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Rosalie Wolf Memorial Lecture: Reconsidering Assumptions Regarding Men as Elder Abuse Perpetrators and as Elder Abuse Victims Jordan I. Kosberg PhD ACSW
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Division of Geriatrics and Palliative Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA Published online: 29 Apr 2014.
Click for updates To cite this article: Jordan I. Kosberg PhD ACSW (2014) Rosalie Wolf Memorial Lecture: Reconsidering Assumptions Regarding Men as Elder Abuse Perpetrators and as Elder Abuse Victims, Journal of Elder Abuse & Neglect, 26:3, 207-222, DOI: 10.1080/08946566.2014.898442 To link to this article: http://dx.doi.org/10.1080/08946566.2014.898442
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Journal of Elder Abuse & Neglect, 26:207–222, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0894-6566 print/1540-4129 online DOI: 10.1080/08946566.2014.898442
Rosalie Wolf Memorial Lecture: Reconsidering Assumptions Regarding Men as Elder Abuse Perpetrators and as Elder Abuse Victims JORDAN I. KOSBERG, PhD, ACSW Downloaded by [Adams State University] at 07:59 10 March 2015
Division of Geriatrics and Palliative Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
From research findings and practice experiences, it is concluded that abuse of older men is especially invisible and underreported, compared to abuse of older women. It is proposed that attention should be directed not to gender, but to those conditions in different countries and cultures leading to abuse of both older men and women, including (but not limited to) economic problems, few alternatives to family care of the elderly, violence, changing characteristics of the family, ageism, and sexism. Advocates for the prevention of elder abuse should work together in combating, reducing, and eliminating the problem of elder abuse of both older men and older women. KEYWORDS elder abuse as a man’s problem, invisibility of men’s abuse, nongendered explanations for abuse, prevention of the abuse of older men, professional ageism and sexism, elder abuse interventions with men, cross-national perspectives, nongendered collaboration The topic of my Rosalie Wolf Memorial Lecture combines two of my special academic interests: The unmet needs of males and the invisible problem of elder abuse. The purpose of my lecture is to address prevalent assumptions that elder abuse is a problem most often perpetrated against older women and that the perpetrators of elder abuse are most often males. Based Rosalie Wolf Memorial Lecture presented at the 7th World Conference of the International Network for the Prevention of Elder Abuse (INPEA), during the meeting of the International Federation on Ageing, Prague, Czech Republic, May 28, 2012. Address correspondence to Jordan I. Kosberg, 7726 Cedar Canyon Court NE, Albuquerque, NM 87122, USA. E-mail: [email protected] 207
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upon findings from empirical research and practice experiences, it is my conclusion that (1) older men can frequently be the victims of elder abuse, (2) perpetrators of elder abuse may well be females, and (3) abuse of males and females (including older persons) might be prevented by focusing upon the unmet needs of potential male abusers. I will conclude my presentation by suggesting that cultural changes, occurring in many countries, may lead to an increase in elder abuse and will require the collaboration of those advocating for the prevention of elder abuse of both older men and older women. The reduction of elder abuse in the world necessitates an understanding that the main causes and consequences of elder abuse are not based upon gender-related considerations.
ELDER ABUSE AS ONLY A WOMAN’S PROBLEM One of the first written works on elder abuse was entitled “Granny Bashing” (Baker, 1975). Perhaps this publication set the stage for the belief that elder abuse was, in the main, a problem faced only by older women. There are several reasons for understanding why it is popularly believed that that elder abuse is considered a problem faced only by older women. First of all, the majority of older persons in most countries are women. Thus, the majority of elder abuse victims must be females. So, too, as women are perceived to be members of the “the weaker sex,” they are less likely to defend themselves from abuse, when compared to older men. Relatedly, males (regardless of age) have been perceived to be members of “the stronger sex,” and more likely to be abusers, or otherwise the perpetuators of the victimization of others, whether male or female. Traditionally, men have been in dominant positions within a marriage, or within the family. They have been expected to be the providers and decision makers in their domestic relationships. Yet, such gender-related roles and responsibilities are changing in many countries, as a result of efforts to achieve greater gender equity. In the process by which cultural change in gender roles, rights, and responsibilities moves forward, there are clashes between “traditionalists” and those advocating for social change. Such clashes can take place within the family, and lead to such domestic problems as spouse abuse, partner abuse, child abuse, and marital separation and divorce, and the victims of such dynamics are seen to be mainly females. It is believed that the above dynamics have been discussed in popular and professional literature on abuse with females being mainly victims and the perpetrators being mainly males. Further, it is believed that a similar propensity for such gender stereotyping can be witnessed in the mass media, whether in movies, television, theater, or in other things that can influence public beliefs.
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Popular generalizations that go beyond family and marital relationships have placed males in privileged positions of power, authority, and wealth in public and private sectors of society (such as government, business, and religious organizations). While such gender-related power inequities had existed in the past, this is not necessarily the norm in the present. Indeed, there is a current trend in many countries, and within many cultures, for greater gender equity in the home and in the workplace. Members of the “women’s movement” (including males as well as females) have been critics of male dominance over females in society. Of course, such advocacy for needed change is to be commended and has been quite effective in achieving greater equity in opportunities and improving the quality of lives for females. No doubt, and rightly so, the movement has focused upon the plight of abused females. There has not, however, been a “men’s movement” that has sought to publicize the inequities facing males, from young boys to older men, and to advocate for needed changes for them. The absence of men’s advocacy for abused males leads to the continuation of erroneous, and unchallenged, assumptions that elder abuse is a problem only for women. It has been found (e.g., Kosberg, 1998; Nicolls & Dulton, 2001; Tutty, 1999) that the abuse of older men is generally an invisible problem, in part due to the failure of males to acknowledge and report their adversities. Embarrassed to be abused by a wife, a child, or a partner or paramour, such males are reluctant to report their abuse. As a result of gender-role socialization, they are less likely than females to admit having problems, including elder abuse. So, too, as men do not admit and report problems, they also do not engage in help-seeking efforts; thus, they fail to utilize health, mental health, protective service, and law enforcement resources that are available in the community. Admittedly, there are also very few, if any, community resources to assist abused older males (such as elder abuse shelters that are willing to accept males). Yet, a false conclusion can be reached that this lack of service utilization by older men is indicative of the fact that there are no abused older men. For all of these reasons, then, elder abuse is not believed to be a problem for men.
FINDINGS ON ABUSED OLDER MALES Over the years, there have been studies that have found, indeed, that older men are victims of elder abuse. The following are a sample of research findings on the abuse of older men. The material indicates that not only are older men abused, but it also suggests that there is a possibility that such men may not admit being abused and, therefore, the abuse will not appear in official statistics. Accordingly, abuse of older men remains underreported and is not known to be a significant problem.
