OLDER PERSONS & THE PANDEMIC 1 Surprise, Seniors Have Rights Too!

THE 1918-1919 FLU AND MY MOTHER

Little did I know a short while ago, that the human rights of our elderly would become the subject of my first blog post. My planning was different. But yet another time, life has proved that it is anything but a gently flowing river. It can evolve with startling speed and, like a bat out of hell, spread disease and sorrow around us. The world is facing its biggest public health challenge since the 1918-1919 flu pandemic, the horrors of which my Swedish mother, born in 1910, often recalled in our conversations. In contrast to Covid-19, which affects comparatively few children, the pandemic hundred years ago did not spare them, and the church bells in my mother’s village all too often tolled for both young and old. It was a time of dread that never left her.

CHOICE OF WORDS

Before continuing, however, I would first like to say a few words about my choice of terminology in this and subsequent blog posts on the subject of elderly and human rights: I simply don’t like to use either of the terms the “elderly” or the “older” to describe a significant and growing part of humanity. Depending on how these terms are used, they can easily have a pejorative connotation, a connotation with which, of course, I do disagree. I actually prefer the Spanish term “mayores”, but my Spanish-English dictionary provides no better translation of that term. For want of a better choice then, I will primarily use “elderly” or “older”. This is also consistent with the terminology used by international organisations, such as the United Nations (UN), the World Health Organization (WHO), and the major regional human rights organisations in Africa, the Americas and Europe. This way, we can also avoid confusion or misunderstandings based on terminology.

OUR ELDERLY AND COVID-19

While I have for a long time intended to cover also the human rights of older persons in my blog, it is now a subject that imperatively propels itself to the centre of our attention. At the time of writing this post, we are still in the midst of the Covid-19 pandemic, and final accurate statistics (if we can ever get them) will have to wait. However, according to what we know so far, Covid-19 has caused a by far excessive number of deaths among the elderly in many countries, including in Europe. The deaths appear to be particularly numerous among persons in care facilities, from which family members and friends were barred during in particular the first wave, in order to help ensure the safety of their loved ones. True, the Covid-19 virus hits elderly people in general in a particularly vicious way due to their decreased immune defence and possible pre-existing medical conditions (multimorbidity). Yet, however important, this is likely to be only part of the story...

OUR ELDERLY, DIGNITY AND HUMAN RIGHTS

If we first focus on the beginning of the story, it holds some reassuring information: Just as their younger sisters and brothers of the human species, the elderly have an inherent right, because of their very humanity, to fully, effectively and equally enjoy their human rights and fundamental freedoms, such as the right to life, the right to be treated with respect for their physical and psychological integrity, the right to liberty and security, the right to the freedoms of religion, opinion and expression, the right to respect for their private life, and the right to an adequate standard of health, and so forth. It is about ensuring that all of us will be able to spend also our later years in respect and dignity: Human Rights – Better life!

STATES HAVE A DUTY TO ELIMINATE AGE DISCRIMINATION

In addition to the various domestic laws and international treaties for the protection of human rights, it is important for all of us to know, and for the elderly most particularly, that special efforts are being made to ensure that governments take effective action to eliminate age discrimination in the field of human rights. In Europe, for instance, the Council of Europe Committee of Ministers has reaffirmed that “all human rights and fundamental freedoms are universal, indivisible, interdependent and interrelated, and [that] their full enjoyment, without any discrimination, by older persons needs to be guaranteed.”[i] This was done in the Committee’s important Recommendation CM/Rec(2014)2 on the promotion of human rights of older persons, adopted in February 2014. A similar provision is contained in the Preamble to the Inter-American Convention on Protecting the Human Rights of Older Persons, where the States Parties also reaffirm “the obligation to eliminate all forms of discrimination, in particular, discrimination for reasons of age”.[ii] Furthermore, “[t]he full realization of all human rights and fundamental freedoms of all older persons”, is one of the central themes that runs through the Madrid International Plan of Action on Ageing, which was agreed upon by the Second World Assembly on Ageing in April 2002, and the implementation of which is being reviewed and appraised every five years.[iii]

It is also noteworthy that, when launching his “Policy Brief: The Impact of COVID-19 on older persons” on 1 May 2020, the UN Secretary-General, António Guterres, stressed that “no person, young or old, is expendable” and that “[o]lder people have the same rights to life and health as everyone else.” He further underlined that “[d]ifficult decisions around life-saving medical care must respect the human rights and dignity of all” and urged us not to treat older people “as invisible or powerless.”[iv]

So far, so good. In theory, at least, there is important work in progress, and in a future blog post, I will focus on some of the main legal aspects of the right to health of older persons.

