Social Work Response to Elder Abuse in Uganda: Voices from Practitioners

ABSTRACT

Social workers across the globe are at the forefront of tackling elder abuse, as they are committed to social justice, human rights, and respect for human diversity. However, research on social workers’ response to elder abuse in Sub-Saharan Africa remains scarce. This qualitative study assessed how social workers in Uganda have responded to elder abuse. In-depth semi-structured interviews were used to collect data from 21 social workers. The findings suggest that social work in Uganda has not asserted itself in the fight against elder abuse. The few social work interventions aimed at reducing the risk of elder abuse are mostly anti-poverty undertakings. Social workers mainly discussed the drivers of elder abuse, correlating them with their interventions, and challenges such as the absence of a specific law for older people, ignorance of older people’s rights, and the underreporting of elder abuse. This study found that advocacy is needed for specific laws that protect the rights of older people, along with public awareness campaigns and the establishment of a research center for aging and later life.

KEYWORDS:

• Elder abuse
• older people
• human rights
• social justice
• Uganda

Social Work Response to Elder Abuse in Uganda: Voices from Practitioners

Older people in Sub-Saharan Africa have been facing elder abuse more than ever (HelpAge International, 2014) and it is estimated to accelerate as society ages (Chane & Adamek, 2015; Kotzé, 2018). The World Health Organization (WHO, 2017) predicted that the number of elder abuse cases will increase globally from 240 million in 2017 to 320 million by 2050. Although Uganda has a rich tradition of caring for older people, this tradition has been declining drastically due to rural dislocation, changing social attitudes, HIV/AIDS, and cultural shifts (Oloka-Onyango, 2008), making them vulnerable to abuse (Ministry of Gender, Labour and Social Development (MoGLSD), 2009). Information – although scarce – has shown that older people are battered, raped, accused of witchcraft, discriminated against, and neglected by their family members (Wamara & Carvalho, 2019). Elder abuse in Uganda is exacerbated by the precarious social and economic situations that characterize older people. For instance, 29% live in abject poverty and 93% do not receive a pension (Uganda Bureau of Statistics (UBOS), 2012-2013, UBOS, 2014). It is obvious that the risk of poverty increases with age, as few older people in the country have access to pension and health care services (S. O. Wandera et al., 2015). Moreover, many older people were self-employed before they stopped working (for reasons such as aging or health problems); after which they became or remained poor and vulnerable because of insufficient savings. Moreover, some older people have lived in poverty throughout their life, which deepens in old age (O. S. Wandera et al., 2017). This is further heightened by discrimination. A recent cross-sectional study on the experience of ageism among older people (n = 541) revealed that 97% of participants had faced some form of discrimination (Uganda Reach the Aged Association, 2019).

The outcomes of elder abuse are enormous, severe, and persistent, both for the victims and society; they include premature death, injury, disease, lost productivity, high risk of hospitalization, malnutrition, and deprivation of human rights and dignity (Hernandez-Tejada et al., 2020; Honarvar et al., 2020; Dong & Simon, 2013). These outcomes are diametrically opposed to the core principles of human rights, social justice, and respect for diversity – values that underpin the profession of social work (Bows & Penhale, 2018; Cox, 2020). This serves as motivation for social workers, as professionals equipped with a wide range of knowledge and theoretical base, to act in the interest of older people and protect them from any form of injustice and human rights violations. Moreover, the WHO (2017) made a clarion call to all national governments, and health and social care professionals to tackle elder abuse head-on and urgently since it is a huge public and human right concern.

The role of social work in responding to elder abuse

The diversified nature of social work offers professionals the opportunity to work with vulnerable people in varied settings (Carvalho, 2014). It involves caring for older people and embodies work aimed at enhancing their social functioning and quality of life – including prevention, investigation, safeguarding against, and intervention with elder abuse (Prinsloo, 2015; Rajeev & Jeena, 2020; Ray & Phillips, 2012). Consequently, social workers are considered among the first responders to such cases, owing to the nature of their work (Band-Winterstein et al., 2021; Bows & Penhale, 2018; Spreadbury & Hubbard, 2020). In some countries (e.g., the United States, United Kingdom, Ireland, and Australia), social workers are among the professionals mandated to report suspected cases of elder abuse, being among the first to come in contact with the victims (Healthcare Australia, 2015; Schmeidel et al., 2012). This role does not require confirming the abuse but simply reporting it, especially when the at-risk individual indicates this intent. Elder abuse is a broad category; thus, social workers must report physical, financial, and sexual abuse, as well as neglect (Bows & Penhale, 2018). A compelling argument for social workers to report abuse is the notion that old age (in some cases) comes with physical and cognitive decline that affects older people’s capability to report it themselves (Band-Winterstein et al., 2021).

