GLOBALLY, the number of cases of elder abuse (abuse of older people) is projected to increase as many countries have rapidly ageing populations, according to the World Health Organization (WHO).

It said even if the proportion of victims of abuse of older people remains constant, the global number of victims will increase rapidly due to population ageing, growing to some 320 million victims by 2050 as the global population of people aged 60 years and more increases to two billion by 2050.

According to the UN body, emerging evidence indicated that the prevalence of abuse of older people in both the community and in institutions increased during the height of the COVID-19 pandemic. A US study, for instance, suggested that rates in the community may have increased by as much as 84 per cent.

WHO’s data said:

* Around 1 in 6 people 60 years and older experienced some form of abuse in community settings during the past year.

* Rates of abuse of older people are high in institutions such as nursing homes and long-term care facilities, with two in three staff reporting that they have committed abuse in the past year.

* Abuse of older people can lead to serious physical injuries and long-term psychological consequences.

* Abuse of older people is predicted to increase as many countries are experiencing rapidly ageing populations.

Elder abuse is a single or repeated act, or lack of appropriate action, occurring within any relationship in which 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.

The WHO said abuse of older people is an important public health problem. It pointed to a 2017 review of 52 studies in 28 countries from diverse regions that estimated that over the past year one in six people (15.7 per cent) aged 60 years and older were subjected to some form of abuse. It said that although rigorous data are limited, the review provides prevalence estimates of the proportion of older people affected by different types of abuse.

Data on the extent of the problem in institutions such as hospitals, nursing homes and other long-term care facilities are scarce. However, a review of recent studies on abuse of older people in institutional settings indicated that 64.2 per cent of staff reported perpetrating some form of abuse in the past year.

Consequences

Abuse of older people, said the WHO, can have serious physical and mental health, financial, and social consequences including, for instance, physical injuries, premature mortality, depression, cognitive decline, financial devastation and placement in nursing homes. For older people, the consequences of abuse can be especially serious and recovery may take longer.

Risk factors

Individual-level characteristics which increase the risk of becoming a victim of abuse include functional dependence/disability, poor physical health, cognitive impairment, poor mental health, and low income. Individual-level characteristics which increase the risk of becoming a perpetrator of abuse include mental illness, substance abuse, and dependency — often financial — of the abuser on the victim. At the relationship level the type of relationship (eg spouse/partner or child/parent) and marital status may be associated with an elevated risk of abuse, but these factors vary by country and region. Community- and societal-level factors linked to elder abuse may include ageism against older people and certain cultural norms (eg normalisation of violence). Social support and living alone reduce the likelihood of elder abuse

Prevention

Many strategies, the WHO reported, have been tried to prevent and respond to abuse of older people, but evidence for the effectiveness of most of these interventions is limited at present. Strategies considered most promising include caregiver interventions which provide services to relieve the burden of caregiving; money management programmes for older adults vulnerable to financial exploitation; helplines and emergency shelters; and multi-disciplinary teams as the responses required often cut across many systems, including criminal justice, health care, mental health care, protective services for adults, and long-term care.

In some countries the health sector has taken a leading role in raising public concern about abuse of older people, while in others the social welfare sector has taken the lead. Globally, too little is known about elder abuse and how to prevent it, particularly in developing countries.

WHO response

On June 15, 2022, World Elder Abuse Awareness Day, WHO and partners published Tackling abuse of older people: Five priorities for the UN Decade of Healthy Ageing (2021–2030). These five priorities, arrived at through wide consultation, are:

* Generate more and better data to raise awareness of the problem.

* Develop and scale up cost-effective solutions to stop abuse of older people.

* Make an investment case focusing on how addressing the problem is money well spent.

* Raise funds, as more resources are needed to tackle the problem.

*Combat ageism as it is a major reason why the abuse of older people receives so little attention.