World Health Organization Releases Report on Elder Abuse

The first World Report on Violence and Health, issued as a result of a 1996 World Health Organization (WHO) resolution declaring that “violence is a leading worldwide public health problem,” prominently features the issue of elder abuse.

The report focuses on seven types of violence: youth violence, child abuse and neglect, violence by intimate partners, abuse of the elderly, sexual violence, self-directed violence (suicide), and collective violence. There is a chapter on each type of violence, plus an overview, recommendations, and resource appendices. WHO characterizes the document as being “aimed primarily at researchers and practitioners,” which it says includes “health care workers, social workers, those involved in developing and implementing prevention programmes and services, educators and law enforcement officials.” However, WHO cautions, the report, “while comprehensive and the first of its kind, is only a beginning. It is hoped that the report will stimulate discussion at local, national and international levels and that it will provide a platform for increased action towards preventing violence.”

Although the elder abuse chapter is shorter than some others due to the dearth of data, the topic is definitely highlighted. Indeed, the Acknowledgements page begins with a “special tribute to the principal author of the chapter on abuse of the elderly, Rosalie Wolf, who passed away in June 2001. She made an invaluable contribution to the care and protection of the elderly from abuse and neglect, and showed an enduring commitment to this particularly vulnerable and often voiceless population.” The other authors of Chapter 5 were Lia Daichman and Gerry Bennett.

The chapter begins with a brief international history of the recognition of elder abuse as a problem, noting that “two fields – public health and criminal justice – have…dictated to a large extent how abuse of the elderly is viewed, how it is analysed, and how it is dealt with.” A paragraph on demographics notes, among other facts, that one million people reach age 60 monthly, “80% of whom are in the developing world.”

The section on how elder abuse is defined reviews a number of cultural approaches to the problem, noting that “studies conducted in China (Honk Kong SAR), Finland, Greece, India, Ireland, Israel, Norway, Poland and South Africa have approached the topic in distinctly different ways. Norwegian researchers, for instance, identified abuse with a ‘triangle of violence’ that includes a victim, a perpetrator and others, who – directly or indirectly – observe the principal players.”

Cultural norms and their influence on the definitions of elder abuse were discussed next. The authors note that “displacing older people as heads of households and depriving them of their autonomy in the name of affection are cultural norms… [that] can leave the older person isolated, depressed and demoralized, and can be considered a form of abuse.” Also discussed are acts of violence against women accused of witchcraft, which, the authors note, “may not be considered locally as ‘elder abuse’.” (In an interesting side note, the authors explain that one alleged sign of being involved in witchcraft is having red eyes. “The eyes of many older women are red from a lifetime of cooking over smoky stoves, or from medical conditions such as conjunctivitis.”) South African focus groups expanded the typical western list of types of elder abuse to include not only accusations of witchcraft, but also “loss of respect for elders, withholding of affection, and lack of interest in the older person’s well-being” and “abuse by systems – the dehumanizing treatment older people are liable to suffer at health clinics and pension offices, and marginalization by the government.”

After reviewing the meager studies of the extent of the problem in both domestic and institutional settings, the authors tackle individual, relationship, and community and societal risk factors. This section reviews both initial thoughts about risk factors such as caregiver stress, the level of impairment of the elder, and the increased vulnerability of female elders, and newer findings that suggest all of these theories may be unsupported.

Although the consequences of elder abuse section notes that “very few empirical studies have been conducted to determine the consequences of mistreatment,” the 1998 Lachs study showing increased mortality rates for abuse victims is discussed at some length.

“What can be done to prevent elder abuse?” is the longest section. Here the authors briefly review what is happening in Argentina, Australia, Brazil, Canada, the Caribbean, Chile, China, Cuba, France, Germany, India, Italy, Japan, Korea, Latin America, New Zealand, Nigeria, Norway, Peru, Poland, the Republic of Korea, South Africa, the United Kingdom, United States, Uruguay, and Venezuela. One training program that caught this reviewer’s attention is a component of the Department for the Promotion of Social Welfare and Old Age in Buenos Aires, “Proteger.” “Professionals and other workers in this programme receive a 6-month training in gerontology, focusing mainly on the prevention of violence and intervention in cases of elder abuse.”

“Local responses” discusses social services, health care, legal action, education, and public awareness campaigns. WHO notes, “[o]nly the United States and a number of Canadian provinces have created a system solely for handling reports of adult mistreatment.” Several projects are discussed, including a Canadian educational project designed for school children and young people.

The recommendations section begins with a discussion of the role of ageism:

Perhaps the most insidious form of abuse against the elderly lies in the negative attitudes towards, and stereotypes of, older people and the process of ageing itself, attitudes that are reflected in the frequent glorification of youth. As long as older people are devalued and marginalized by society, they will suffer from loss of self-identity and remain highly susceptible to discrimination and all forms of abuse.

Other elder abuse-specific recommendations are:
1. Building greater knowledge about elder abuse (particularly its causes, the role of culture and ageism, the impact of abuse, and the evaluation of interventions);
2. Enacting stronger laws, including guaranteeing basic human rights and addressing abusive traditions; and
3. Promoting more effective prevention strategies such as addressing ageism and raising awareness.

Overall, the report lists nine recommendations regarding violence. These may prove helpful to advocates in this country, since they back up some of our common priorities (see, for example, “National Elder Abuse Action Agenda, Proceedings Released,” in this edition of AAR).

1. Create, implement and monitor a national action plan for violence prevention;
2. Enhance capacity for collecting data on violence;
3. Define priorities for, and support research on, the causes, consequences, costs and prevention of violence;
4. Promote primary prevention responses;
5. Strengthen responses for victims of violence;
6. Integrate violence prevention into social and educational policies, and thereby promote gender and social equality;
7. Increase collaboration and exchange of information on violence prevention;
8. Promote and monitor adherence to international treaties, laws and other mechanisms to protect human rights; and
9. Seek practical, internationally agreed responses to the global drugs trade and the global arms trade.

To help carry out these recommendations, representatives from ten United Nations agencies met in Geneva, Switzerland, in November 2001 “to discuss their work on interpersonal violence and to find ways to coordinate future efforts in this field. Although United Nations agencies had previously collaborated successfully on conflict-related violence, little interagency work had been done to prevent everyday acts of violence and crime….” The meeting’s participants “outlined a range of collaborative activities they would undertake. For the short term, these include the preparation of a guide to United Nations resources and activities for the prevention of interpersonal violence, highlighting the core competencies of each agency in preventing interpersonal violence and identifying areas not currently addressed by United Nations organizations. Based on this guide, a web site will be developed to help participating agencies exchange information and to serve as a resource for other United Nations agencies, governments, nongovernmental organizations, researchers and donors. For the medium and longer term, collaborative efforts will include advocacy work, data collection and analysis, research and prevention initiatives.”