Social work also involves other roles – protection of at-risk older people by organizing respite care, arrangement of timely referrals for legal and medical interventions, and arrangement of follow-up meetings with other care professionals and the victim’s family to share information and make important decisions (Bows & Penhale, 2018). This includes conducting assessments and developing care plans for the victims (Day et al., 2012; O’Donnell, 2015). Extant literature reveals that social workers organize educational and public awareness programs to empower older people to recognize their strength, and restore and construct good relationships with families, communities, and other older people (Crockett et al., 2018; Kirk et al., 2019). Moreover, social workers are responsible for safeguarding older people’s property from mismanagement. If mismanagement is suspected (Spreadbury & Hubbard, 2020), social workers can use their knowledge and relational skills to make timely interventions, such as coordinating family meetings to secure the future protection and welfare of older people and their needs.

Further, social work also embodies advocacy for better welfare outcomes for victims of elder abuse (Milne et al., 2014; Ray & Phillips, 2012). With their knowledge, skills, and values, social workers organize advocacy campaigns to enable elder abuse victims to enjoy their rights, participate in decisions regarding their care, and attain the highest level of autonomy (Wamara, 2017; O’Donnell, 2014). Therefore, at the macrolevel, social workers engage in social policy and research to influence policies and decisions regarding the protection of older people (Bows & Penhale, 2018). Hence, social work response to elder abuse has received considerable attention in gerontological research, especially in developed and industrialized nations (Band-Winterstein et al., 2021; Crockett et al., 2018; Kirk et al., 2019). However, such research remains scant in the case of Sub-Saharan Africa, despite the increasing cases of elder abuse in the region. Available literature explores the nature and perspectives of elder abuse, discrimination of older people, isolation and loneliness, access to health care by older people, and poverty in old age (Chane & Adamek, 2015; O. S. Wandera et al., 2017; Wamara & Carvalho, 2019). Therefore, this qualitative study assessed how social workers in Uganda have responded to elder abuse.

Materials and methods

The following research question was explored: How do social workers in Uganda respond to elder abuse? This research question was formulated based on the values underlining social work and the fact that it facilitates the inclusion of marginalized, socially excluded, dispossessed, vulnerable, and at-risk people (International Federation of Social Workers (IFSW), 2012). A qualitative research paradigm was adopted to tackle the research question and provide rich descriptions of the respondents’ perspectives and experiences (Denzin & Lincoln, 2011). The data were collected from trained and qualified social workers working with both governmental and non-governmental organizations (NGOs) in four districts in Uganda: Hoima (western region), Jinja (eastern region), Gulu (northern region), and Luwero and Wakiso (central region). These districts were selected because of the increased development activities and urbanization, which were presumed to accelerate the marginalization and vulnerability of the older population.

Recruitment of participants and sampling

Purposive sampling was employed to recruit social workers working with older people through the district community development officers (DCDOs) and the directors of NGOs who contacted the prospective participants and provided the author with the names and contact details of those who agreed to participate. To ensure that the participant could answer all the interview questions, the following selection criteria were determined: individuals with 1) training in social work, 2) at least a bachelor’s degree in social work, and 3) experience working directly with older people (or majority of their service users were older adults). In total, 23 social workers – nine social workers from NGOs, six CBOs, eight from local governments and two from the Ministry of Gender, Labor and Social Development were invited to participate; however, the latter two did not participate because of the lockdown imposed by the government of Uganda to control the spread of COVID-19. It was impossible to contact them by phone since their contact details were unavailable. The author met all the participants before conducting the interviews to provide them a detailed explanation of the study and a written consent form. This guaranteed validity, as only genuinely willing participants were considered. Ultimately, the author interviewed 21 social workers (10 men and 11 women, with three to 12 years of experience working with older people) between January and September 2020.

Data collection methods

An in-depth semi-structured interview guide was used to conduct semi-structured interviews to collect data. The guide’s development was based on the research question; this allowed a high degree of flexibility to formulate new questions depending on the emerging issues. Of the 21 participants, three preferred telephonic interviews because of the COVID-19 pandemic. The telephonic interviews were scheduled with the respondents to obtain detailed responses. The key topics included in the interview guide were: how often the social workers handled cases of elder abuse, the interventions used, and the challenges encountered when tackling elder abuse.