For now, we need to ask ourselves what is happening to the elderly in their normal life around the world, first in general and then in connection with the Covid-19 pandemic. This is where we need to resume the sad part of the story…

THE SCANDAL OF WORLDWIDE ELDER ABUSE

The research of the WHO has laid bare a worrisome situation: The hidden problem of elder abuse. The WHO defines elder abuse as “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. This type of violence constitutes a violation of human rights and includes physical, sexual, psychological, and emotional abuse; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect.”[v]

According to the WHO, a study from 2017 estimated that 15.7% of persons 60 years or older, had experienced some form of abuse over the preceding year.[vi] This amounts to approximately 1 out of 6 persons, a shocking number in itself. However, the actual numbers

are likely to be much higher, “as only 1 in 24 cases of elder abuse is reported, in part because older people are often afraid to report cases of abuse to family, friends, or to the authorities.”[vii]

Cases of abuse appear to occur more frequently in institutional settings than in community settings, although they exist there too. According to an analysis made by the WHO of 9 studies in 6 countries based on staff self-reports on perpetrating abuse in institutional settings, the abuse amounted to 64.2% or 2 in 3 staff members.[viii] On the other hand, the overall prevalence of elder abuse as reported by older adults in community settings was 15.7%.[ix] As predicted by the WHO, these numbers are likely to increase with the rapidly aging population in many countries. It is estimated that the world population of people aged 60 years or older will increase from 900 million in 2015 to about 2 billion in 2050.[x]

DANGEOURS EFFECTS OF ABUSE

Abuse is always demeaning and can lead to physical, psychological and financial harm. Elder abuse is also particularly dangerous, because even “relatively minor injuries can cause serious and permanent damage, or even death.”[xi] Add to this the reluctance of the victims themselves to denounce ill-treatment or negligence out of fear of revenge, and we have an unknown number of silently suffering people 60 years or older. WHO also reports that a follow-up study shows that “victims of elder abuse are twice more likely to die prematurely than people who are not victims of elder abuse.”[xii]

There are consequently very good reasons for taking elder abuse seriously and for adopting strong preventive actions to eliminate it in both institutional and community settings.

THE PANDEMIC AND THE ELDERLY

The above brief reference to WHO’s work on elder abuse shows that many people 60 years or older are already in normal circumstances living in a situation so vulnerable that it may pose dangers to their physical and mental health, and in extreme cases, even to their life. Then along comes a pandemic we cannot control, hitting the elderly harder than any other group, and particularly those living in institutions.

In my next blog post, we will take a look at the situation with regard to the Covid-19 pandemic and our elderly in Spain, Sweden, and Switzerland. The statistics available are still often imprecise and/or incomplete. However, as you will see, the examples chosen are sufficient to illustrate the grave human, legal and medico-ethical problems to which the pandemic has given rise for, most particularly, older persons in care homes. We have therefore to keep asking ourselves whether the human rights of older persons have been well protected so far during the pandemic? Whether our politicians and the medical personnel have the required knowledge about patients’ human rights? And, for instance, whether more could have been done to protect the older victims of the Covid-19 virus?

Welcome back to find out more about the pandemic and human rights and how Human Rights can mean ... a Better Life!

Anna-Lena Christina

5 November 2020

___________________________ [i] Preambular paragraph 10 to Recommendation CM/Rec(2014)2 on the promotion of human rights of older persons; for the full text of the Recommendation, see: https://search.coe.int/cm/Pages/result_details.aspx?ObjectId=09000016805c649f. The Council of Europe is a pan-European organisation with 47 Members States created in 1949. It is particularly known for its important work to promote human rights and fundamental freedoms across Europe on the basis of the European Convention on Human Rights and the European Social Charter. For more information about the Committee of Ministers of the Council of Europe, see: https://www.coe.int/en/web/cm/about-cm. [ii] Preambular paragraph 4 to the Convention; for the full text of this treaty, see: http://www.oas.org/en/sla/dil/docs/inter_american_treaties_A-70_human_rights_older_persons.pdf [iii] Paragraph 12(a) of the Plan of Action: For the texts of both the Political Declaration and the Plan of Action, see https://www.un.org/esa/socdev/documents/ageing/MIPAA/political-declaration-en.pdf. [iv] See Mr. Guterres’ video message at: http://webtv.un.org/search/antónio-guterres-un-secretary-general-on-the-launch-of-the-policy-brief-on-older-persons/6153268153001/?term=Policy%20Brief:%20The%20Impact%20of%20COVID-19%20on%20older%20persons&sort=date&page=14, consulted on 2 November 2020.

[v] See WHO Fact sheet of 15 June 2020 at https://www.who.int/news-room/fact-sheets/detail/elder-abuse, consulted on 2 November 2020. [vi] Ibid; the study was “based on the best available evidence from 52 studies in 28 countries from diverse regions.”

[vii] Ibid. [viii] Ibid. [ix] Ibid. [x] Ibid. [xi] Ibid. [xii] Ibid.