Physical abuse of older people reported at the Institute of Forensic Medicine in Recife, Pernambuco State, Brazil A violência física contra a pessoa idosa revelada em serviço médico-legal, Recife, Pernambuco, Brasil

This cross-sectional study aimed to determine the profile of physical abuse against older people who underwent forensic examination at the Institute of Forensic Medicine in Recife, Pernambuco State, Brazil. The cases, with data from 1,027 forensic reports, were described according to characteristics of the incident, victim, and aggressor. Most cases of violence were produced by mechanical energy, either with blunt objects or by empty-handed attack; the most common day of the week was Sunday, most frequently in the evening, and in the victim’s home; typical cases involved mild injuries on more than one part of the victim’s body. The majority of the victims were men, 60 to 69 years of age, brown (mixed-race), married or living with a partner, and retirees/ pensioners. The majority of the aggressors were men, known to the victim, and attacking alone. The social transcendence of violence against older people clearly calls for investment in programs to deal with the problem in order to ensure better quality of life for the elderly. Elder Abuse; Violence; Aged Introduction As part of Brazil’s demographic transition, the country’s population is following the worldwide trend and becoming increasingly older. Compared to the European countries, in Brazil the phenomenon has been more intense and rapid, coinciding with an urbanization process, often associated with industrialization, but without the corresponding improvements in quality of life for the majority of the population 1,2. Thus, populating aging, combined with the stress of modern living, aggravates individual and family problems and conflicts in collective life in both the public and private spheres. Such problems mount up and can be expressed in the form of violence 3. In this context, the elderly population becomes vulnerable due to physiological, psychological, and socioeconomic issues 4. The World Health Organization (WHO) defines violence as the intentional use of physical force or power, whether real or threatened, against oneself or another person, group, or community, resulting or with the possibility of resulting in injury, death, psychological harm, developmental disability, or deprivation 5. According to the WHO 5 and the Brazilian National Policy for the Reduction of Morbidity and Mortality from Accidents and Violence 6, violence can be classified as: physical, psychological, sexual, or financial abuse, neglect, abandonment, or selfARTIGO ARTICLE 1 Programa Integrado de Pós-graduação em Saúde Coletiva, Universidade Federal de Pernambuco, Recife, Brasil. 2 Secretaria de Saúde do Estado de Pernambuco, Recife, Brasil. 3 Núcleo de Saúde Pública e Desenvolvimento Social, Universidade Federal de Pernambuco, Recife, Brasil. Correspondence M. B. Abath Programa Integrado de Pós-graduação em Saúde Coletiva, Universidade Federal de Pernambuco. Av. Professor Moraes Rego s/n, Cidade Universitária, Recife, PE 50670-901, Brasil. [email protected] Abath MB et al. 1798 Cad. Saúde Pública, Rio de Janeiro, 26(9):1797-1806, set, 2010 neglect. Physical abuse of elders, the object of this study, relates to the use of physical force to compel older persons to act against their wishes, to hurt them, or to cause them pain, incapacity, or death 6,7. Elder abuse is a public health problem 7,8. Elder abuse was described for the first time in 1975 9, and the first publications on the issue came from the United States, Canada, and the United Kingdom and other European countries 10. In Brazil, despite the issue’s public health relevance, the phenomenon did not gain visibility until the 1990s 5,7, and studies on violence against older people are still rare 8,11. Due to the incipient state of the research, the prevalence of violence against older people in Brazil is still unknown 12. Two population-based surveys, in Camaragibe (Pernambuco State) 11 and Niterói (Rio de Janeiro State) 8, showed a prevalence of 21% for various forms of violence in the former case and 10.1% for domestic physical abuse in the latter. Worldwide, the prevalence of elder abuse varies from 3% to 10%, and the incidence increased by 150% in ten years 13. According to a recent systematic review, other authors showed prevalence rates ranging from 3.2% to 27.5% 14. A nationwide incidence survey in the United States in 1996 showed that approximately 450,000 older people (≥ 60 years) had suffered domestic abuse 15 (1% of the country’s elderly population) 14. In Boston (USA), the rate in persons over 65 years of age reached 3.2%, and physical abuse was the most frequent form (2%) 16. In Amsterdam (Netherlands), prevalence in persons over 65 years of age was 5.6%, with physical abuse ranking third (1.2%) 17. According to a study in Barcelona, Spain, 11.9% of older people (≥ 70 years) had suffered abuse, mostly psychological in nature, followed by physical abuse, neglect, and abandonment 13. In Seoul, Korea, a population-based survey showed that 6.3% of older people (≥ 65 years) had suffered some type of violence, with physical abuse as the least frequent (1.9%) 18. In a study focusing on physical and psychological abuse in older people (≥ 60 years) in Hong Kong, the prevalence reached 21.4% 19. Considering the magnitude and transcendence of elder abuse, as well as the lack of studies on this issue in Brazil, it is necessary to construct new objects of research that can help reveal the problem in a comprehensive, detailed, rigorous, and relevant way. One way of demonstrating the profile of elder abuse (in order to back measures to combat it) is to analyze medical examiners’ reports on injuries issued by the Institute of Forensic Medicine. Possibly because these examiners’ reports are used in court, the data they contain tend to be more reliable and complete than that obtained from patients’ medical charts, which often fail to even mention physical abuse as the source of the injury. The current study thus describes the profile of physical abuse according to the characteristics of the event, victim, and aggressor, among older people submitted to forensic examination of injuries from 2004 to 2007 at the Institute of Forensic Medicine (Instituto Médico-Legal – IML) in Recife, Pernambuco State, Brazil.