ISSUE Ageways 59

Practical issues in ageing and development APRIL 2002

Violence and

Elder abuse - a hidden reality Challenging harmful beliefs Learning about rights Action to promote respect plus Gender in project planning NOTICEBOARD

Comment Letters

Action against abuse New format one aspect of ageing, and that Welcome to Ageways 59, in which Thank you to everyone who has education never ends. we focus on an issue that is written about Ageways’ new format. She came to the group feeling beginning to emerge as a serious Here are a few responses.We will isolated. Now she says it has changed and widespread problem – violence include a survey form in issue 60 her life. She began to see herself as and abuse of older people. to obtain more feedback. an ageing person, with inevitable A key problem is lack of recognition Thank you very much for your excellent loss, but also with new things to of , and a taboo in publication.The contents are useful for discover: living alone without feeling talking about it. The causes of elder us, and the new look is better. lonely, developing her independence, abuse are often complex, linked widening her social and emotional Sarangadhar Smal, Director, Nysasdri, India. links, and planning projects she to wider problems in society and Email: [email protected] age-discriminatory attitudes could achieve. and systems. We like the new style Ageways and Prof. Psic. Graciela Petriz, have always found Ageways a very Programme of Continuing Education This issue of Ageways suggests useful resource for our training and for Older People (PEPAM), Faculty of practical ways of identifying, community work. Humanities and Educational Science, preventing and dealing with elder calle 47 N° 879, 1900 La Plata, Argentina. Maria Kanger, Executive Director, COMBRA, abuse. It emphasises the need for Fax: 54 221 423 6672 Uganda. Email: [email protected] a broad approach that tackles not Email: [email protected] only the effects of abuse but also Congratulations on the new look of its underlying causes, requiring Ageways, which will definitely Support for disabled children action at all levels of society. contribute to make it a more I have informally rendered services effective and attractive tool for to older people since 1985. I am Celia Till and Fiona Clark information exchange. increasingly convinced that Editors Birgitte Ebbesen, UNHCR, rue Van Eyck, 11B, community-based rehabilitation 1050 Brussels, Belgium. projects for older people and for those with mental handicap are Contents We are glad about the contents and mutually supportive. Elder abuse – a hidden reality 4 new presentation of Ageways.It gives us useful guidance on extending We find from home visits to identify Challenging beliefs services to older people. mentally handicapped children, that about witchcraft 6 they always live with older people, R M Premadasa Bodhinayake, President, A place to learn about rights 7 Uva Farmers Development Foundation, either grandparents or other relatives. Dealing with abuse 8 Jangulla, Hali Ela, Sri Lanka. Indeed, we often rely on the oral Finding out about abuse 10 traditions of older people to identify One woman’s experience those with mental handicap. Information sources 12 I would like to tell you the story of one Last Christmas 2001 we held a party Taking gender into account 13 woman’s experience from the many in the village for disabled people. Members and programmes 15 workshops we hold with older people The turn-out was amazing. From Action to promote respect 16 as part of the Programme for the youngest to the oldest, Continuing Education of Older People. everyone enjoyed themselves. Themes of future issues Issue 60 (June 2002) HIV/AIDS In the group, people can discuss their In our outreach stations we have Issue 61 (October 2002) Livelihoods fears – of ageing, illness and death. found 30 previously unknown older Issue 62 (March 2003) End of life By sharing these fears, they are disabled people.We now have plans Issue 63 (June 2003) Disability gradually understood. Participants get to build a day care centre specifically to know each other and establish a We welcome articles for for older people. network among themselves. consideration.They should be Please could you consider issuing received three months before A student in the 80-plus group has guidelines on how to approach this the month of publication. learnt that chronological age is just combination of older people and

2 Ageways 59 NOTICEBOARD

News people with mental disabability. Second World Assembly on Ageing More information: Andrew Humphreys, We need to work towards integrating HelpAge International has arranged Campaign Coordinator, Action on Ageing, the two vulnerable age groups within for more than 50 older people from HelpAge International, PO Box 32832, London N1 9ZN, UK. one action programme. Africa, Asia, Latin America, Caribbean Email: [email protected] Josephine Bakhita, Director, Amani Centre and eastern Europe to take part in the Website: http://www.helpage.org for Children with Mental Disabilities, Second World Assembly on Ageing, The draft Plan of Action is available PO Box 579, Morogoro,Tanzania. Madrid in April 2002. A new on the United Nations Programme Fax: +255 23 2600829 International Plan of Action on Ageing on Ageing website at: Email: [email protected] will be adopted at the assembly. http://www.un.org/esa.socdev/ageing Radio programme is run by us The move forms part of HelpAge International Day parade I would like to correct some errors in International’s Action on Ageing the article in Ageways 56 about my campaign, which seeks to ensure that radio programme, Older People’s Words. the demands of older people living in poverty are included in the new plan, Firstly, the programme is run entirely and that resources will be available to by the production team – currently implement it. myself and Maximiliano Mores. It does not belong to FAIAF. At the assembly, HelpAge International will launch a new report, State of the The programme was my own idea. As a world's older people 2002. The report social communications graduate, I was draws on consultations with older interested in using communications to people around the world, and provide a social service. A colleague Mbané Jean Robert/EPV identifies three pillars for policy and and I researched older people’s action on ageing: equal rights for older Older people in the village of Fomopea, communications needs, and we Cameroon, celebrated the International citizens; a fair share of national and developed the programme as a result. Day for Older People on 1 October with international resources; and inclusion a march and speeches organised by local FAIAF – an Argentinian NGO in decision-making and in civil society. NGO Ensemble Protégéons les Vieux (EPV). supporting older people – took part in one of the programmes. Later, we received money to cover some of our expenses from an NGO coordinating New publications body which FAIAF is a member of.We have never received any professional How to build a good small NGO is More information: HelpAge International Asia/Pacific Regional Development Centre fees or government support. available on the web. It contains guidelines and exercises, with links to (address on page 15). If anyone needs further information, other resources. It includes a section please can they contact me. on best practice for projects with older Addressing the nutritional needs María Cecilia Lorenzo, people in Africa, written by Amleset of older people in emergency Older People’s Words, Av.Tronador 2395, Tewodros, HelpAge International’s situations in Africa: ideas for action Bo Parque Capital, Córdoba CP 5016, highlights key issues affecting the Argentina. Tel: +54 351 4692079 Africa regional training coordinator. nutrition of older people in Email: [email protected] Available at: emergencies and suggests ways in http://www.networklearning.org which the rights and needs of older We welcome letters from readers. people can be more effectively Please write to: The Editor, Working with video provides practical addressed. Ageways, HelpAge International, guidelines on using video to empower older people, developed at a PO Box 32832, London N1 9ZN, UK More information: Dolline Busolo, or email: [email protected] workshop organised by HelpAge Regional Nutritionist, HelpAge International Letters may be edited. International’s Asia/Pacific Regional Africa Regional Development Centre Development Centre in October 2000. (address on page 15).

