Intended for healthcare professionals


Listening to the voices of abused older people: should we classify system abuse?

BMJ 2015; 350 doi: (Published 04 June 2015) Cite this as: BMJ 2015;350:h2697
  1. Yuliya Mysyuk, PhD candidate12,
  2. Rudi Gerardus Johannes Westendorp, professor of medicine at old age123,
  3. Simon Biggs, professor of gerontology and social policy4,
  4. Jolanda Lindenberg, scientific staff12
  1. 1Leyden Academy on Vitality and Ageing, Leiden, 2333AA, Netherlands
  2. 2Leiden University Medical Centre, Leiden, Netherlands
  3. 3Department of Public Health, University of Copenhagen, Denmark
  4. 4University of Melbourne, School of Social and Political Sciences, Melbourne, Australia
  1. Correspondence to: J Lindenberg Lindenberg{at}
  • Accepted 30 March 2015

Elder abuse is often the result of the organisation of health systems rather than the fault of individuals, argue Yuliya Mysyuk and colleagues. They call for system abuse to be acknowledged and addressed by incorporating older people’s views when designing health services

Over the past few decades it is has become clear that abuse of older people is a far reaching public health problem that affects the quality of life of people worldwide.1 2 3 4 It disproportionately affects people with mental health problems, such as depression and dementia.1 5 Currently, the most widely used definition comes from the World Health Organization: “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.”6 The definition focuses on a trusting relationship, includes acts of omission and commission, and is mostly interpreted as referring to interpersonal relationships.7 However, scandals in the UK, such as at Mid Staffordshire8 and Leas Cross,9 indicate that the problem goes beyond interpersonal relationships.

For older people, care professionals are among the most important groups to identify and report abuse.10 11 Despite this, only a small percentage of cases are reported by physicians10 12 and elder abuse remains under-reported.13 14 15 It is therefore important that those involved in healthcare are in touch with the experiences and perceptions of elder abuse among victims. Yet, despite some exceptions16 the voices of older people are relatively absent in debates about the typology of elder abuse, which is generally categorised as physical, emotional, financial, sexual, and neglect.1

To illustrate older people’s views on abuse we draw on our qualitative studies on perspectives on elder abuse involving more than 100 people …

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