National Research Council

Institute of Medicine

Board on Global Health

Forum on Global Violence Prevention

Elder Abuse and Its Prevention is the summary of a workshop convened in April 2013 by the Institute of Medicine's Forum on Global Violence Prevention. Using an ecological framework, this workshop explored the burden of elder abuse around the world, focusing on its impacts on individuals, families, communities, and societies. Additionally, the workshop addressed occurrences and co-occurrences of different types of abuse, including physical, sexual, emotional, and financial, as well as neglect. The ultimate objective was to illuminate promising global and multisectoral evidence-based approaches to the prevention of elder maltreatment. 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. The workshop discussions included innovative intervention models and opportunities for prevention across sectors and settings. 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. Elder Abuse and Its Prevention discusses 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.

Workshop Summary

Elder Abuse and Its Prevention

Violence against women and children is a serious public health concern, with costs at multiple levels of society. Although violence is a threat to everyone, women and children are particularly susceptible to victimization because they often have fewer rights or lack appropriate means of protection. In some societies certain types of violence are deemed socially or legally acceptable, thereby contributing further to the risk to women and children. In the past decade research has documented the growing magnitude of such violence, but gaps in the data still remain. Victims of violence of any type fear stigmatization or societal condemnation and thus often hesitate to report crimes. The issue is compounded by the fact that for women and children the perpetrators are often people they know and because some countries lack laws or regulations protecting victims. Some of the data that have been collected suggest that rates of violence against women range from 15 to 71 percent in some countries and that rates of violence against children top 80 percent. These data demonstrate that violence poses a high burden on global health and that violence against women and children is common and universal. Preventing Violence Against Women and Children focuses on these elements of the cycle as they relate to interrupting this transmission of violence. Intervention strategies include preventing violence before it starts as well as preventing recurrence, preventing adverse effects (such as trauma or the consequences of trauma), and preventing the spread of violence to the next generation or social level. Successful strategies consider the context of the violence, such as family, school, community, national, or regional settings, in order to determine the best programs.

Preventing Violence Against Women and Children

The past 25 years have seen a major paradigm shift in the field of violence prevention, from the assumption that violence is inevitable to the recognition that violence is preventable. Part of this shift has occurred in thinking about why violence occurs, and where intervention points might lie. In exploring the occurrence of violence, researchers have recognized the tendency for violent acts to cluster, to spread from place to place, and to mutate from one type to another. Furthermore, violent acts are often preceded or followed by other violent acts. In the field of public health, such a process has also been seen in the infectious disease model, in which an agent or vector initiates a specific biological pathway leading to symptoms of disease and infectivity. The agent transmits from individual to individual, and levels of the disease in the population above the baseline constitute an epidemic. Although violence does not have a readily observable biological agent as an initiator, it can follow similar epidemiological pathways. On April 30-May 1, 2012, the Institute of Medicine (IOM) Forum on Global Violence Prevention convened a workshop to explore the contagious nature of violence. Part of the Forum's mandate is to engage in multisectoral, multidirectional dialogue that explores crosscutting, evidence-based approaches to violence prevention, and the Forum has convened four workshops to this point exploring various elements of violence prevention. The workshops are designed to examine such approaches from multiple perspectives and at multiple levels of society. In particular, the workshop on the contagion of violence focused on exploring the epidemiology of the contagion, describing possible processes and mechanisms by which violence is transmitted, examining how contextual factors mitigate or exacerbate the issue. Contagion of Violence: Workshop Summary covers the major topics that arose during the 2-day workshop. It is organized by important elements of the infectious disease model so as to present the contagion of violence in a larger context and in a more compelling and comprehensive way.

Forum on Global Violence Prevention

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