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The Gerontologist Apr 2016Elder mistreatment is now recognized internationally as a pervasive and growing problem, urgently requiring the attention of health care systems, social welfare... (Review)
Review
PURPOSE
Elder mistreatment is now recognized internationally as a pervasive and growing problem, urgently requiring the attention of health care systems, social welfare agencies, policymakers, and the general public. In this article, we provide an overview of global issues in the field of elder abuse, with a focus on prevention.
DESIGN AND METHODS
This article provides a scoping review of key issues in the field from an international perspective.
RESULTS
By drawing primarily on population-based studies, this scoping review provided a more valid and reliable synthesis of current knowledge about prevalence and risk factors than has been available. Despite the lack of scientifically rigorous intervention research on elder abuse, the review also identified 5 promising strategies for prevention.
IMPLICATIONS
The findings highlight a growing consensus across studies regarding the extent and causes of elder mistreatment, as well as the urgent need for efforts to make elder mistreatment prevention programs more effective and evidence based.
Topics: Aged; Elder Abuse; Geriatric Assessment; Global Health; Guidelines as Topic; Humans; Prevalence; Risk Factors
PubMed: 26994260
DOI: 10.1093/geront/gnw004 -
The New England Journal of Medicine Nov 2015Because older victims of abuse tend to be isolated, their interactions with physicians are important opportunities to recognize abuse and intervene. This review explores... (Review)
Review
Because older victims of abuse tend to be isolated, their interactions with physicians are important opportunities to recognize abuse and intervene. This review explores the manifestations of elder abuse and the role of multidisciplinary teams in its assessment and management.
Topics: Aged; Elder Abuse; Humans; Physical Examination; Prevalence; Risk Factors; Social Welfare
PubMed: 26559573
DOI: 10.1056/NEJMra1404688 -
The Lancet. Global Health Feb 2017Elder abuse is recognised worldwide as a serious problem, yet quantitative syntheses of prevalence studies are rare. We aimed to quantify and understand prevalence... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Elder abuse is recognised worldwide as a serious problem, yet quantitative syntheses of prevalence studies are rare. We aimed to quantify and understand prevalence variation at the global and regional levels.
METHODS
For this systematic review and meta-analysis, we searched 14 databases, including PubMed, PsycINFO, CINAHL, EMBASE, and MEDLINE, using a comprehensive search strategy to identify elder abuse prevalence studies in the community published from inception to June 26, 2015. Studies reporting estimates of past-year abuse prevalence in adults aged 60 years or older were included in the analyses. Subgroup analysis and meta-regression were used to explore heterogeneity, with study quality assessed with the risk of bias tool. The study protocol has been registered with PROSPERO, number CRD42015029197.
FINDINGS
Of the 38 544 studies initially identified, 52 were eligible for inclusion. These studies were geographically diverse (28 countries). The pooled prevalence rate for overall elder abuse was 15·7% (95% CI 12·8-19·3). The pooled prevalence estimate was 11·6% (8·1-16·3) for psychological abuse, 6·8% (5·0-9·2) for financial abuse, 4·2% (2·1-8·1) for neglect, 2·6% (1·6-4·4) for physical abuse, and 0·9% (0·6-1·4) for sexual abuse. Meta-analysis of studies that included overall abuse revealed heterogeneity. Significant associations were found between overall prevalence estimates and sample size, income classification, and method of data collection, but not with gender.
INTERPRETATION
Although 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.
FUNDING
Social Sciences and Humanities Research Council of Canada and the WHO Department of Ageing and Life Course.
Topics: Aged; Elder Abuse; Female; Global Health; Humans; Male; Middle Aged; Prevalence
PubMed: 28104184
DOI: 10.1016/S2214-109X(17)30006-2 -
Journal of the American Geriatrics... Jun 2015This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a... (Review)
Review
This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem. Evidence suggests that elder abuse is prevalent, predictable, costly, and sometimes fatal. This review will highlight the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences in community populations. The global literature in PubMed, MEDLINE, PsycINFO, BIOSIS, Science Direct, and Cochrane Central was searched. Search terms included elder abuse, elder mistreatment, elder maltreatment, prevalence, incidence, risk factors, protective factors, outcomes, and consequences. Studies that existed only as abstracts, case series, or case reports or recruited individuals younger than 60; qualitative studies; and non-English publications were excluded. Tables and figures were created to highlight the findings: the most-detailed analyses to date of the prevalence of elder abuse according to continent, risk and protective factors, graphic presentation of odds ratios and confidence intervals for major risk factors, consequences, and practical suggestions for health professionals in addressing elder abuse. Elder abuse is common in community-dwelling older adults, especially minority older adults. This review identifies important knowledge gaps, such as a lack of consistency in definitions of elder abuse; insufficient research with regard to screening; and etiological, intervention, and prevention research. Concerted efforts from researchers, community organizations, healthcare and legal professionals, social service providers, and policy-makers should be promoted to address the global problem of elder abuse.
