ORIGINAL RESEARCH

Violence and abuse against the elderly: social representations of young people, adults and the elderly

Ana Karênina de Freitas Jordão do Amaral^I, Maria Adelaide Silva Paredes Moreira^II, Maria Adriana Coler^III, Maria do Socorro Costa Feitosa Alves^IV, Felismina Rosa Parreira Mendes^V, Antonia Oliveira Silva^VI

^I Speech therapist. PhD. Adjunct Professor. Federal University of Paraíba. Paraíba, Brazil. E-mail: akfjafono@hotmail.com
^II Physical therapist. PhD. Adjunct Professor. Federal University of Paraíba. Paraíba, Brazil. E-mail: jpadelaide@hotmail.com
^III Nurse. PhD. University of Bridgeport. Bridgeport, United States. E-mail: mfcoler@gmail.com
^IV Nurse. PhD. Full Professor. Federal University of Rio Grande do Norte. Rio Grande do Norte, Brazil. E-mail: socorrocfa@hotmail.com
^V Nurse. PhD. Professor. University of Évora. Évora, Portugal. E-mail: fm@uevora.pt
^VI Nurse. PhD. Full Professor. Federal University of Paraíba. Paraíba, Brazil. E-mail: alfaleda2@gmail.com
^VII Integrant of the international project:Violence against the elderly in different age groups: a study of social representations, in ongoing investigation in Brazil, Italy, Portugal, the United States and Argentina, funded by Capes and CNPq.

DOI: http://dx.doi.org/10.12957/reuerj.2018.31645

ABSTRACT

Objective: to examine social representations constructed by young people, adults and the elderly regarding violence and abuse against older people. Method: this exploratory, qualitative study used social representations theory in the period from March to September 2015 with 150 randomly chosen participants. Data were collected by semi-structured interview using two stimulus-terms: violence and abuse against elderly persons. The empirical material was organized into two corpuses and processed with IRaMuTeQ® software. The processed data pointed to three semantic classes for the stimulus-term violence, and two for the stimulus-term abuse. The project was approved by the research ethics committee (Protocol 0516/14). Results: younger participants mentioned types of violence; adults talked about violence-related offenses; and the elderly associated violence and abuse with dimensions of affect. Conclusion: it is hoped that the findings will contribute to scaling educational and protective actions for effective application of policies for the elderly.

Descriptors: Old man; violence; mistreatment; health.

INTRODUCTION

It is known that the aging of the population is a global phenomenon. In Brazil, there are more than 20 million elderly people, corresponding to about 11% of the population. Projections indicate that this percentage will triple in 40 years and, in order to guarantee the healthy and balanced aging of these people, with dignity and without oppression, it is necessary to work intensely in the prevention of violence^1,2.

Population aging will change the profile of the world population in the coming years and will require different perspectives that involve social, cultural, economic and affective aspects directly associated with the quality of life of this population^3,4. It should be noted that the aging process is usually accompanied by a decline in the general functions in which motor function is certainly compromised^2,5.

Violence against the elderly is a serious problem that society must confront and combat. Elderly people have been victims of various kinds of ill-treatment, ranging from insults and beatings by family members/caregivers, to disrespect on the part of public transport and public or private institutions. According to Law nº 12,461, of July 26, 2011⁶, violence against the elderly is defined as an action/omission practiced in a public or private place that causes death, and physical or psychological harm or suffering^7,8.

The World Health Organization defines violence as the deliberate use of physical force or authority, concrete or coercive, against oneself, another person, group or community. The term maltreatment would therefore be considered a form of violence and can be characterized by: child abuse, youth violence, intimate partner violence, sexual violence and elderly abuse⁹. With regard to violence against the elderly and its manifestations, special attention is needed because they constitute barriers to equal rights¹⁰.

In this context, the question is: what are the social representations about violence and abuse in the view of young people, adults and the elderly? Thus, the object of this study was to know what people of different age groups think about violence and maltreatment of the elderly. Therefore, this study aimed to analyze the social representations about violence and maltreatment of the elderly, built by young people, adults and the elderly.

THEORETICAL REFERENCE

Violence against the elderly is considered a public health problem in terms of magnitude and political, social, economic and cultural impact that negatively affect the quality of life and interfere with a healthy and satisfying life. It generates consequences for the aging persons and their families and communities, increasing the demand for health care services worldwide^2,11,12. Despite the numerous public policies in Brazil, the implementation of singular actions for resolving violence against this group is still timid^13,14.

