The World Health Organization (WHO) has updated its fact sheet on elder abuse.

This follows the publication of an article in the Lancet Global Health, that reported the findings of a systematic review and meta-analysis on elder abuse in the community.

Background information:

Elder abuse is 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.

Key Messages:

Around 1 in 6 older people experienced some form of abuse in the past year.

Rates of abuse may be higher for older people living in institutions than in the community.

Elder abuse can lead to serious physical injuries and long-term psychological consequences.

Elder abuse is predicted to increase as many countries are experiencing rapidly ageing populations.

Although rigorous data are limited, the study provides pooled prevalence estimates of number of older people affected by different types of abuse:

• psychological abuse: 11.6%
• financial abuse: 6.8%
• neglect: 4.2%
• physical abuse: 2.6%
• sexual abuse: 0.9%

Data on the extent of the problem in institutions such as hospitals, nursing homes, and other long-term care facilities are scarce.

Abusive acts in institutions include

• physically restraining patients,
• depriving them of dignity (for instance, by leaving them in soiled clothes) and choice over daily affairs;
• intentionally providing insufficient care (such as allowing them to develop pressure sores);
• over- and under-medicating and withholding medication from patients; and
• emotional neglect and abuse.

For older people, the consequences of abuse can be especially serious because their bones may be more brittle and convalescence longer. Even relatively minor injuries can cause serious and permanent damage, or even death.

A 13-year follow-up study found that victims of elder abuse are twice more likely to die prematurely than people who are not victims of elder abuse.

It is predicted that by the year 2050, the global population of people aged 60 years and older will more than double, from 900 million in 2015 to about 2 billion, 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 victims will increase rapidly due to population ageing, growing to 320 million victims by 2050.

Risk factors

Risk factors that may increase the potential for abuse of an older person can be identified at individual, relationship, community, and socio-cultural levels.

Individual

Risks at the individual level include

• poor physical and mental health of the victim, 
• mental disorders and
• alcohol and substance abuse in the abuser.

Other individual-level factors which may increase the risk of abuse include

• the gender of victim (higher for women) and
• a shared living situation.

Relationship

A shared living situation is a risk factor for elder abuse. It is not yet clear whether spouses or adult children of older people are more likely to perpetrate abuse.

An abuser’s dependency on the older person (often financial) also increases the risk of abuse.

In some cases, a long history of poor family relationships may worsen as a result of stress when the older person becomes more care dependent.

Finally, as more women enter the workforce and have less spare time, caring for older relatives becomes a greater burden, increasing the risk of abuse.

Community

Social isolation of caregivers and older persons, and the ensuing lack of social support, is a significant risk factor for elder abuse by caregivers.

Socio-cultural

Socio-cultural factors that may affect the risk of elder abuse include:

• depiction of older people as frail, weak and dependent;
• erosion of the bonds between generations of a family;
• systems of inheritance and land rights, affecting the distribution of power and material goods within families;
• migration of young couples, leaving elderly parents alone in societies where older people were traditionally cared for by their offspring; and
• lack of funds to pay for care.

Within institutions, abuse is more likely to occur where:

• standards for health care, welfare services, and care facilities for elder persons are low;
• where staff are poorly trained, remunerated, and overworked;
• where the physical environment is deficient; and
• where policies operate in the interests of the institution rather than the residents.

Prevention

Interventions that have been implemented – mainly in high-income countries – to prevent abuse include:

• public and professional awareness campaigns
• screening (of potential victims and abusers)
• school-based intergenerational programmes
• caregiver support interventions (including stress management and respite care)
• residential care policies to define and improve standards of care
• caregiver training on dementia.

Efforts to respond to and prevent further abuse include interventions such as:

• mandatory reporting of abuse to authorities
• self-help groups
• safe-houses and emergency shelters
• psychological programmes for abusers
• helplines to provide information and referrals
• caregiver support interventions.

Evidence for the effectiveness of most of these interventions is limited at present.

Globally, too little is known about elder abuse and how to prevent it, particularly in developing countries.

Useful Links:

Link to the updated fact sheet:

http://who.int/mediacentre/factsheets/fs357/en/

Link to the related WHO news release:

http://who.int/mediacentre/news/releases/2017/abuse-older-people/en/

Link to the article in Lancet Global Health:

Click to access PIIS2214-109X(17)30006-2.pdf

Link to WHO page on elder abuse:

http://who.int/ageing/projects/elder_abuse/en/

Link to WHO page on prevention of elder maltreatment:

http://who.int/violence_injury_prevention/violence/elder_abuse/en/