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A b u s e o f t h e e l d e r l y
Until the advent of initiatives to address child
abuse and domestic violence in the last quarter of
the 20th century, ab use of t he elderly remained
a private mat ter, w ell hidden from public view.
Tod a y, it is increasingly being seen a s an impor-
ta nt prob lem a nd one that is likely to g row as
ma ny countries experience ra pidly a geing popu-
lations. It is predicted that by the year 2025, the
global populat ion of those ag ed 60 years and
older w ill more th a n d oub le, from 542 million in
1995 to a bo ut 1.2 billion.
Similar to ot her types of violence, abuse of the
elderly includes physical, sexua l an d psycho logical
ab use, a s we ll as neg lect . Elderly people, tho ugh,
are also vulnerable t o economic abuse, in w hich
ot hers make improper use of the ir resources.
TH E EXTEN T OF TH E PR OBLEM
Informa tion on t he extent o f a buse in elderly
popu lation s is sca nt. The fe w popula tion-based
studies that have been conducted suggest tha t
bet w een 4 % an d 6 % of elderly people ha ve
experienced some fo rm of a buse in the home.
The e lderly are a lso a t risk of a buse in institut ions
such a s hospita ls, nursing ho mes and oth er long-
te rm care fa cilities. In a survey in the Un ited
States, for example, 36% of nursing-home staff
reported having w itnessed a t least one incident of
physical abuse of an elderly pat ient in the previ-
ous year, 10% admitted having committed at least
one a ct of physical abuse the mselves, and 40%
said that they had psychologically abused patients.
Abusive a cts within institutions fo r the e lderly
a lso include ph ysically restraining pa tient s,
depriving the m of dignity an d choice o ver daily
affairs, and providing insufficient care (for example,
allowing them to develop pressure sores).
THE CO NSEQU ENCES O F ELDER AB USE
For older peo ple, the consequences of a buse can
be e specia lly serious be cause th eir bone s are
more bri t t le an d convalescence ta kes themlong er. Even a relatively minor injury can cause
ser ious and permanent da mag e.
W H A T A R E TH E R I SK FA C TOR S FOR
E LD E R A B U S E ?
A number of situa tions appea r to put the e lderly
a t risk of violence. In some cases, stra ined f a mily
relation ships ma y w orsen as a result of stress a nd
frustrat ion as the older person becomes more
depend ent. In ot hers, a caregiver s depende nce
on an older person for accommodation or f inan-cial support may be a source of conflict.
Socia l isolation is a sig nifica nt risk fa ctor fo r an
older person to suffer mistreat ment. Many elderly
people a re isolate d b ecause of physical or menta l
infirmities, or through the loss of friends and
family members.
Cultural and socioeconomic factors that may affect
the risk of elder a buse include:
the d epiction of o lder people a s frai l, w ea k and
dependent
erosion of the bo nds between generat ions ofa family
restructuring of the ba sic support net w orks for
the elderly
systems of inheritance and land rights, affecting
the dist r ibut ion of pow er and ma ter ia l goo ds
w ithin fa milies
migration of yo ung couples to o ther area s,
leaving elderly parents alone, in societies where
older people were tra ditionally cared f or by
their offspring.
Older men a re at r isk of ab use in abo ut the sam e
proportion as w omen. But in cultures whe rew omen have inferior social sta tus, elderly wo men
are a t specia l r isk of being a band oned w hen they
are widowed and having their property seized.
Ma l e
1995 2025
Female Total
Population
(in
millions)
1 2 0 0
1 0 0 0
80 0
60 0
40 0
20 0
0
Projected grow th in the global population aged 60 years
and o lder, 1995-2025
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Within institut ions, ab use is more likely to occur
w here care stand ards are low , sta f f a re poorly
trained or overworked, interactions between staf f
and residents are difficult, the physical environ-
ment is def icient, a nd w here policies operate in
the interests of the insti tution rather tha n of th e
residents.
W H A T C A N B E D O N E TO P R E V EN T
E LD E R A B U S E ?
Countr ies around the w or ld are a t varying stag es
in their na tiona l and local response to the care
and protection of the elderly. While some coun-
tr ies include ab use o f t he elderly under their leg al
statut es and have f ully developed systems for
reporting and treating cases of abuse, others
ha ve a much more l imited response.
Social services
In g enera l, coun tries tha t d eliver services to
ab used, neg lected or exploited o lder people ha ve
do ne so through th e existing he alth a nd social
services net w ork. Such services typically includemed ica l, lega l, psycho logical and f inancial, as w ell
as help with housing and other environmental
issues.
Othe r inte rventions include eme rgen cy shelters,
support groups specifically aimed at older abused
people, an d t elephone he lplines. In some low -
income countries, local projects have been estab-
lished to help older people plan prog rammes and
de velop the ir ow n services.
Health careIn some countries, the medical profession has
played a leading role in raising public concern
ab out e lder abuse. How ever, few intervention
program mes for abused elders are housed in hos-
pita l set t ings and many do ctors do not diagnose
ab use because i t is not pa rt of t heir training.
Some o f the signs and symptoms of ab use
include:
dela ys betw een injuries or illness an d seeking
medical attention
impla usible or vag ue explana tions fo r injuries
or ill-health, from either patient or caregiver
dif fering case histories from pat ient a nd care-
giver
frequen t visits to emerge ncy depa rtments
because a chronic cond ition ha s wo rsened,
despite a care plan a nd resources to d ea l with
this in the ho mefunction a lly-impaired older pat ients who a rrive
w itho ut th eir main caregiver
laborat ory f indings tha t a re inconsistent w ith
the history provided.
Education and public aw areness campaigns
Public educat ion and aw areness raising a re impor-
ta nt elements in preventing a buse and neg lect .
The a im of such effo rts is to info rm practitione rs
an d th e ge neral public ab out t he various types of
ab use, how to ident i fy the signs and symptoms ofabuse and w here help can be ob ta ined.
The med ia can also be a po w erful too l for chan g-
ing att i tudes and reducing stereotyping of the
elderly.
Educationa l prog rammes aimed a t older people
the mselves a re usually more successful if t he
information o n a buse is woven into w ider to pics,
such as successful ageing or health care.
For more information, please visi t : http: / /ww w.who. int /vio lence_injury_prevention, or e-mai l : vio [email protected]
World Health Organization 200 2. All rights reserved.