The interviews lasted between one to one-and-a-half hours, which was enough for the participants to share their experiences. The interviews began with rapport building through introductions. This was followed by four questions, and each included further prompts as follows. (1) How often did social workers handle cases of elder abuse in their organization or department? (2) How were they informed about these cases? (3) What kind of interventions was employed by social workers? (4) What were the difficulties faced by social workers while addressing elder abuse? The prompts revolved around the causes of elder abuse in the country, government program and projects that target older people, opportunities for social work in the country, work with the victims and their families, and effectiveness of their interventions. All interviews were conducted by the author to ensure uniformity.

Data analysis

Qualitative content analysis was employed to identify relevant themes from the data and determine whether there were variations in the content (Berg, 2001). This included a series of steps. First, the author transcribed the audiotapes verbatim to ensure reliability. Second, the author thoroughly read all the transcripts and field notes to understand the content as a whole. It was noted that most of the social workers discussed the perceived causes of elder abuse, social work interventions, and challenges. Third, the author sorted the interview text according to the three themes as bases. Fourth, the author crossed-checked the themes found in some transcripts, by asking certain participants additional questions to gain credibility and trustworthiness. Fifth, the author read and reflected on the findings to facilitate the discussion.

Ethical considerations

The ethical standards of social work practice were followed since qualitative designs share similar values and ethics. Beauchamp and Childress (1989) determined ethics such as respect for autonomy, beneficence, non-maleficence, and social justice. In line with these ethical values, autonomy was respected by sharing the details of the project. Each participant was informed about the study’s aim, methods, and the voluntary nature of their participation. The confidential nature of the participants’ responses was emphasized. All the participants signed consent forms. The principle of beneficence was ensured by emphasizing the benefits of engaging in the study, while the principle of non-maleficence was maintained by stressing the participant’s right to abstain from the study or withdraw at any time. Finally, the researcher sought and received ethical approval from Uganda National Council of Science and Technology, reference number SS 5049 and Uppsala Regional Ethics Board in Sweden, reference number 2019–02916.

Results

The following three overarching themes were identified from the participant’s narratives: (1) perceived causes of elder abuse, (2) social work interventions, and (3) challenges. The themes are explained using participants’ quotes to enliven the analysis and demonstrate credibility (Berg, 2001).

Theme 1: Perceived causes of elder abuse

Lack of awareness on what constitutes elder abuse

The lack of awareness on what constitutes abuse was reported as a cause of elder abuse. The participants explained that most of the time, older people were unaware that they were being abused. Additionally, the families and community were generally ignorant about the various forms of abuse. They reported that since elder abuse had not gained national notoriety, it was rarely mentioned in the public domain. Some social workers confirmed that they heard about elder abuse for the first time after joining institutions that worked with older people. One social worker remarked, “I heard about elder abuse after joining this organization (the agency the participant works with); I never heard about this in the university apart from child abuse” (Social Worker 5, interview, June 21, 2020).

According to the participants, scant understanding of elder abuse obstructed it from being reported to the relevant agencies for timely action. Several participants believe that older people are unaware of their rights; thus, they seldom challenged their abusers. The lack of knowledge about older people’s rights was considered two-fold. One social worker said, “Older people do not know that they have rights, and the abusers also don’t know that older people have rights” (Social Worker 9, interview, July 17, 2020).

“Older people are believed to be different from others.”

The participants correlated elder abuse and discrimination. They reported that discrimination based on age was widespread and posed a threat to the rights of older people in the country. According to the participants, ageism signified negative beliefs, prejudices, and attitudes regarding older people. Following are some of the prejudices: older people lack the energy and skills to work; older people are greedy, vulnerable, and a burden to society; they are rigid and conservative; and they are poor, slow workers, senile, and technophobic. Some participants also reported that people strongly believe that older people should not engage in sexual relations because of their age. They recounted that ageist conceptions exposed older people to dehumanizing actions and the society had little concern about their wellbeing. One of the social workers remarked that,

Today, people make a lot of stereotypes about older people in this country and that is the beginning of elder abuse. With such stereotypes, young people think that older people receive what is due to them and they do not see anything wrong in their actions. They also think whatever they do for older people, they are helping them (Social Worker 12, interview, July 16, 2020).

Generally, the participants agreed that ageist stereotypes obstructed society from fulfilling the practical needs of older people.

“Most of the older people are poor.”

Poverty was identified as another cause of elder abuse. Participants reported that most of the older people were poor and depended on their adult children and relatives, who in turn found it difficult to provide for them along with their own children and other dependents. Overreliance on children and relatives and the fear of alienation restricted older people from reporting abuse. One social worker remarked, “Many older people depend on their children and relatives because they don’t have money. In such circumstances, they cannot report abuse because they know reporting would lead to starvation and death. So, they suffer silently” (Social Worker 12, interview, July 16, 2020) and another respondent shared that,

Older people are poor; they depend on others for survival. In most cases, those caring for them also have families and children to look after and when the demand is too much, it’s always the older people who are neglected (Social Worker 7, interview, June 30, 2020).

