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Journal of Health Sciences Management and Public Health DOMESTIC VIOLENCE AND SENIORS Petra Zimmelová1 ABSTRACT Domestic violence is mentioned in recent years particularly in connection with children and women.

In recent years, seniors rank between victims of domestic violence more and more often.

The article deals with general knowledge about specifics of domestic violence, presenting further a part of the research of violence committed on seniors - physical violence.
Key words: Senior – violence – victim of psychical violence – neglect – dependence INTRODUCTION The English term “domestic violence” is translated into Czech as “domácí násilí”.

It covers all forms of physical, sexual and psychical violence committed between individual family members (1, 2, 3, 4, 7).

A characteristic feature of domestic violence is its repetition, long-term character and almost everyday presence.
It is a pattern of coercive behaviour used by one person to dominate other person or persons.

It can have different forms: rude curses, permanent criticism, humiliating insults, taunting, eroding self- confidence, suppression of personal liberty, economic exploiting, threatening with bodily harm or direct bodily harm (5, 6, 8).

Research of questions of violence in family is a relatively new matter all 1 University of South Bohemia, Faculty of Health and Social Studies, Èeské Budìjovice, ÈR.
over the world (for example in Australia and in the USA, this issue is dealt with more than 20 years, more recently it is discussed in Great Britain or the Netherlands).

The results of the first investigations and researches carried out in these countries brought data about considerable extent of violence in families, but at the beginning, the society always reacted very negatively to these data.
But later it revealed that although the number and character of the cases differ in individual countries, domestic violence is a serious problem that occurs in all countries and social classes, regardless of education, religious orientation, age or ethnicity (4, 7, 9, 10, 12).
In spite of existence of studies concentrated on the research of statistical data concerning violence committed on old people (“elder abuse” or “abuse of the elderly”), this phenomenon got attention only more 5 9 Journal of Health Sciences Management and Public Health than 10 years later, in connection with violence committed on children.

As Kalvach (13) states, 10 times less publications are dedicated to the issue of maltreatment of seniors than to children with the same problem.
the Researches carried out in the USA, Canada and Great Britain detected cases of different forms of violence in 3 – 6% of 65-year-old and older persons.

In 1990, the Health Care Committee of the Council of Europe recommended issue of maltreatment of seniors to be studied with preference.

In 1995 the International Conference of Violence in Family discussed the issue of violence.

When an old person becomes victim, a huge problem arises.

The problem is not only legislative, but also ethical and moral.
The difficult part of the problem in distinguishing violence (its obvious traces) in old persons.

In seniors, a situation when they do not go out for a longer time is not surprising.

People in the surroundings hardly become aware of it or notice it in time.

lays particularly Considerable myths carry over in each society, representing the biggest obstacle to learn to know this phenomenon and to recognize it as a serious social problem.
First of all, the belief is widespread that violence in family is a private issue, that the victim asks for it, in case of seniors it is a common myth of disobedience, situated in the same category as concerning children.

By the spirit of the motto “spare the rod and spoil the child”, a public opinion is 6 0 widespread that a slap is sometimes better than in-depth explanations.
In this regard, each new initiative oriented against violence in family firstly had to concentrate on increasing the sensitivity of the public against this phenomenon (11, 14, 15, 16).

MATERIAL AND METHODS Characteristics of the samples of the seniors/respondents , questionnaires.
In the scope of the research carried out at the Faculty of Health and Social Care of South Bohemian University in 2004, when one part of it was dedicated to the issue of domestic violence committed on seniors, the results mapping domestic physical violence were most alarming.

Questionnaire investigation took place from June to October 2004 on the territory of towns and villages of South Bohemian Region.
The total number of respondents consists of 1300 seniors (seniors were surveyed, the criterion was age over 60).

In our research, all types of question- naires dealt with the question of direct physical violence and all respondents were asked about it.

In the complexes of the seniors, the following 3 types of questions appeared: - Question No.

1 Have you met physical attacks or are you physically attacked by your environment?

- Question Nr.

2 Has a family member attacked you physically?


Journal of Health Sciences Management and Public Health - Question Nr.