It is known that the problem of violence against the elderly at global level, from a social, political and cultural point of view, is a matter of concern. This theme is an important object of research whose findings may contribute to the adoption of socially contextualized health practices and protective actions to meet the unique needs of specific social groups, based on socially shared forms of knowledge capable of defining types of needs in the prevention and in the fight against violence, and thus collaborating in a unique way with the public and health policies directed to the victims. In this sense, aging brings profound and different changes to the population that can be analyzed in multiple dimensions: sociability, relations between the generations, material and affective transmissions, different forms of violence and isolation, among others¹⁵.

Such complexity is a fertile territory to be investigated that engenders the interface of aging/violence and its repercussions on the health and quality of life of the elderly persons. There is a need to investigate subjective dimensions of violence against the elderly, in which different areas of knowledge, in particular health, can gain visibility through the opportunity of mediation by offering comprehensive and humanized care.

There is a need for raising questions about aging in the interface with violence capable of favoring spaces for dialogue involving the individual experience of the elderly person in the professional daily life in health, with emphasis on the consequences of the different types of violence suffered. We opted to work on subjective dimensions of aging and violence against the elderly because this phenomenon is as serious as the violence experienced by children.

This study is grounded in the theoretical contribution of social representations as a particular modality of knowledge whose function is to elaborate behaviors and communication among people of certain social groups. It allows analyzing the social insertion of people and the said group in the choice of positioning before the object of representation, characterizing an important dimension of social representations - the practices and behaviors¹⁶.

The importance of informal shared knowledge in specific groups about what they think of violence against the elderly and the social influences of the communication of their members in the sharing of ideas, values ​​and beliefs is undeniable. Such knowledge is part of daily realities, identifiable from psycho-sociological and cultural aspects in a socio-cultural context of great importance for defining the behaviors of their members^17,18.

METHODOLOGY

This is an exploratory study with a qualitative approach carried out in the city of João Pessoa/Paraíba/Brazil conducted with 150 randomly selected participants of both sexes, inserted in the campus I of the Federal University of Paraíba and in Family Health Units, distributed in three age groups: young people (18 to 29 years old), adults (30 to 59 years old) and elderly (60 years old and over). The state of Paraíba has an elderly population that exceeds 450 thousand. João Pessoa has about 74 thousand elderly people, corresponding to 16.53% of the elderly in the state, and is considered the third city in Brazil with greater number of elderly ¹.

All participants in the study were informed about the objectives of the study and signed an Informed Consent Form. The research project was approved by the Research Ethics Committee of the Health Sciences Center of the Federal University of Paraíba, under protocol 0596/14.

Data were collected from March to September 2015 through semi-structured interviews, contemplating in the first part, a Free Word Association Test with the inducer terms: violence and maltreatment against elderly people. In the second part, sociodemographic data were addressed. The data were organized in two corpora.

The corpora corresponding to the textual material were organized with the help of Open Office 4.0.0 softwares and by the software of Textual Analysis IRaMuTeQ® that tried to identify and organize the text segments (TS) corresponding to each corpus referring to the inducing stimuli, revealing the approximation and opposition of modalities in the construction of factors stemming from Descending Hierarchical Classification (DHC)^19-21. In this stage, the TS are classified according to their words in which this set is divided based on the frequency of occurrence of reduced forms (words which already went through stemming). After this step, the analysis in matrices takes place. The software structures the data in a graphical representation known as DHC Dendrogram. This clarifies relations between classes according to the characteristic lexical vocabulary and the different variables. These classes are composed of several TS in function of a classification according to the distribution of their vocabulary capable of indicating possible social representations/fields of images on subjects related to the analyzed corpora^20,21.

RESULTS AND DISCUSSION

Of the 150 participants of the study, there were 75 men and 75 women; 52 (34.7%) said to be married, 49 (32.7%) unmarried, 21 (14%) widowed, and 11 (7.3%) divorced; 109 (72.7%) reported having children; 37 (24.7%) lived with other family members, 31 (20.7%) with spouse and children, 28 (18.7%) with the father and/or mother, 26 (17.3%) with spouse or partner; 57 (38%) completed high school; 71 (47.3%) claimed to be employed; 38 (25.3%) were retired and 25 (16.7%) students; and 81 (54%) were service professionals.