The participants believe that poverty is forcing young people to migrate in search of work, leaving older people to fend for themselves and thereby exposing the latter to vulnerabilities, loneliness, and isolation, which culminates in abuse. In addition, some participants reported that the lack of transportation and inability to afford court fees to challenge their abusers prevented older people from reporting their abuse. They also confirmed that some people responsible for looking after older people were poor and depended on them; therefore, they ended up abusing the latter by stealing from them.

“They live with big families.”

Many social workers mentioned that elder abuse was promoted by the extended and beanpole families that include many people. They accepted that in such arrangements, older people were at a greater risk of being abused by the adult children. It was said that in such families the abusers and victims share strong dependence and attachment; therefore, it was difficult to notice abuse since it could be kept within family members. The participants mentioned that elders were not cared for in extended families because they did not get their meals on time or what they wanted to eat (for example, the food would be served to every family member at the same time, instead of accommodating the older person’s needs). A participant mentioned, “In big families, older people do not get what they want because most of those big families are poor and if they ask for something, they are insulted or reminded of how they failed to plan during their heyday” (Social Worker 6, interview, June 28, 2020).

Peer influence

Peer groups that influence young people to engage in sordid behavior were identified as another cause of elder abuse. The participants believe that peer groups influence young people to steal older people’s property to arrange money for alcohol and drugs. They recounted that adult children who assaulted their aging parents were mostly under the influence of alcohol or drugs. It is easier for children under their grandparent’s care to associate with such peer groups than those under their parent’s care because grandparents tend to be more lenient and liberal toward their grandchildren.

Cultural and family changes: “Families are no longer playing their role.”

Further, cultural decline was identified as being instrumental in facilitating elder abuse. The participants believe that people are deviating from traditional ways that value and respect older people because of their knowledge and experience. A social worker remarked:

Older people are majorly abused because society is quickly moving away from the cultural values and customs. In the past, older people were powerful and respected. Children would greet them by kneeling down and would take pride in helping them (Social Worker 15, interview, August 11, 2020).

The participants further described that Uganda’s culture mandates every member of the society to support older people and other weak members of the family. They expressed their frustration about the decline in this belief due to modernization and self-centeredness that were inauspiciously shaping the social bonds between generations, causing generational conflict. They mentioned that urbanization had weakened intergenerational harmony and imperiled social cohesiveness, which was essential to ensuring care and protection for older people. They also mentioned that self-centeredness had ushered in the era of nuclear families that did not accommodate older people.

Majority of the participants denounced the increasing desire for material gain. They pointed out that greed was making young people conniving and untrustworthy. One social worker remarked:

There was a man who sold his father’s plot of land when the father was in the village. When the father came back, he found people building a new house on his land and when he made enquiries, he was told that his son had sold the land (Social Worker 2, interview, March 14, 2020).

Silent media and associations

The participants also highlighted the media’s silence regarding elder abuse. The frequency with which the media was reporting cases of elder abuse was insufficient to garner support against the issue. One social worker expressed, “The only media story on elder abuse that gained national infamy in Uganda was the physical battering of an older person by a grandson in Omoro district” (Social Worker 12, interview, July 16, 2020). They also hinted that older people’s organizations were incapable of advocating against, and disseminating information about, elder abuse. For the participants, the silence and inaction of other organizations highlight the failure of people who were supposed to protect older people.

Severance of family ties was reported to aggravate elder abuse. Social workers described that the family provided a strong social fabric for the care of older people. However, this caring practice was diminishing because of HIV/AIDS, civil war, youth unemployment, and family conflicts. The following excerpt explains this: “Older people are currently vulnerable because of the breakdown of the traditional family setup. They work on their own to survive. Many are engaged in petty business and are despised for this pursuit, and their products are bought at the lowest prices” (Social Worker 7, interview, June 30, 2020).

Further, the participants revealed that most of the older people did not have documents to support the ownership of their land. They did not demarcate their land, and in most cases, the boundaries were ambiguous. This made older people more susceptible to land grabbing. The participants reported that conflict over land had strengthened the disunity between community and family, which increased the risk of elder abuse. In addition, the participants felt that the government of Uganda had not invested enough resources to improve the welfare of its older citizens. For example, geriatric services were almost negligible, and the relationship between health workers and older people was poor. The participants mentioned that because of the lack of training in geriatrics, health workers did not associate with older people properly, causing anger and frustration among the latter.