Ageways 59 3 VIOLENCE AND ABUSE Elder abuse a hidden reality

The extent and nature of violence and abuse of older people Experiences is just beginning to emerge. Fiona Clark discusses why it of abuse happens and what can be done to prevent it. Based on evidence in the HelpAge International network, older people have most frequently identified physical violence as their primary concern, as well as financial abuse, such as robbery, theft and being persuaded to hand over money or property.

In Africa, older people are increasingly at risk of physical violence related to cultural beliefs and accusations of witchcraft, especially against older women.

In a single month, HelpAge Hein du Plessis International partners in Pension queue in South Africa – attacks at pension pay points relate to wider issues Mozambique identified 142 acts of poverty and unemployment, and ageism in society. of abuse committed against older people in the communities in which and abandonment – lder abuse is a serious they work. Of these, two-thirds were insufficient care or attention to problem across the globe, committed against older women, meet the person’s nutritional, health, but it is still under- and the largest number related hygiene or emotional needs acknowledged and largely to witchcraft accusations. E sexual – any sexual act against the under-reported. Cases that do come to light are often dismissed as a person’s will, from suggestive words In a study in townships of the domestic issue – in a way that or actions to forced sex Cape Flats, South Africa, however, and economic or financial – robbery, older people identified once were – rather than being related theft, illegally taking assets and as the most common form of to wider issues of property violence, including adult sons requiring action cultural – being forbidden to speak forcing their mothers to have sex at all levels. the person’s own language or wear with them. traditional dress Abuse can take different forms, and structural or institutional – lack of Older people in Eastern Europe there are many reasons why it takes social security systems and fair and Russia have identified increased place. Studies have identified the pensions to allow a reasonable street and robbery as a form following forms of elder abuse, quality of life, difficulty accessing of abuse. Research by HelpAge drawing on older people’s own government services because of International in Kenya highlights definitions: mistreatment and by faced by older government officers, age people in health centres. physical violence – beating, discriminatory policies and practices. pushing, pinching or any act that Another form of abuse is the causes physical injury Key problems are a lack of recognition insecurity and violence that older psychological or emotional – of elder abuse (acts of abuse may be people are subjected to in conflict , jokes, threats or indifference, regarded as normal behaviour), situations and emergencies, and affecting a person’s mental people’s reluctance to talk about it, and lack of provision for older people wellbeing the consistent that it takes place. in relief programmes.

4 Ageways 59 VIOLENCE AND ABUSE

of poverty and unemployment, Who are the Who is most at risk? combined with ageism in society. While it is difficult to generalise, abusers? Ultimately, however, violence is an certain factors can increase the risk of The reasons for elder abuse are outcome of unequal power relations abusive situations arising. Guidelines often complex, relating both to the and .Violence against from the Department of Health in individual and to the economic, social, older people is an extreme example South Africa state that elder abuse is cultural and political situation. of their powerlessness. more likely to occur if the person is Many studies point to carers of older physically dependent, mentally people – whether family members, impaired, or has insufficient income Action at all levels to be self-reliant. volunteer carers or professionals – Action to combat elder abuse as the main abusers.While this is a A study of violence against older needs to be taken at all levels. serious problem, the circumstances women in Chile found that gender, need to be taken into account. More information is needed on the co-residence with an adult carer, causes and consequences of elder Abusive behaviour by public services, mental or physical disability, abuse, drawing on data provided by such as at pension pay points, diminished family role, and fear older people themselves. government offices or other service added to their vulnerability. Broad-based interventions need to providers, is a reflection of society’s be developed, which involve older Older people with strong social negative attitudes to poor and people in tackling abuse and its contacts, and those with economic vulnerable people. underlying causes. and material assets, are likely to be A change in attitude is required, to better able to resist the threat of Older people themselves can be break taboos about elder abuse, abuse, or to seek support if it does abusive.They may abuse themselves and treat the issue as seriously as occur. However, assets and property through self-neglect, or they may gender-related abuse, child abuse, can also put older people at greater abuse members of their families or and generalised crime. risk of abuse, from younger family communities. A report from South Governments need to develop members wishing to inherit property. Africa states that older people's comprehensive strategies to stop abusive behaviour is often the result In many African countries, for example, abuse of older people, including a of alcohol abuse, unemployment and a widow’s property is passed to her supportive legal framework, and post-retirement depression. eldest son or back to the husband’s public education and training for public sector staff to equip them to It is important to see older people in family, which can put pressure on the detect and act on abuse. the context of their family, community widow to move out. In countries such A change of attitude is required and political environment, and to as Argentina and Brazil, the recent among families, communities and recognise and deal with the causes economic downturn has resulted in older people’s organisations to of abuse as well as its effects. adult children moving back to their parents’ houses with their children. acknowledge the extent of the Sometimes, the older person is problem and deal with it on a The law enforcers do relegated to the smallest room, practical, day-to-day level. or forced to move out. Older people need to be informed of not take us seriously. their rights and responsibilities and When I reported physical HelpAge International has also supported in exercising them, with received repeated reports of older reference to the Universal Declaration assault by my son, I was people in South Africa being attacked of Human Rights, the United Nations told:‘Old man, go and and robbed at pension pay points, Principles for Older Persons, the and of older people in Russia being International Plan of Action on sort it out with your robbed in their apartments.These Ageing, and national laws and polices. family.’ types of violence relate not only to References are available on request. older people’s difficulty protecting Fiona Clark is policy officer, Older man in Kenya themselves, but also to wider issues HelpAge International London.

