Elder abuse widespread and unreported, says new report by Secretary-General 

By: United Nations
March 2002

An older person, perhaps one of the "oldest old", frail and dependent on others for their most basic needs, discovers that their bank account has been looted - by someone on whom they depends. An older woman, moderately disabled and living in a nursing home, is physically neglected by the staff and left to suffer intense pain that goes unrelieved and untended, due to common bedsores - which, left untreated, can result in death. An older man, depending on his family for care, is emotionally abused and humiliated, but remains powerless to stop it, due to his dependent situation. Abuse of older persons - physical, sexual and emotional - and their financial exploitation, commonly go unnoticed and unreported, with only the most severe cases commanding attention.

Growing awareness of incidents such as these has for the first time placed the subject of "elder abuse" on the United Nations agenda. A report recently released by United Nations Secretary-General Kofi Annan* surveys abuse of older persons around the world based on studies conducted over the last 20 years. The report, which will contribute to the discussions and negotiations at the Second World Assembly on Ageing in Madrid this April, finds that abuse is widespread, is usually not reported, and has significant financial and human costs.

How much abuse is there?

So far, large-scale studies on the prevalence of elder abuse have been restricted to developed nations, and the available data are limited. But the information that is available shows that both older men and women fall victim to abuse, and that abuse of older persons in both developed and developing countries is surprisingly widespread. In Australia, Canada and the United Kingdom, surveys have found that the proportion of older persons reported as abused or neglected range from 3 to 10 per cent. In Canada, neglect was found to be the most common form of abuse, at 55 per cent of reported cases. Fifteen per cent of cases were physical abuse, and 12 per cent were financial exploitation.

In the United States between 1986 and 1996, the National Center on Elder Abuse recorded a 150 per cent increase in incidents of abuse reported by state adult protective services. In one 12-month period, 36 per cent of nursing staff said they had witnessed an incident of physical abuse; 10 per cent were found to have committed at least one act of physical abuse; 81 per cent had observed an incident of psychological abuse; and 40 per cent had verbally abused a resident.

In developing countries, where most of the world's older persons live - most of them poor - there have not yet been any studies or systematic collection of statistics done. Even so, there is ample evidence from crime records, news reports filed by journalists, social welfare records and some small studies, that elder abuse - physical, emotional and financial - is widespread.

In India, in a sample of 1,000 older persons, it was revealed that 4 per cent had been physically abused. In another smaller sample of 50 persons aged 70 years and over living in an urban area, 20 per cent said they had been neglected in their households. Similarly, in Argentina, 45 per cent of an urban sample of older persons reported that they had been mistreated, most often through psychological abuse.

In Brazil, a survey found that 35 per cent of reported cases of abuse were psychological, physical or financial. The other 65 per cent of incidents involved "social abuse", where the victims believed they were discriminated against by society because of their age.

Abuse takes many forms

Abuse has many faces. It can be physical, causing pain or bodily harm. It can be emotional or psychological, such as verbal abuse, humiliation or intimidation. Or it can be financial, where a trusted caregiver may illegally use or misappropriate an older person's financial assets or property.

Abuse also takes place within the family. This can include neglect, such as the failure to provide attention, adequate food, clean clothing, a safe and comfortable place to live, good health care, personal hygiene, and the opportunity for social contacts. Sexual abuse by caretakers ranges from violent rape to indecent assault or sexual harassment. Spousal abuse can combine many forms, such as physical, emotional and sexual abuse, financial exploitation, or neglect, in a lifelong or more recent partnership.

What makes such abuse especially wrenching is the dependence of the abused victim on the abuser.

Older persons can also suffer from a loss of respect within the family, which can result in behaviour that is disrespectful, dishonouring, isolating or contemptuous. Social or domestic violence can occur when the relations between an older person and his/her family break down. Sadly, the perpetrators of violence and abuse against older persons are most often family members, friends or acquaintances.

Older persons can also abuse themselves, through self-neglect. Sometimes cultural abuse takes place, such as when an older person - usually a woman - has been accused of bringing trouble or bad luck to a community in the form of a drought, flood, or a spate of illness and death. Incidents have been reported where a woman has been ostracized, tortured, maimed, or even killed if she failed to flee the community.

Abuse can also be political, and political violence and armed conflict can affect older persons directly or indirectly, through forced displacement. The special needs of displaced older persons are rarely provided for in humanitarian relief plans. In refugee camps, older persons often lose out when forced to compete for food and health care distribution.

HIV/AIDS-related violence occurs in countries affected by the pandemic, where older women are commonly burdened with care-giving responsibilities for dying relatives as well as orphaned children. The stigma of HIV/AIDS often leads to the isolation of members of affected households.

Abuse has consequences and costs

Although not widely documented, the financial and human costs of abuse of older persons are estimated to be quite considerable. The direct costs of the abuse are many and various: they can be costs associated with prevention and intervention, including providing services, criminal justice procedures, institutional care, and prevention, education and research programmes. The indirect and human costs of abuse of older persons result from reduced productivity, diminished quality of life, emotional pain and suffering, distrust, the loss of self-esteem, disability and premature death.