Theme 2: Social work interventions

The findings revealed that the participants employed six major interventions to address elder abuse. Most of these were intended to reduce poverty and vulnerability among older people, which, according to the participants, reduced the risk of elder abuse. The few direct and deliberate interventions that tackled elder abuse were implemented by social workers working with NGOs, while government-employed social workers addressed elder abuse through mainstream poverty eradication programs.

Awareness creation

Most participants recognized awareness creation regarding elder abuse as the first intervention. This involves educating and empowering older people about their rights, which helps them challenge and report abuse. A participant reported, “When older people are aware of their rights and relevant laws, they proactively demand their rights. They also become defenders of the uninformed older people whose rights are being abused” (Social Worker 8, interview, July 9, 2020). Awareness creation was conducted through face-to-face education sessions, radio talk shows, radio spot messages, posters, and stickers. Some of the posters included messages such as Ngat ma otegi mito konywa wek kwone obed maber [an older person needs our support for a better living]. Community-based facilitators (older people’s ambassadors) and parasocial workers, who are trained and facilitated by NGOs, conducted the face-to-face human rights education sessions.

Cash transfer

Cash transfer was another form of intervention. The participants revealed that they provided grants to older people aged 80 years and above under the Social Assistance Grant for Empowerment (SAGE) to address urgent problems, such as their nutrition, access to health, improved savings, and reduced dependence on the extended family. The following excerpt reflects this.

When older people received the SAGE money, they were able to go to the hospitals and receive treatment. They were able to buy food, salt, and dry cells so that they can listen to their radios. Older people want to listen to radios for information, but many cannot afford to buy dry cells (Social Worker 5, interview, June 5, 2020).

However, some participants regarded the monthly remittances as inadequate. Additionally, some of them expressed disagreement about the grant’s age criteria for the candidates (80 years or above) as several old people aged between 65–75 years also lived in abject poverty. It was also mentioned that in some sub-counties in Lira and Karamoja, there were very few older people aged 80 years and above.

Livelihood support activities

Further, livelihood support activities were employed to tackle elder abuse by addressing the triple problems of poverty, vulnerability, and marginalization. While some of the livelihood support activities directly targeted older people, others empowered them to take care of orphans. Since NGOs and governmental organizations prefer to support older people in groups, some social workers organized them in groups, developed group constitutions, helped with registration, and opened bank accounts for them. Importantly, social workers assessed the older people’s situation to establish the right businesses for them, such as piggery, apiary, poultry, and goat-rearing projects to enhance their income. The following excerpt reflects this.

We do economic strengthening for the older people, especially the victims of abuse. We group them and provide start-up capital, a minimum of 500,000 Uganda shillings (US$ 140). They use this money to buy piglets, chicken, and farm inputs (Social Worker 2, interview, March 14, 2020).

Older people also engaged in craftwork such as making beads, local musical instruments, bowls, and arrows. Some of them received farm inputs like seeds, seedlings, and other planting material under the Wealth Creation Program created by the government of Uganda to tackle poverty. However, this was limited to those who possess the physical strength to engage in farming.

Psychosocial support

Another intervention identified from the data was psychosocial support to help older people cope with the psychological and social impacts of elder abuse. This intervention enables victims to comprehend their situation, explore their problem, and understand the options available to address the abuse. Through psychosocial support, victims are assisted to develop their own plan of action to cope with abuse. The participants reported that they administered cognitive–behavioral conjoint therapy (CBCT) to improve interpersonal relations and restore hope for those who were at the verge of dying by suicide because of abuse.

We do what we call CBCT for older people who have suffered trauma because of serious abuse. We group them and take them through CBCT for 10 weeks, making them believe that what happened to them cannot be reversed but they can become better by learning how to manage future problems (Social Worker 2, interview, March 14, 2020).

Mediation

Another intervention technique employed by social workers was mediation to resolve family conflicts. Specifically, they supported older people and their families to identify key areas of disagreement, understand options for mutual gain, and formulate a plan of action.

We do mediation. We ask them to pinpoint the areas of conflict within the family. After we generate a list of alternatives that can end the conflict in the family and then we support the family to cope up with an action plan. Our work is to make follow-ups and review the action plan (Social Worker 3, interview, March 18, 2020).

The participants believe that mediation is less invasive than the criminal justice system because conflicts are settled within the families. However, some participants doubt the effectiveness of mediation because of its complex nature – its success entirely depends on who implements the action plan – especially if those who abuse older people are the ones expected to implement the plan.