Topics: Aged; Elder Abuse; Female; Humans; Male; Prevalence; Risk Factors; Social Work; Socioeconomic Factors
PubMed: 26096395
DOI: 10.1111/jgs.13454 -
Clinics in Geriatric Medicine Aug 2018Elder abuse and neglect are common and may have serious medical and social consequences but are infrequently identified. An emergency department (ED) visit represents a... (Review)
Review
Elder abuse and neglect are common and may have serious medical and social consequences but are infrequently identified. An emergency department (ED) visit represents a unique but usually missed opportunity to identify potential abuse and initiate intervention. ED assessment should include observation of patient-caregiver interaction, comprehensive medical history, and head-to-toe physical examination. Formal screening protocols may also be useful. ED providers concerned about elder abuse or neglect should document their findings in detail. ED interventions for suspected or confirmed elder abuse or neglect include treatment of acute medical, traumatic, and psychological issues; ensuring patient safety; and reporting to the authorities.
Topics: Aged; Elder Abuse; Emergency Medical Services; Emergency Service, Hospital; Geriatric Assessment; Health Services for the Aged; Humans
PubMed: 30031426
DOI: 10.1016/j.cger.2018.04.007 -
European Journal of Public Health Feb 2019A recent study has shown that close to one in six older adults have experienced elder abuse in a community setting in the past year. It is thought that abuse in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A recent study has shown that close to one in six older adults have experienced elder abuse in a community setting in the past year. It is thought that abuse in institutions is just as prevalent. Few systematic evidence of the scale of the problem exists in elder care facilities. The aim of this review is to conduct a systematic review and meta-analysis of the problem in institutional settings and to provide estimates of the prevalence of elder abuse in the past 12 months.
METHODS
Fourteen academic databases and other online platforms were systematically searched for studies on elder abuse. Additionally, 26 experts in the field were consulted to identify further studies. All studies were screened for inclusion criteria by two independent reviewers. Data were extracted, and meta-analysis was conducted. Self-reported data from older residents and staff were considered separately.
RESULTS
Nine studies met the inclusion criteria from an initial of 55 studies identified for review. Overall abuse estimates, based on staff reports, suggest that 64.2% of staff admitted to elder abuse in the past year. There were insufficient studies to calculate an overall prevalence estimate based on self-reported data from older residents. Prevalence estimates for abuse subtypes reported by older residents were highest for psychological abuse (33.4%), followed by physical (14.1%), financial (13.8%), neglect (11.6%), and sexual abuse (1.9%).
CONCLUSIONS
The prevalence of elder abuse in institutions is high. Global action to improve surveillance and monitoring of institutional elder abuse is vital to inform policy action to prevent elder abuse.
Topics: Aged; Aged, 80 and over; Elder Abuse; Female; Homes for the Aged; Humans; Male; Nursing Homes; Prevalence
PubMed: 29878101
DOI: 10.1093/eurpub/cky093 -
The Cochrane Database of Systematic... Aug 2016Maltreatment of older people (elder abuse) includes psychological, physical, sexual abuse, neglect and financial exploitation. Evidence suggests that 10% of older adults... (Review)
Review
BACKGROUND
Maltreatment of older people (elder abuse) includes psychological, physical, sexual abuse, neglect and financial exploitation. Evidence suggests that 10% of older adults experience some form of abuse, and only a fraction of cases are actually reported or referred to social services agencies. Elder abuse is associated with significant morbidity and premature mortality. Numerous interventions have been implemented to address the issue of elder maltreatment. It is, however, unclear which interventions best serve to prevent or reduce elder abuse.
OBJECTIVES
The objective of this review was to assess the effectiveness of primary, secondary and tertiary intervention programmes used to reduce or prevent abuse of the elderly in their own home, in organisational or institutional and community settings. The secondary objective was to investigate whether intervention effects are modified by types of abuse, types of participants, setting of intervention, or the cognitive status of older people.
SEARCH METHODS
We searched 19 databases (AgeLine, CINAHL, Psycinfo, MEDLINE, Embase, Proquest Central, Social Services Abstracts, ASSIA, Sociological Abstracts, ProQuest Dissertations & Theses Global, Web of Science, LILACS, EPPI, InfoBase, CENTRAL, HMIC, Opengrey and Zetoc) on 12 platforms, including multidisciplinary disciplines covering medical, health, social sciences, social services, legal, finance and education. We also browsed related organisational websites, contacted authors of relevant articles and checked reference lists. Searches of databases were conducted between 30 August 2015 and 16 March 2016 and were not restricted by language.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), cluster-randomised trials, and quasi-RCTs, before-and-after studies, and interrupted time series. Only studies with at least 12 weeks of follow-up investigating the effect of interventions in preventing or reducing abuse of elderly people and those who interact with the elderly were included.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and assessed the studies' risk of bias. Studies were categorised as: 1) education on elder abuse, 2) programmes to reduce factors influencing elder abuse, 3) specific policies for elder abuse, 4) legislation on elder abuse, 5) programmes to increase detection rate on elder abuse, 6) programmes targeted to victims of elder abuse, and 7) rehabilitation programmes for perpetrators of elder abuse. All studies were assessed for study methodology, intervention type, setting, targeted audience, intervention components and intervention intensity.
