While Japan's aging population is usually talked of in terms of rising welfare expenditures and the financial burden it will impose on future generations, recently a new problem has emerged: abuse of the elderly. Lawyers and other experts handling the issue say that compared with child or spouse abuse, abuse of the elderly tends to take longer to surface, in part because the elderly feel responsible when the violence is inflicted by their offspring, and also because the government and local administrators have so far failed to address the problem.

The Japan Federation of Bar Associations submitted a proposal to the Health, Labor and Welfare Ministry in October with an eye to obliging authorities to get tough on abuse. Its 54-page recommendation refers to the need to help not only victims but also the perpetrators -- in most cases, a member of the victims' family experiencing mental, physical and economic hardship as a result of caring for their elderly relative.

The nationwide lawyer group has already briefed ministry and local government officials and called on them to establish a law -- along the lines of the Child Abuse Prevention Law instituted in 2000 and the Domestic Violence Prevention Law in 2001 -- to crack down on elder abuse.

According to a nationwide poll taken by the Institute for Health Economies and Policy on behalf of the welfare ministry and released in April -- Japan's first survey of elder abuse -- 11 percent of those responding who have suffered abuse have been in a life-threatening situation.

Sons were responsible for the abuse in 32 percent of the cases, followed by daughters-in-law and spouses, each at 20 percent. About 64 percent of the cases involved mental abuse, including yelling or willful neglect, 52 percent involved denying meals or other forms of care and 50 percent included beating people or tying them to their bed.

The average age of the victims was 81.6, with women accounting for 76 percent of the total. The survey covered 1,991 abused seniors as reported by licensed care managers, including doctors, nurses and other health-care professionals. Among care managers responding, nearly 90 percent said it is difficult to find out and help victims of abuse because their families frequently hamper efforts to intervene.

A victim often hesitates to call for help and even tries to conceal the abuse from care managers or other third parties, the lawyers said in the proposal.
They said that in some cases, elderly victims refuse to flee out of fear that their offspring might steal their possessions, or because they blame themselves for the way they raised their children.

Those who believe they failed as parents consider it their duty to stay with their abusive offspring until they die. They never admit to being abused and refuse to seek help, according to the lawyer federation. One face of the problem is the growing number of murders or attempted murders when the perpetrators can no longer cope physically or mentally with caring for an elderly spouse or parent.

"To lessen the accumulating stress of people taking care of the elderly, we need to establish a more effective support system, one that includes counseling," the lawyers' proposal says, urging authorities to inform people who care for aging parents about public services they can turn to for help.

The current nursing-care insurance program is too complicated for some people to understand, and they have no idea how it can help them or how they can apply for help, the lawyers said.

They cited the importance of creating a network of communities, local-level authorities, nursing-care professionals and legal experts to identify abuse cases quickly. Problems inside the home have traditionally been regarded as a family matter. Therefore police, neighbors and schools authorities are reluctant to get involved if the family denies the allegations.

"Abuse generally takes place behind closed doors, and often follows years of complex family relations. In many cases, those carrying out the abuse often neglect human rights and are not aware that what they are doing constitutes abuse," the recommendation says.

According to the government poll, in 54.1 percent of the cases, the alleged abusers did not recognize they were abusing their victim, compared with 24.7 percent who did. In 29.8 percent of cases, those being abused did not realize they were abused, apparently due to dementia or other mental problems.
The federation cited this point to argue that elderly victims need to receive even more attention than victims of child abuse or other domestic violence.

Under the child abuse law, citizens are obliged to report suspected cases of abuse to authorities even if they have no direct evidence but see signs such as bruises or abnormal behavior, while the law against domestic violence urges people to report their suspicions.

By contrast, those who report suspected cases of elder abuse do so at the risk of violating privacy. Licensed care managers and other nursing-care workers who care for the elderly could be charged with violating the confidentiality of those they work for if they pass on information concerning alleged abuses obtained on the job.

The lawyers have expressed concern that this legal constraint sweeps the problem under the rug and endangers the elderly, and have demanded a quick response from all concerned.

"Considering these aspects of elder abuse, outside intervention is indispensable, and assessment and management by nonfamily members are crucial," their recommendation says.