Research and advocacy

Finally, some participants mentioned that they were undertaking advocacy and research to influence legislation. Many social workers reported that they participated in advocacy campaigns to demand protection laws, gender-inclusive budgets, better social protection systems, inclusive financial services, and inclusion of older people in government programs. The participants networked and collaborated with local and national organizations to tackle abuse and discrimination of older people. One social worker explained, “We work with the Uganda Social Protection Platform to advocate for social protection financing so as to provide basic welfare to older people. We realized that older people are suffering because a majority lack some form of social security” (Social Worker 12, interview, July 16, 2020). Advocacy also involved efforts to convince the government to redefine its priorities and reallocate resources to cater to older people’s needs. The participants revealed that they used important days like the International Day for Older Persons and the World Elder Abuse Awareness Day as platforms for national dialogue. Some participants also collaborated with legal aid organizations to offer free legal services to older people.

To facilitate evidence-based advocacy against elder abuse, the participants also engaged in research such as conducting surveys on the experiences of ageism, needs assessment for older refugees, and rights and voices of older people. Research was conducted to highlight older people’s needs and risk factors for abuse so that relevant government agencies could take actions to protect the rights of older people. One social worker reported that,

We do some research in this organization; last year we conducted a survey on older people’s experiences of ageism with funding from Help Age International but as you know, doing research is one thing and disseminating it is another. We lack resources to disseminate such important findings to the public (Social Worker 16, interview, August 16, 2020).

Theme 3: Challenges

“There is no specific law for older people like for the case of children.”

The participants believe that their efforts to address elder abuse are affected by the absence of a specific law on the rights of older people. They explained that existing Ugandan laws for older people treat them equally like other groups. However, specific issues like elder abuse are not addressed by these laws. Additionally, these laws do not mandate social workers to provide care and protect older people. Therefore, their role in the context of older people remains ambiguous. Further, the participants discussed the laws’ poor implementation. According to them, those who were responsible for the implementation of these laws lacked commitment, motivation, and resources. Moreover, owing to insufficient dissemination, several social workers were unaware of these laws.

The dissemination is very poor. When these laws are made, they are disseminated to only top leaders including Ministers, Permanent Secretaries, Chief Administrative Officers, and District Chairpersons. They are not disseminated to those who work with the older people like us (Social Worker 5, interview, June 21, 2020).

The participants also revealed that in many cases, dissemination of laws is relegated to NGOs, who tend to target only a small number of people and limited geographical locations.

Limited gerontological and legal knowledge

The participants acknowledged the lack of knowledge among the practitioners who work with older people. They revealed that majority of the community development officers (CDOs) working with older people did not have any basic training in gerontology and were simply assigned by the chief administrative officers to oversee older people’s activities. Since CDOs did not study social work, their approaches and methods disregard the retention of an individual’s worth and dignity. Most of the participants accepted that they lacked knowledge on the care and protection of older people; thus, they offered services in a generalized manner. In fact, the participants believe that social work training does not equip social workers with the legitimate power to remove at-risk older people from their families or inspect their homes, which further hinders responding to elder abuse. Social workers also mentioned that they did not offer their services in association with other professions such as medicine and law. One participant reported that, “We lack proper coordination when it comes to addressing elder abuse. Once you refer the case, that is all, you do not get feedback unless you follow up” (Social Worker 9, interview, July 12, 2020). They believe that an interdisciplinary approach and comprehensive services are required to address the complexity and diversity of the said issue. They stated that because of insufficient knowledge on the relevant laws, they were unable to protect older people from land grabbing. For this, they require the assistance of people with relevant legal background.

Most of the interventions that directly addressed elder abuse were implemented by NGOs as project activities. The social workers felt that such interventions were not sustainable because of their short lifespans.

The participants also reported that insufficient resources hindered social work activities. They recounted that it was difficult to monitor whether a decision was made during mediations. They also lacked casebooks and means of transport to follow up on cases of elder abuse. They revealed that development partners preferred funding activities for children and women than the rights of older people. Further, one sub-county was allotted one CDO who was responsible for the management of welfare for children, women, older people, and disability affairs; this has caused the neglect of elder abuse. Additionally, the participants stated that there were few organizations that worked with older people; as such, social workers lacked substantial support to influence policies.

Inadequate government funding

The participants also stressed that the Functional Adult Literacy (FAL) program, which disseminates basic knowledge and skills such as reading, writing, and numeracy among older people, was not receiving funds from the government. The program empowers older people to address their needs, live a more productive, healthier, and happier life, and address their abuse.

“Elder abuse is not recognized as a problem.”