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In 1977, Susan Steinmetz coined the term “The Battered Husband Syndrome” and suggested that the abuse of older husbands was as likely as the abuse of older wives. In 1988, there was a study of elder abuse in the Boston Area (Pillemer & Finkelhor, 1998) that found the per capita rate of elder abuse of men to be higher than that for women. In 1993, the National Center on Elder Abuse reported findings from its U.S. National Study of Elder Abuse (Tatara, 1993) and included the finding that suggested the proportion of abused older men exceeded those of older women. In 1998, I published an article that reported findings on the abuse of older men (Kosberg, 1998). In this article, I had suggested a typology for explaining high-risk possibilities for the abuse of older men. The first group of older men includes those characterized as having high-risk lifestyles and living in high-risk social settings. Also included are older men who live alone (and/or who are lonely), those living in inner-city settings or in rural areas, older prisoners, older gay men (abused in domestic relationships or by homophobics), and those living within long-term care facilities. A second group of high-risk men are those who live in family settings (the location of most elder abuse). This group include older fathers who are “paid back” by adult children who had either been abused decades earlier by their fathers, or adult children who had witnessed the abuse of their mothers over the years. So, too, older wives who have been abused by their husbands can seek retribution against their husbands when these men become increasingly impaired and dependent. The third group of older men who are at high risk for elder abuse include those who engage in self-abuse, self-destructive acts of omission or commission. Such men suffer from physical and/or mental health problems, which can result in depression, anxiety, and anger. The consequence of such personal health adversities can lead to acting out behavior (striking out at others and, thus, becoming victims of retribution), neglectful behavior (“giving up,” which results in death), or suicide. In 2007, I published a book, Abuse of Older Men (Kosberg, 2007), copublished simultaneously with a special edition of the Journal of Elder Abuse and Neglect (volume 19, issue 1–2) that focused upon the abuse of older men. Two additional articles from the special edition were published in the following issue of the journal (volume 19, issue 3–4). A summary of all the articles on abuse of older men, in both issues, is presented to illustrate the diversity of topics. Included are articles on intimate partner abuse of older men (Reeves, Desmarais, Nicholls, & Douglas, 2007), the possibility of sexual abuse of older men (Teaster et al., 2007), and the existence of “fractured relationships” between adult children and their elderly fathers that could lead to the abuse of these fathers (Stratton & Moore, 2007). Other contributions address the detection of abused older male patients by their physicians (Yaffe, Weiss, Wolfson, & Lithwick, 2007), the vulnerability of elderly prisoners (Stojkovic, 2007), and the possible abuse of custodial grandparents (Butler & Thomas, 2007). There were two articles describing
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challenges faced by professionals working with male victims of elder abuse (Blundo & Bullington, 2007; Kaye, Kay, & Crittenden, 2007). More recent work focusing upon elder abuse of male includes a 2011 article reporting the findings from focus group discussions on the relationships associated with the abuse of marginalized elders (Walsh, Olson, Ploeg, Lohfeld, & MacMillan, 2011). Abuse and maltreatment were discussed on the basis of age, gender, disability, race and culture, sexual orientation, and poverty. There was a lack of consensus about whether or not gender-linked oppression—power imbalances—is associated with elder abuse. As older men were perceived to experience more abuse, the relationship between abuse and female gender oppression could not be supported. That same year, a study of abuse among older Chinese in Canada (Lai, 2011) did find more abuse among women. However, the author went on to suggest potential underreporting by males in the study, especially by those from ethnocultural minority groups. The author concluded by suggesting that the study of abuse among older minority group men can lead to unreliable research and survey findings on the prevalence of elder abuse. In a study of community services for Asian male victims of crime and abuse, Cheung, Leung, and Tsui (2009) came to a similar conclusion that feelings of shame, disgrace, humiliation, and “loss of face” by (Asian) men can lead to a reluctance to admit having personal problems and to a reluctance to seek available community services. Finally, in 2012, a Canadian report (Poole & Retschlin, 2012) found that the rates of physical and emotional elder abuse were similar for older men and women. Thus, a conclusion can be reached (from this summary of studies on the abuse of older persons) that elder abuse is not only a problem for females; it adversely affects the lives of older men, as well.
THE INVISIBILITY OF ABUSED OLDER MALES As mentioned, there has been a lack of awareness about and concern for abused older men, in part as a result of the lack of research studies and a scarcity of popular and professional publications focusing upon this group of abused persons. In addition, abused older men are often invisible as a result of living in prisons, homeless shelters, inner cities, or rural areas, and in geriatric or mental health facilities (Kosberg, 1998). Older men predominantly live with families within domestic settings, and such settings house the majority of abused older men, and family members are the largest group of elder abusers. Within homes, the abuse of men can remain out of sight and unreported. Also, within domestic settings, some older men have, unfortunately, been identified and reported as elder abusers when, in fact, they are the abused (Nicolls & Dutton, 2001). In such cases, the abused male may have
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engaged in self-defense (for example, defending himself from attacks by his wife). When this domestic incident is investigated, there might well be disbelief that a wife would abuse her husband. A police officer, protective service worker, or any person in authority may erroneously assume the older man is the abuser and seek to bring charges against him. The possibility of an abused person protecting himself (or herself), and being labeled as the abuser is referred to as “reciprocal abuse.” Such an abusive situation “blames the victim” and fails to correctly identify the actual abuser. When an abused older male fails to report his adversity, his abuse remains hidden. There are many reasons for the likelihood that abused older men do not report their victimization. First of all, an abused older man may feel shame (and stigma) for being abused. This is probably especially true if the abuser is a female and/or a close relative. An abused older man, no different than an abused older woman, may be reluctant to report abuse for fear of retaliation by the abuser. Should the older man be dependent upon the abusing person, such as living in the home of the abuser or causing expenses to the abuser, it is unlikely that any outsider will be informed of the abuse. Indeed, the abused older man may conclude that his dependency upon a care provider (family member or not) may give rise to his abuse, believing that if only he could be independent, the abuse would not have taken place. Relatedly, the abused man may not report his adversity because he believes that he is being “paid back” for earlier acts of commission (such as spousal abuse or child abuse) or omission (his being an absent or disinterested father). Here again, the abused older man may believe that he is the victim of his own doing and will be unlikely to report his abuse. Finally, an older abused man may seek to escape his abuse and neglect by committing suicide. The death will be reported as suicide and not as a result of elder abuse. Also, when institutionalization in a mental facility results from the mental anguish of being abused, the older person (male or female) will be reported to be mentally ill, not a victim of abuse. Thus, for such reasons, among others, I believe that often the abuse of older males remains undetected and unreported. So, too, this problem fails to garner the attention of the community, as well as the concern of community professionals who can—and who should—develop both preventive and interventive resources for abused older males, no more, but no less than for abused older females.
NON-GENDERED EXPLANATIONS FOR ELDER ABUSE The point to be made is that predominant explanations for elder abuse are not gender-related, but rather they are gender-neutral (Kosberg & Namiash, 1996). In focusing upon the characteristics of abusers, prominent findings of high-risk characteristics include substance abuse, mental/emotional illness, lack of caregiving experiences, history of intrafamily abuse, caregiving stress
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and burden, dependence on the older person, financial problems, employment or other competing caregiving tasks, family violence/disharmony, and personality characteristics (lack of sympathy, self-centeredness, resentment, anger). Similarly, there are few gender-related explanations for older abuse victims, found to be male as well as female. High risk characteristics of abuse victims include substance abuse, marital status, health condition, cognitive impairment, dependency on others, inability to perform activities of daily living (ADLs), isolation, and having a provocative personality. Accordingly, there is no pervasive reason to believe that abusers are male or that the abused are female. I will concede the point that males are more prone to engage in abusive behavior than are females. There are explanations for males’ propensity for violence against others, within the home or community. This hardly excuses them from their abuse. As I will discuss, in knowing reasons why males engage in abusive behavior, we might better know how to intervene to prevent their abuse of others. The first group of explanations for a propensity for some males to abuse others is related to a historical tradition that has been passed down from generation to generation. Men had controlled the financial resources of the family and of society. As such, they were the decision makers (in marriage, family, and community). In certain groups, there were, and may still be, certain cultural, historical, and religious imperatives for male dominance and female subservience. Both males and females had to abide by such gendered distinctions, and some still do. A second group of explanations for male dominance (that can lead to abuse) is related to the existence of male gender-role socialization in different cultures and countries. For example, boys can be raised (that is, socialized) to be stoic, self-reliant, independent, in control, and strong. Supporting such gendered-role norms for males to follow, there is also peer pressure to be “man-like,” which, in turn, supports the sustainment of such male-appropriate attitudes and behavior. It has been found that traditionally raised males are less likely to admit having problems and perceive there to be a stigma in asking or seeking needed help for their problems (Addis & Mahalik, 2003; McCarthy & Holiday, 2004). The unresolved problems of such traditional males may well give rise to abuse. In better understanding why some males might engage in abuse of others, we also need to understand men’s coping mechanisms. Some men can engage in proactive and thoughtful problem solving. Other men, influenced by their upbringing, face their problems through avoidance, denial, anger, and distractions, or cope with their problems through the use of alcohol or pharmacological substances (Courtenay, 2003). Poor coping mechanisms have been found related to stress for men, leading to cardiovascular reactivity and higher levels of such physiological consequences as depression, anxiety, irritability, and anger (Adler, Patterson, & Grant, 2002). Thus, given traditional cultural expectations for males, gender role socialization, and inadequate coping mechanisms, stressed or depressed men may have difficulty dealing
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with their problems and turn to abuse of others out of frustration or anger (or as a way to confirm their masculine identities). Thus, as research has found both males and females engage in the abuse of others, there are explanations for understanding abuse (and other forms of victimization) by males. One way by which we can preclude men’s abuse of others is by encouraging them, and assisting them, to acknowledge their problems and to seek necessary assistance. In doing this, we not only help them, but we can help prevent their possible abuse of family members, friends, and others in society.
