Elder abuse is a violation on older adults’ fundamental rights to be safe and free from violence and contradicts efforts toward improved well-being and quality of life in healthy aging. Data suggest that 1 in 10 older adults in the United States experience physical, psychological, or sexual abuse, neglect, or financial exploitation. In low- and middle-income countries, where the burden of violence is the greatest, prevalence is likely higher. Predictions indicate that by 2050, 22 percent of the world population will be 60 years or older, doubling the 2009 global population of older adults (UN, 2009). However, despite the magnitude of elder abuse globally, it has been an underappreciated public health problem. Resources allocated toward understanding elder abuse and effective interventions for preventing it are often limited and fall short of those applied to more recognized public health problems.
On April 17 and 18, 2013, the Institute of Medicine’s (IOM’s) Forum on Global Violence Prevention convened a 2-day workshop on elder abuse and its prevention (see Box 1-1 for the Statement of Task). Part of the Forum’s mandate is to engage in multisectoral, multidirectional dialogue that explores crosscutting approaches to violence prevention. While elder
1 The planning committee’s role was limited to planning the workshop. The workshop summary was prepared by the rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the Forum on Global Violence Prevention, the Institute of Medicine, or the National Research Council, and they should not be construed as reflecting any group consensus.
Statement of Task
Elder Abuse and Its Prevention: A Workshop
Violence and related forms of abuse against elders is a global public health and human rights problem with far-reaching consequences, resulting in increased death, disability, and exploitation with collateral effects on well-being. Data suggest that at least 10 percent of elders in the United States are victims of elder maltreatment every year. In low- and middle-income countries, where the burden of violence is the greatest, the figure is likely even higher. In addition, elders experiencing risk factors such as diminishing cognitive function, caregiver dependence, and social isolation are more vulnerable to maltreatment and underreporting. As the world population of adults aged 65 and older continues to grow, the implications of elder maltreatment for health care, social welfare, justice, and financial systems are great. However, despite the magnitude of global elder maltreatment, it has been an underappreciated public health problem.
The Institute of Medicine will host a 2-day public workshop on global elder abuse and its prevention. Using an ecological framework, this workshop will explore the burden of elder abuse around the world, focusing on its impacts on individuals, families, communities, and societies. Additionally, the workshop will address occurrences and co-occurrences of different types of abuse, including physical, sexual, emotional, and financial, as well as neglect. The ultimate objective is to illuminate promising global and multisectoral evidence-based approaches to the prevention of elder maltreatment.
The workshop will be planned and conducted by an ad hoc committee that will develop the workshop agenda, select and invite speakers and discussants, and moderate the discussions. Experts will be drawn from the public and private sectors as well as from academic organizations to allow for multilateral, evidence-based discussions. Following the conclusion of the workshop, an individually authored summary of the event will be prepared by a designated rapporteur. The workshop will be free and open to the public.
abuse has been addressed in previous Forum workshops,2 it has lacked the attention that some other forms of violence, such as child abuse and sexual violence, have received. The Forum chose to dedicate a workshop to elder abuse and its prevention to shed light on this underappreciated and often overlooked form of violence. This workshop was an opportunity to engage
2 Previous Forum on Global Violence Prevention workshop summaries include Preventing Violence Against Women and Children (IOM and NRC, 2011); Social and Economic Costs of Violence (IOM and NRC, 2012a); Communications and Technology for Violence Prevention (IOM and NRC, 2012b); Contagion of Violence (IOM and NRC, 2013); and Evidence for Violence Prevention Across the Lifespan and Around the World (IOM and NRC, 2014). All Forum workshop summaries and additional information on previous workshops are available at http://www.iom.edu/globalviolenceprevention.
in a more comprehensive discussion of the global burden of elder abuse and how to prevent it. Considering the limited awareness of the magnitude of elder abuse, even within the violence prevention community, workshop speakers discussed the prevalence and characteristics of elder abuse around the world, risk factors for abuse and potential adverse health outcomes, and contextually specific factors, such as culture and the role of the community.
