Abstract

Elder abuse, any intentional or negligent act that causes harm, distress, or suffering to an adult aged 65 or older, has become a significant social issue in South Korea. Based on a 15-year nationwide report on elder abuse from 2008 to 2022, this study aims to thoroughly examine current trends and issues surrounding elder abuse. Three key issues emerged: 1) family members as primary perpetrators, 2) increases in elder abuse in nursing homes, and 3) co-occurrence of multiple types of elder abuse. To effectively address this growing concern and uphold the human rights of older individuals, six recommendations are proposed: 1) expanding employment opportunities for older adults, 2) addressing the reluctance to report elder abuse, 3) developing tailored strategies for preventing and addressing different types of elder abuse, 4) enhancing family education and therapy in elder abuse prevention, 5) providing elder abuse education for long-term care staff, and 6) improving monitoring systems for elder abuse prevention in nursing homes. This study provides a foundation for effective elder abuse prevention through policy measures aimed at addressing the human rights challenges associated with elder abuse.

Introduction

As of 2024, South Korea (hereafter, Korea) is projected to have a total population of just over 50 million (1). The population growth rate is expected to turn negative from 2021, possibly falling below 50 million by 2041, with projections of decrease to 30 million by 2066 (1). However, the proportion of people aged 65 and older in the total population is expected to rise annually from 17.5% in 2022 to 40% in 2050. The aging index (i.e., the ratio of people aged 65 and over to 100 people aged 14 and under) is projected to increase from 152 in 2022 to 456.2 in 2050, reaching 620 by 2070, propelling Korea into an ultra-aging society (2). The country’s rapid economic growth, enhanced living standards, and advancements in disease prevention and treatment have led to a significant increase in the proportion of the older population as a result of increasing life expectancy (3, 4). With the swift rise in the older population, combined with the rapid increase in nuclear families, diminishing sense of dependency, and inadequate personal, social, and national preparation to support aging individuals, elder abuse has emerged as a pressing and unprecedented social issue (5).

In 2018, South Korea’s Welfare of Senior Citizens Act defined “elder abuse” as any act of physical, mental, emotional, or sexual violence, as well as economic exploitation, abandonment, or neglect, directed toward individuals aged 65 or older (5). Instances of elder abuse encompass actions, ranging from neglecting the essential needs of older individuals to negligence by nursing facilities that are obligated to provide care, constituting a serious anti-social and criminal offense (6). Compared to other social issues such as child and marital abuse, elder abuse has gained significantly less public attention, remaining largely overlooked (7). Conversely, the risk of elder abuse is likely to escalate with the increasing number of vulnerable populations, including older adults who are economically disadvantaged, chronically ill, socially isolated, and those with dementia, who struggle with communication (7).

According to the Status Report on Elder Abuse by the South Korean Ministry of Health and Welfare, the reported cases of elder abuse have almost doubled in a decade, escalating from 2,674 in 2009 to 5,243 in 2019, and further to 6,259 in 2020, marking a 19.4% increase from the previous year (8). Elder abuse is now beyond an individual or household problem. The demand and need to protect abused individuals and enhance their rights and interests has transcended the individual level, becoming imperative at a societal level. It is recognized that Korea is still lagging behind other developed nations in terms of social awareness, as well as in the legal and institutional frameworks regarding elder abuse. Thus, this paper aims to examine three major issues in elder abuse cases reported from 2008 to 2022, obtained by the Korea Elder Protection Agencies, and provide six suggestions to foster a societal environment where elder abuse issues can be openly discussed and effectively addressed.

Current Issues

Family Members as a Primary Perpetrator

The most distinctive characteristic of elder abuse in Korea is that it predominantly occurs within families and is often influenced by family dynamics and cultural context within the country. Over the course of 15 years from 2008 to 2022, family members including spouse, son, daughter-in-law, daughter, son-in-law, grandchild, and other relatives were identified as the most frequent perpetrators of elder abuse (9). Particularly, sons and spouses, who play crucial roles in elder care, account for more than 70% of the total cases (9). What makes it worse is that elder abuse is much less reported than it actually occurs because it is regarded as a private family issue. Older adults who suffer abuse tend to endure silently, treat their pain as a family shame, and hesitate to report it, fearing further harm and retaliation from family members.