Data from the Free Word Association Test were structured in: 1) a corpus on violence, in which a DHC was obtained retaining 138 TS, of which 92% were used to compose three classes of responses of the volunteers; and 2) a corpus on maltreatment, a DHC with 124 TS, of which 82.67% were used and organized in two classes of responses of the participants.

Classes were organized in dendrograms, illustrating the relationships among each other and with the description of each one, above all, by the lexical vocabulary of their TS and variables. In light of the Theory of Social Representations, these classes may indicate common sense knowledge or fields of images about a given object^18,22.

Senses associated to violence

Data obtained under the stimulus violence pointed out three semantic classes, consisting of the differences between their contents. They can be seen in Figure 1.

Figure 1: CHD Dendogram with contents on violence against the elderly person. João Pessoa, PB, 2016.

Class 3 - types of violence

In the formation of this class, young participants collaborated with 13.8% of the TS, which describe violence as a physical act that causes pain in the form of verbal aggression with words that have the intention of causing humiliation or moral effect on the elderly person. Such contents are exemplified by:

Class 1 - descriptions of criminal acts

This class is composed by 71 TS (51.5%) of the set of responses, thus constituting the largest class, with the highest frequency of occurrence. The content shows that for adults today, using drugs that can cause death or lead someone to kill or steal is considered a crime, and this can be committed or suffered by young people. This class presents current central notions about violence shown in the media and which are on the spotlight due to their social repercussions.

Class 2: Motivations for violence

With 34.8% of the TS, this class shows that the elderly associate violence with the lack of respect or cruelty due to education or lack of love, indicating the human rights as responsible and considering contempt as a form of violence.

Senses associated to maltreatment

Data obtained for the stimulus maltreatment pointed to two semantic classes consisting of the differences between the contents or vocabularies of the TS on the stimulus maltreatment, presented in Figure 2.

Figure 2: Dendogram of the CHD with semantic contents about ill-treatment against the elderly person. João Pessoa, PB, 2016.

Class 1: vulnerability to maltreatment

The class is formed by 64 TS (51.6%), where it is shown that, in the view of young and adult people, the elderly areunprotected, debilitated individuals who usually live alone or are abandoned, fragile, defenseless:

Class 2: descriptions of family maltreatment

With 60 TS (48.4%), this class includes the speeches of adult and elderly individuals about descriptions of situations of verbal maltreatment toward the elderly. The participants affirm that the elderly person lived a life of dedication to the family and in the old age, the family showsimpatience, ignore him, causing him to live sad for the lack of love and subjected to the custody of the family:

The profile of the study participants reflects the reality of João Pessoa, in the Northeast of Brazil. It is the main financial and economic center of the state, being the fifth most populous city in the region. The majority of the elderly population in the city consists of women in all age groups, which consist of five-year intervals (60-64/65-69/70-74/75-79/80) or more. Although João Pessoa presents a high rate of violence, it is still considered one of the capitals with best quality of life^1,2.

Cultural issues pervade societies and, commonly, prejudice and discrimination are old and frequent forms of violence against the elderly. In the most different sociocultural contexts, young people and adults tend to devalue them and treat them as disposable, useless and without social function²³. These types of behaviors tend to lead the elderly to depression, isolation and, in some cases, self-neglect, culminating in the desire for death^24,25. Other studies have shown similar aspects regarding the tendency towards a culture of seeing violence against the elderly and the violation of their rights as something natural^2,10.

Study on violence against elderly people with similar socio-demographic profile was carried out in another city of Brazil²⁵. The sample was not stratified by sex and age, which makes it difficult to compare. Nonetheless, the data point to a greater participation of women in scientific research.

With regard to the findings for the stimulus violence in Class 3 - types of violence – it was observed that the social representations more associated with the types of violence were preferably expressed by young people. There is a clear understanding that violence is not restricted to physical aggression. The social representations of participants associated with the different ways of speaking with the elderly make reference to humiliation and rude attitudes. Several studies have demonstrated mental suffering in the form of humiliation and that rude attitudes in the way of speaking are capable of provoking self-destructive processes, sometimes leading to suicide attempts ^2,24. In a study carried out in Camaragibe (PE), for example, psychological violence had one of the highest rates as reported by the elderly through the Crime Stoppers program²⁶.

