Population ageing is an important issue globally. Abuse of the elderly is an important social and public health issue arising from this increase in longevity. Most of the literature on elder abuse is based on studies conducted in developed countries and very little is known about elder abuse in developing countries. There is also cultural variation how abuse of the elderly is perceived. The volume of the elderly population is increasing rapidly in developing countries while traditional social support systems are deteriorating each day due to urbanization and modernization. Subsequently, elderly individuals are at a high risk of being abused. Studies show that the abuse of the elderly has an impact on the health and well-being of elders and can lead to increased health care costs nationwide. It is imperative that international and state organizations as well as every member of society take action to solve the hidden elder abuse issue through comprehensive research so that the elderly can enjoy their remaining years.
Keywords: Elderly abuse; Abuse of Elderly; Mistreatment of Elderly; Elderly; Developing Country
There is no commonly accepted definition of elder abuse [1-3]. Elder abuse is typically defined differently by various professionals to fit discipline-specific purposes such as legal, law enforcement, medical or protection requirements . The concept of elder abuse is also understood differently by older people and caregivers [4-6].
Mistreatment of older people – referred to as ‘‘elder abuse’’ – was first described in British scientific journals in 1975 under the term ‘‘granny battering’ [7,8]. Ground-breaking work on elder abuse was initiated in the UK and the US, but with different perceptions of the settings of elder abuse. In the UK, the focus of elder abuse was within medical and institutional settings, while in the US, elder abuse was observed as a family and domestic violence problem . Although elder abuse was first identified in developed countries where most of the existing research has been conducted, anecdotal evidence and other reports from developing countries have shown that it is a universal phenomenon. The fact that elder abuse is being taken far more seriously now reflects the growing worldwide concern about human rights and gender equality, as well as about domestic violence and population ageing .
Definition and types of elderly abuse
Debates about how to define elder abuse as well as which types of behavior should be included in the definition greatly limited progress during the early period of research on this topic . Studies in elder abuse suggest that a clear definition of elder abuse is important to recognize, diagnose, and intervene and to provide treatment to the problem  or at least to determine the liability of the abuser . A consistent definition is further needed to monitor the incidence of elder abuse and examine trends over time. A widely accepted definition of elder abuse is given by the International Network for Prevention of Elder Abuse (INPEA) and the World Health Organization (WHO) cited in De Donderet al., 2011. Elder abuse is defined as “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”. The definition implies that an abusive act towards an older person could be either an act of commission or omission by any person in a position of trust such as a family member, friend or neighbor. The National Center on Elder Abuse (NCEA) (2005)  identified six categories of elder abuse: (1) Physical Abuse, (2) Emotional Abuse, (3) Neglect, (4) Abandonment, (5) Sexual Abuse and (6) Self-neglect. For wider use, international scholars have agreed upon five categories of elder abuse: (1) physical abuse, (2) psychological abuse, (3) financial abuse, (4) sexual abuse and (5) neglect .
Prevalence of elder abuse
Although elder abuse seems like a significant problem, prior research suggests only 2 to 6% of elderly individuals in Australia, Britain, Canada, Costa Rica, the Netherlands and the United States have reported experiencing physical and psychological abuse, exploitation, or neglect . Cooper et al.,  in a systematic review of forty-nine elder abuse studies, noted that the prevalence of abuse reported by the general population studies ranged from 3.2 to 27.5 percent. In a review of twenty-six studies by Sooryanarayana et al.,  they noted the lowest reported prevalence rate of abuse in the community was 1.1% in the United States while the highest rates were found in Spain with suspected abuse at 44.6%. And nearly 50% of elders living with family members in Thailand report having been abused . Similarly, a study from Africa show that 64.3% of men and 60.3% of women experienced elder abuse in the past . However, operational definitions, as well as details of actions and behaviors considered elder abuse differed among the various studies [20,22-25].