Ageways 59 5 VIOLENCE AND ABUSE

Challenging beliefs about witchcraft

In northern Tanzania, communities are participating in a wide-ranging programme to improve the security of older women, including challenging beliefs about witchcraft.

n some parts of the world, cooking methods. Red eyes, for notably Africa, older women example, are seen as a sign of being are accused of being witches. a witch. An actual cause is a lifetime They are driven from their cooking over an open fire. New I designs of fuel-efficient stoves are communities and even killed. The problem is particularly being tried out, to reduce the risk acute in Sukumaland in to women’s eyes. northern Tanzania. The programme also challenges The Sukumaland Older Women’s negative attitudes to older people, Programme was started two years which allow accusations of witchcraft ago by HelpAge International and to thrive. It includes awareness-raising International Susan Majiba/HelpAge local NGO, the Magu Poverty about ageing and gender issues, Making baskets to sell is part of a broad Focus on Older People Rehabilitation and training older people in their programme to improve older women’s security. Centre (MAPERECE). It aims to legal and human rights. reduce witchcraft allegations and Cultural groups who perform improve the security of older representatives were not serious traditional dances and songs are people, especially older women. about implementing forestry by-laws. helping to promote positive messages The forestry officer promised to look about older people, by developing into the issue. new songs that encourage respect Building support for elders.They also perform role-plays In one village, the older people’s The programme uses a wide range depicting how older people are committee has identified vulnerable of practical interventions and accused of witchcraft and the violence older people and mobilised the advocacy to tackle the underlying that may result, sometimes to crowds community to provide them with causes of elder abuse, and strengthen of more than a thousand people. basic care in the form of food, local capacity to support older people. soap and firewood. In several Participants range from older people’s villages, the community has agreed groups and local communities to Change in attitude to build houses for vulnerable government officials, schools and older people. There are signs that attitudes are the media. beginning to shift in favour of older Older people themselves are The programme began with a gradual people. Initially, the government noticing a change in attitude. process of building support. Meetings denied the existence of witchcraft As one older woman said: involving both men and women were beliefs. However, in 1999, the ‘Before, I had to step off the path held in 70 villages to identify villagers’ International Year of Older Persons, to get past a group of young people, needs and elect village committees, it officially condemned the practice, but now the young people step through which the programme and government representatives aside to let me pass by.’ is implemented. are starting to show support. The programme is funded by Comic For example, at a village meeting The programme includes interventions Relief and the UK Department for between the older people’s aimed at improving older people’s International Development. health and wellbeing, focusing on committee, village leaders and the new approaches to vital areas such district forestry officer, older people More information: HelpAge International as nutrition, housing, agriculture and remarked that village government Programme (address on page 15).

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A place to learn about rights

An older people’s centre in Bolivia is proving a popular Pedro Chambi is a member of the Mama Margarita older people’s group. venue for research, training and advocacy to promote ‘In the meetings we talk about issues older people’s rights. to do with older people,’ he says. ‘Lately we have been talking about Older people in Bolivia are the poorest Together, the Archbishop of La Paz, the the law.The young women at the sector of society, but policy makers fail older people’s network, DEFAN, and centre help us a lot.’ to take them into account.Their social the government agreed to introduce a invisibility and the view that they are provisional documentation system, in seen as unproductive and dependent which older people who had no birth Guidelines on leads to violation of their rights. Many certificate could produce witnesses to abuse older people from indigenous groups testify to their approximate age.This are illiterate and do not speak Spanish, highlighted older people’s The centre has reviewed the effectiveness of the legal system which makes it harder for them to vulnerability, and showed what and health service, from the point defend themselves against abuse could be done by joining forces. of view of older people.This has or claim their rights under the law. highlighted a lack of provision for The government has made some Recognising rights dealing with elder abuse, and the important commitments to older The following year, DEFAN established centre has developed a methodology people, but without a concerted the Social-Legal Centre in La Paz. and drafted guidelines. effort by government and civil At the heart of the project is a The centre is developing a training society, these achievements will not recognition of older people’s right programme for older people on rights be implemented. In 1997, it to benefit from social services, and and leadership, and coordinating with introduced the bolivida, a universal the need for older people to be different organisations such as local pension.This provides only a small involved in development processes government, ministries, schools and payment once a year, but it makes and policies that affect them. colleges, and the police, to raise a difference to the poorest older awareness of older people’s rights people. However, the majority of The centre is housed in a room on loan and promote their involvement at older people could not claim it, from the bishop’s office. It is staffed by a higher level of decision-making. because they had no documentation. a multi-disciplinary team of social workers and students on placements, Contacts are now being made in four a part-time legal advisor, psychologist, more regions of Bolivia with a view and members of DEFAN. Its activities to replicating the centre. In future, it include individual socio-legal advice, is hoped that the role of the centre strengthening older people’s groups will change, as older people take on and networks, campaigning for more leadership roles, and public programmes for older people, carrying services assume their responsibilities out research, and raising awareness to this sector of the population. of older people’s rights. In a short time the centre has gained The centre is funded by the UK Department the support of a range of institutions, for International Development and the including local government and the European Commission through HelpAge police. In the past year, it has been International’s Active Ageing programme. used by 3,500 older people, mainly With thanks to Sonia Cuentis, from rural areas around La Paz, Social-Legal Centre including older people’s groups (email: [email protected])

Beatriz Lucero Amurrio/HelpAge International Amurrio/HelpAge Beatriz Lucero who have come for training in and Sarah Allen, HelpAge International Pedro Chambi values the chance to group organisation and income- Latin America Regional Development socialise and learn about the law. generating projects. Centre (address on page 15).