The mistreatment of older victims has been shown to cause a range of long-term physical and psychological health problems, including permanent physical damage; medication and alcohol dependency; lowered immune system response; chronic eating disorders and malnutrition; self-harm or self-neglect; depression; fearfulness and chronic anxiety; suicidal tendencies; and death.

A global response to the problem: protecting the rights of older persons

In some cases, mistreatment of older persons may be part of a broader landscape of poverty, structural inequalities and other human rights abuses. Such circumstances are often accompanied by low detection of cases of mistreatment, an absence of formal structures and mechanisms to respond to them, and a lack of resources to respond to violence against older persons or to empower older persons to prevent their abuse.

Intervention to treat the social, economic and political conditions that are fertile ground for abuse of elders can improve the general conditions of life of older persons, and can reduce the violation of their rights as well as those of other population groups. Since the 1980's, efforts to promote the human rights and to protect the rights of older men and women have led to the recognition of elder abuse as a human rights issue. The Universal Declaration of Human Rights sets out core entitlements of all human beings in the civil, political, social, economic and cultural spheres.

The International Plan of Action on Ageing, adopted at the first World Assembly on Ageing in Vienna in 1982, outlines the rights of older persons. Furthermore, the United Nations Principles for Older Persons, adopted by the General Assembly in 1991, elaborate their rights in matters of independence, participation, care, self-fulfilment and dignity.

Commitments and guiding principles have also been adopted at United Nations conferences and summits with particular reference to advancing the rights of older persons. Among these are the Copenhagen Declaration and Programme of Action of the World Summit for Social Development, 1995; the Beijing Declaration and the Platform for Action of the Fourth World Conference on Women, 1995; the Further Initiatives for Social Development of the twenty-fourth special session of the UN General Assembly, 2000; and the United Nations Millennium Declaration of the United Nations Millennium Summit, 2000.

Awareness, education and advocacy

The response to the abuse of older persons has been focused on raising awareness and understanding of elder abuse. These efforts are reflected in the wide media coverage given to serious acts of abuse and cases of scandalous neglect. The media has played a critical role in bringing attention and stimulating attendant policy response to the abuse of older persons. 

Educational programmes to equip participants in the assessment and detection of abuse and neglect for effective intervention have targeted lawyers, politicians, law enforcement officers, social workers and other professionals. Materials have been developed to assist them in this effort, including screening tools to identify abusive and potentially abusivesituations, protocols for referral and intervention, and training resource kits for service providers. Handbooks have been useful for caregivers to assess risks of abuse and to identify community resources for assistance.

The World Health Organization (WHO) has recognized the need to develop a global strategy for the prevention of the abuse of older people. This strategy is being developed within the framework of a working partnership between the WHO Ageing and Life Course unit of the Department of Non-communicable Disease Prevention and Health Promotion, the WHO Department of Injury and Violence Prevention, the International Network for the Prevention of Elder Abuse (INPEA), HelpAge International and partners from academic institutions in a range of countries.  

Information dissemination has increased through fact sheets, training videos and CD-ROMs, and directories of help resources and websites.

National telephone help-lines have been established in a number of countries to educate callers about the abuse of older persons and available resources, and to refer them to help agencies. Non-governmental organizations also offer awareness and education programmes in a number of settings. Community development programmes that address needs and concerns of older persons have also helped to raise awareness and educate about abuse.

Legislation, protective mechanisms and legal intervention

In some countries, growing awareness of the abuse of older persons and changing social policies have led to the enactment of new legislation to criminalize elder abuse and to increase penalties for certain crimes against older persons. In some cases, regulations and policies have been adopted to supplement state laws and to establish enforcement systems. In other countries, there is thus far little or no legislation designed specifically to protect older persons from abuse.

WHO's initial step in developing its global strategy was to set up a study in eight countries: Argentina, Austria, Brazil, Canada, India, Kenya, Lebanon and Sweden. The study involved focus groups of older persons in each community, and primary health care workers, in order to establish the different forms of elder abuse as identified by older people themselves and the primary health care teams. A focus on primary health care was chosen, as it is within this context that elder abuse can first be identified - or overlooked altogether. Making primary health care workers aware of the problem is thus a crucial step in preventing and managing elder abuse.

Analysis of the major themes revealed remarkable similarities across the participating countries. Older people perceived three broad categories of abuse:

     · Neglect - isolation, abandonment and social exclusion

     · Violation - of human, legal and medical rights

     · Deprivation - of choices, decisions, status, finances and respect

The study concludes with recommendations for action, some of which are already being implemented with others to follow in the near future. These recommendations can be summarized as follows:

     · Develop a screening and assessment tool for use in primary health care settings;

     · Develop an education package on elder abuse for primary health care professionals;

     · Develop and disseminate a research methodology 'kit' to study elder abuse;

     · Develop a Minimum Data Set concerning violence and older people;

     · Ensure dissemination of the research findings through scientific journals;

     · Develop a global inventory of good practices;

     · Mobilize civil society through raising awareness of the widespread magnitude of elder abuse.

For further information, please contact:

United Nations Programme on Ageing
UN Department of Economic and Social Affairs
Tel: (212) 963-0500
E-mail: sidorenko@un.org

UN Department of Public Information
Tel: (212) 963-0499
E-mail: mediainfo@un.org

Published by the United Nations Department of Public Information DPI/2264 March 2002