Risk factors of elder abuse:
A review article by Lachs& Pillemer (2015)  suggests risk factors of elder abuse. Older women are more likely than older men to become victims of abuse. Among older adults, a younger age has been consistently associated with a greater risk of abuse, including emotional, physical, financial abuse and neglect. A shared living environment is a major risk factor for elder abuse. Living with a larger number of household members other than a spouse is associated with an increased risk of abuse, especially financial and physical abuse. Moreover, having a lower income is associated with a greater likelihood of financial abuse, emotional and physical abuse, and neglect. Studies consistently suggest that isolation and a lack of social support are important risk factors for elder abuse  . Some researchers [27,28] claim that stress experienced by caregivers is a major risk factor for elder abuse and many researchers also found that dependency , undue influence , marital status , financial problem and victim’s health  are among some of the factors associated with elder abuse.
Effects of elder abuse
Studies have shown that victims of elder abuse are at increased risk for death, after adjusting for any chronic illnesses they may have [33,34]. Elder abuse greatly increases the likelihood of placement in a nursing home  and of hospitalization . The psychological effects of abuse include increased rates of depression, anxiety, and other negative consequences and have been well documented [37-39]. Previous studies found that elder abuse is a significant predictor of suicide ideation ; injury, pain, and decreased quality of life; psychological problems including depression, anxiety and post-traumatic stress and death due to neglect and loneliness . Thus, all forms of elder abuse, both direct and indirect, affect the health and well-being of elders and can lead to increased health care costs .
The Situation in the Developing World
Concerns about population ageing apply to both developed and many developing countries as well and, subsequently, it is turned into a global issue. In the coming decades population ageing is likely to become one of the most important determinants of society characteristics and will provide direction for many technological developments .
In many parts of the world elder abuse occurs with little recognition or response. Until recently, this serious social problem was hidden from the public view and considered mostly a private matter. Even today, elder abuse continues to be taboo, mostly underestimated, and ignored by societies across the world. Evidence is accumulating, however, to indicate that elder abuse is an important public health and societal problem .
Older people are the fastest growing segment of the population world-wide and this growth is mainly taking place in developing countries which results in dramatic increases . As the population of the elderly increases, there is no safety net in place for most of the elderly already living in the least developed or developing countries of the world. In the many parts of today’s developing world, family is traditionally valued as the cradle of love where family needs including those of the aged were met. However, on the other hand, globalization, industrialization, urbanization and modernization have weakened traditional family and community networks to provide support to elderly [45,46]. With the rapid decline of fertility in many developing countries, the source of support for elders is changing from the extended family to the nuclear family. Concurrently, many countries still lack appropriate policies and programs to support their growing number of elders. It subsequently shows that the prevalence of the hidden problem of elder abuse will increase rapidly in the future and it will create major social and public health problems.
Issues of concern
The population aged 65 and over is expected to increase from 40 million in 2010 to over 70 million by 2030 . As adults grow older they may become more physically frail, may not see or hear as well as they used to, and may develop cognitive problems such as dementia. Subsequently, they become increasingly vulnerable to abuse and neglect. Moreover, the American Geriatrics Society’s Foundation for Health in Aging  reports many elder abuse cases are not reported. Those who consider reporting abuse often choose not to because they may have been abused by a family member, a loved one, or a trusted caregiver. It can be extremely difficult to tell others that someone you trust and love is abusing or neglecting you. Making matters worse, abusers often blame their victims, telling them that the abuse is their “fault,” and threatening them if they reveal the abuse to anyone. If the older person is dependent on the abuser for care, he or she may feel as if he or she has no option but to live in fear and pain. To help address elder abuse and neglect, states should create agencies that should provide elderly protective services making some revisions on the prevailing laws related to senior citizens . Finally, for comparison purposes, a standard definition of abuse of the elderly needs to be adopted and there should also be valid and reliable measures and a consensus on measuring of elder abuse. Moreover, concern of international organizations, state and society, should be directed towards how to solve this hidden elder abuse issue with intensive research so that there is a suitable environment for the elderly to live out their remaining years.
I would like to thank Dr. James D. Brightman, for his kind support of editing the English and encouraging the preparation of this review article.