Ageways 59 7 VIOLENCE AND ABUSE

Dealing with abuse Everyone working with older people needs to be aware of the Taking action possibility of abuse.They need to be able to recognise and deal Those who abuse older people may with abuse, and know how to reduce the risk of abuse. do so for a variety of reasons. It is important to find out about and deal with the underlying causes of abuse. various reasons – illness (such as For example, relatives may be stressed Signs of abuse dementia or depression), side effects because they lack information or Abusers are often those close to an of medication, disability (such as training, or are too busy with other older person. Abuse may be taking blindness or mobility problems), or, responsibilities.The same can apply place in the older person’s home, particularly with older men, because to health workers or professional residential home, day centre or they do not know how to carry out carers. A carer may have been abused hospital. Abuse can take many forms domestic tasks. Neglect may also be as a child, and not know how else and show up in different ways. a result of poverty – because the to behave, or wish to ‘get their person cannot afford food or fuel. , which includes own back’. hitting and pushing, can result in Financial or material abuse includes If you suspect that an older person visible signs, such as cuts and bruises, stealing or using the person’s money may be at risk of abuse: perhaps broken spectacles, or a or belongings without their consent, change in the person’s behaviour. including moving into their home or Be vigilant Keep in touch with the Giving inappropriate medication selling their possessions. older person.Try to visit them or using physical restraint to keep regularly so that you can notice if a ‘difficult’ older person quiet is a Cultural abuse includes forbidding there are any changes in their form of physical abuse. people to speak their own language behaviour or appearance. or wear traditional clothes, or giving Sexual abuse means sexual contact of them food that they are not meant Speak out It can be difficult to any kind without the person’s consent. to eat for religious reasons. speak out against abuse.The person An older person may be too frail to you are accusing of abuse may be Structural or institutional abuse is resist, or feel too ashamed to report able to harm you.The older person a failure by the state and society to what has happened. Signs include experiencing abuse may be unwilling protect older people’s human rights. bruising in the genital area, discharge to talk about it, because they are If an older person is too poor to be or infection, and change in behaviour. too ashamed, or cannot accept that able to meet their basic needs for their son or daughter is neglecting can take the form shelter, food and health care, they them or stealing from them, or they of isolating the older person, are suffering from structural abuse, are scared of making things worse. humiliating them, making fun of them, because everyone has a right to Make sure you know where to go or treating them like a child, including these. Structural abuse includes for support. ‘punishing’ them. Signs include crying, being denied the right to education, insomnia, confusion, being either very employment, legal protection, Work with others to oppose abuse passive or agitated, trembling, not participation in civil society and so Abuse of any vulnerable person, making eye contact, and looking on, because of age discrimination. young or old, is a violation of their scared or anxious. human rights. Learn about human For all forms of abuse, there are two rights and help others to do so (see Neglect may show up as malnutrition signs to watch out for and respond to: page 10). Find out what laws or or dehydration.The person may have if an older person tells you that they organisations you can use to promote chronic health problems, or look are being mistreated older people’s rights.Work with people uncared for (poor hygiene, uncombed if a carer – in the family or an in your community to set up groups hair, dirty or torn clothes). Older institution – refuses to allow visitors and networks to support older people people may neglect themselves for to see an older person alone. and raise awareness of their rights.

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Government Assist older people's groups to advocate for policies supporting their need for a dignified life, such as a universal social security system, and to press for laws protecting older people to be implemented.

Legal rights There are many legal instruments supporting the rights of older people. These include:

David Woodroffe/HelpAge International Source:Woodroffe/HelpAge David there is no artist Where Universal Declaration of Encourage older people to learn about their rights. Human Rights United Nations Principles for Older Persons Often the best counsellors are older Encourage the group to carry out Regional declarations – for example, people themselves. In Mozambique, awareness-raising campaigns directed the American Declaration of Human Tanzania and Peru, for example, older at families and the local community. Rights mentions the right to social people are trained as counsellors Families Share discussions that have security, and the duty of children to to support other older people taken place in the older people’s support and protect their parents (see page 16). group with families, so that they when they need it become aware of the messages and National constitutions – for example, treat older people with respect. the Peru constitution mentions the Avoiding abuse duty of the community and state to There are ways in which you can Local community Organise protect older people work with older people’s groups and discussion groups and campaigns. National and international laws. others to help reduce the risk of Stick up posters with slogans Adapted with thanks from Del elder abuse. promoting a culture of respect for older people. Organise activities with Maltrato al Trato Digno (From Abuse to Respect), a handbook in Spanish Individually Encourage older people younger age groups, such as school for counsellors produced by Centro to feel positive about themselves. students, to raise awareness of older Proceso Social, Peru. Centro Proceso People who love and respect people’s rights and contributions. Social trains older people as themselves are better able to stand Spread the news about older counsellors, supports the up for themselves and others. people's rights. development of older people’s Focus on the older person’s positive Institutions Develop a 'watchdog' groups, and encourages institutions qualities, involve them in the group, to promote older people’s rights. and give them responsibilities so group to ensure that older people are that they feel useful. treated well. Get the support of local More information: Luz Barreto Carreño, public and private institutions to set Programmes Director, Centro Proceso Groups of older people Get the up a local network to protect older Social, Av. Gerardo Unger 663 – San Martin de Porres, Lima, Peru. group to think about the poor people, and offer them help to do so. Email: [email protected] treatment that older people receive. Get them to commit themselves long- Additional information from American Promote the idea that everyone term, and to establish mechanisms Association of Retired Persons website: deserves to be well treated. Support and resources to protect older http://www.aarp.org/confacts/health/ those who have been abused. people’s rights. avoidabuse.html

Ageways 59 9 VIOLENCE AND ABUSE

Finding out about abuse

The following exercises can be used to raise awareness Pass round copies of the Universal of older people’s rights, and to find out if older people Declaration of Human Rights (see page 12). Use the following questions are being denied their rights. to prompt discussion:

Why do we have human rights? What are they really about? Are they a way of living? Are they laws? Are they about how a government treats its citizens? Are they about how one human being treats another? What happens when a government does not respect human rights? What happens when individuals do not respect the rights of others? The answers to the last question should allow you to introduce the idea of abuse and lead into a discussion about abuse (see below).