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WAYS TO PREVENT MALES FROM ABUSING OTHERS It is not the purpose of this presentation to deny that males engage in abuse of older persons, or any others. The point to be made, though, is that males can be influenced to abuse by their gender role socialization. Given the problems men may face, they can feel overwhelmed, depressed, and angered. Unresolved or untreated, these emotions may result in the abuse of others in the family (such as a wife, child, or older relative) or nonrelatives (including friends and strangers). Several years ago, I had submitted an abstract on the need to be attentive to the unmet needs of men for presentation at an international conference. The abstract was accepted and assigned to be presented at a session where all the other presentations were focused upon the abuse of females by males in their lives. The audience and presenters were mainly female. Before the session began, I received not-so-subtle negative comments about the topic of my presentation. When it was my turn to speak, I started by asking the audience if they had given any thought to the possibility that men who had abused women in their lives had had unresolved and untreated problems that had given rise to the abuse. I went on to suggest that one way by which abuse of females might be prevented was by paying some attention to the unmet needs of men. It is my opinion that the audience became more attentive and listened to what I had to say; several thanked me for my presentation afterwards. I believe that prevention of elder abuse by males necessitates an understanding of how they deal with their problems. For sure, there are variations among males within any country, in terms of their upbringing, norms that influence attitudes and behavior, and relationships with females in a marriage, in the family, and in society. This section is admittedly informed by findings on males in the U.S., if not from other Westernized countries. It is hoped that those from less developed or non-Westernized countries or cultural groups, will seek to compare and contrast my thoughts with their own experiences with regard to men’s (a) definitions of problems, (b) help-seeking behavior, (c) service utilization, and (d) professional biases.
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There is a suggestion in the literature that males are less likely to recognize and label feelings of distress as problematic, especially those men whose gender-role socialization has been extremely traditional and rooted in religious or cultural imperatives (Addis & Mahalik, 2003; Courtenay, 2002). These men might be less likely to seek help for problems as diverse as depression, substance abuse, physical disabilities, marital discord, or stressful life events. Often, these men will deny the problem or the need to seek help. Further, the existence of certain conditions (e.g., erectile dysfunction, depression, abuse by a female) might be met with embarrassment or denial by some men, and the problem will remain unidentified (and untreated). Although some men will acknowledge their problems, they are less likely than women to seek help. As mentioned, men are often socialized to be independent, stoic, in control, and self-reliant. They believe that “real men do not cry” and do not admit having problems. Accordingly, males facing personal challenges often do not seek professional care because they feel uncomfortable in formal service systems and do not wish to be identified as a client or patient. Some men believe that they cannot afford needed assistance, or they may have a work schedule conflicting with professional or agency office hours. It is also possible that some men who are in need of professional assistance are reluctant to seek such assistance, as they are not legal residents within the country in which they now live. If community resources exist and are perceived to be helpful, men can be influenced to seek assistance from them. But even if the resources exist, research has found that failure by men to use, or continue to use, available resources can be influenced by a number of considerations (Addis & Mahalik, 2003; Berger, Levant, McMillan, Kelleher, & Sellers, 2005). Some men are unwilling to spend lengthy periods of time within waiting rooms. Moreover, they are often very reluctant to publicly disclose the nature of their problem to a receptionist or professional aide in the waiting room. The preponderance of female clients or patients, or female staff, may also cause men discomfort in an agency or care facility. The female-oriented appearance of an agency or facility has been identified as a barrier for men to feel comfortable (International Longevity Center-USA, 2004). Such distractions can include the presence of ferns and plants, female-oriented magazines, and mainly females in the waiting room. To summarize, I believe that men facing unresolved problems may engage in abuse of others (including older persons). Men may not identify their discomfort as a problem, they may not engage in help-seeking behavior, and they may not utilize or continue to utilize needed and available assistance. There is one additional reason for men with problems not receiving necessary and effective medical, psychological, or social care and treatment: professional biases against men. There is evidence that some help-providers (such as MDs, nurses, social workers, and psychologists)—both male and female—can be biased against
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men with problems who seek their help. Such biases might result from past adverse experiences of these professionals with men in their lives. This is to suggest that professionals might have had absent or abusing fathers, husbands or intimate relationships with males who abused, or other males who were abusive or otherwise hurtful or cruel. It is likely that a professional who had suffered as a result of the actions of a male acquaintance, friend, or family member, might lack the interest or commitment to effectively provide assistance to a male client or patient. This negative professional bias against males can lead them to trivialize men’s problems or minimize men’s need for effective treatment. It has also been found that physicians, and others, spend less time with male patients than with female patients, or otherwise communicate less information to males (Elderkin-Thompson & Waitzkin, 1999; Möller-Leimkühler, 2002). Shorter professional time spent with male clients or patients will limit the professionals’ ability to learn about and understand these men’s problems and feelings.
PREVENTING THE ABUSE OF OLDER MEN As had been mentioned, there is a body of literature supporting the fact that men in general, and older men in particular, are abused. Given that the abuse of older men is often “invisible” and not reported, the following are methods for preventing the abuse of older men and providing interventions for those older men who are abused. First, it is necessary to publicize the existence of the abuse of older men. This invisible problem should be made better known to the public, which can be accomplished through the publication of articles, editorials, and news reports. Further, there is a need for abused men to step forward to discuss their abuse. Just as former professional football quarterback Terry Bradshaw spoke of his depression, and former senator Robert Dole spoke of this Erectile Dysfunction, so too can prominent (and nonprominent) males speak out publicly about their abuse. A few years ago, lifelong actor Mickey Rooney gave testimony to the U.S. Senate on his abuse at the hands of relatives. The testimony of this elderly respected actor was widely covered by the mass media and led, no doubt, to an increased awareness of this form of abuse in the U.S. Such public testimonies by well-known men who had been abused will help in making known the existence of such abuse in other countries, as well. Relatedly, there is a need for the professional sector of society to take responsibility for learning more about the existence of the abuse of older men through targeted research studies and surveys. Funding bodies, both government and private organizations, can encourage and make possible the development of knowledge about the problem. There are also roles for educators within professional schools, as well as in general public education, to provide awareness of elder abuse in general, and against older
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men in particular. Awareness of such abuse has ramifications for the training and education of future professionals for at least two reasons. First, as professionals, they will be aware of the possible abuse of clients and patients, both males and females. Second, such knowledge will make them cognizant of the possibility that negative past experiences with males in their past or present lives might lead them to be less motivated to provide effective care to male clients, patients, or program participants. At the community level, there is a need for widespread efforts to challenge the existence of both ageism and sexism in society. Both forms of discrimination can exist at the same time and can result in ignoring or minimizing the possibility of abuse against older men, as well as believing that older men’s abuse is less important than such abuse of older women. There is no place for such beliefs in contemporary society; they are wrong, unfair, and discriminatory. The point had been made that elder abuse of males is not insignificant in number or importance; yet there are few, if any, resources for them. Accordingly, there is a need to ensure the existence of resources for vulnerable and abused older men. Whether medical or psychological care facilities, temporary abuse shelters, housing for older persons, or legal and protective programs for abused men (and women), a community needs to ensure that it has the necessary resources for the victims of elder abuse, both male and female. To suggest there is a need for advocacy on behalf of older men might be met with skepticism—that it is not needed or that men can pretty well take care of themselves. Further, when a problem is seen to be everyone’s responsibility, it often becomes no one’s (or no group’s) responsibility. Certainly, in the U.S., the women’s movement, which included efforts by private and governmental organizations, led to significant and needed advances for all women. The Older Women’s League (OWL) had existence in the past to advocate for older women, and was supported by both private and public resources. Should not such awareness and advocacy be developed to ensure equitable attention to, and resources for, older men? No doubt, such an organized effort seeking advocacy for older men will be composed of both males and females of all ages. Indeed, some might even suggest that such advocacy efforts are needed for all males who might face inequitable penalties, court decisions, public policies, or greater expectations when compared to females. A term “boy bashing” has been coined to describe such inequity toward young males by parents or educational systems.
