Fighting stereotypes

Ageism We all generally value and respect the older people we love or know well. But our attitudes to other older people within the broader community can be different. In many traditional societies, older people are respected as "elders". However, in other societies, older women and men may be less respected. The marginalization can be structural, for example enforced retirement ages, or informal, such as older people being viewed as less energetic and less valuable to a potential employer. These attitudes are examples of "ageism" - the stereotyping of, and discrimination against, individuals or groups because of their age. Ageist attitudes can portray older people as frail, "past their sell-by date", unable to work, physically weak, mentally slow, disabled or helpless. Ageism serves as a social divider between young and old. Stereotypes These stereotypes can prevent older men and women from fully participating in social, political, economic, cultural, spiritual, civic and other activities. Younger people may also influence these decisions in the attitudes they convey to older people, or even by building barriers to their participation. Ageist stereotypes can also prevent us meeting the challenges of population ageing since they can prevent us asking the right questions or finding innovative solutions.

Elder maltreatment
Key facts

Around 4-6% of elderly people have experienced some form of maltreatment at home. Elder maltreatment can lead to serious physical injuries and long-term psychological consequences. Elder maltreatment is predicted to increase as many countries are experiencing rapidly ageing populations. The global population of people aged 60 years and older will more than double, from 542 million in 1995 to about 1.2 billion in 2025.

Elder maltreatment 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. This type of violence constitutes a violation of human rights and includes physical, sexual, psychological, emotional; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect. Scope of the problem Maltreatment of elderly people is an important public health problem. While there is little information regarding the extent of maltreatment in elderly populations, especially in developing countries, it is estimated that 4-6% of elderly people in high-income countries have experienced some form of maltreatment at home. However, older people are often afraid to report cases of maltreatment to family, friends, or to the authorities. Data on the extent of the problem in institutions such as hospitals, nursing homes and other longterm care facilities are scarce. A survey of nursing-home staff in the United States of America, however, suggests rates may be high:

36% witnessed at least one incident of physical abuse of an elderly patient in the previous year; 10% committed at least one act of physical abuse towards an elderly patient; 40% admitted to psychologically abusing patients.

There is even less data on elder maltreatment in institutional settings in developing countries. Abusive acts in institutions include physically restraining patients, depriving them of dignity (by for instance leaving them in soiled clothes) and choice over daily affairs, intentionally providing insufficient care (such as allowing them to develop pressure sores), over- and under-medicating and withholding medication from patients; and emotional neglect and abuse. Elder maltreatment can lead to physical injuries ranging from minor scratches and bruises to broken bones and head injuries leading to lasting disabilities and serious, sometimes longlasting, psychological consequences, including depression and anxiety. For older people, the consequences of maltreatment can be especially serious because their bones are more brittle and convalescence is longer. Even relatively minor injuries can cause serious and permanent damage, or even death. Globally, the number of cases of elder maltreatment is projected to increase as many countries have rapidly ageing populations whose needs may not be fully met due to resource constraints. It is predicted that by the year 2025, the global population of people aged 60 years and older will more than double, from 542 million in 1995 to about 1.2 billion. Risk factors Risk factors that may increase the potential for maltreatment of an older person can be identified at individual, relationship, community, and socio-cultural levels.

Individual

Risks at the individual level include dementia of the victim, and mental disorders and alcohol and substance abuse in the abuser. Other individual-level factors which may increase the risk of abuse include gender of victim and a shared living situation. While older men have the same risk of abuse as women, in some cultures where women have inferior social status, elderly women are at higher risk of neglect through abandonment when they are widowed and their property is seized. Women may also be at higher risk of more persistent and severe forms of abuse and injury.
Relationship

A shared living situation is a risk factor for elder maltreatment. It is not yet clear whether spouses or adult children of older people are more likely to perpetrate abuse. An abuser's dependency on the older person (often financial) also increases the risk of abuse. In some cases, a long history of poor family relationships may worsen as a result of stress and frustration as the older person becomes more dependent. Finally, as more women enter the workforce and have less spare time, caring for older people becomes a greater burden, increasing the risk of abuse.
Community

Social isolation of caregivers and older persons, and the ensuing lack of social support, is a significant risk factor for elder maltreatment by care-givers. Many elderly people are isolated because of physical or mental infirmities, or through the loss of friends and family members.
Socio-cultural

Socio-cultural factors that may affect the risk of elder maltreatment include:

depiction of older people as frail, weak and dependent; erosion of the bonds between generations of a family; systems of inheritance and land rights, affecting the distribution of power and material goods within families; migration of young couples, leaving elderly parents alone, in societies where older people were traditionally cared for by their offspring; lack of funds to pay for care.

Within institutions, maltreatment is more likely to occur where:

standards for health care, welfare services and care facilities for elder persons are low where staff are poorly trained, remunerated, and overworked where the physical environment is deficient where policies operate in the interests of the institution rather than the residents.

