Ageing in the Twenty-First Century: - HelpAge International

Exposing elder abuse and
discrimination
“Professionals need to recognize the risk of potential
neglect, abuse or violence by formal and informal caregivers
both in the home and in community and institutional
settings.” (Madrid Plan, para. 107)
While the mistreatment of older persons is not new,
elder abuse has only recently become recognized as a
form of abuse in its own right. There are insufficient
data from developing countries to give any estimate
of how widespread elder abuse is in these regions.
However, WHO estimates that 4-6 per cent of older
people in high-income countries have experienced some
form of maltreatment at home. 278 More cases are coming
to light; however, elder abuse often remains hidden
within families and few countries provide adequate
measures to protect older people from abuse.
What exactly is elder abuse and how common is it?
WHO defines elder abuse as an act of commission
or of omission (neglect) that may be intentional or
unintentional, and that may be of a physical nature,
psychological (involving emotional or verbal
aggression), financial or material, inflicting
unnecessary suffering, injury or pain. 279
However, definitions vary across countries and cultures,
as well as service sectors, making it hard to measure
the extent of elder abuse. Studies, reported cases,
policies and interventions show that elder abuse is not
considered a serious social problem in all countries of
the world. More information is still needed on how
different countries and cultures define elder abuse in
order to develop and implement policies to prevent it. 280
Abuse takes different forms in different social,
economic, political and cultural contexts and is
certainly not limited to any one context or region.
Increasing dependence, isolation and frailty can make
older people particularly vulnerable to violence, abuse
and neglect. Physical abuse, including sexual abuse,
is considered the most serious, but is also the least
frequently reported by either victims or service systems.
The most prevalent types of self-reported abuse are
psychological and financial. Neglect, including selfneglect,
is associated with care-dependent older people
and their caregivers 281 and older people receiving adult
protective services. 282
Self-neglect occurs when older people engage in
behaviour that threatens their safety, even though they
are competent and understand the consequences of
decisions. Self-neglect is also associated with mental
impairment such as dementia, isolation, depression,
and alcohol abuse. The incidence of self-neglect is
highest among women living alone. 283 Professional
interventions by social workers and/or nurses generally
focus on building trust with the older person to allow
some service aimed at reducing a dangerously unhealthy
living situation, while still protecting the older person’s
autonomy.
In a study of elder abuse in Europe, WHO estimates
that annually 4 million people aged 60 or over
experience physical abuse, 1 million experience sexual
abuse, 29 million experience mental abuse and 6 million
experience financial abuse. 284
A 2011 report from the Older People’s Commissioner for
Wales discusses abuse in hospitals. It cites examples of
slow response to continence needs, sharing personal
information in the hearing of others, staffing levels
being too low to meet the requirements of older patients
and staff’s lack of knowledge of the needs of people with
dementia. 285
Some older people, for example, those with dementia
become incapable of managing their personal and
financial affairs. They are at risk of abuse by guardians
appointed to protect their interests. For example,
the US Government Accountability Office identified
hundreds of allegations of physical and financial
exploitation by guardians in the District of Columbia
between 1990 and 2010. In 20 cases, guardians stole or
improperly obtained US$5.4 million in assets from 158
victims, many of whom were older people. 286
In some cases, extreme violence and abuse against
older people occurs as a result of traditional beliefs.
Where belief in witchcraft is strong, older women are
often targeted with witchcraft accusations and related
violence. In Tanzania, for example, police reports from
eight regions between 2004 and 2009 show that 2,585
older women were killed after being accused of
witchcraft. 287
Challenges
One of the main challenges, besides the provision of
adequate age- and sex-disaggregated data, is the fact that
elder abuse is a highly sensitive and often taboo subject,
as its practice and its denial involves people in positions
of trust – family members, officials and the wider
community. Older people often do not want to speak
about such experiences because they are seen as a threat
to the prestige of the family or they are ashamed at
being subjected to violence and exploited by their own
children or other relatives.
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