GENDER AND ELDER ABUSE IN CROSS-NATIONAL PERSPECTIVE It is my conclusion that elder abuse against men is a significant and under-reported problem that should receive similar attention as that given to the prevention of elder abuse against women. So too, comparable resources
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should be made available for abused men. Nongender explanations far exceed the gender-related reasons for the abuse of older persons; thus, elder abuse should be seen to be perpetrated by, and to, both males and females. It is my belief that greater attention should be given to the unmet needs of males (and females), as one method by which to prevent their abuse of others. Accordingly, it is my hope that those of us committed to the reduction and elimination of global elder abuse, in the present and future, will focus upon those conditions within different countries that give rise to problems for its citizens (e.g., widespread poverty, few alternatives to family care for their older relatives, crime, and violence). These problems can lead individuals to seek out scapegoats or convenient victims. Unfortunately, such scapegoats or victims may well be older persons—both male and female. In addition to addressing those conditions leading to sources of problems for citizens, the vulnerability of older persons as a group seems to be increasing. The proportion of older persons is increasing around the world, and it is the oldest of the old—those most likely to be impaired, in need of assistance, and vulnerable—whose numbers and proportion are increasing the fastest (Hooyman & Kiyak, 2011). Further, there is seen to be a decline in the number of adult children available to care for their parents, as a result of declining family size, relocation from rural to urban areas, increase in divorces and remarriages, and international emigration. Religion (which tends to support filial piety) seems to be in a decline in some countries. The importance of older persons in any country, and the responsibilities for them, has been seen to be inversely related to the country’s stage of development. Indeed, a Modernization Theory (Cowgill & Holmes, 1972) posits that more modern societies have a lower regard for older persons than those that are less developed. This theory, as a linear process, has been challenged by many, and modified by its theorists. However, it is believed that the relationship between a country’s regard for its older persons (and the extent of elder abuse) and the level of economic development in countries may not be that relevant. The fact is that there are those in most countries who are impoverished, hungry, poorly housed, and threatened by violence. In the face of economic downturns, even affluent countries will prioritize their needs, and the characteristics of citizens whose needs are seen to be most important. Often, the needs of those in advanced age—whether male or female—are not seen to be a priority. In an aging world, there are no countries that are immune to the problem of elder abuse and neglect; thus, we are all affected by similar dynamics that can lead to adversity faced by older persons. Social changes in the countries of the world have ramifications for gender and gender relations. It is believed that each nation, and cultural groups therein, lies on a continuum ranging from those with traditional male domination, to those moving toward cultural changes with regard to gender
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role equity, to those that reflect advanced stages of equity in gender roles, rights, and responsibilities in the home and in the workplace. Where gender can play a most significant role in predicting abuse may be seen in the first two types of societies. In the first, fundamental, traditional gender role and status differences strongly exist between males and females and permeate the fabric of society. In the second, cultural changes toward greater equity in gender roles can result in extreme discrepancies in expectations between those who oppose change and those who desire faster and greater changes in gender equity. The discord existing between these two factions can well affect the relationships between husbands and wives or intergenerationally within a family. There are many reasons to be concerned about older family members, given such family discord. For the first types of societies, should the rationale for male superiority be based upon religious dictates, public policies, or cultural norms, change in gender relationships will be vigorously resisted within a family or in a society. But, if it is not gender-related differences that lead to the existence and extent of elder abuse in a country, what should we be focusing upon in efforts to reduce the problem in different countries? As mentioned, the major correlates of elder abuse and neglect are not gender-related, but are related to individual anger, anxiety, depression, frustration, retaliation, hopelessness, emotional and cognitive impairments, or a desire to obtain the financial or material resources from a frail, vulnerable, or incompetent older person. Accordingly, we need to focus attention on those societal conditions leading to an individual’s abuse of an older person. It is believed that adversity (that is, abuse or neglect) within a family, community, or society can result from (a) individual or family poverty, (b) hostility or conflict within a country, (c) minimal public resources available to relieve or to support family caregivers, or to replace the family when none exists, (d) an unsympathetic view of older, dependent, or frail persons, or (e) an absence of concern for one’s fellow citizens. We need to always be aware that not every family member, friend, or neighbor—or paid staff member in a private home or a public facility— will be well-motivated, experienced, suitable, or appropriate to care for, or interact with, an older person. We have too much evidence of elder abuse to be so naïve. Certainly, when it comes to caregiving, if and when possible, screening of those who are or will be providing care to an older person should be undertaken to minimize the possibility of an older person being placed in the care of someone who cannot or will not provide safe, humane, and effective care to the older person (Kosberg, 1988). Older women and men are abused in all countries of the world, where abusers are both men and women. Advocates for the prevention of elder abuse should not seek to pit one gender against the other; rather, they should work toward the goals of reducing and eliminating conditions that lead individuals to abuse older women and older men. There is no question
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that you (in the audience) have had an impact in confronting and reducing elder abuse in your own countries, and—together—throughout the world. You have made a difference; yet, you have many challenges facing you in the coming years in reducing and eliminating the problem of abuse of older women and older men. Together, within and between our own countries, we need to work toward common goals and objectives. The quality of the lives of our older persons—both males and females—may depend upon the success of our efforts.
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CONCLUDING THANKS I would be truly remiss if I did not offer my thanks to the Selection Committee of the International Network for the Prevention of Elder Abuse (INPEA), and endorsement by its Executive Committee, for my selection as a recipient of the International Rosalie Wolf Award. I also wish to thank the President of INPEA, Dr. Gloria Gutman, for her support and leadership. So, too, I would be remiss if I did not acknowledge the role that Rosalie Wolf had played in my own work in the area of elder abuse, in general, and in the area of abuse of older men, in particular. As a colleague and friend, and as the Editor-in-Chief of the Journal of Elder Abuse and Neglect, Rosalie was very supportive of my work on the “invisible” problem of elder abuse and neglect of older men. There is little question in my mind that I am giving this prestigious lecture to you today as a result of Rosalie’s guidance and encouragement in the past. Thus, it is an especially meaningful honor for me to receive the Rosalie Wolf International Memorial Award.
ACKNOWLEDGEMENTS I would like to acknowledge the leadership of Carla Herman, MD, MPH, Chief of the Division of Geriatrics and Palliative Medicine in the School of Medicine at the University of New Mexico, for recognizing the importance of social and psychological considerations in the discussion of the causes and consequences of medical health problems of older persons, and who provided an “academic home” for me after my relocation to Albuquerque almost 4 years ago. So, too, I would like to acknowledge the encouragement and assistance of Karen Stein, PhD, Editor-in-Chief of the Journal of Elder Abuse and Neglect, and her staff, as I worked on this article, which is based upon my Rosalie Wolf Memorial Lecture at the 7th Annual World Conference of the International Network for the Prevention of Elder Abuse (INPEA) in Prague, Czech Republic, in 2012.
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REFERENCES Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. American Psychologist 58(1), 5–14. Adler, K. A., Patterson, T. L., & Grant, I. (2002). Physiological challenges associated with caregiving among men. In B. J. Kramer & E. H. Thompson Jr. (Eds.), Men as caregivers: Theory, research, & service implications (pp. 127–151). New York, NY: Springer Publishing Company. Baker, A. A. (1975). Granny battering. Modern Geriatrics, 5(8), 20–24. Berger, J. M., Levant, R., McMillan, K. K., Kelleher, W., & Sellers, A. (2005). Impact of gender role conflict, traditional masculinity ideology, alexithymia, and age on men’s attitudes toward psychological help seeking. Psychology of Men & Masculinity 6(1), 73–78. Blundo, R., & Bullington, J. (2007). Abuse of elder male clients: Efforts and experiences in rural & urban Adult Protective Services. Journal of Elder Abuse & Neglect, 19(1–2), 173–191. Butler, L., & Thomas, R. L. (2007). The vulnerability for elder abuse among a sample of custodial grandfathers: An exploratory study. Journal of Elder Abuse & Neglect 19(3–4), 133–150. Cheung, M., Leung, P., & Tsui, V. (2009). Asian male domestic violence victims: Services exclusive for men. Journal of Family Violence, 24, 447–462. Courtenay, W. H. (2002). A global perspective on the field of men’s health. International Journal of Men’s Health, 1(1), 1–13. Courtenay, W. H. (2003). Key determinants of the health and well-being of men and boys. International Journal of Men’s Health, 2(1), 1–30. Cowgill, D., & Holmes, L. D. (1972). Aging & modernization. New York, NY: Appleton-Century-Crofts. Elderkin-Thompson, V., & Waitzkin, H. (1999). Differences in clinical communication by gender. Journal of General Internal Medicine, 14, 112–121. Hooyman, N. R., & Kiyak, H. A. (2011). Social gerontology: A multidisciplinary perspective (9th ed.). New York, NY: Allyn & Bacon. International Longevity Center-USA. (2004). Promoting men’s health: Addressing barriers to healthy lifestyle & preventive health care. New York, NY: ILC-USA. Kaye, L. W., Kay, D., & Crittenden, J. A. (2007). Intervention with abused older males: Conceptual & clinical perspectives. Journal of Elder Abuse & Neglect, 19(1–2), 153–172. Kosberg, J. I. (1988). Preventing elder abuse: Identification of high risk factors prior to placement decision. Gerontologist 28(1), 43–50. Kosberg, J. I. (1998). The abuse of elderly men. Journal of Elder Abuse & Neglect 9(3), 69–88. Kosberg, J. I. (Ed.) (2007). Abuse of older men. Binghamton, NY: The Haworth Maltreatment & Trauma Press. Kosberg, J. I., & Nahmiash, D. (1996). Characteristics of victims & perpetrators & milieus of abuse & neglect. In L. A. Baumhover & S. C. Beall (Eds.), Abuse, neglect, and exploitation of older persons: Strategies for assessment and intervention (pp. 31–49). Baltimore, MD: Health Professions Press. Lai, D.W.I. (2011). Abuse and neglect experienced by aging Chinese in Canada. Journal of Elder Abuse & Neglect, 23(4), 326–347.
