Prevent elder abuse

Elder abuse is rarely discussed in policy circles, less prioritised for research and addressed by only a handful of organisations

International Day of Older Persons is 1 October. Ageism is a widely prevalent and prejudicial attitude that stems from the assumption that age discrimination, and sometimes neglect and abuse of older persons is a social norm and therefore, acceptable. It is a reality in some form in all societies, and finds expression in individuals’ attitudes, institutional and policy practices, as well as media representation that devalue and exclude older persons. In 2014, Governments around the world adopted a resolution at the Economic and Social Council that recognized ageism as “the common source of, the justification for and the driving force behind age discrimination.” Such discrimination shapes how older persons are treated and perceived by their societies, including in medical settings and workplaces, creating environments that limit older persons’ potential and impact their health and well-being. The failure to tackle ageism undermines older persons’ rights and hinders their contributions to social, economic, cultural and political life. The theme of the 2017 International Day of Older Persons is about enabling and expanding the contributions of older people in their families, communities and societies at large. It focuses on the pathways that support full and effective participation in old age, in accordance with old persons’ basic rights, needs and preferences. This year’s theme underscores the link between tapping the talents and contributions of older persons and achieving the implementation of the 2030 Agenda and the Madrid International Plan of Action on Ageing, which is currently undergoing its third review and appraisal process. Elder abuse is a significant public health problem. Each year, hundreds of thousands of adults over the age of 60 are abused, neglected, or financially exploited. Elder abuse, including neglect and exploitation, is experienced by 1 out of every 10 people, ages 60 and older, who live at home. This statistic is likely an underestimate because many victims are unable or afraid to disclose or report the violence.

Around 1 in 6 older people experience some form of abuse, a figure higher than previously estimated and predicted to rise as populations age worldwide. Elder abuse, though rarely discussed and infrequently reported, is a major public health problem. Family members and strangers often target older adults due to vulnerabilities such as disability and isolation. Identifying and reporting elder abuse can be challenging, as many victims feel ashamed or unsure of how to get help.

A new study, supported by WHO and published in the Lancet Global Health, has found that almost 16% of people aged 60 years and older were subjected to psychological abuse (11.6%), financial abuse (6.8%), neglect (4.2%), physical abuse (2.6%) or sexual abuse (0.9%). The research draws on the best available evidence from 52 studies in 28 countries from different regions, including 12 low- and middle-income countries.

"The abuse of older people is on the rise; for the 141 million older people worldwide this has serious individual and societal costs," says Alana Officer, Senior Health Adviser, Department of Ageing and Life Course at WHO. "We must do much more to prevent and respond to the increasing frequency of different forms of abuse."

Elder abuse and health: Awareness about elder abuse, still largely a taboo topic, has started to increase across the world. It is defined as actions or lack of appropriate action which can cause harm or distress to an older person, occurring within any relationship where there is an expectation of trust. All types of elder abuse can have an impact on the health and wellbeing of the older person. Psychological abuse is the most pervasive and includes behaviours that harm an older person’s self-worth or wellbeing such as name calling, scaring, embarrassing, destroying property or preventing them from seeing friends and family.

Financial abuse includes illegally misusing an older person’s money, property or assets. Neglect includes the failure to meet an older person’s basic needs, such as food, housing, clothing and medical care.

Health effects of abuse include traumatic injury and pain, as well as depression, stress and anxiety. Elder abuse can lead to an increased risk of nursing home placement, use of emergency services, hospitalization and death. Despite the frequency and the serious health consequences, elder abuse remains one of the least investigated types of violence in national surveys, and one of the least addressed in national plans to prevent violence. By 2050 the number of people aged 60 and over will double to reach 2 billion globally, with the vast majority of older people living in low- and middle-income countries. If the proportion of elder abuse victims remains constant, the number of people affected will increase rapidly due to population ageing, growing to 320 million victims by 2050.

Elder abuse is rarely discussed in policy circles, less prioritized for research and addressed by only a handful of organizations. Governments must protect all people from violence. We must work to shed light on this important societal challenge, understand how best to prevent it, and help put in place the measures needed. Elder abuse is an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult. (An older adult is defined as someone age 60 or older.) The following six types of maltreatment occur among persons over the age of 60.