This exercise can also be done using the United Nations Principles for Older Persons (see page 12).

Identifying abuse

Céline Hall/HelpAge International Céline Hall/HelpAge This exercise can be used with people working with older people, or older Health check-up with Alzheimer Society Romania. Everyone has a right to medical care. people themselves, to help them identify instances of elder abuse. Older people’s For example, everyone has the right If necessary, remind everyone about to an adequate standard of living, human rights. rights including medical care and necessary social services; security in old age; If there are more than eight people, Understanding and respecting and participation in the cultural divide the group into smaller groups. older people’s rights are key to life of the community. Give each group a short story, in which preventing abuse. an older person suffers an experience The following exercise can be used that amounts to abuse. For example: The Universal Declaration of Human with people who work with older Rights, adopted by United Nations people, such as project staff, An older woman goes to a clinic for member states in 1948, states that volunteers or carers, or with groups treatment for the pain in her left leg. all human beings are equal in dignity of older people, to raise awareness The nurse says:‘Go away, it’s just old age and rights. It sets out the rights and of older people’s rights. Note that that is causing the pain.What can we do duties that everyone has, regardless participants will need to be able about it?’The woman asks:‘If it’s old age, of their status. to read to do this exercise. why isn’t there a pain in both legs?’

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The nurse makes fun of the woman in get people to talk about sensitive Practical points for front of everyone:‘Listen to this old bag issues, such as abuse.They allow of bones, she thinks she knows more people to talk in a way they feel focus groups than the nurses about medical things.’ comfortable with, and they encourage She gives the woman a shove in the participation from people who may Facilitators need an back and tells her to get out and make feel they have nothing to say. understanding of the ethnic, way for younger patients. cultural, religious, social and Focus groups often reveal complex economic background of the Ask the groups to list ways in which issues that would not be revealed in participants. the older person’s human rights are other ways, such as one-to-one The group should involve no being denied. Ask them to explain interviews.They can help people more than ten people. A good why these are human rights . acknowledge that abuse is discussion can take place with Then ask each group to report back to happening in their community six people. everyone.You can encourage people or institution. A session should take two to add to the different groups’ lists. Do not start by trying to talk about hours at most. Involvement must be voluntary. Some of the responses should include: abuse, but structure the discussion in Participants may need Right to equality – the woman is a way that can lead people to talk refreshments. treated differently because she is old. about abuse, using their own words – You may need to run separate Right to human dignity – she is they may not necessarily use the word groups for men and women. insulted and made fun of in front ‘abuse’.For example: The facilitator of a women’s of others. Storyline – Start telling a story group should be a woman. Right to physical security – the and ask participants to complete it. It may be useful to involve the woman is deliberately pushed. You can ask for clarification, or group in recording key issues Right to healthcare – she is not introduce new elements in the story. treated for her complaint. on a flipchart, if they are This helps to generate an open comfortable with this. discussion about sensitive topics, The facilitator needs to notice including violence. participants’ body language, Acknowledging Timeline – Ask participants if there as well as what they say. elder abuse are changes in people’s attitude and Participants who have experienced abuse may People who have suffered abuse are behaviour towards older people. require support – counselling often unwilling to admit it, especially Do things happen now that did not should be offered to those who physical abuse. happen in the past? Why? need it. People may complain of neglect, theft, Geographical distancing – or being spoken to rudely. However, Encourage participants to describe they often find an excuse, such as: events that happen far away, ‘My son probably needed the money’ in another country or region. Adapted, with thanks, from ‘Rights or ‘The nurse was very busy’. Afterwards, compare these with and older people’,a training pack the local experience. prepared by HelpAge International’s A younger person may excuse abuse Africa Regional Centre and from If participants have mentioned of an older person by saying:‘But he material produced by the Ageing several different kinds of abuse, it can was being very difficult’ or ‘She was and Life Course, World Health be useful to ask them to rank them refusing treatment’. Organization. in order of importance.They can do Focus groups (structured discussions this by arranging objects that More information: Amleset Tewodros, in a small group) are a good way to represent different forms of abuse. Training Manager (address on page 15).