The fact that family members are the primary perpetrators of elder abuse can be understood in the context of Korea’s traditional family culture. In Confucianism, which is deeply embedded in Korean society, close family members are culturally and customarily responsible for supporting their aging parents (10). However, in the absence of sufficient support systems for families, this responsibility can lead to overwhelming caregiver burden and fatigue, which may ultimately result in elder abuse. Notably, sons often bear the greatest pressure among family members due to traditional expectations that they, as male children, are primarily responsible for the care of their aging parents. As a result, there has been a significant increase in abuse perpetrated by sons.

Increase of Elder Abuse in Nursing Homes

A notable increase in elder abuse has been observed in nursing homes. The percentage of older Koreans residing in nursing homes rose from 40% in 2011 to 76.2% in 2018 (11). Since the implementation of the Long-term Care Insurance Act in 2008, there has been a rise in the number of older individuals residing in long-term care facilities along with an increase in abuse incidents in this setting (11). Reported abuse in nursing homes was about 10% in 2017 and soared to 25.8% in 2021, equating to nearly a quarter of all reported cases (9). The issue of elder abuse in nursing homes, is much more complicated because it involves not only mistreatment by staff as well as conflicts among residents, direct care workers’ job satisfaction and turnover, and inadequate facility resources and support (12). In addition, nursing home residents with multiple conditions such as dementia or mental illness are more vulnerable to abuse (9). Some major reasons behind elder abuse in facilities include a lack of standardized nursing home quality assessments by the government, a lack of elder abuse prevention training or continued education for staff, and differing understandings and expectations among residents regarding cohabitation (13, 14).

Co-Occurrence of Multiple Types of Elder Abuse

The last issue of elder abuse is the co-occurrence of multiple types of abuse. These types often happen simultaneously, exacerbating the physical and psychological harm experienced by older adults. Among various types-such as physical abuse, emotional abuse, financial abuse, neglect, sexual abuse, self-neglect, and abandonment-emotional abuse consistently had the highest average rate over the 15-year period (2008-2022); at 40.6%, followed by physical abuse at 30.8% (9). Notably, in 2021, emotional and physical abuse combined accounted for over 80% of total cases (9).

Physical abuse involves using force or using tools to inflict harm, pain, or disability on an older adult, including actions like handcuffing or imposing non-consensual labor (15). Emotional abuse encompasses behaviors like blame, insults, or threats that cause distress, as well as deliberate social isolation and exclusion from important decisions (15). Research indicates that the physical trauma and emotional scars resulting from elder abuse can lead to long-lasting adverse effects, such as depression, anxiety, post-traumatic stress disorder, a decline in quality of life, and even suicide (16).

In addition, sexual abuse-which includes both sexual humiliation and acts of sexual violence such as unwanted physical contact and verbal harassment-has doubled over the past 15 years. Its prevalence rose from 1% in 2008 to 2.5% in 2022, with older adults suffering from cognitive impairments being particularly vulnerable (9). Furthermore, there is a pressing need to address mistreatment against bisexual and gay older adults. LGBTQ older adults often face discrimination in accessing government benefits, including housing, pensions, and healthcare, and are frequently pressured into unwanted disclosure of their sexual orientation (9).

Suggestions

Expanding Employment Opportunities for Older Adults

High economic dependence on children due to poverty is a major contributor to elder abuse (17). To address this, stable employment policies for older adults are essential, including the creation of suitable jobs and the provision of ongoing employment opportunities to ensure financial independence. Empowering older individuals to live independently as active members of society is crucial for fostering a sense of pride and self-sufficiency. Expanding employment opportunities for older adults has been shown to positively impact not only their financial stability but also their physical and mental health, as well as their social relationships.