3 Were you sometime threatened by physical violence, or was physical violence sometimes used on you?

RESULTS Characteristics of the samples of seniors/respondents according to sex, age, home care and place of permanent are demonstrated on the table 1 and 2. residence From the total number of 1300 respondents, 169 gave a positive answer, which is 13% of the total number of the respondents.
Very interesting was the comparison with the number of positive answers to the question Do you know a case of maltreatment of a senior from your environment?

the Here, 289 respondents gave a positive answer, which makes 22,3% from total number of respondents.

It can be deduced from this disproportion that in some cases, seniors do not consider violence on their own person as violence, they consider occasional “hand beating” as insignificant.
Other way out from this difference of results is also shame of the senior to confess that he/she has failed as educator.

The senior often maintain the position: “When my children or relatives and surroundings maltreat me physically, I am simply old, bad, superfluous, useless, burden, load, good-for-nothing” etc.

(the curses come directly from questionnaires, as the respondents stated them).

It is true that seniors tried to cover maximally any traces leading to reveal physical violence in this Table 1.
Characteristics of the sample – seniors/respondents according to the sex and age Sex Men Women Total Quality/number (N) 60-64 years 65-69 years 70-74 years 75-79 years 469 831 1300 55 151 206 99 178 277 156 224 380 102 153 255 80 years and more 54 128 182 Table 2.
Characteristics of the respondents/seniors in the domestic/home environment according to the place of permanent residence (750 respondents received the optional(voluntary) questions, 48 of them have not responded to the questions) The place of permanent residence Village (<1 000 inhabitants) Village (>1 000 inhabitants) Town/City Number(quality) of respondents 198 245 307 6 1 Journal of Health Sciences Management and Public Health situation.
Most frequently we meet this covering in seniors who are dependent on the aggressors.

In their perception of the situation, physical violence from family members is very often accepted far better than loss of care person from the family and necessity to use services of professionals.

Other reason why seniors very often deny existence of physical violence is the fear from possible increase of aggression.

Very often, the seniors on whom domestic violence is committed are health handicapped.
In case of physical handicaps, immobility, worsened mobility, it is practically impossible for the senior to defend himself in some way.

When the senior would want to express request for help, it mostly resounds to empty walls.

In the time when the society fights against disregard of people towards public violence displays, we will seek very difficultly witnesses and methods of help for this hidden type of domestic violence committed on immobile seniors.
In these cases, the person of the doctor is a very important and often the only person who can help in case of physical violence.

He is often the only “stranger” who enters into the domestic environment of the victim confined to bed or with limited mobility.

When the doctors will be informed of the necessity to concentrate to evident displays of physical violence in seniors and have exact mechanisms how to proceed in 6 2 case of detecting violence, the situation can be markedly improved.
DISCUSSION Risk factors of maltreatment of seniors The risk factors concern the victim and the culprit.

These are the so called “criminogenous variables”.

These variables should act as a warning signal for doctors and other persons who can come into contact with cases of maltreatment.

The presence of variables should increase the effort to register the sad displays of senior neglect that occur in the family most often.
Factors increasing the danger of maltreatment of seniors: - Generally bad health condition - Disorders of cognitive and functions communication (syndrome of dementia) - Loss of self-sufficiency - - Living Social isolation together with the aggressor and dependence on him (15, 18, 19, 21).

Factors increasing probability that somebody will commit maltreatment of a dependent person: - Alcoholism, drug addiction.

- Psychopathology, psychopathy.

- Low intellect level.


- Previous aggressive or asocial behaviour.

- Overburden and existence problems of the family and decrease of their willingness and possibilities to provide high- quality care.

- Material, housing dependence of the victim on the aggressor.

- Low level of interest and protection by the society against undesirable behaviour including protection of rights and dignity of clients in long-term institution care.

- Discrimination attitudes in the society.


- Burn-out syndrome in nursing staff.

– Forms of neglect and maltreatment of seniors Maltreatment and neglect occur in the following forms, being the first of them stated as basic forms in literature (17, 20, 21, 22, 24, 25, 27, 29): is 1.

Body maltreatment understood as deliberate causing of pain, intentional denial to satisfy basic life needs, motiveless restricting of personal liberty.
This is a whole scale of violence forms, from beating over kicks, strangling, knocking down or other aggressive ways of maltreatment to deliberate exposing to cold, denying food or medicines.

Such behaviour leads unequivocally to multiple injuries, fractures, bruises, burns on unusual places (buttock), to cachexia or other visible signs of maltreatment.

The injuries are usually untreated and variously old.