The participants believe that the nonrecognition of elder abuse as a social problem is another significant challenge and that older people do not report abuse because they are often dependent on their tormentors or afraid of being considered bad parents. One participant reported, “Older people do not report because usually the abusers are their own children. They fear to report their own children because they fear of being accused of poor child upbringing” (Social Worker 14, interview, August 10, 2020).

“Reporting elder abuse is tricky.” Many participants argued that elder abuse was both a criminal and civil issue, but it was easier to report criminal abuses than civil abuses. Criminal cases were easier to report while civil abuses were registered in the court of law, which required going through certain procedures that older people dislike.

Discussion

The following three themes were identified from the analysis: perceived causes of elder abuse, current social work interventions, and challenges. While Uganda has made remarkable progress in improving the welfare of older people on several fronts, it lags behind in tackling elder abuse mainly because the issue has not gained significant public attention. This is attributed to the silence of the media and weak organizations of older people to educate the public about elder abuse. This finding is consistent with the findings of Penhale (2020) who reported that elder abuse was systematically ignored by the media. The case of non-vibrant associations of older people is observed by Oloka-Onyango (2008) who found that most of the older people’s associations in Uganda have a weak capacity to advocate for the rights of their service users. Therefore, social workers need to cooperate with the media and enhance the capacities of older people’s associations to protect the rights of older people.

Corresponding with the observation made in Twikirize et al. (2014), this study found that in Uganda, social work has not established itself in the fight against elder abuse because professional care and protection of older people is just beginning to emerge in the country. Oloka-Onyango (2008) attributed the lack of professional care to two factors. First, the traditional family and clan systems were significantly strong and guaranteed oversight and care of older people; therefore, for a long time, gerontology was not a scientific or administrative concern. Second, the social and political instabilities that plagued the country obstructed the recognition that older people require care and protection. The participants of this study confirmed that gerontology was not yet a part of social work education or training. They admitted to not studying about aging during their social work training. This supports Oloka-Onyango’s (2008) claim that the six-week certificate training course offered at Nsamizi Training Institute for Social Development was the only gerontological social work training in Uganda. Cox and Pardasani (2017) identified the need to offer gerontological courses to social work students and develop geriatric social work to prepare them to serve the aging population appropriately.

Most of the interventions identified in this study fall under community development, developmental, and therapeutic social work approaches. This can be explained by the remedial (providing skills to vulnerable groups), therapeutic (reducing trauma and helping the victims recover from the effects of unfortunate events such as flood, war, violence, HIV/AIDS), and curative (addressing the factors associated with poverty, vulnerability, and marginalization) nature of social work in the country (Twikirize et al., 2013). Moreover, social workers could be motivated by the perception that elder abuse is a developmental deficit-related issue with psychosocial effects. However, research from South Africa identifies elder abuse as a structural and cultural issue that requires structurally and culturally relevant interventions (Kotzé, 2018). Therefore, this study highlights that social workers should design structurally and culturally appropriate interventions to tackle elder abuse. Social workers clearly identified insufficient funding as one of the main challenges, stemming from the government’s prioritization of developmental projects. According to a study in Uganda, welfare systems for older people received limited funding from the government and relied majorly on external funding, as the government had other priorities (Cammack & Twinamatsiko, 2013). This is because expenditures on older people are considered charity that depletes public resources without generating resources in return. Given that elder abuse affects the rights of older people and has severe consequences, the results of this study highlight the urgent need to fund interventions to tackle elder abuse in the country.

The participants recognized elder abuse as an underreported social problem; this corresponds with the findings of several studies on social work (e.g., Penhale, 2020). Beard and Payne (2005) determined four reasons behind the underreporting of elder abuse in the United States: older people’s ignorance about abuse, failure to report due to ill-health, fear of future harm, and disregard of abusive actions as criminal. The WHO (2017) revealed that only one in twenty four cases of elder abuse is reported. The findings of the present study establish that the underreporting of elder abuse cases is due to older people’s ignorance of what constitutes abuse and their fear of being reprimanded for the poor upbringing of their children. This finding corresponds with Smith (2015) who observed similar ethical dilemmas in reporting elder abuse. Consequently, mandatory reporting policies, including easy reporting mechanisms such as telephone services, should be established to tackle this challenge.

Extant literature on aging is replete with calls for advocacy to improve the wellbeing of older people (Cox, 2020; Peisah et al., 2020), and the participants of the current study reiterated the importance of advocacy to free older people from abuse. The participants confirmed that advocacy provides older people with voices to express their experiences and report abuse.

