World Elder Abuse Awareness Day 2019

Stan Lee, the visionary comic-book writer and publisher behind Marvel Comics, and a 71-year-old Burundian refugee named Bernice have something in common.

They are both victims of elder abuse.

Last month, Lee’s former manager was charged with five counts of elder abuse, including theft, embezzlement, forgery, or fraud against an elder adult, according to a recent LA Times article. Bernice was brutally attacked in the middle of the night after a couple in her tent accused her of witchcraft. Although their stories on the surface seem wildly disparate, the motives behind their cases are not. In Tanzania, accusations of witchcraft against older women are often thinly veiled attempts to wrest away their property and land.

In rural parts of Tanzania, accusing someone of being a witch is an effective tactic for driving away someone you don’t want around. “If I stayed, they would have killed me,” Bernice said.

Elder abuse is a devastating public health problem unbounded by geographic region, race, gender, sexual orientation, or socioeconomic status. About 1 in 6 people, or roughly 141 million people globally, are estimated to have experienced elder abuse in the past year, according to a systematic review and meta-analysis of elder abuse prevalence studies published in the Lancet Global Health.

Elder abuse will continue to rise as long as it remains a back-burner issue on global health and public policy agendas.

The global population of people aged 60 and over will more than double between 2015 and 2050 to about two billion, or 1 in 5 people. If we assume that the overall prevalence rate of elder abuse remains constant, the number of victims will rise to 320 million victims by 2050.

The true prevalence of elder abuse, however, is likely much higher as only 1 in 24 elder abuse cases ever gets reported, according to the WHO. Data on elder abuse is also sparse. The few studies available on the subject often cannot be compared or combined due to divergent methodologies or inconsistent definitions of elder abuse and that of its sub-categories—physical, psychological, sexual, and financial abuse and neglect.

Where is the Data?

The urgency behind addressing issues such as domestic violence and child abuse has only recently entered into the public consciousness, in large part through awareness campaigns that generate the momentum necessary to change societal attitudes and influence national priorities. Such campaigns are built upon solid bases of evidence—data and statistics that give shape to the scope and extent of the problem. But when it comes to elder abuse, no such evidence base exists.

Compared to other public health issues, elder abuse receives little attention, in part because many research studies fail to include people over the age of 49. Older people are excluded from surveys such as the WHO’s Multi-country Study on Women’s Health and Domestic Violence against Women. Demographic and Health surveys similarly institute age cut-offs, excluding people over the age of 54 or 59.

What limited data on elder abuse does exist is mostly concentrated in high-income countries such as the United States, Canada, Germany and the United Kingdom. A global review of elder abuse prevalence studies in 2017 found a “dearth of elder abuse studies from low-income and middle-income countries from southeast Asia and Africa.”

Other Barriers

Lack of data, however, cannot be an excuse for lack of action.

According to HelpAge International Senior Rights Advisor Bridget Sleap, “I think it’s very easy for states to say, ‘We can’t take any action because there is no data. When we try to advocate for a much larger response, we shouldn’t only rely on the data message, but we should also try to address some of the other barriers that are stopping states from taking action and try to address those as well.”

One such barrier is the lack of services designed to reach older women. For example, a study of intimate partner violence in South Asia found that violence screenings were primarily offered as part of pregnancy-related services, which effectively excludes older women from being screened.

Health services that are poorly tailored to older people are a direct reflection of societal biases about who needs help and how. Sexual health services are a case in point.  According to the Global Study of Sexual Attitudes and Behaviors, only 9% of women aged 40 to 80 were asked about their sexual health by a provider in the past three years, even though almost half (49%) reported having at least one sexual problem.

In the same way that sex among older people is considered taboo, so is abuse. Reporting rates for elder abuse are so low because many victims fear the social stigma that comes with speaking up. In other cases, victims remain silent because the perpetrators are close friends, caregivers, or family members. According to a study by HelpAge India, the most common perpetrators of abuse were sons (57%) and daughters-in-law (38%).  

Addressing the Issue

Elder abuse, if left unaddressed, has serious ramifications for older people, including psychological trauma, health complications, and increased mortality. But the effects of elder abuse are not static, a closed system between victim and perpetrator. Elder abuse has reverberating consequences across our society and economy. Older people who are abused are hospitalized more often and more likely to end up in nursing homes, driving up healthcare costs. They are more likely to be physically and financially dependent, which increases the burden of caregivers, who are disproportionately women. 

Because elder abuse can take so many forms and happen to anyone in later life, systems-level change is required to address its root causes. This will require attention and problem-solving from stakeholders across sectors, disciplines, and civic spheres—from grassroots advocates to government leaders. The task in front of us will touch criminal justice, primary care, social work, and legislative frameworks at all levels of government.

When we take a systems approach, real progress towards protecting older people from abuse is possible. Our work in Tanzania to prevent attacks against older people implemented a bottom-up strategy that started with local communities and wove all the way into national policy. In villages where attacks were happening, we delivered awareness sessions to dispel myths of witchcraft and educated older people about their legal rights; provided fuel efficient stoves so older women would no longer have irritated, red eyes, a commonly-thought marker of a witch; and educated local police forces on ways to prevent and manage elder abuse cases. At the policy level, HelpAge’s ongoing engagement with civil society and government administrators has led to the finalization of a five-year National Strategy to Eradicate Killings of Older People in Tanzania earlier this year.

“It’s because of all of those actions together,” affirms Head of Policy and Influencing at Age International, Ken Bluestone. “Underpinning all of this is working across multiple generations within the community, working with the community, understanding this situation that older women are facing and building that trust within the community.”