Elder abuse has several aspects that are unique from other forms of violence. These unique aspects deserve specific illumination, such as the role of cognitive impairment and social isolation. Thus, workshop speakers highlighted these aspects in terms of ethical considerations in research and practice and rights versus protection of older adults. While the workshop covered scope and prevalence and unique characteristics of abuse, the intention was to move beyond what is known about elder abuse to foster discussions about how to improve prevention, intervention, and mitigation of the victims’ needs, particularly through collaborative efforts. Therefore the workshop discussions included innovative intervention models and opportunities for prevention across sectors and settings. These discussions are covered in this summary report.
DEFINITIONS AND CONTEXT
Within the field of elder abuse, different terms are used to define the parameters of violence, abuse, neglect, self-neglect, and exploitation of the elderly as described within specific context. For example, the 2003 National Research Council report Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America defined elder mistreatment “as (a) intentional actions that cause harm or create serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder or (b) failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm” (NRC, 2003, p. 1). For specificity of context, this definition is intended to exclude cases of self-neglect and cases involving victimization of elders by strangers (p. 1). The World Health Organization uses the term “elder abuse” and has adopted the definition developed in 1995 by Action on Elder Abuse in the United Kingdom: “elder abuse is a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (WHO, 2008, p. 6). Still others use the term “elder maltreatment,” borrowing from the field of child maltreatment in which maltreatment “refers to the physical and emotional mistreatment, sexual abuse, neglect and negligent treatment of children, as well as to their commercial or other exploitation” (WHO and International Society for Prevention of Child Abuse and Neglect, 2006). However, there are no standard, universally accepted definitions of elder
abuse, elder mistreatment, or elder maltreatment. While this report highlights some of the issues with a lack of common definitions, as well as ongoing efforts to establish them, it does not attempt to resolve them. Rather, as a summary report, terminology is applied based on the language used by the individual speakers and participants. In text that is not directly attributable to individual speakers and participants, the term elder abuse is applied.
ORGANIZATION OF THE REPORT
This report provides a summary account of the presentations given at the workshop and expert papers submitted by workshop speakers. Opinions expressed within this summary are not those of the IOM, the Forum on Global Violence Prevention, or their agents, but rather of the presenters themselves. Such statements are the views of the speakers and do not reflect conclusions or recommendations of a formally appointed committee. This summary was authored by a designated rapporteur based on the workshop presentations and discussions and does not represent the views of the institution, nor does it constitute a full or exhaustive overview of the field.
The workshop summary is organized thematically, covering the major topics that arose during the 2-day workshop, to present these issues in a larger context and in a compelling and comprehensive way. The thematic organization also allows the summary to serve as an overview of important issues in the field; however, such an organization results in some repetition, as themes are interrelated and the presented examples support several different themes and subthemes raised by speakers. The themes presented in this summary were the frequent and crosscutting elements that arose from the various workshop presentations, but the choice of these themes does not represent any formal consensus process.
The first part of this report consists of an introduction and five chapters, which provide a summary of the workshop; the second part consists of submitted papers from speakers on the substance of the work they presented. These papers were solicited from speakers in order to offer further information about their work and illuminate how such contributions can advance the field of elder abuse prevention; not all speakers contributed papers. The appendixes contain additional information regarding the agenda and participants.
IOM (Institute of Medicine) and NRC (National Research Council). 2011. Preventing violence against women and children: Workshop summary. Washington, DC: The National Academies Press.
IOM and NRC. 2012a. Social and economic costs of violence: Workshop summary. Washington, DC: The National Academies Press.
IOM and NRC. 2012b. Communications and technology for violence prevention: Workshop summary. Washington, DC: The National Academies Press.
IOM and NRC. 2013. Contagion of violence: Workshop summary. Washington, DC: The National Academies Press.
IOM and NRC. 2014. Evidence for violence prevention across the lifespan and around the world: Workshop summary. Washington, DC: The National Academies Press.
NRC. 2003. Elder mistreatment: Abuse, neglect, and exploitation in an aging America. Washington, DC: The National Academies Press.
UN (United Nations). 2009. World population ageing. Department of Economic and Social Affairs, Population Division. New York: UN.
WHO (World Health Organization). 2008. A global response to elder abuse and neglect: Building primary health care capacity to deal with the problem worldwide: Main report. Geneva, Switzerland: WHO.
WHO and International Society for Prevention of Child Abuse and Neglect. 2006. Preventing child maltreatment: A guide to taking action and generating evidence. Geneva, Switzerland: WHO.