Prevention

Many strategies have been implemented to prevent elder maltreatment and to take action against it and mitigate its consequences. Interventions that have been implemented mainly in highincome countries to prevent maltreatment include:

public and professional awareness campaigns, screening (of potential victims and abusers) caregiver support interventions (e.g. stress management, respite care) caregiver training on dementia.

Efforts to respond to and prevent further maltreatment include interventions such as:

screening potential victims mandatory reporting of maltreatment to authorities adult protective services home visitation by police and social workers self-help groups safe-houses and emergency shelters caregiver support interventions.

There is little evidence of the effectiveness of these interventions at present. Caregiver support after maltreatment has occurred to reduce the likelihood of its reoccurrence has been shown to work. Furthermore, caregiver support to prevent elder maltreatment before it occurs and professional awareness of the problem appears promising. Evidence suggests that adult protective services and home visitation by police and social workers for victims of elder maltreatment may in fact have adverse consequences, increasing elder maltreatment. Multiple sectors can contribute to reducing elder maltreatment, including:

the social welfare sector (through the provision of legal, financial, and housing support); the education sector (through public education and awareness campaigns); the health sector (through the detection and treatment of victims by primary health care workers).

In some countries, the health sector has taken a leading role in raising public concern about elder maltreatment, while in others the social welfare sector has taken the lead. Globally, too little is known about elder maltreatment and how to prevent it, particularly in developing countries. The scope and nature of the problem is only beginning to be delineated, many risk factors remain contested, and the evidence for what works to prevent elder maltreatment is limited. WHO response WHO and partners collaborate to prevent elder maltreatment through initiatives that help to identify, quantify and respond to the problem, including:

building evidence on the scope and types of elder maltreatment in different settings (to understanding the magnitude and nature of the problem at the global level);

developing guidance for Member States and all relevant sectors to prevent elder maltreatment and strengthen their responses to it; disseminating information to countries and supporting national efforts to prevent elder maltreatment; collaborating with international agencies and organizations to deter the problem globally.

Interesting facts about ageing

28 March 2012 The world population is rapidly ageing Between 2000 and 2050, the proportion of the world's population over 60 years will double from about 11% to 22%. The absolute number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period. Low- and middle-income countries will experience the most rapid and dramatic demographic change It took more than 100 years for the share of France's population aged 65 or older to double from 7 to 14%. In contrast, it will take countries like Brazil and China less than 25 years to reach the same growth. The world will have more people who live to see their 80s or 90s than ever before The number of people aged 80 years or older, for example, will have almost quadrupled to 395 million between 2000 and 2050. There is no historical precedent for a majority of middle-aged and older adults having living parents, as is already the case today. More children will know their grandparents and even their great-grandparents, especially their great-grandmothers. On average, women live six to eight years longer than men. How well we age depends on many factors The functional capacity of an individual's biological system increases during the first years of life, reaches its peak in early adulthood and naturally declines thereafter. The rate of decline is determined, at least in part, by our behaviours and exposures across the whole life course. These include what we eat, how physically active we are and our exposure to health risks such as those caused by smoking, harmful consumption of alcohol, or exposure to toxic substances. Even in poor countries, most older people die of NCDs Even in poor countries, most older people die of noncommunicable diseases such as heart disease, cancer and diabetes, rather than from infectious and parasitic diseases. In addition, older people often have several health problems at the same time, such as diabetes and heart disease.

Globally, many older people are at risk of maltreatment Around 4-6% of older people in developed countries have experienced some form of maltreatment at home. Abusive acts in institutions include physically restraining patients, depriving them of dignity (by for instance leaving them in soiled clothes) and intentionally providing insufficient care (such as allowing them to develop pressure sores). The maltreatment of older people can lead to serious physical injuries and long-term psychological consequences. The need for long-term care is rising The number of older people who are no longer able to look after themselves in developing countries is forecast to quadruple by 2050. Many of the very old lose their ability to live independently because of limited mobility, frailty or other physical or mental health problems. Many require some form of long-term care, which can include home nursing, community care and assisted living, residential care and long stays in hospitals. Worldwide, there will be a dramatic increase in the number of people with dementias such as Alzheimer's disease, as people live longer The risk of dementia rises sharply with age with an estimated 25-30% of people aged 85 or older having some degree of cognitive decline. Older people with dementia in low- and middle-income countries generally do not have access to the affordable long-term care their condition may warrant. Often their families do not often have publicly funded support to help with care at home. In emergency situations, older people can be especially vulnerable When communities are displaced by natural disasters or armed conflict, older people may be unable to flee or travel long distances and may be left behind. Yet, in many situations they can also be a valuable resource for their communities as well as for the humanitarian aid process when they are involved as community leaders.

Knowledge translation on ageing and health

A framework for policy development 2012
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Publication details

Editors: World Health Organization Number of pages: 23 Publication date: April 2012 Languages: English
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Knowledge translation on ageing and health pdf, 1.93Mb

Overview The objective of the document is to assist policy- and decision -makers in integrating evidencebased approaches to ageing in national health policy development processes, specific policies or programmes addressing older population needs and other health programmes concerned with such issues as HIV, reproductive health, chronic diseases.

