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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 lenceprevention@who.int

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