The injuries are on places where a person would not cause them himself or herself.
In worst cases, the victim can even die.

Journal of Health Sciences Management and Public Health threats, expressing 2.

Psychical (emotional) maltre- atment - for this type of maltreatment, putting down, knowing lowering of self- confidence and self-respect, menaces, verbal aggression (curses, offences, taunting etc.)

are typical.

Violation of rights with typical the menaces possibility of moving, displa- cement or situation (often involuntary) into an institution, e.g.
old people’s home or sanatorium of long-term ill persons is not a rare thing.

Often the powerlessness, superflu- ousness, inferiority or burden- someness of seniors is pointed out, having unequivocal impact on their low self-esteem.

A frequent sign is depression or inexplicable changes in the behaviour of the senior (22, 23, 26).

3.

Material financial and maltreatment – is usual in relation to old persons, less frequent in relation to children where particularly hectoring rights are abused.
Often financial resources, e.g.

pension or savings are injustifiedly enforced, writing down or change of testament, transfer of property or flat are enforced, there lack of willingness to finance nursing or health care, e.g.

medicines.

The persons disposing of finances of old persons refuse to pay them clothing, food or reproach them such expenses.

The old person is is 6 3 Journal of Health Sciences Management and Public Health not able to explain logically how he/she handles his/her incomes.

4.
4.

Sexual maltreatment – does not occur so often as in children, but when it arises, then it is committed mainly on women or in connection with psychical deviations (gerontophilia).

A sign can be contamination of underwear with blood because of injury of genital or anal region, pain in this region, inexplicable inflammation processes, sexual diseases, difficult walk, painful sitting because of injury of genitals etc.

5.
5.

Neglect (omission) of care – can be understood as failure of care by the nursing person who is responsible for protection and security and for satisfaction of basic needs of the dependent person.

This case is a frequent form of maltreatment of old persons who may not take notice of it in time.

The consequences typical for neglect of care are practically identical with the consequences caused by self- neglect of a lonely non-self- sufficient person.
They are particularly health disorders caused dehydration, insufficient nutrition, non- observing of basic personal hygiene, neglect of cleanness of clothes and environment, chill, injuries caused by falls, different skin diseases (decubitus or bedsore Apathy, etc.).

deprivation, particularly communication deprivation, anxiety, depression etc.

can be by 6 4 displays of this condition.


Therefore it is very important to distinguish the type of neglected care – whether by another person or by the individual himself/ herself (28, 30, 31).

6.

Mistreatment – there are forms of nursing that are undesirable in their essence and cannot be ranked into the previous groups, e.g.

excessive or unsuitable administering of sedatives or psychopharmacs.

The group of mistreatment should include often also unintentional of mistreatment caused by bad nutrition.
Unlike energetic undernourishment caused by protein lack undernourishment can cause death even in a quite healthy looking old person during several weeks to months.

serious, food, form one of 7.

Abandonment – getting rid of responsibility for obligatory care for old person.

This sphere could include also cases of involuntary placement of the person into an institution or general omission or non-provision of health and social care (32, 33, 34).
CONCLUSION The placement of this issue at the same level as violence committed on children and women is very important.

In the present situation of the violence committed on seniors in the Czech Republic, creation of consulting centres seems to be ideal.
These centres could help victims in domestic environment, and at the Journal of Health Sciences Management and Public Health same time they should provide also right education of care persons (in domestic environment), particularly in connection with the burn-out syndrome.

competent persons, the need to warn of these cases and to strengthen the self-confidence of seniors will be provoked in the whole society as well.
Generally, the issue of domestic violence should be fully extended with the issue of seniors.

When discussion in the whole society is provoked and this phenomenon is in foreground of the interest of all In case of failure of professional care persons, it is necessary, in the scope of prevention, to distil mechanisms minimizing totally the possibility of emergence of violent behaviour into the management of these services.

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Acknowledgement: The research of physical violence was financed and implemented in the scope of the research project RM 01/15/04 of the Ministry of Foreign Affairs of the Czech Republic ojaxuri Zaladoba da moxucebi ojaxuri Zaladoba da moxucebi ojaxuri Zaladoba da moxucebi ojaxuri Zaladoba da moxucebi ojaxuri Zaladoba da moxucebi petra zimelova ojaxuri Zaladobis bolodroindeli SemTxvevebi ukavSirdeba bavSvebs da qalebs.
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