Forms of elder abuse are: (1) Physical Abuse: the intentional use of physical force that results in acute or chronic illness, bodily injury, physical pain, functional impairment, distress, or death. Physical abuse may include, but is not limited to, violent acts such as striking (with or without an object or weapon), hitting, beating, scratching, biting, choking, suffocation, pushing, shoving, shaking, slapping, kicking, stomping, pinching, and burning; (2) Sexual Abuse or Abusive Sexual Contact: forced or unwanted sexual interaction (touching and non-touching acts) of any kind with an older adult. This may include but is not limited to forced or unwanted completed or attempted contact between the penis and the vulva or the penis and the anus involving penetration, however slight. It might also include forced or unwanted contact between the mouth and the penis, vulva, or anus; forced or unwanted penetration of the anal or genital opening of another person by a hand, finger, or other object; forced or unwanted intentional touching, either directly or through the clothing, of the genitalia, anus, groin, breast, inner thigh, or buttocks. These acts also qualify as sexual abuse if they are committed against an incapacitated person who is not competent to give informed approval;

(3) Emotional or Psychological Abuse: verbal or nonverbal behavior that results in the infliction of anguish, mental pain, fear, or distress. Examples of tactics that may exemplify emotional or psychological abuse of an older adult include behaviors intended to humiliate (e.g., calling names or insults), threaten (e.g., expressing an intent to initiate nursing home placement), isolate (e.g., seclusion from family or friends), or control (e.g., prohibiting or limiting access to transportation, telephone, money or other resources); (4) Neglect: failure by a caregiver or other responsible person to protect an elder from harm, or the failure to meet needs for essential medical care, nutrition, hydration, hygiene, clothing, basic activities of daily living or shelter, which results in a serious risk of compromised health and safety. Examples include not providing adequate nutrition, hygiene, clothing, shelter, or access to necessary health care; or failure to prevent exposure to unsafe activities and environments; and (5) Financial Abuse or Exploitation: the illegal, unauthorized, or improper use of an older individual’s resources by a caregiver or other person in a trusting relationship, for the benefit of someone other than the older individual. This includes, but is not limited to, depriving an older person of rightful access to, information about, or use of, personal benefits, resources, belongings, or assets. Examples include forgery, misuse or theft of money or possessions; use of coercion or deception to surrender finances or property; or improper use of guardianship or power of attorney.

Unfortunately, elder abuse has been (1) poorly or imprecisely defined, (2) defined specifically to reflect the unique statutes or conditions present in specific locations, or (3) defined specifically for research purposes. As a result, a set of universally accepted definitions does not exist.

A consistent definition is needed to monitor the incidence of elder abuse and examine trends over time. Consistency helps to determine the magnitude of elder abuse and enables comparisons of the problem across locations. This ultimately informs prevention and intervention efforts.

The writer is Former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control & Research (IEDCR),  Dhaka, Bangladesh

Prevent elder abuse

Elder abuse is rarely discussed in policy circles, less prioritised for research and addressed by only a handful of organisations

