Editorial

Last week’s UK newspapers saw further evidence of lobbying by industry against a ban on smoking in public places. Gareth Davis, chief executive of
Imperial Tobacco, said that a ban would not harm tobacco sales in the long term, but would harm the hospitality industry. But evidence from Ireland, which introduced a ban on smoking in public places earlier this year, shows that cigarette sales are down. Meanwhile, a systematic review of research on the impact of bans on bar and restaurant revenue reveals that studies funded by the tobacco industry show a negative economic impact, whereas independent studies show either no impact or a positive impact on restaurant and bar sales and employment. Leadership from Bush, Blair, and other politicians is needed, now, to ratify the FCTC and to demonstrate that they too, like the 32 countries that have ratified, take the health of their people seriously and are committed to global tobacco control. If they need more facts to convince them, they could do worse than study an atlas of heart disease and stroke published last week by WHO in conjunction with the
US Centers for Disease Control and Prevention. They would be left in no doubt about the importance of preventing smoking, and the need to focus efforts on children and adolescents. With reports that one in three girls in the UK are now smokers by 16 years of age, the time for listening to the tobacco industry is over. s The Lancet

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How would you like to be treated when you are 75?
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Please refer to the printed journal.

See Seminar page 1263

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According to this year’s UN Population Fund State of
World Population report, the proportion of the population aged 65 and older will have doubled in most regions between 2000 and 2050. For example, an estimated 29% of the population in Europe and 18% in
Asia will be 65 years or older. This shift in demographics, which is further compounded by the effects of
HIV/AIDS on family structure in African and increasingly also in southeast Asian countries, is likely to weaken traditional respect for elderly people and family-based systems for providing old-age care and support, making elderly people vulnerable to ill-treatment and abuse by carers and society as a whole.
In their Seminar on elder abuse, Mark Lachs and Karl
Pillemer look at prevalence, definitions, the evidence for major risk factors and intervention strategies, and give physicians a framework for how best to deal with suspected maltreatment of elderly people. Elder abuse has only recently been made a public issue, 30 years after child abuse began to be tackled. Generally accepted definitions now also include psychological and financial abuse. However, there are still scant data on true prevalence and the effect of intervention strategies. One of the most harrowing statistics in the
Seminar is that people who have been mistreated are
3·1 times more likely to die within 3 years compared with those not abused, even when corrected for comorbidities and other confounding factors. So, what is being done about protection of elderly people?

In its 2000 “No Secrets” national framework, the
UK Government set out guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. Earlier this year, a Health Select Committee looked at what has been achieved and pointed out many gaps and shortcomings in existing systems and policies. On
July 26, the “Protection of Vulnerable Adults” scheme was implemented in England and Wales that bans known abusers from working with vulnerable adults in care homes and through domiciliary care agencies. The London-based charity Action on Elder
Abuse (AEA) was given £431000 by the Department of Health to explore the feasibility of a national recording system for the incidence of elder