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McCarthy, J., & Holliday, E. L. (2004). Help-seeking and counseling within a traditional male gender role: An examination from a multicultural perspective. Journal of Counseling & Development, 82(1), 25–30. Möller-Leimkühler, A. M. (2002). Barriers to help-seeking by men: A review of sociocultural & clinical literature with particular reference to depression. Journal of Affective Disorders, 1, 1–9. Nicolls, T. L., & Dutton, D. G. (2001). Abuse committed by women against male intimates. In B. J. Brothers (Ed.), The abuse of men (pp. 41–57). New York, NY: Haworth Press. Pillemer, K. A., & Finkelhor, D. (1988). The relevance of elder abuse: A random sample survey. Gerontologist, 28(1), 51–57. Poole, C., & Rietschlin, J. (2012). Intimate partner victimization among adults aged 60 and older: An analysis of the 1999 & 2004 general social survey. Journal of Elder Abuse & Neglect, 24(2), 120–137. Reeves, K. A., Desmarais, S. L., Nicholls, T. L, & Douglas, K. S. (2007). Intimate partner abuse of older men: Considerations for the assessment of risk. Journal of Elder Abuse & Neglect 19(1–2), 7–27. Steinmetz, S. K. (1977–1978). The battered husband syndrome. Victimology, 2, 499–509. Stojkovic, S. (2007). Elder prisoners: A growing and forgotten group within correctional systems vulnerable to elder abuse. Journal of Elder Abuse & Neglect, 19(3–4), 97–117. Stratton, D. C., & Moore, A. J. (2007). Fractured relationships and the potential for abuse of older men. Journal of Elder Abuse & Neglect, 19(1–2), 75–97. Tatara, T. (1993). Understanding the nature and scope of domestic elder abuse with the use of state aggregate data: Summaries of the key findings of a national survey of state APS and aging agencies. Journal of Elder Abuse & Neglect, 5(4), 35–59. Teaster, P. B., Ramsey-Klawsnik, H., Mendiondo, M. S., Abner, E., Cecil, K., & Tooms, M. (2007). From behind the shadows: A profile of the sexual abuse of older men residing in nursing homes. Journal of Elder Abuse & Neglect, 19(1–2), 29–45. Tutty, L. (1999). Husband abuse: An overview of research & perspectives. Ottawa, ON: National Clearinghouse on Family Violence, Health Canada. Walsh, C. A., Olson, J. L., Ploeg, J., Lohfeld, L., & MacMillan, H. L. (2011). Elder abuse and oppression: Voices of marginalized elders. Journal of Elder Abuse and Neglect, 23(1), 17–42. Yaffe, M. J., Weiss, D., Wolfson, C., & Lithwick, M. (2007). Detection and prevalence of abuse of older males: Perspectives from family practice. Journal of Elder Abuse & Neglect, 19(1–2), 47–60.
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Rosalie Wolf Memorial Lecture: Reconsidering Assumptions Regarding Men as Elder Abuse Perpetrators and as Elder Abuse Victims Jordan I. Kosberg PhD ACSW
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Division of Geriatrics and Palliative Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA Published online: 29 Apr 2014.
Click for updates To cite this article: Jordan I. Kosberg PhD ACSW (2014) Rosalie Wolf Memorial Lecture: Reconsidering Assumptions Regarding Men as Elder Abuse Perpetrators and as Elder Abuse Victims, Journal of Elder Abuse & Neglect, 26:3, 207-222, DOI: 10.1080/08946566.2014.898442 To link to this article: http://dx.doi.org/10.1080/08946566.2014.898442
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Journal of Elder Abuse & Neglect, 26:207–222, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 0894-6566 print/1540-4129 online DOI: 10.1080/08946566.2014.898442
Rosalie Wolf Memorial Lecture: Reconsidering Assumptions Regarding Men as Elder Abuse Perpetrators and as Elder Abuse Victims JORDAN I. KOSBERG, PhD, ACSW Downloaded by [Adams State University] at 07:59 10 March 2015
Division of Geriatrics and Palliative Medicine, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
From research findings and practice experiences, it is concluded that abuse of older men is especially invisible and underreported, compared to abuse of older women. It is proposed that attention should be directed not to gender, but to those conditions in different countries and cultures leading to abuse of both older men and women, including (but not limited to) economic problems, few alternatives to family care of the elderly, violence, changing characteristics of the family, ageism, and sexism. Advocates for the prevention of elder abuse should work together in combating, reducing, and eliminating the problem of elder abuse of both older men and older women. KEYWORDS elder abuse as a man’s problem, invisibility of men’s abuse, nongendered explanations for abuse, prevention of the abuse of older men, professional ageism and sexism, elder abuse interventions with men, cross-national perspectives, nongendered collaboration The topic of my Rosalie Wolf Memorial Lecture combines two of my special academic interests: The unmet needs of males and the invisible problem of elder abuse. The purpose of my lecture is to address prevalent assumptions that elder abuse is a problem most often perpetrated against older women and that the perpetrators of elder abuse are most often males. Based Rosalie Wolf Memorial Lecture presented at the 7th World Conference of the International Network for the Prevention of Elder Abuse (INPEA), during the meeting of the International Federation on Ageing, Prague, Czech Republic, May 28, 2012. Address correspondence to Jordan I. Kosberg, 7726 Cedar Canyon Court NE, Albuquerque, NM 87122, USA. E-mail: [email protected] 207
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upon findings from empirical research and practice experiences, it is my conclusion that (1) older men can frequently be the victims of elder abuse, (2) perpetrators of elder abuse may well be females, and (3) abuse of males and females (including older persons) might be prevented by focusing upon the unmet needs of potential male abusers. I will conclude my presentation by suggesting that cultural changes, occurring in many countries, may lead to an increase in elder abuse and will require the collaboration of those advocating for the prevention of elder abuse of both older men and older women. The reduction of elder abuse in the world necessitates an understanding that the main causes and consequences of elder abuse are not based upon gender-related considerations.
ELDER ABUSE AS ONLY A WOMAN’S PROBLEM One of the first written works on elder abuse was entitled “Granny Bashing” (Baker, 1975). Perhaps this publication set the stage for the belief that elder abuse was, in the main, a problem faced only by older women. There are several reasons for understanding why it is popularly believed that that elder abuse is considered a problem faced only by older women. First of all, the majority of older persons in most countries are women. Thus, the majority of elder abuse victims must be females. So, too, as women are perceived to be members of the “the weaker sex,” they are less likely to defend themselves from abuse, when compared to older men. Relatedly, males (regardless of age) have been perceived to be members of “the stronger sex,” and more likely to be abusers, or otherwise the perpetuators of the victimization of others, whether male or female. Traditionally, men have been in dominant positions within a marriage, or within the family. They have been expected to be the providers and decision makers in their domestic relationships. Yet, such gender-related roles and responsibilities are changing in many countries, as a result of efforts to achieve greater gender equity. In the process by which cultural change in gender roles, rights, and responsibilities moves forward, there are clashes between “traditionalists” and those advocating for social change. Such clashes can take place within the family, and lead to such domestic problems as spouse abuse, partner abuse, child abuse, and marital separation and divorce, and the victims of such dynamics are seen to be mainly females. It is believed that the above dynamics have been discussed in popular and professional literature on abuse with females being mainly victims and the perpetrators being mainly males. Further, it is believed that a similar propensity for such gender stereotyping can be witnessed in the mass media, whether in movies, television, theater, or in other things that can influence public beliefs.
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Popular generalizations that go beyond family and marital relationships have placed males in privileged positions of power, authority, and wealth in public and private sectors of society (such as government, business, and religious organizations). While such gender-related power inequities had existed in the past, this is not necessarily the norm in the present. Indeed, there is a current trend in many countries, and within many cultures, for greater gender equity in the home and in the workplace. Members of the “women’s movement” (including males as well as females) have been critics of male dominance over females in society. Of course, such advocacy for needed change is to be commended and has been quite effective in achieving greater equity in opportunities and improving the quality of lives for females. No doubt, and rightly so, the movement has focused upon the plight of abused females. There has not, however, been a “men’s movement” that has sought to publicize the inequities facing males, from young boys to older men, and to advocate for needed changes for them. The absence of men’s advocacy for abused males leads to the continuation of erroneous, and unchallenged, assumptions that elder abuse is a problem only for women. It has been found (e.g., Kosberg, 1998; Nicolls & Dulton, 2001; Tutty, 1999) that the abuse of older men is generally an invisible problem, in part due to the failure of males to acknowledge and report their adversities. Embarrassed to be abused by a wife, a child, or a partner or paramour, such males are reluctant to report their abuse. As a result of gender-role socialization, they are less likely than females to admit having problems, including elder abuse. So, too, as men do not admit and report problems, they also do not engage in help-seeking efforts; thus, they fail to utilize health, mental health, protective service, and law enforcement resources that are available in the community. Admittedly, there are also very few, if any, community resources to assist abused older males (such as elder abuse shelters that are willing to accept males). Yet, a false conclusion can be reached that this lack of service utilization by older men is indicative of the fact that there are no abused older men. For all of these reasons, then, elder abuse is not believed to be a problem for men.