With regard to Class 1 - descriptions of criminal acts - social representations associated with the contraventions/infractions that could be directly related to violence against the elderly were evident. Studies point to the use of alcohol or other drugs as a risk factor for violence ^25,27,28 and these factors were the ones most evoked by adult participants. Reports have linked the use of alcohol or other drugs to crimes that are reported daily and that generate violence also in households. In this context, the elderly live with several generations, as found in our sample (96% of the 50 participants). They evidence a knowledge that there is something that causes or provokes the possibility of violence within the residence of the elderly. The issue of drugs that involves money that is taken away from the elderly, involving aggression against the elderly to obtain they want (the drugs), was a content frequently evoked by the adults.

The World Health Organization, in a report on prevention of violence, determines the reduction to the availability of harmful use of alcohol as one of the strategies to prevent violence². However, there are still many difficulties for the concrete implementation of this and other strategies, mainly because the action plans are not always subsidized by real data that can adequately support them^2,14.

The Class 2 - motivations for violence - refers to statements related to the lack of love and respect, disrespect for human rights, lack of education that generates violence, associated for the most part by the elderly. In these propositions, the three main types of prejudice about old age are rooted in the fact that the deterioration of the body distorts reality and leads to the belief that aging is an illness, promoting the idea that the elderly are disposable because they are no longer productive, and become a burden to family members. Thus elderly people are seen as a problem. People report that they feel overwhelmed with daily life with multiple activities to care for the elderly. It is also perceived that they are not prepared to understand the aging process and evict exhaustion in aggressive attitudes. The elderly person ends up seeing himself as a social burden^2,23,29.

Education towards and about aging would be an alternative to minimize/prevent the issue of violence against the elderly. Strategies are pointed out within this perspective: support to families who care for the elderly and training of professionals to guide, treat and refer whenever necessary^2,12. However, the change of culturally established beliefs needs to be put as a key point to change the issue of prejudice against aging and contribute to the transformation of behaviors possibly motivating violence.

With regard to maltreatment, in Class 1 - vulnerability to maltreatment – the content were found to be directed at the elderly, who are seen as fragile, not knowing how to defend themselves, and these ideas were evoked by young people and adults. The accounts recall the fact that people forget that one day they will also grow old, so that they should change this behavior if they want to be treated well in the future. This finding refers to the negation of aging so well understood by other authors: social representations that no one wants to be old, precisely because of already entrenched cultural issues that deem the aging process as something bad, destructive³⁰. The youth is regarded as an ideal of beauty, and the elderly as a disposable. This age-based discrimination does not match the fact that the majority of the Brazilian elderly population is healthy, active and employed (even after retirement), heads of families, and contributors to their own sustainance².

In Class 2 of maltreatment - descriptions about family maltreatment – the content was associated with family conflicts related to violence against the elderly in the home context, having been mostly evoked by adults and elderly individuals. These family conflicts are pointed out in studies as fomented by financial resources in which family members take ownership of the possessions of the elderly and become the legally responsible for their decisions^12,32. However, even when they are able to decide on their resources, many older people are prevented from doing so and are left in a situation of abandonment or neglect².

Although Brazil has had an improvement in some indices such as literacy and famine, it has been going through a recession for some years, with a contraction of economic activities, decreasing GDP, and increasing unemployment^33,34. Throughout the country, it is common for people to take advantage of the frailty of the elderly in order to make use of their assets, proceeds, pensions, retaining magnetic banking cards with the objective of using them, and not for the benefit of the elderly. The request of consecutive loans in the name of the elderly, jeopardizing their income, is also a growing practice².

Family conflicts are mostly mentioned in the representations of adults and elderly individuals, as one of the causes of violence, since they ignore them, neglect their needs and revert their resources to the family, especially in cases of demented individuals who need more specialized care and attention^35-38.

CONCLUSION

Age groups have experiences and live with elderly individuals. Young people evoked more types of violence and are aware that the issue is not restricted to physical violence. They have a vision of the extent to which violence can damage the quality of life. The adults evoked more contents related to the contraventions associated with violence against the elderly, and the contents were directed to fragile, debilitated elderly. They also reported family conflicts as possible causes. The elderly presented a broader view of the theme; they are the ones who suffer violence of the most diverse types in daily life. They mentioned the issue of dedication to the family and that, after so many years, they suffer with the lack of love and disrespect.

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