Protecting the global longevity dividend
Authors: Desmond O'Neill
Journal: The Lancet Global Health (2017)

One of the unheralded developments in global health is the welcome increase in the number of older people (ie, aged 60 or 65 years and older) in low-income and middle-income countries. In parallel with the gains from this longevity dividend, ageing presents particular challenges to health services. These challenges arise from increasing interindividual variability and complexity of presentation of health conditions for which specialist geriatric services can provide effective responses.1Ellis G Whitehead MA O'Neill D Langhorne P Robinson D Comprehensive geriatric assessment for older adults admitted to hospital.Cochrane Database Syst Rev. 2011; 7 (CD006211)Crossref PubMed Scopus (2) Google Scholar However, even in developed countries the twin scourges of ageism and undue tolerance of gerontological illiteracy hamper the provision of age-attuned services. These issues are of particular relevance to the systematic review2Yon Y Mikton CR Gassoumis ZD Wilber KH Elder abuse prevalence in community settings: a systematic review and meta-analysis.Lancet Glob Health. 2017; 5: e147-e156Summary Full Text Full Text PDF PubMed Scopus (346) Google Scholar of the prevalence of elder abuse by Yongjie Yon and colleagues in The Lancet Global Health. Despite a growing awareness of the scale of problem since the original description of elder abuse in the biomedical literature over 40 years ago,3Burston GR Granny-battering.BMJ. 1975; 3: 592Crossref PubMed Scopus (158) Google Scholar research and service development lags behind that of child abuse and domestic violence.4Wolfe DA Elder abuse intervention: lessons from child abuse and domestic violence initiatives.in: Bonnie RJ Wallace RB Elder mistreatment: abuse, neglect, and exploitation in an aging America. National Research Council, Washington2002: 501-525Google Scholar A particular challenge has been the scarcity of reliable estimates of the prevalence of elder abuse to underpin policy, procedures, and guidelines. Several messages emerged from this carefully executed meta-analysis.2Yon Y Mikton CR Gassoumis ZD Wilber KH Elder abuse prevalence in community settings: a systematic review and meta-analysis.Lancet Glob Health. 2017; 5: e147-e156Summary Full Text Full Text PDF PubMed Scopus (346) Google Scholar The first is that elder abuse is more common than previously suspected, affecting one in six older adults. By contrast with earlier portrayals emphasising physical violence,3Burston GR Granny-battering.BMJ. 1975; 3: 592Crossref PubMed Scopus (158) Google Scholar the most common forms of elder abuse are psychological and financial abuse, followed at some distance by physical and sexual abuse. This phenomenon is relevant for planning effective strategies for prevention, identification, and management of this distressing and common problem.5O'Dwyer C O'Neill D Developing strategies for the prevention, detection and management of elder abuse: the Irish experience.J Elder Abuse Negl. 2008; 20: 169-180Crossref PubMed Scopus (12) Google Scholar From a global health perspective, one of the most troubling aspects of the review by Yon and colleagues is the dearth of studies from low-income and middle-income countries. Almost two-thirds of older people live in these regions, and the absence of a focus on this key issue reflects wide neglect of gerontological and geriatric expertise within their health systems,6Tam WJ Yap P Health care for older adults in Uganda: lessons for the developing world.J Am Geriatr Soc. 2016; (published online Oct 22.)DOI:10.1111/jgs.1456PubMed Google Scholar as well as in global health in general.7Esser DE Ward PS Ageing as a global public health challenge: from complexity reduction to aid effectiveness.Glob Public Health. 2013; 8: 745-768Crossref PubMed Scopus (8) Google Scholar This research vacuum is unfortunate not only for the populations involved, but also in terms of the loss of possible valuable knowledge exchange for care and protection arising from the experiences of different cultures and social structures.8Lloyd-Sherlock P Social policy and population ageing: challenges for north and south.Int J Epidemiol. 2002; 31: 754-757Crossref PubMed Scopus (34) Google Scholar An outstanding question from prevalence surveys is the extent to which elder abuse occurs in nursing homes, a setting that is not only under-researched, but also where there is concern that abuse takes place more often and in different patterns than in the community.9Castle N Ferguson-Rome JC Teresi JA Elder abuse in residential long-term care: an update to the 2003 National Research Council report.J Appl Gerontol. 2015; 34: 407-443Crossref PubMed Scopus (47) Google Scholar The magnitude of the problem emerging should prompt an urgency to investigate the most effective ways of preventing and managing elder abuse, further fuelled by the dearth of large, high quality, studies.10Baker PR Francis DP Mohd Hairi NN Othman S Choo WY Interventions for preventing elder abuse: applying findings of a new Cochrane review.Age Ageing. 2016; (published online Oct 13.)DOI:10.1093/ageing/afw186PubMed Google Scholar Elder abuse is a challenging area of practice and research, which requires a coordinated multisectoral approach and leadership and expertise from clinicians from various disciplines.11Du Mont J Kosa D Macdonald S Elliot S Yaffe M Determining possible professionals and respective roles and responsibilities for a model comprehensive elder abuse intervention: a Delphi consensus survey.PLoS One. 2015; 10: e0140760Google Scholar Financial elder abuse is a particularly problematic area for clinicians. Whereas training programmes for those working in the banking and financial sectors might help in prevention, no effective programmes are available for clinicians. Detection can be challenging, and cultural norms of what is considered to be a normative intergenerational transfer can vary between and within countries. Older people are a vital part of our society, a demographic bounty that is increasingly experienced across parts of the globe where, until recently, life expectancy was low. The scant attention paid to the study of this major threat to their health and wellbeing in low-income and middle-income countries should act as a catalyst for the global health community to examine to what extent the sector is agnostic, or indeed ageist, in its attitudes to the more complex health and social needs arising from the improved health and longevity in these countries. Less than 1% of studies on MEDLINE link global health with ageing, and only one in 20 of these studies relates to elder abuse. The combined focus of the global health community has had a major impact on communicable disease over many decades, most notably HIV. Although a change of direction has been noted in terms of an increased emphasis on non-communicable diseases, the collective scholarship and advocacy of the gerontological sciences have clearly been central to the promotion and advancement of progress in combating elder abuse. Therefore, enhancement of global responses to emerging problems such as elder abuse will require creative collaboration between global health and gerontology. This collaboration should in turn lead to a rethink of how equitably the UN and WHO dedicate their resources across the lifespan, and particularly to what extent this reflects the often complex needs of the growing numbers of older people. Careful meta-analyses such as the one presented in The Lancet Global Health2Yon Y Mikton CR Gassoumis ZD Wilber KH Elder abuse prevalence in community settings: a systematic review and meta-analysis.Lancet Glob Health. 2017; 5: e147-e156Summary Full Text Full Text PDF PubMed Scopus (346) Google Scholar further this cause by highlighting that a new goal for global health is to nurture and protect the global longevity dividend. We declare no competing interests. Elder abuse prevalence in community settings: a systematic review and meta-analysisAlthough robust prevalence studies are sparse in low-income and middle-income countries, elder abuse seems to affect one in six older adults worldwide, which is roughly 141 million people. Nonetheless, elder abuse is a neglected global public health priority, especially compared with other types of violence. Full-Text PDF Open Access