The findings of the present study indicate that social workers are working independently to tackle elder abuse in the country, which means the absence of collaboration among professionals such as nurses, doctors, and psychologists. However, collaboration exists between organizations but not professionals. This finding supports Spitzer and Mabeyo (2016) who observed the lack of collaboration between social workers and health professionals. This is contrary to the literature that emphasizes an interdisciplinary approach involving psychological, medical, social, political, and legal interventions and actions (Falck, 2013). Therefore, the need for different professionals to coalesce and address the different dimensions of abuse is now recognized as significant (Spitzer & Mabeyo, 2016). Social workers are encouraged through their code of ethics to embrace interdisciplinary collaboration to achieve the best welfare outcomes for their service users (National Association of Social Workers (NASW), 2008). This implies that social workers should take the lead and coordinate with other professionals to provide comprehensive services to the victims of elder abuse.

Further, the participants revealed that cash grants for older people have ensured their nutrition, health, and savings, and reduced dependence. This corresponds with the findings of Merttens and Jones (2014) who studied cash grants for older people in Uganda. This suggests that cash grants should be enhanced and provided to people aged 60 years and above.

Recommendations

This study found that there is no legislation that directly addresses the rights of older people in Uganda. While Uganda has several laws, policies, and action plans for older people, they do not mention elder abuse but instead, poverty, social security, and ill health. Therefore, social workers should advocate for a specific law that addresses the specific needs of this population. Further, the role of advocacy is highlighted to inform policymakers about elder abuse as a national problem that threatens the wellbeing of older people, and demand proper implementation of the corresponding laws. This will not only address elder abuse but ensure equal opportunities for them and increase their participation in the development process. Social workers should also create nationwide awareness campaigns to educate the public about the rights of older people.

Given that elder abuse is diverse, Ugandan social work institutions should establish a research center for aging and later life to bolster aging research and demonstrate the contribution of social work toward the wellbeing of older people in the country. This will facilitate evidence-based advocacy, which is crucial for policy formulation and change. To address elder abuse, social workers need to adopt an integrative approach that brings the community, family members, and older individuals together and communicate regarding the concerns of aging in a transparent manner. Similarly, social work should promote a multidisciplinary practice to address the multifaceted nature of elder abuse. Professionals such as lawyers, media practitioners, psychologists, doctors, and nurses should support social workers in providing comprehensive services to improve the welfare outcomes for older people in the country.

Further, appropriate action, such as the quick dissolution of cases involving older people, must be deployed to tackle the increasing number of land grabbing cases. Social workers should design programs that assist older people in acquiring land titles. They should work with the government to promote programs that motivate the younger generation to migrate from urban areas to rural areas and address the isolation and loneliness of older people.

While social workers have relied on the World Elder Abuse Awareness Day for national dialogue, it has been mainly organized in central districts; however, elder abuse occurs in both rural and urban communities. Therefore, its observance needs to be decentralized at the district and sub county level to provide rural communities an opportunity to acquire better knowledge of elder abuse, and allow them to express their voices against elder abuse and neglect. Moreover, social workers should not only use this platform for advocacy but also to emphasize that safeguarding older people is everyone’s duty and urge the public to recognize and report abuse, to promote older people’s wellbeing.

Limitations of the study

The lockdown imposed by the Ugandan government as a preventive measure against the spread of the coronavirus (COVID-19) made it difficult to interview social workers from the Ministry of Gender, Labor, and Social Development. Since the study relied on the responses of social workers from different local governments, potentially valuable information from the ministry officials’ perspective is missing. Further, the study relied on the responses of 21 social workers, which limits the possibility of generalizing the conclusions of this study. Additionally, the study employed telephonic interviews, which were heavily affected by technical glitches such as poor sound and faulty connections. Some of the recorded interviews were inaudible and difficult to transcribe. Moreover, the interviews were susceptible to postponement by the participants, which adversely affected the data collection schedule.

While it was determined that social workers used several interventions to tackle elder abuse, this study did not assess their effectiveness because the participants mentioned that the effectiveness of these interventions was evaluated by the monitoring and evaluation unit. Hence future research should evaluate the effectiveness of such interventions to improve gerontological social work practice. Finally, the COVID-19 pandemic and subsequent lockdown caused the closure of organizations that help older people. Therefore, further research is required to explore the effects of the COVID-19 pandemic on both older people and the social work response.

Acknowledgments

The author appreciates Professor Thomas Strandberg and Dr Maria Bennich for their supervisory role in this project at Örebro University. The author would like to thank all the District Community Development Officers for Hoima, Gulu, Jinja and Luwero for coordinating the recruitment of the study participants.

Disclosure Statement

The author has no relevant or material financial interests to declare that relate to the research described in this article.

Additional information

Funding

This project has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No 754285