Ageways 59 11 VIOLENCE AND ABUSE

Information sources

Universal Declaration of More information: Silvia Perel Levin, Ageing professionals in identifying, treating Human Rights and Life Course, NCD Prevention and Health and preventing elder abuse; support Set of principles adopted by United Pormotion,World Health Organization, advocacy on behalf of abused and 20 Avenue Appia, CH-1211 Geneva 27, Nations General Assembly in 1948. Switzerland. Email: [email protected] neglected elders; and stimulate All UN member countries are bound research into the causes, consequences, to apply these principles. Leaflets promoting rights treatment and prevention of elder United Nations High Commissioner for Access to health care, Access to welfare abuse and neglect. and support and Giving to family and Human Rights (UNHCR), 8-14 Avenue de la More information: Dr Gery Bennett, Paix, CH-1211 Geneva 10, Switzerland. society are three leaflets promoting Secretary, INPEA. Fax: +44 20 7377 7844 http://www.unhchr.ch/udhr/index.htm older people’s rights to policy makers Email: [email protected] and the media in South Africa. United Nations Principles International Day for Older People More information: HelpAge International for Older Persons Takes place on 1 October each year. Adopted by the UN General Assembly programme,South Africa (address on page 15). More information: in 1991, setting out older people’s People’s Movement for UN Programme on Ageing (see above) rights to independence, participation, Human Rights care, self-fulfilment and dignity. Website with a section on ‘Human Human Rights Day Governments were encouraged Rights and Aged Persons’,summing up Takes place on 10 December each year. to incorporate the principles into international agreements under which More information: UNHCR (see above). their national programmes older people’s rights are protected and Regional rights programme whenever possible. should be promoted. It also connects An Africa-wide programme run by United Nations Programme on Ageing, with main development issues around HelpAge International’s Africa Regional Department of Social Development, livelihoods, food, poverty, refugees and United Nations, 2 UN Plaza, New York, Development Centre to increase discrimination, and provides links to NY 10017, USA. Fax: +1 212 963 3016 understanding of the nature and African and Asian learning institutions http://www.un.org/esa/socdev/iyop/ extent of violations of the rights of iyoppop.htm for human rights education. older people, and develop guidelines Del Maltrato al Trato Digno http://www.pdhre.org for interventions aiming to address (From Abuse to Respect) Older people in Africa the issue.The programme is producing Training manual for counsellors in Video highlighting problems a video on older people’s rights. Spanish, produced by Centro Proceso encountered by older people in Africa, More information: Pension Munyama, Social, Peru. such as HIV/AIDS, shelter and Rights Coordinator, HelpAge International Details on page 9. emergencies, with testimonies from Africa Regional Development Centre (address on page 15). older people and views of people WHO report on elder abuse specialising in ageing issues. Aimed Report of a study by the World Health at generating changes in policy Organization and partners in eight Back issues of Ageways towards older people by countries – Argentina, Austria, Brazil, Training older people to governments and others. Canada, India, Kenya, Lebanon and protect their rights Sweden – with older people in the More information: HelpAge International (Programme in Peru) issue 53 Africa Regional Development Centre community and primary health care Learning about legal matters (address on page 15). workers.The study aims to establish (Training older people in Tanzania) components of elder abuse, as International Network for the issue 54 identified by older people themselves Prevention of Elder Abuse (INPEA) Fighting for the rights of older people and by those forming the primary Aims to increase society’s ability to (Pension payments in South Africa) health care teams, and make recognise and respond to the issue 54 recommendations for action. lt will mistreatment of older people.The Elder protection feed into the development of a global network’s objectives are to increase (How to identify and resolve abuse) strategy for the prevention of abuse public awareness of elder abuse; issue 49 of older people. Due April 2002. promote education and training of

12 Ageways 59 PROJECT PLANNING Taking gender into account

Ageing affects men and women in different ways. The following exercises are designed help to understand these differences, and take them into account in planning projects.

Men and women have different Ask participants to discuss the roles throughout their lives, leading following issues: to different experiences and Roles – what do people do for needs in old age. Many of these themselves, their families, the differences are related to unequal community? power relationships. Policies and Resources – who has access to land, programmes that do not address crops, animals, tools, cash? Who has gender issues – issues relating to control of these? the way that society treats people Expectations – do people in the according to whether they are community have specific ideas male or female – are bound to about what men and women should promote inequality. do at different ages? Do they have ideas about who can access or control resources? Roles and resources Ask the groups to make separate lists of This exercise helps participants what the men and women in each age appreciate that: band do. Discuss the lists. Geoff O’Donoghue/HelpAge International Men usually work to earn an income, and men and women have different Participants will see that: may face particular problems when they roles in their community Men and women have different can no longer do so. older men and women have roles. different roles from younger men Older men and women have how to eat a healthy diet and how to and women. different roles from younger men take care of themselves. and women. If there are a lot of participants, break Men usually go out to work – playing Men and women of all ages the group into smaller groups. a ‘productive’ role – while women take perform certain activities because Provide them with writing materials. care of the home and family – playing society expects them to. Ask each group to think about a a ‘reproductive’ role. Much of men’s community that they are all familiar Gender-related issues vary between work is more public and therefore with – a particular village or urban different societies and cultures. acknowledged and valued. Much of district – which includes people of However, in many societies: women’s work takes place in the different ages. Women have a lower status than home and is undervalued. men, leading to a poorer diet, less Explain that you will ask each group access to education, risk of sexual Older men may become depressed to think about what people in the violence and physical abuse, and when they can no longer work and community do, in each of the exclusion from decision-making. contribute an income. Older men following age bands: Women are often expected to do living alone may not know how to 20-45 year olds what their husbands tell them. look after themselves. 45-60 year olds They may not be comfortable Women often remain socially 60-75 year olds about speaking up in front of integrated for longer. However, older over-75 year olds. their husbands. women are more likely to be widowed, If there are several groups, you Boys and men are excluded from live alone, and live in poverty. could ask each group to discuss one many household activities.They may Property and inheritance laws often age band. not learn important life skills, such as discriminate against widows. In older