International Day of Older Persons is 1 October. Ageism is a widely prevalent and prejudicial attitude that stems from the assumption that age discrimination, and sometimes neglect and abuse of older persons is a social norm and therefore, acceptable. It is a reality in some form in all societies, and finds expression in individuals attitudes, institutional and policy practices, as well as media representation that devalue and exclude older persons. In 2014, Governments around the world adopted a resolution at the Economic and Social Council that recognized ageism as the common source of, the justification for and the driving force behind age discrimination. Such discrimination shapes how older persons are treated and perceived by their societies, including in medical settings and workplaces, creating environments that limit older persons potential and impact their health and well-being. The failure to tackle ageism undermines older persons rights and hinders their contributions to social, economic, cultural and political life. The theme of the 2017 International Day of Older Persons is about enabling and expanding the contributions of older people in their families, communities and societies at large. It focuses on the pathways that support full and effective participation in old age, in accordance with old persons basic rights, needs and preferences. This years theme underscores the link between tapping the talents and contributions of older persons and achieving the implementation of the 2030 Agenda and the Madrid International Plan of Action on Ageing, which is currently undergoing its third review and appraisal process. Elder abuse is a significant public health problem. Each year, hundreds of thousands of adults over the age of 60 are abused, neglected, or financially exploited. Elder abuse, including neglect and exploitation, is experienced by 1 out of every 10 people, ages 60 and older, who live at home. This statistic is likely an underestimate because many victims are unable or afraid to disclose or report the violence. Around 1 in 6 older people experience some form of abuse, a figure higher than previously estimated and predicted to rise as populations age worldwide. Elder abuse, though rarely discussed and infrequently reported, is a major public health problem. Family members and strangers often target older adults due to vulnerabilities such as disability and isolation. Identifying and reporting elder abuse can be challenging, as many victims feel ashamed or unsure of how to get help. A new study, supported by WHO and published in the Lancet Global Health, has found that almost 16% of people aged 60 years and older were subjected to psychological abuse (11.6%), financial abuse (6.8%), neglect (4.2%), physical abuse (2.6%) or sexual abuse (0.9%). The research draws on the best available evidence from 52 studies in 28 countries from different regions, including 12 low- and middle-income countries. The abuse of older people is on the rise; for the 141 million older people worldwide this has serious individual and societal costs, says Alana Officer, Senior Health Adviser, Department of Ageing and Life Course at WHO. We must do much more to prevent and respond to the increasing frequency of different forms of abuse. Elder abuse and health: Awareness about elder abuse, still largely a taboo topic, has started to increase across the world. It is defined as actions or lack of appropriate action which can cause harm or distress to an older person, occurring within any relationship where there is an expectation of trust. All types of elder abuse can have an impact on the health and wellbeing of the older person. Psychological abuse is the most pervasive and includes behaviours that harm an older persons self-worth or wellbeing such as name calling, scaring, embarrassing, destroying property or preventing them from seeing friends and family. Financial abuse includes illegally misusing an older persons money, property or assets. Neglect includes the failure to meet an older persons basic needs, such as food, housing, clothing and medical care. Health effects of abuse include traumatic injury and pain, as well as depression, stress and anxiety. Elder abuse can lead to an increased risk of nursing home placement, use of emergency services, hospitalization and death. Despite the frequency and the serious health consequences, elder abuse remains one of the least investigated types of violence in national surveys, and one of the least addressed in national plans to prevent violence. By 2050 the number of people aged 60 and over will double to reach 2 billion globally, with the vast majority of older people living in low- and middle-income countries. If the proportion of elder abuse victims remains constant, the number of people affected will increase rapidly due to population ageing, growing to 320 million victims by 2050. Elder abuse is rarely discussed in policy circles, less prioritized for research and addressed by only a handful of organizations. Governments must protect all people from violence. We must work to shed light on this important societal challenge, understand how best to prevent it, and help put in place the measures needed. Elder abuse is an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult. (An older adult is defined as someone age 60 or older.) The following six types of maltreatment occur among persons over the age of 60. Forms of elder abuse are: (1) Physical Abuse: the intentional use of physical force that results in acute or chronic illness, bodily injury, physical pain, functional impairment, distress, or death. Physical abuse may include, but is not limited to, violent acts such as striking (with or without an object or weapon), hitting, beating, scratching, biting, choking, suffocation, pushing, shoving, shaking, slapping, kicking, stomping, pinching, and burning; (2) Sexual Abuse or Abusive Sexual Contact: forced or unwanted sexual interaction (touching and non-touching acts) of any kind with an older adult. This may include but is not limited to forced or unwanted completed or attempted contact between the penis and the vulva or the penis and the anus involving penetration, however slight. It might also include forced or unwanted contact between the mouth and the penis, vulva, or anus; forced or unwanted penetration of the anal or genital opening of another person by a hand, finger, or other object; forced or unwanted intentional touching, either directly or through the clothing, of the genitalia, anus, groin, breast, inner thigh, or buttocks. These acts also qualify as sexual abuse if they are committed against an incapacitated person who is not competent to give informed approval; (3) Emotional or Psychological Abuse: verbal or nonverbal behavior that results in the infliction of anguish, mental pain, fear, or distress. Examples of tactics that may exemplify emotional or psychological abuse of an older adult include behaviors intended to humiliate (e.g., calling names or insults), threaten (e.g., expressing an intent to initiate nursing home placement), isolate (e.g., seclusion from family or friends), or control (e.g., prohibiting or limiting access to transportation, telephone, money or other resources); (4) Neglect: failure by a caregiver or other responsible person to protect an elder from harm, or the failure to meet needs for essential medical care, nutrition, hydration, hygiene, clothing, basic activities of daily living or shelter, which results in a serious risk of compromised health and safety. Examples include not providing adequate nutrition, hygiene, clothing, shelter, or access to necessary health care; or failure to prevent exposure to unsafe activities and environments; and (5) Financial Abuse or Exploitation: the illegal, unauthorized, or improper use of an older individuals resources by a caregiver or other person in a trusting relationship, for the benefit of someone other than the older individual. This includes, but is not limited to, depriving an older person of rightful access to, information about, or use of, personal benefits, resources, belongings, or assets. Examples include forgery, misuse or theft of money or possessions; use of coercion or deception to surrender finances or property; or improper use of guardianship or power of attorney. Unfortunately, elder abuse has been (1) poorly or imprecisely defined, (2) defined specifically to reflect the unique statutes or conditions present in specific locations, or (3) defined specifically for research purposes. As a result, a set of universally accepted definitions does not exist. A consistent definition is needed to monitor the incidence of elder abuse and examine trends over time. Consistency helps to determine the magnitude of elder abuse and enables comparisons of the problem across locations. This ultimately informs prevention and intervention efforts. The writer is Former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control Research (IEDCR), Dhaka, Bangladesh