Missing Voices: Views of Older Persons on Elder Abuse

By World Health Organization and
International Network for the
Prevention of Elder Abuse
2002

In February 2001, the World Health Organization (WHO) and the International Network for the Prevention of Elder Abuse (INPEA) initiated a Global Response Against Elder Abuse Project (GRAEAP) to “raise the awareness among health professionals and the public at large about the problem of elder abuse world-wide, and to develop a global strategy within the context of Primary Health Care for the prevention of elder abuse.”

Because nearly all the studies of elder abuse have been done in developed nations and because most research studies use existing classifications of types of abuse, one of the first tasks of GRAEAP was to “[c]arry out focus group research in urban settings in five developing countries…to identify key themes and issues relating to the perceptions, beliefs and attitudes about elder abuse among the persons most concerned: older persons themselves and primary health care workers.” A meeting of the GRAEAP advisory group and the national coordinators of the countries participating in the project met in October 2001 to go over the focus groups findings and develop strategies for next steps. Missing Voices: Views of Older Persons on Elder Abuse is their report.

Initially, five developing countries were chosen as the sites of focus groups: Argentina, Brazil, India, Kenya and Lebanon. Austria, Canada, and Sweden later joined the project due to the interest of researchers in those countries. Eight focus groups of eight to ten people each were to be held in each country (several countries actually held fewer focus groups, sometimes as few as two). Six of the groups were with older persons; two were for health care professionals. Each country was supposed to have two women-only and two men-only groups.

Some cross-cultural research studies in the United States have shown that elders sometimes conceive of “elder abuse” in ways that are not included under either law or elder abuse professionals’ definitions (see, for example, “Domestic Abuse in Later Life: Cultural Considerations,” at www.WordBridges.net/ElderAbuse/Research/2002-09-05R.pdf). This was definitely the case in these international studies. Although existing elder abuse literature focuses on individual and familial risk factors (an approach the authors say leads to elder abuse being seen as “a family problem, rather than being viewed as a larger societal concern”), the report argues that “structural-societal factors” underpin “virtually all aspects of elder abuse reported from developing countries.”

Structural and Societal Abuse

“Participants, particularly from developing countries, primarily blamed governments and structural factors for the mistreatment they experience in their homes, in public, and in health care institutions,” the report states. “The prevention of elder abuse is clearly viewed as a public responsibility….” Among the specific societal abuses participants identified were inadequate pensions, feeling insecure in their ability to live in their own home, changes in social roles that result in stressed and absent younger generations, and lack of access to basic health and social services (for younger family members as well as elders). Poor and/or female elders were seen as most vulnerable to this type of abuse.

Neglect and Abandonment

Abandonment, considered a relatively minor problem in the United States, was rated “the most significant issue in elder abuse” (emphasis in the original) in Kenya, and was a serious problem in Brazil. In both countries, elders are commonly abandoned at hospitals. Kenya hospital staff estimated that 15-30% of their older patients have been abandoned there. The problem there is particularly acute during droughts or seasons where there is a poor crop yield or a major loss of livestock. In Brazil, by contrast, abandonment “was linked with long weekends, Carnival, school holidays and Christmas.” One respondent said, “Over school holidays, the first thing a family who has a place to go in the countryside does, is to grab the elder and put him/her in a hospital.”

Disrespect and Ageist Attitudes

“Disrespect is the most painful form of mistreatment identified by older adults in all countries,” the report flatly states. “The experiences of disrespect reported by participants need to be understood as viewed by older persons both as a cause of all other forms of abuse and as an important form of abuse in itself.” Negative stereotypes about older people and ageist attitudes promoted by the media, along with Westernization, were blamed for causing this disrespect, which is manifested not only by individuals, but also by health care, governmental, and commercial institutions, and by public transport systems.

Legal and Financial Abuse

Focus groups in India and Lebanon identified “legal abuse” as a problem in their countries. In India, this takes the form of daughters-in-law making false police reports under the dowry laws. In Lebanon, “legal abuse was said to occur because there are no laws to protect the rights of older adults, particularly regarding inheritance issues.”

Suggested Prevention Strategies

As with types of abuse, the focus group participants’ thoughts on possible prevention strategies both echoed and differed from typical prevention agendas in the U.S. Although awareness and education, professional training, strong protective laws, and research all showed up in the Missing Voices list, so, too, did:

• [E]ncourage a closer and positive contact between generations”;
• “Empowerment of elders”;
• Working with the media to change negative images of older adults in society;
• Providing recreational facilities to decrease loneliness; and
• Improved health care plans.

Next Steps

Producing Missing Voices is only the first step for the Global Response Against Elder Abuse Project. At its October 2001 meeting, GRAEAP agreed to the following action agenda:

• To develop an education package on elder abuse for the training of primary health care professionals;
• To develop and pilot a screening and assessment tool for primary health care professionals in developing countries;
• To develop and disseminate a Research Methodology ‘Kit’ to expand the study of elder abuse in developing countries;
• To develop a Minimum Data Set on elder abuse;
• To promote intergenerational pilot studies of older and younger people in their organizations;
• To develop a global inventory of good practice in the prevention of elder abuse;
• To mobilize civil society through raising awareness of the widespread magnitude of elder abuse;
• To promote policy change to address elder abuse; and
• To ensure dissemination of the research findings through scientific journals.

It appears that any news related to this group’s work will likely be covered by the Ageing and Life Course section of the World Health Organization, at www.who.int/hpr/ageing/elderabuse.htm.