FINDINGS ON ABUSED OLDER MALES Over the years, there have been studies that have found, indeed, that older men are victims of elder abuse. The following are a sample of research findings on the abuse of older men. The material indicates that not only are older men abused, but it also suggests that there is a possibility that such men may not admit being abused and, therefore, the abuse will not appear in official statistics. Accordingly, abuse of older men remains underreported and is not known to be a significant problem.
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In 1977, Susan Steinmetz coined the term “The Battered Husband Syndrome” and suggested that the abuse of older husbands was as likely as the abuse of older wives. In 1988, there was a study of elder abuse in the Boston Area (Pillemer & Finkelhor, 1998) that found the per capita rate of elder abuse of men to be higher than that for women. In 1993, the National Center on Elder Abuse reported findings from its U.S. National Study of Elder Abuse (Tatara, 1993) and included the finding that suggested the proportion of abused older men exceeded those of older women. In 1998, I published an article that reported findings on the abuse of older men (Kosberg, 1998). In this article, I had suggested a typology for explaining high-risk possibilities for the abuse of older men. The first group of older men includes those characterized as having high-risk lifestyles and living in high-risk social settings. Also included are older men who live alone (and/or who are lonely), those living in inner-city settings or in rural areas, older prisoners, older gay men (abused in domestic relationships or by homophobics), and those living within long-term care facilities. A second group of high-risk men are those who live in family settings (the location of most elder abuse). This group include older fathers who are “paid back” by adult children who had either been abused decades earlier by their fathers, or adult children who had witnessed the abuse of their mothers over the years. So, too, older wives who have been abused by their husbands can seek retribution against their husbands when these men become increasingly impaired and dependent. The third group of older men who are at high risk for elder abuse include those who engage in self-abuse, self-destructive acts of omission or commission. Such men suffer from physical and/or mental health problems, which can result in depression, anxiety, and anger. The consequence of such personal health adversities can lead to acting out behavior (striking out at others and, thus, becoming victims of retribution), neglectful behavior (“giving up,” which results in death), or suicide. In 2007, I published a book, Abuse of Older Men (Kosberg, 2007), copublished simultaneously with a special edition of the Journal of Elder Abuse and Neglect (volume 19, issue 1–2) that focused upon the abuse of older men. Two additional articles from the special edition were published in the following issue of the journal (volume 19, issue 3–4). A summary of all the articles on abuse of older men, in both issues, is presented to illustrate the diversity of topics. Included are articles on intimate partner abuse of older men (Reeves, Desmarais, Nicholls, & Douglas, 2007), the possibility of sexual abuse of older men (Teaster et al., 2007), and the existence of “fractured relationships” between adult children and their elderly fathers that could lead to the abuse of these fathers (Stratton & Moore, 2007). Other contributions address the detection of abused older male patients by their physicians (Yaffe, Weiss, Wolfson, & Lithwick, 2007), the vulnerability of elderly prisoners (Stojkovic, 2007), and the possible abuse of custodial grandparents (Butler & Thomas, 2007). There were two articles describing
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challenges faced by professionals working with male victims of elder abuse (Blundo & Bullington, 2007; Kaye, Kay, & Crittenden, 2007). More recent work focusing upon elder abuse of male includes a 2011 article reporting the findings from focus group discussions on the relationships associated with the abuse of marginalized elders (Walsh, Olson, Ploeg, Lohfeld, & MacMillan, 2011). Abuse and maltreatment were discussed on the basis of age, gender, disability, race and culture, sexual orientation, and poverty. There was a lack of consensus about whether or not gender-linked oppression—power imbalances—is associated with elder abuse. As older men were perceived to experience more abuse, the relationship between abuse and female gender oppression could not be supported. That same year, a study of abuse among older Chinese in Canada (Lai, 2011) did find more abuse among women. However, the author went on to suggest potential underreporting by males in the study, especially by those from ethnocultural minority groups. The author concluded by suggesting that the study of abuse among older minority group men can lead to unreliable research and survey findings on the prevalence of elder abuse. In a study of community services for Asian male victims of crime and abuse, Cheung, Leung, and Tsui (2009) came to a similar conclusion that feelings of shame, disgrace, humiliation, and “loss of face” by (Asian) men can lead to a reluctance to admit having personal problems and to a reluctance to seek available community services. Finally, in 2012, a Canadian report (Poole & Retschlin, 2012) found that the rates of physical and emotional elder abuse were similar for older men and women. Thus, a conclusion can be reached (from this summary of studies on the abuse of older persons) that elder abuse is not only a problem for females; it adversely affects the lives of older men, as well.
THE INVISIBILITY OF ABUSED OLDER MALES As mentioned, there has been a lack of awareness about and concern for abused older men, in part as a result of the lack of research studies and a scarcity of popular and professional publications focusing upon this group of abused persons. In addition, abused older men are often invisible as a result of living in prisons, homeless shelters, inner cities, or rural areas, and in geriatric or mental health facilities (Kosberg, 1998). Older men predominantly live with families within domestic settings, and such settings house the majority of abused older men, and family members are the largest group of elder abusers. Within homes, the abuse of men can remain out of sight and unreported. Also, within domestic settings, some older men have, unfortunately, been identified and reported as elder abusers when, in fact, they are the abused (Nicolls & Dutton, 2001). In such cases, the abused male may have
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engaged in self-defense (for example, defending himself from attacks by his wife). When this domestic incident is investigated, there might well be disbelief that a wife would abuse her husband. A police officer, protective service worker, or any person in authority may erroneously assume the older man is the abuser and seek to bring charges against him. The possibility of an abused person protecting himself (or herself), and being labeled as the abuser is referred to as “reciprocal abuse.” Such an abusive situation “blames the victim” and fails to correctly identify the actual abuser. When an abused older male fails to report his adversity, his abuse remains hidden. There are many reasons for the likelihood that abused older men do not report their victimization. First of all, an abused older man may feel shame (and stigma) for being abused. This is probably especially true if the abuser is a female and/or a close relative. An abused older man, no different than an abused older woman, may be reluctant to report abuse for fear of retaliation by the abuser. Should the older man be dependent upon the abusing person, such as living in the home of the abuser or causing expenses to the abuser, it is unlikely that any outsider will be informed of the abuse. Indeed, the abused older man may conclude that his dependency upon a care provider (family member or not) may give rise to his abuse, believing that if only he could be independent, the abuse would not have taken place. Relatedly, the abused man may not report his adversity because he believes that he is being “paid back” for earlier acts of commission (such as spousal abuse or child abuse) or omission (his being an absent or disinterested father). Here again, the abused older man may believe that he is the victim of his own doing and will be unlikely to report his abuse. Finally, an older abused man may seek to escape his abuse and neglect by committing suicide. The death will be reported as suicide and not as a result of elder abuse. Also, when institutionalization in a mental facility results from the mental anguish of being abused, the older person (male or female) will be reported to be mentally ill, not a victim of abuse. Thus, for such reasons, among others, I believe that often the abuse of older males remains undetected and unreported. So, too, this problem fails to garner the attention of the community, as well as the concern of community professionals who can—and who should—develop both preventive and interventive resources for abused older males, no more, but no less than for abused older females.
