June 15th is celebrated as World Elder Abuse Awareness Day.
The global population of people aged 60 years and older will more than double, from 900 million in 2015 to about 2 billion in 2050, with the vast majority of older people living in low- and middle-income countries.
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 includes
- physical, sexual, psychological, and emotional abuse;
- financial and material abuse;
- neglect; and
- serious loss of dignity and respect.
Around 1 in 6 people 60 years and older experienced some form of abuse in community settings during 2017.
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.
Rates of elder abuse are high in institutions such as nursing homes and long-term care facilities, with 2 in 3 staff reporting that they have committed abuse in the past year.
Abusive acts in institutions may 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.
Within institutions, abuse is more likely to occur where:
• standards for health care, welfare services, and care facilities for elder persons are low;
• staff are poorly trained, remunerated, and overworked;
• the physical environment is deficient; and
• policies operate in the interests of the institution rather than the residents.
Elder abuse can lead to serious physical injuries and long-term psychological consequences.
Victims of elder abuse are twice more likely to die prematurely than people who are not victims of elder abuse
Elder abuse is predicted to increase as many countries are experiencing rapidly ageing populations.
Risk Factors for Elder Abuse
- poor physical and mental health of the victim, and
- mental disorders and alcohol and substance abuse in the abuser
In cultures where women have inferior social status, elderly women are at higher risk of neglect and financial abuse (such as seizing their property) when they are widowed. Women may also be at higher risk of more persistent and severe forms of abuse and injury.
A shared living situation is a risk factor for elder 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.
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 factors that may affect the risk of elder abuse include:
- ageist stereotypes where older adults are depicted 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 older parents alone in societies where older people were traditionally cared for by their offspring; and
- lack of funds to pay for care.
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. However, caregiver support after abuse has occurred reduces the likelihood of its reoccurrence and school-based intergeneration programmes (to decrease negative societal attitudes and stereotypes towards older people) have shown some promise.
Evidence suggests that adult protective services and home visitation by police and social workers for victims of elder abuse may in fact have adverse consequences, increasing elder abuse.
Link to the WHO news release:
Link to WHO factsheet on Elder Abuse:
Link to World Report on Ageing and Health (2015):
Link to studies on consequences of elder abuse (visualizations):
Link to ‘Elder abuse prevalence in community settings’ article in The Lancet (free):