Ageways 59 13 PROJECT PLANNING

Taking gender into account continued

age, a woman’s son may take the The game helps participants to see Ask participants to keep in mind the role of head of the house. how associations about the animal following questions (you may want kingdom are reflected in society’s to write these up): Older women’s health may be views of men and women. For affected by a lifetime of gender- Where does the statement example, in one workshop, one based inequalities and multiple come from? Who says it? pair liked the lion ‘because he is pregnancies. How does it affect the way we strong and king of the jungle’. think of older men and women? Both older men and women are Encourage participants to explore how How do we know whether viewed negatively.They are their comments about the animals and it is true or not? discriminated against in different their choices for another life reveal their What evidence do we ways. For example, older women attitudes to men and women. have to challenge it? may be accused of witchcraft, while older men may be accused of Review the activity: being lazy. Which statements were easy to agree on and which were difficult? Older men and women contribute This exercise helps participants Why? to their families and communities understand gender-based Where do such statements come by giving advice, take care of children, against older people. from? Who makes them? Why? passing on cultural traditions, and How do they affect the way we contributing to the household Divide participants into small groups. think of and treat older people? economy. Give each group a set of statements Give examples. on separate pieces paper. How do they affect older For example: women and the way they see themselves? The animal game Older people are always bad- How do they affect older men and The following exercise helps tempered and complaining. the way they see themselves? participants examine their Older women turn into witches. How do they affect the way assumptions about men and women, Many older men turn into older men and women relate to and power inequalities between autocratic self-important rulers. each other? the sexes. Older women are lazy. Older men just sit around and Sum up with a reminder that older Write the incomplete name of a variety wait to be served. people are often excluded from society. of animals or birds on pieces of paper – Older men can't look after Point out that the statements show for example, lion, giraffe, eagle, parrot, themselves or look after a home. how girls and women are discriminated honeybee. Ask everyone to find a Older men often find it more against, even when they have grown partner. Ask each pair to choose an difficult to learn new things older, and how men can suffer as a animal or bird that they like and than older women. result of a change in their status as complete its name. Ask pairs to they get older. Ask the groups to put the statements answer the following: on the floor in front of them, face up. Adapted with thanks from material Agree one reason why you Give each group two envelopes labelled for a workshop organised by like this animal. 'True' and 'False'. HelpAge International’s Africa If you were given a chance to Regional Development Centre in Ask participants to take turns to pick have another life what would you Nairobi in 2001 and from the up and read out the statements. Ask choose to be, male or female? centre’s ‘Training manual on the groups to discuss each statement, What would you like to do? ageing in Africa’. decide whether it is true or false, Give one reason for your choice. and put it in the appropriate envelope. More information: Amleset Tewodros, Ask pairs to introduce each other to the Point out that discussion is more Regional Training Manager big group and share their discussions. important than quick decisions. (address on page 15).

14 Ageways 59 MEMBERS AND PROGRAMMES

Mauritius Family Planning Instituto de Acção Social de Macau Slovene Foundation (Slovenska HelpAge International Association Mongolian Association of Elderly Fondacija), Slovenia Muthande Society for the Aged People Zivot 90, Czech Republic Members (MUSA), South Africa* NACSCOM, Malaysia* Regional Centre for Welfare of Ageing Office of Seniors Interests, Australia Latin America Caribbean Persons in Cameroon (RECEWAPEC) Pakistan Medico International Asociación Gerontológica Action Ageing Jamaica Senior Citizens’ Council, Mauritius Positive Ageing Foundation, Australia Costarricense (AGECO), Costa Rica* Extended Care Through Hope and Sierra Leone Society for the Welfare Resource Integration Centre (RIC), Caritas Chile Optimism (ECHO), Grenada of the Aged Bangladesh CooperAcción, Peru HelpAge Barbados/Barbados Sudanese Society in Care of Older Senior Citizen Association of FAIAF,Argentina National Council on Aging* People (SSCOP) Thailand* Fundación Centro de Estudios e HelpAge Belize* Uganda Reach the Aged Association Singapore Action Group of Elders Investigaciones del Trabajo National Council of and for Older Tsao Foundation, Singapore (CESTRA), Colombia* Persons/HelpAge St Lucia Asia / Pacific USIAMAS, Malaysia* Lima Co-ordinating Group Old People’s Welfare Association Bangladesh Women’s Health (Mesa de Trabajo de ONGs (OPWA), Montserrat Coalition (BWHC) Europe Sobre Ancianidad), Peru* REACH Dominica* China National Committee on Aging Caritas Malta HelpAge, Malta Red de Programas Para al Adulto Society of St Vincent de Paul (SVP), (CNCA)* Centre for Policy on Ageing, UK Mayor, Chile Antigua Coalition of Services of the Elderly Cordaid, Netherlands Pro Vida Bolivia* (COSE), Philippines* Counsel and Care, UK Pro Vida Colombia* Africa Council on the Ageing (Australia) DaneAge Association, Denmark Pro Vida Ecuador Associaçaó dos Aposentados de Fiji Council of Social Services Elderly Woman’s Activities Centre, Pro Vida Perú Lithuania Moçambique (APOSEMO) Foundation for Older People’s North America Elim Hlanganani Society for the Development (FOPDEV),Thailand Eurolink Age, UK American Association of Retired Care of the Aged, South Africa HelpAge India* Help the Aged (UK)* Persons (AARP)* HelpAge Ghana (HAG)* HelpAge Korea* London School of Hygiene and Help the Aged (Canada)* HelpAge Kenya* HelpAge Sri Lanka* Tropical Medicine (LSHTM), UK HelpAge Zimbabwe* Helping Hand Hong Kong* Mission Armenia * Full member

Caribbean Rwanda HelpAge International PO Box 8300 Kingston CSO, Jamaica HelpAge International PO Box 24, Kibungo, Rwanda Tel: +1 876 7547643, Tel/fax: +250 566569 Regional Fax: +1 876 7547642 Country Email: development Email: [email protected] programmes [email protected] centres Latin America South Africa Casilla 766, La Paz, Bolivia Cambodia PO Box 30832, Braamfontein 2017, These offices can put you in touch Tel: +591 2 2415283 PO Box 525, Phnom Penh, Cambodia South Africa Tel/fax: +27 11 4039677 with members in their region. Fax: +591 2 2410957 Tel: +855 23 216076, Email: [email protected] Email: [email protected] Fax: +855 23 216076 Africa Email: [email protected] Sudan PO Box 14888,Westlands, 00200 East and Central Europe c/o Acropole Hotel, PO Box 48, Nairobi, Kenya Tel: +254 2 444289 network Ethiopia Khartoum 2, Sudan Fax: +254 2 441052 Coordinated from the HelpAge PO Box 3384, Addis Ababa, Ethiopia Tel: +249 11 461657 Email: [email protected] International London office Tel: +251 1 631020 Fax: +249 11 461594 (email: [email protected]) and by: Fax: +251 1 611563 Email: [email protected] Asia/Pacific Nijole˙ Arbacviauskiene˙, Chairperson, Email: [email protected] c/o Faculty of Nursing, Chiang Mai Elderly Woman’s Activities Centre, Tanzania University, Chiang Mai 50200, V. Landsbergio-Zemkalnio 6-37, Mozambique PO Box 9846, Dar es Salaam, Thailand Tel: +66 53 894805 Kaunas LT-3042, Lithuania CP 4112, Maputo, Mozambique Tanzania Fax: +66 53 894214 Tel: +370 7 719757 Tel: +258 1 415816 Tel: +255 222 774796 Email: [email protected] Fax: +370 7 719757 Fax: +258 1 416435 Fax: +255 222 775894 Website: http://www.helpageasia.com Email: [email protected] Email: [email protected] Email: [email protected] Ageways mailing list request form To go on the mailing list for Ageways, please complete this form using CAPITAL LETTERS and send it to: Publications, HelpAge International, PO Box 32832, London N1 9ZN, UK Fax: +44 20 7843 1840. Alternatively, email your details to: [email protected] If anyone else in your organisation would like to receive Ageways, please photocopy this form and ask them to complete and return it.