NON-GENDERED EXPLANATIONS FOR ELDER ABUSE The point to be made is that predominant explanations for elder abuse are not gender-related, but rather they are gender-neutral (Kosberg & Namiash, 1996). In focusing upon the characteristics of abusers, prominent findings of high-risk characteristics include substance abuse, mental/emotional illness, lack of caregiving experiences, history of intrafamily abuse, caregiving stress
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and burden, dependence on the older person, financial problems, employment or other competing caregiving tasks, family violence/disharmony, and personality characteristics (lack of sympathy, self-centeredness, resentment, anger). Similarly, there are few gender-related explanations for older abuse victims, found to be male as well as female. High risk characteristics of abuse victims include substance abuse, marital status, health condition, cognitive impairment, dependency on others, inability to perform activities of daily living (ADLs), isolation, and having a provocative personality. Accordingly, there is no pervasive reason to believe that abusers are male or that the abused are female. I will concede the point that males are more prone to engage in abusive behavior than are females. There are explanations for males’ propensity for violence against others, within the home or community. This hardly excuses them from their abuse. As I will discuss, in knowing reasons why males engage in abusive behavior, we might better know how to intervene to prevent their abuse of others. The first group of explanations for a propensity for some males to abuse others is related to a historical tradition that has been passed down from generation to generation. Men had controlled the financial resources of the family and of society. As such, they were the decision makers (in marriage, family, and community). In certain groups, there were, and may still be, certain cultural, historical, and religious imperatives for male dominance and female subservience. Both males and females had to abide by such gendered distinctions, and some still do. A second group of explanations for male dominance (that can lead to abuse) is related to the existence of male gender-role socialization in different cultures and countries. For example, boys can be raised (that is, socialized) to be stoic, self-reliant, independent, in control, and strong. Supporting such gendered-role norms for males to follow, there is also peer pressure to be “man-like,” which, in turn, supports the sustainment of such male-appropriate attitudes and behavior. It has been found that traditionally raised males are less likely to admit having problems and perceive there to be a stigma in asking or seeking needed help for their problems (Addis & Mahalik, 2003; McCarthy & Holiday, 2004). The unresolved problems of such traditional males may well give rise to abuse. In better understanding why some males might engage in abuse of others, we also need to understand men’s coping mechanisms. Some men can engage in proactive and thoughtful problem solving. Other men, influenced by their upbringing, face their problems through avoidance, denial, anger, and distractions, or cope with their problems through the use of alcohol or pharmacological substances (Courtenay, 2003). Poor coping mechanisms have been found related to stress for men, leading to cardiovascular reactivity and higher levels of such physiological consequences as depression, anxiety, irritability, and anger (Adler, Patterson, & Grant, 2002). Thus, given traditional cultural expectations for males, gender role socialization, and inadequate coping mechanisms, stressed or depressed men may have difficulty dealing
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with their problems and turn to abuse of others out of frustration or anger (or as a way to confirm their masculine identities). Thus, as research has found both males and females engage in the abuse of others, there are explanations for understanding abuse (and other forms of victimization) by males. One way by which we can preclude men’s abuse of others is by encouraging them, and assisting them, to acknowledge their problems and to seek necessary assistance. In doing this, we not only help them, but we can help prevent their possible abuse of family members, friends, and others in society.
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WAYS TO PREVENT MALES FROM ABUSING OTHERS It is not the purpose of this presentation to deny that males engage in abuse of older persons, or any others. The point to be made, though, is that males can be influenced to abuse by their gender role socialization. Given the problems men may face, they can feel overwhelmed, depressed, and angered. Unresolved or untreated, these emotions may result in the abuse of others in the family (such as a wife, child, or older relative) or nonrelatives (including friends and strangers). Several years ago, I had submitted an abstract on the need to be attentive to the unmet needs of men for presentation at an international conference. The abstract was accepted and assigned to be presented at a session where all the other presentations were focused upon the abuse of females by males in their lives. The audience and presenters were mainly female. Before the session began, I received not-so-subtle negative comments about the topic of my presentation. When it was my turn to speak, I started by asking the audience if they had given any thought to the possibility that men who had abused women in their lives had had unresolved and untreated problems that had given rise to the abuse. I went on to suggest that one way by which abuse of females might be prevented was by paying some attention to the unmet needs of men. It is my opinion that the audience became more attentive and listened to what I had to say; several thanked me for my presentation afterwards. I believe that prevention of elder abuse by males necessitates an understanding of how they deal with their problems. For sure, there are variations among males within any country, in terms of their upbringing, norms that influence attitudes and behavior, and relationships with females in a marriage, in the family, and in society. This section is admittedly informed by findings on males in the U.S., if not from other Westernized countries. It is hoped that those from less developed or non-Westernized countries or cultural groups, will seek to compare and contrast my thoughts with their own experiences with regard to men’s (a) definitions of problems, (b) help-seeking behavior, (c) service utilization, and (d) professional biases.
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There is a suggestion in the literature that males are less likely to recognize and label feelings of distress as problematic, especially those men whose gender-role socialization has been extremely traditional and rooted in religious or cultural imperatives (Addis & Mahalik, 2003; Courtenay, 2002). These men might be less likely to seek help for problems as diverse as depression, substance abuse, physical disabilities, marital discord, or stressful life events. Often, these men will deny the problem or the need to seek help. Further, the existence of certain conditions (e.g., erectile dysfunction, depression, abuse by a female) might be met with embarrassment or denial by some men, and the problem will remain unidentified (and untreated). Although some men will acknowledge their problems, they are less likely than women to seek help. As mentioned, men are often socialized to be independent, stoic, in control, and self-reliant. They believe that “real men do not cry” and do not admit having problems. Accordingly, males facing personal challenges often do not seek professional care because they feel uncomfortable in formal service systems and do not wish to be identified as a client or patient. Some men believe that they cannot afford needed assistance, or they may have a work schedule conflicting with professional or agency office hours. It is also possible that some men who are in need of professional assistance are reluctant to seek such assistance, as they are not legal residents within the country in which they now live. If community resources exist and are perceived to be helpful, men can be influenced to seek assistance from them. But even if the resources exist, research has found that failure by men to use, or continue to use, available resources can be influenced by a number of considerations (Addis & Mahalik, 2003; Berger, Levant, McMillan, Kelleher, & Sellers, 2005). Some men are unwilling to spend lengthy periods of time within waiting rooms. Moreover, they are often very reluctant to publicly disclose the nature of their problem to a receptionist or professional aide in the waiting room. The preponderance of female clients or patients, or female staff, may also cause men discomfort in an agency or care facility. The female-oriented appearance of an agency or facility has been identified as a barrier for men to feel comfortable (International Longevity Center-USA, 2004). Such distractions can include the presence of ferns and plants, female-oriented magazines, and mainly females in the waiting room. To summarize, I believe that men facing unresolved problems may engage in abuse of others (including older persons). Men may not identify their discomfort as a problem, they may not engage in help-seeking behavior, and they may not utilize or continue to utilize needed and available assistance. There is one additional reason for men with problems not receiving necessary and effective medical, psychological, or social care and treatment: professional biases against men. There is evidence that some help-providers (such as MDs, nurses, social workers, and psychologists)—both male and female—can be biased against
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men with problems who seek their help. Such biases might result from past adverse experiences of these professionals with men in their lives. This is to suggest that professionals might have had absent or abusing fathers, husbands or intimate relationships with males who abused, or other males who were abusive or otherwise hurtful or cruel. It is likely that a professional who had suffered as a result of the actions of a male acquaintance, friend, or family member, might lack the interest or commitment to effectively provide assistance to a male client or patient. This negative professional bias against males can lead them to trivialize men’s problems or minimize men’s need for effective treatment. It has also been found that physicians, and others, spend less time with male patients than with female patients, or otherwise communicate less information to males (Elderkin-Thompson & Waitzkin, 1999; Möller-Leimkühler, 2002). Shorter professional time spent with male clients or patients will limit the professionals’ ability to learn about and understand these men’s problems and feelings.