World Health Day 2012 - Good health adds life to years

Karsten Thormaehlen

4 April 2012 -- Ageing and health - to which each and every one of us can relate - is the theme of this year's World Health Day. Using the slogan "Good health adds life to years", campaign activities and materials focus on how good health throughout life can help older men and women lead full and productive lives and be a resource for their families and communities.

Director-General's message on World Health Day World Health Day web site

WHO Global Network of Age-friendly Cities and Communities

WHO/ Harold Ruiz

1 April 2012 -- The Network was established to foster the exchange of experience and mutual learning between cities and communities worldwide. Any city or community committed to creating inclusive and accessible urban environments to benefit their ageing populations is welcome to join.

First international age-friendly cities conference

WHO/Tom Pietrasik

December 2011 -- The conference took place in Dublin, Ireland, to strengthen the WHO Global Network of Age-friendly Cities and advance thinking and approaches on how to make cities more age-friendly. It brought together a broad range of leaders and senior managers from members of the Network, senior managers of municipal authorities, CEOs interested in or already championing an Age-friendly City initiative.

Highlights
World Health Day 2012 - Good health adds life to years WHO Global Network of Age-friendly Cities and Communities First international age-friendly cities conference

fact buffet
2 billion2 billion people will be aged 60 and older by 2050. This represents both challenges and opportunities.
10 facts on ageing and the life course

4-6%Around 4-6% of older persons in high-income countries have experienced some form of maltreatment at home.
Fact sheet: elder maltreatment

25-30%of people aged 85 or older have some degree of cognitive decline.

Facts about ageing About the topic Ageing and life-course

Populations around the world are rapidly ageing. This is a cause for celebration. In part it reflects our successes in dealing with childhood disease, maternal mortality and in helping women achieve control over their own fertility.
Interesting facts about ageing

The world population is rapidly ageing. Between 2000 and 2050, the proportion of the world's population over 60 years will double from about 11% to 22%. The absolute number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period.
Fighting stereotypes

We all generally value and respect the older people we love or know well. But our attitudes to other older people within the broader community can be different. In many traditional societies,

older people are respected as "elders". However, in other societies, older women and men may be less respected.
What WHO is doing

WHO's activities related to ageing in the areas of health services, rehabilitation and long-term care, prevention of disease, and other activities.

Health topics

Ageing

In almost every country, the proportion of people aged over 60 years is growing faster than any other age group, as a result of both longer life expectancy and declining fertility rates. This population ageing can be seen as a success story for public health policies and for socioeconomic development, but it also challenges society to adapt, in order to maximize the health and functional capacity of older people as well as their social participation and security.
World Health Day 2012: Ageing and health

Ageing and health is the theme of this year's World Health Day on 7 April. The Day will focus on how healthy behaviours throughout life can help older men and women lead full and productive lives and be a resource for their families and communities.

What WHO is doing

30 March 2012
Health services Strengthening primary health care

Quality, safety and access issues for primary care for older people, including the early detection and management of common conditions like hypertension and diabetes, are not well understood. WHO will work to identify strategies that can enhance existing efforts to strengthen health systems to make services more effective and more accessible for older people, particularly in low- and middle-income countries. For example, the focus of WHO's prevention of blindness programme will aim to provide technical capacity to countries to help them tackle age-related chronic eye disease such as cataract, diabetic retinopathy, glaucoma, age related macular degeneration and uncorrected presbyopia. The WHO programme for the prevention of deafness is supporting governments to develop comprehensive national plans for ear and hearing health. Age-related hearing issues need to be a central component of these plans.
Harnessing technology

Innovation and technology can help older people in many ways: to better monitor health status and detect early signs of disease; connect older people to health care; underpin new approaches; ensure better data collection and monitoring; create training opportunities for health workers and caregivers; develop new versions of diagnostic, monitoring and assistive devices; and to assist older people with functional loss to remain independent. We need to encourage these developments, but also to remember that the majority of older people live in less developed countries. Fostering the development/adaptation and transfer of appropriate technology and innovative solutions to these settings can help us achieve health equity. A WHO steering group has been established to turn this vision into reality.
Building the skills for the 21st century health workforce

New curricula are needed to ensure that the global workforce has the appropriate skills to deal with the older populations that will form the bulk of their practice. WHO has undertaken an initial global review of medical curricula. This identified a number of possible approaches for making university training more relevant to the needs of older populations.

WHO will be looking to partner organizations to develop these further and provide guidance for universities in developing their curricula in a way that will most effectively meet the workforce needs of the 21st century.
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Global health and ageing pdf, 1.66Mb

Overview Population aging is a powerful and transforming demographic force. We are only just beginning to comprehend its impacts at the national and global levels. As we prepare for a new demographic reality, we hope this report raises awareness not only about the critical link between global health and aging, but also about the importance of rigorous and coordinated research to close gaps in our knowledge and the need for action based on evidence-based policies.