Title How old are you? Do you work for an organisation? How many copies of Ageways do First name Under 30 30-60 Over 60 Yes No you need? English Surname Do you have access to the web? If yes, which of the following Spanish (Horizontes) Job title describes your organisation? Yes No Russian Organisation name Older people's organisation Ukrainian What is your job? /pensioners' association Social worker Health worker Community-based organisation If 10 or more please say how you will use them Address Trainer Administrator Local or national NGO/religious Student Librarian organisation Emergency relief worker Government organisation Other (please specify) International NGO/religious organisation International government or We will use this information to City multilateral agency (e.g.WHO) distribute Ageways.We may also use it to distribute other HelpAge Postal code What sort of area do you work in? Training/educational institution International materials, or pass it Country Urban Rural Other (please specify) to other organisations to distribute their materials. Tel Does your work focus primarily on Fax older people? If you do not wish to receive information other than Email Yes No Ageways, please tick this box. Ageways 59 15 Action to promote respect

HelpAge International is a global network of not-for-profit organisations with a mission to work with and for disadvantaged older people worldwide to achieve a lasting improvement in the quality of their lives. Ageways exchanges practical information on ageing and agecare issues, particularly good practice developed in the HelpAge

EWAC International network. It is published Discussing elder abuse in Argentina. Learning self-defence in Lithuania. three times a year by HelpAge International, with funding from In Argentina, elder abuse has been Thousands of pension payments were Help the Aged (UK). coming to light, but in the provinces suspended in the northern province Copies are available in English, Spanish there is no system for preventing or of South Africa in 1998. Local NGO, (Horizontes), Russian and Ukrainian, free of treating it. A team of social workers Elim-Hlanganani Society for the Care charge on request to project staff, carers and older people’s organisations. Please complete who work with older people of the Aged, teamed up with a local and return the form on page 15. researched elder abuse in Tandil, law centre to support pensioners’ Buenos Aires province. In November fight for their rights. In a court ruling, Ageways is also available on the web at: http://www.helpage.org 2001, they led two workshops at a the judge ordered pension conference on violence in old payments to be resumed. Edited by Celia Till and Fiona Clark Additional editing by Anne-Marie Sharman age, organised by the non- More information: Florence Khosa, governmental organisation, Elim-Hlanganani Society for the Care Translations coordinated by ZONTA-Río Gallegos in Río Gallegos, of the Aged, Box 72, Elim Hospital, 0960, Caroline Dobbing and Viktor Mishchenko Santa Cruz province. Elim, Northern Province. South Africa HelpAge International Email: [email protected] PO Box 32832 Social workers, government officials, London N1 9ZN, UK Peer counselling is helping older carers, lawyers, police and older people in Chokwe, southern Tel: +44 20 7278 7778 people’s leaders learnt how to Fax: +44 20 7713 7993 Mozambique, to rebuild their lives identify cases of abuse and overcome Email: [email protected] after severe flooding destroyed problems tackling abuse. Community Ageways email: [email protected] their homes. Older people have members, including older people, Registered charity number: 288180 been trained to listen to other older worked to develop older people’s The views expressed in Ageways are those people’s problems and provide ability to detect cases of abuse of the contributors and do not necessarily advice.‘I would have not spoken among their peers. represent the views of HelpAge International. about this problem of witchcraft All reasonable care has been taken to produce More information: Lic. Maria Pura accusation except to a fellow older information in Ageways accurately. HelpAge Cordonnier Email: [email protected] person who understands this International does not accept any liability for loss or damage, however sustained, by any or Lic. Ivan Olivera, 4 de abril 15, CP 7000 phenomenon’,said one older woman. Tandil, Buenos Aires, Argentina person as a result of use of any information More information: Nec Chipfupa, contained in Ageways. Programme Manager, HelpAge The failing economy in Eastern Europe Any parts of this publication may be International, Mozambique (address has led to a growth in violent crime, reproduced for non-profit purposes unless on page 15). especially against older women. indicated otherwise. Please clearly credit In Lithuania, the Elderly Woman’s Older people in Karagwe, north-west Ageways and send us a copy. Activities Centre (EWAC) is helping Tanzania, are being trained to advise Designed by Solutions Design Consultants, SW20 women protect themselves other older people about laws Printed by APG Limited ISSN 1469-6223 through self-defence classes. relating to inheritance, land tenure Front cover photo: Rani Biwa’s home was ruined v and marriage. More information: Nijole˙ Arbaciauskiene˙ by a cyclone in Orissa, India. In emergencies, older Chair, Elderly Woman’s Activities Centre More information: HelpAge International, people’s needs are often neglected - an example (address on page 15). Tanzania (address on page 15). of structural abuse. Rob Penn/HelpAge International

16 Ageways 59