PREVENTING THE ABUSE OF OLDER MEN As had been mentioned, there is a body of literature supporting the fact that men in general, and older men in particular, are abused. Given that the abuse of older men is often “invisible” and not reported, the following are methods for preventing the abuse of older men and providing interventions for those older men who are abused. First, it is necessary to publicize the existence of the abuse of older men. This invisible problem should be made better known to the public, which can be accomplished through the publication of articles, editorials, and news reports. Further, there is a need for abused men to step forward to discuss their abuse. Just as former professional football quarterback Terry Bradshaw spoke of his depression, and former senator Robert Dole spoke of this Erectile Dysfunction, so too can prominent (and nonprominent) males speak out publicly about their abuse. A few years ago, lifelong actor Mickey Rooney gave testimony to the U.S. Senate on his abuse at the hands of relatives. The testimony of this elderly respected actor was widely covered by the mass media and led, no doubt, to an increased awareness of this form of abuse in the U.S. Such public testimonies by well-known men who had been abused will help in making known the existence of such abuse in other countries, as well. Relatedly, there is a need for the professional sector of society to take responsibility for learning more about the existence of the abuse of older men through targeted research studies and surveys. Funding bodies, both government and private organizations, can encourage and make possible the development of knowledge about the problem. There are also roles for educators within professional schools, as well as in general public education, to provide awareness of elder abuse in general, and against older
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men in particular. Awareness of such abuse has ramifications for the training and education of future professionals for at least two reasons. First, as professionals, they will be aware of the possible abuse of clients and patients, both males and females. Second, such knowledge will make them cognizant of the possibility that negative past experiences with males in their past or present lives might lead them to be less motivated to provide effective care to male clients, patients, or program participants. At the community level, there is a need for widespread efforts to challenge the existence of both ageism and sexism in society. Both forms of discrimination can exist at the same time and can result in ignoring or minimizing the possibility of abuse against older men, as well as believing that older men’s abuse is less important than such abuse of older women. There is no place for such beliefs in contemporary society; they are wrong, unfair, and discriminatory. The point had been made that elder abuse of males is not insignificant in number or importance; yet there are few, if any, resources for them. Accordingly, there is a need to ensure the existence of resources for vulnerable and abused older men. Whether medical or psychological care facilities, temporary abuse shelters, housing for older persons, or legal and protective programs for abused men (and women), a community needs to ensure that it has the necessary resources for the victims of elder abuse, both male and female. To suggest there is a need for advocacy on behalf of older men might be met with skepticism—that it is not needed or that men can pretty well take care of themselves. Further, when a problem is seen to be everyone’s responsibility, it often becomes no one’s (or no group’s) responsibility. Certainly, in the U.S., the women’s movement, which included efforts by private and governmental organizations, led to significant and needed advances for all women. The Older Women’s League (OWL) had existence in the past to advocate for older women, and was supported by both private and public resources. Should not such awareness and advocacy be developed to ensure equitable attention to, and resources for, older men? No doubt, such an organized effort seeking advocacy for older men will be composed of both males and females of all ages. Indeed, some might even suggest that such advocacy efforts are needed for all males who might face inequitable penalties, court decisions, public policies, or greater expectations when compared to females. A term “boy bashing” has been coined to describe such inequity toward young males by parents or educational systems.
GENDER AND ELDER ABUSE IN CROSS-NATIONAL PERSPECTIVE It is my conclusion that elder abuse against men is a significant and under-reported problem that should receive similar attention as that given to the prevention of elder abuse against women. So too, comparable resources
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should be made available for abused men. Nongender explanations far exceed the gender-related reasons for the abuse of older persons; thus, elder abuse should be seen to be perpetrated by, and to, both males and females. It is my belief that greater attention should be given to the unmet needs of males (and females), as one method by which to prevent their abuse of others. Accordingly, it is my hope that those of us committed to the reduction and elimination of global elder abuse, in the present and future, will focus upon those conditions within different countries that give rise to problems for its citizens (e.g., widespread poverty, few alternatives to family care for their older relatives, crime, and violence). These problems can lead individuals to seek out scapegoats or convenient victims. Unfortunately, such scapegoats or victims may well be older persons—both male and female. In addition to addressing those conditions leading to sources of problems for citizens, the vulnerability of older persons as a group seems to be increasing. The proportion of older persons is increasing around the world, and it is the oldest of the old—those most likely to be impaired, in need of assistance, and vulnerable—whose numbers and proportion are increasing the fastest (Hooyman & Kiyak, 2011). Further, there is seen to be a decline in the number of adult children available to care for their parents, as a result of declining family size, relocation from rural to urban areas, increase in divorces and remarriages, and international emigration. Religion (which tends to support filial piety) seems to be in a decline in some countries. The importance of older persons in any country, and the responsibilities for them, has been seen to be inversely related to the country’s stage of development. Indeed, a Modernization Theory (Cowgill & Holmes, 1972) posits that more modern societies have a lower regard for older persons than those that are less developed. This theory, as a linear process, has been challenged by many, and modified by its theorists. However, it is believed that the relationship between a country’s regard for its older persons (and the extent of elder abuse) and the level of economic development in countries may not be that relevant. The fact is that there are those in most countries who are impoverished, hungry, poorly housed, and threatened by violence. In the face of economic downturns, even affluent countries will prioritize their needs, and the characteristics of citizens whose needs are seen to be most important. Often, the needs of those in advanced age—whether male or female—are not seen to be a priority. In an aging world, there are no countries that are immune to the problem of elder abuse and neglect; thus, we are all affected by similar dynamics that can lead to adversity faced by older persons. Social changes in the countries of the world have ramifications for gender and gender relations. It is believed that each nation, and cultural groups therein, lies on a continuum ranging from those with traditional male domination, to those moving toward cultural changes with regard to gender
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role equity, to those that reflect advanced stages of equity in gender roles, rights, and responsibilities in the home and in the workplace. Where gender can play a most significant role in predicting abuse may be seen in the first two types of societies. In the first, fundamental, traditional gender role and status differences strongly exist between males and females and permeate the fabric of society. In the second, cultural changes toward greater equity in gender roles can result in extreme discrepancies in expectations between those who oppose change and those who desire faster and greater changes in gender equity. The discord existing between these two factions can well affect the relationships between husbands and wives or intergenerationally within a family. There are many reasons to be concerned about older family members, given such family discord. For the first types of societies, should the rationale for male superiority be based upon religious dictates, public policies, or cultural norms, change in gender relationships will be vigorously resisted within a family or in a society. But, if it is not gender-related differences that lead to the existence and extent of elder abuse in a country, what should we be focusing upon in efforts to reduce the problem in different countries? As mentioned, the major correlates of elder abuse and neglect are not gender-related, but are related to individual anger, anxiety, depression, frustration, retaliation, hopelessness, emotional and cognitive impairments, or a desire to obtain the financial or material resources from a frail, vulnerable, or incompetent older person. Accordingly, we need to focus attention on those societal conditions leading to an individual’s abuse of an older person. It is believed that adversity (that is, abuse or neglect) within a family, community, or society can result from (a) individual or family poverty, (b) hostility or conflict within a country, (c) minimal public resources available to relieve or to support family caregivers, or to replace the family when none exists, (d) an unsympathetic view of older, dependent, or frail persons, or (e) an absence of concern for one’s fellow citizens. We need to always be aware that not every family member, friend, or neighbor—or paid staff member in a private home or a public facility— will be well-motivated, experienced, suitable, or appropriate to care for, or interact with, an older person. We have too much evidence of elder abuse to be so naïve. Certainly, when it comes to caregiving, if and when possible, screening of those who are or will be providing care to an older person should be undertaken to minimize the possibility of an older person being placed in the care of someone who cannot or will not provide safe, humane, and effective care to the older person (Kosberg, 1988). Older women and men are abused in all countries of the world, where abusers are both men and women. Advocates for the prevention of elder abuse should not seek to pit one gender against the other; rather, they should work toward the goals of reducing and eliminating conditions that lead individuals to abuse older women and older men. There is no question
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that you (in the audience) have had an impact in confronting and reducing elder abuse in your own countries, and—together—throughout the world. You have made a difference; yet, you have many challenges facing you in the coming years in reducing and eliminating the problem of abuse of older women and older men. Together, within and between our own countries, we need to work toward common goals and objectives. The quality of the lives of our older persons—both males and females—may depend upon the success of our efforts.
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CONCLUDING THANKS I would be truly remiss if I did not offer my thanks to the Selection Committee of the International Network for the Prevention of Elder Abuse (INPEA), and endorsement by its Executive Committee, for my selection as a recipient of the International Rosalie Wolf Award. I also wish to thank the President of INPEA, Dr. Gloria Gutman, for her support and leadership. So, too, I would be remiss if I did not acknowledge the role that Rosalie Wolf had played in my own work in the area of elder abuse, in general, and in the area of abuse of older men, in particular. As a colleague and friend, and as the Editor-in-Chief of the Journal of Elder Abuse and Neglect, Rosalie was very supportive of my work on the “invisible” problem of elder abuse and neglect of older men. There is little question in my mind that I am giving this prestigious lecture to you today as a result of Rosalie’s guidance and encouragement in the past. Thus, it is an especially meaningful honor for me to receive the Rosalie Wolf International Memorial Award.
ACKNOWLEDGEMENTS I would like to acknowledge the leadership of Carla Herman, MD, MPH, Chief of the Division of Geriatrics and Palliative Medicine in the School of Medicine at the University of New Mexico, for recognizing the importance of social and psychological considerations in the discussion of the causes and consequences of medical health problems of older persons, and who provided an “academic home” for me after my relocation to Albuquerque almost 4 years ago. So, too, I would like to acknowledge the encouragement and assistance of Karen Stein, PhD, Editor-in-Chief of the Journal of Elder Abuse and Neglect, and her staff, as I worked on this article, which is based upon my Rosalie Wolf Memorial Lecture at the 7th Annual World Conference of the International Network for the Prevention of Elder Abuse (INPEA) in Prague, Czech Republic, in 2012.
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