Addressing the Reluctance to Report Elder Abuse: The Role of Education and Support Systems

Older adults’ deep love for their children often makes it difficult for them to report elder abuse. Even when abuse occurs, they are frequently hesitant to come forward, fearing the exposure of their children’s actions and the potential for worsening the situation or facing re-abuse (18). This reluctance to report abuse contributes significantly to its persistence. To address this, it is crucial to establish a system that enables immediate reporting of elder abuse by the elderly themselves, preventing further abuse and promoting prevention measures. As a practical solution, nursing homes should educate older adults about behaviors that constitute elder abuse, ensuring both residents and staff have a clear understanding. Those who experience abuse should be institutionally protected and supported in reporting it promptly.

Developing Tailored Strategies for Preventing and Addressing Different Types of Elder Abuse

To effectively prevent and address various forms of abuse, tailored strategies should be developed specific to the prevention and intervention of each type of abuse. Clear and specific response strategies, including defined reporting methods and procedures, are essential for optimal prevention and treatment. Currently, elder abuse is addressed in a broad, undifferentiated manner, without distinguishing between its various types (9). To improve outcomes, differentiated prevention and post-intervention measures should be developed for each type of abuse, beginning with the most prevalent forms and gradually expanding to cover all types.

Enhancing Family Education and Therapy in Elder Abuse Prevention

As family members are often the primary perpetrators of elder abuse, the issue is frequently seen as an internal family matter. This reluctance to disclose abuse and the tendency to deny its existence contribute to its recurrence (18). To address this, family education is essential to help members recognize and manage their emotions. Additionally, older victims should receive social education to prevent strong attachments and biases from disrupting healthy family dynamics. Social workers or related-field consultants may play a key role in facilitating these efforts by guiding both families and victims. Implementing family therapy and family-strengthening programs is also vital to support the overall well-being of the entire family.

Elder Abuse Education for Long-term Care Staff

The number of long-term care service workers serving older individuals is significantly increasing (11). To appropriately leverage this growing workforce, it is essential to establish a system that uses these workers to detect elder abuse early and prevent it through ongoing monitoring (19). Effective elder abuse prevention requires both active educational efforts and responsive actions that are supported by nursing home providers. For example, nursing staff and direct care workers should develop a strong understanding of residents’ rights and elder abuse to prevent themselves from unintentionally becoming perpetrators. Ongoing training programs should be implemented for nursing home staff to reinforce their role in preventing and identifying abuse. Additionally, clear procedures and methods for intervening in cases of elder abuse should be established.

Improving Monitoring Systems for Elder Abuse Prevention in Nursing Homes

Older individuals living in nursing homes often experience physical and mental discomfort, making it difficult for them to properly express themselves if they are being abused. While the installation of security cameras in public areas of these facilities can raise concerns about privacy violations, their potential to protect residents and prevent elder abuse should be carefully considered. Security cameras should be viewed as a tool for enhancing public safety, preventing abuse, and supporting legal action, rather than merely as a violation of personal rights. Currently, emergency telephones are available in long-term care facilities but are ineffective due to lack of awareness (9). To improve their effectiveness, emergency numbers should be simplified for easier memorization by residents, and stronger confidentiality measures should be implemented to ensure swift responses to elder abuse while maintaining privacy.

Conclusion

This paper makes a significant and original contribution to the existing literature on elder abuse in two ways. It is one of the first trials to examine 15 years of national data, spanning from 2008 to 2022, obtained by the Korea Elder Protection Agencies. This extensive review provides a comprehensive and longitudinal perspective on elder abuse trends in Korea, offering a depth of analysis rarely seen in previous studies. Second, the study extends beyond simply reviewing the prevalence and types of elder abuse. It takes an actionable approach by offering evidence-based suggestions to prevent elder abuse, addressing a critical gap in the literature that often stops at listing findings without exploring practical interventions. The study holds strong policy implications by directly linking its findings to actionable strategies, making it a valuable resource for policymakers aiming to create more effective elder protection frameworks.

Given the increasing prevalence of elder abuse and its significant societal impacts, a comprehensive response to this issue is necessary. The three characteristics of elder abuse in Korea observed in this paper are entangled in complex family dynamics and are interconnected in the country’s financial, economic, political, and cultural context. Thus, it is vital to address elder abuse comprehensively and explore various dimensions, including individual, social, legal, and institutional, to develop effective preventive and responsive strategies against elder abuse.