were fearful of mom's ability to live alone. All children reside out of the area. Mom has successfully recovered, maintains her beautiful home, attends church daily, and has daily phone contacts with her children. She is determined to live alone with minimal care from her children and service providers.
Joshua Coleman's book, ''When Parents Hurt, Compassionate Strategies When You and Your Grown Child Don't Get Along,'' offers some solutions. These apply to both the parent and the adult child.
1. Don't give up. Continue with weekly letters, emails, and phone calls when you feel rejected. Take responsibility for your mistakes even if you don't think they were mistakes. Parents and children have different perspectives.
2. Friends, family members and therapists can help the parent and child cope with estrangement.
3. Be patient. Reconciliation takes many conversations. There will be ruminations and regrets. Forget such thoughts as, ''What did I do wrong?; I'm too nosy; I should have; I could have; I'm sorry.'' Proper boundaries need to be noticed.
Advice to parents - Do what you can to understand the situation and make things right. Let respect be your guide. Let go of the anger you feel. Never give up.
Advice to children - Let respect be your guide. Understand the situation. Give your parents a break. They won't be around forever.
The spiritual truths children can learn from the sometimes overwhelming tasks of caring for an elder are that they too as children are weak, frail and flawed. If the child can allow the relationship with the elder to become the focus of attention and to notice, to listen and to put himself/herself in the parent's shoes, then the life lesson about the child's inadequacy can be changed into a kind of blessing. Some of what is learned in the relationship with the elder will be hard to face, but could provide strength and joy and could be a special memory to share with children and grandchildren. Elders can teach their loved ones to slow down and pay attention to important things. (Networker, Hargrave 2005)
Seek professional help, starting with your primary care physician. Mental health symptoms such as depression and anxiety can be medically evaluated and when necessary, medication can be prescribed. The medical team and treatment facilities can provide referrals for individual and or family counseling. Caregiver support groups are helpful. There is no easy black-and-white solution to long-term problems. Professional counseling can validate, clarify, increase awareness and bring increased stability and peace within a family system. It is sad when people suffer unnecessarily.