One of the unheralded developments

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. 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 review of the prevalence of elder abuse by Yongjie Yon and colleagues in . Despite a growing awareness of the scale of problem since the original description of elder abuse in the biomedical literature over 40 years ago, research and service development lags behind that of child abuse and domestic violence. 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. The first is that elder abuse is more common than previously suspected, affecting one in six older adults. By TMC125 with earlier portrayals emphasising physical violence, 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. 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, as well as in global health in general. 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. An outstanding question from prevalence surveys is the extent to which elder abuse occurs in nursing homes, a setting L-dopa 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. 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. 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. 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.
Although child survival has improved substantially in the past 15 years, the decline in neonatal mortality (particularly deaths related to neonatal sepsis) has been more modest, which has contributed to the overall non-attainment of Millennium Development Goal 4 (to reduce child mortality). WHO recommends admission to hospital for any young infant (neonates and those aged 28–59 days) with clinically severe infections. However, access to hospital care and lack of willingness (mostly on the part of parents) to admit a young infant with possible bacterial infection are some of the many factors that have contributed to neonatal sepsis continuing to account for about 7% of all child mortality.