MAIN RESULTS
The search and selection process produced seven eligible studies which included a total of 1924 elderly participants and 740 other people. Four of the above seven categories of interventions were evaluated by included studies that varied in study design. Eligible studies of rehabilitation programmes, specific policies for elder abuse and legislation on elder abuse were not found. All included studies contained a control group, with five of the seven studies describing the method of allocation as randomised. We used the Cochrane 'Risk of bias' tool and EPOC assessment criteria to assess risk of bias. The results suggest that risk of bias across the included body of research was high, with at least 40% of the included studies judged as being at high risk of bias. Only one study was judged as having no domains at high risk of bias, with two studies having two of 11 domains at high risk. One study was judged as being at high risk of bias across eight of 11 domains.All included studies were set in high-income countries, as determined by the World Bank economic classification (USA four, Taiwan one, UK two). None of the studies provided specific information or analysis on equity considerations, including by socio-economic disadvantage, although one study was described as being set in a housing project. One study performed some form of cost-effectiveness analysis on the implementation of their intervention programmes, although there were few details on the components and analysis of the costing.We are uncertain whether these interventions reduce the occurrence or recurrence of elder abuse due to variation in settings, measures and effects reported in the included studies, some of which were very small and at a high risk of bias (low- and very low-quality evidence).Two studies measured the occurrence of elder abuse. A high risk of bias study found a difference in the post-test scores (P value 0.048 and 0.18). In a low risk of bias study there was no difference found (adjusted odds ratio (OR) =0.48, 95% 0.18 to 1.27) (n = 214). For interventions measuring abuse recurrence, one small study (n = 16) reported no difference in post-test means, whilst another found higher levels of abuse reported for the intervention arms (Cox regression, combined intervention hazard ratio (HR) = 1.78, alpha level = 0.01).It is uncertain whether targeted educational interventions improve the relevant knowledge of health professionals and caregivers (very low-quality evidence), although they may improve detection of resident-to-resident abuse. The concept of measuring improvement in detection or reporting as opposed to measuring the occurrence or recurrence of abuse is complicated. An intervention of public education and support services aimed at victims may also improve rates of reporting, however it is unclear whether this was due to an increase in abuse recurrence or better reporting of abuse.The effectiveness of service planning interventions at improving the assessment and documentation of related domains is uncertain. Unintended outcomes were not reported in the studies.
AUTHORS' CONCLUSIONS
There is inadequate trustworthy evidence to assess the effects of elder abuse interventions on occurrence or recurrence of abuse, although there is some evidence to suggest it may change the combined measure of anxiety and depression of caregivers. There is a need for high-quality trials, including from low- or middle-income countries, with adequate statistical power and appropriate study characteristics to determine whether specific intervention programmes, and which components of these programmes, are effective in preventing or reducing abuse episodes among the elderly. It is uncertain whether the use of educational interventions improves knowledge and attitude of caregivers, and whether such programmes also reduce occurrence of abuse, thus future research is warranted. In addition, all future research should include a component of cost-effectiveness analysis, implementation assessment and equity considerations of the specific interventions under review.
Topics: Aged; Caregivers; Elder Abuse; Humans; Interrupted Time Series Analysis; Nursing Homes; Nursing Staff; Primary Prevention; Randomized Controlled Trials as Topic; Secondary Prevention; Tertiary Prevention
PubMed: 27528431
DOI: 10.1002/14651858.CD010321.pub2 -
Revista Brasileira de Enfermagem 2023to analyze the concept of elder abuse and identify its respective antecedents, attributes and consequents. (Review)
Review
OBJECTIVE
to analyze the concept of elder abuse and identify its respective antecedents, attributes and consequents.
METHODS
this is a conceptual analysis according to Walker and Avant's proposition. The search for the concept was mediated by an integrative review in the LILACS, PubMed, CINAHL, Web of Science and BDENF databases.
RESULTS
as antecedents, female, family member, low social support and low income or socioeconomic conditions stand out. Attributes were threats and/or intimidation, intentional use of physical force, using resources without authorization, unwanted sexual activity, offering low insufficient amount of nutrients for older adults and not meeting older adults' affective/emotional needs. Consequents were psychological disorders, dependence on aggressors, environment of insecurity and damage/loss of human rights or human dignity.
FINAL CONSIDERATIONS
the phenomenon under discussion is broad and multifaceted, suggesting expansion of studies related to the theme in order to explore it in detail.
Topics: Humans; Female; Aged; Elder Abuse; Family
PubMed: 38055495
DOI: 10.1590/0034-7167-2023-0150 -
Journal of the National Medical... Jan 2005Elder abuse and neglect has been recognized as a growing problem in the United States, and this trend is likely to increase unless firm steps are taken to prevent it....
Elder abuse and neglect has been recognized as a growing problem in the United States, and this trend is likely to increase unless firm steps are taken to prevent it. All 50 states have reporting requirements for elder abuse and neglect. However, to date, there is no federal policy requiring reporting of elder abuse and neglect. In order to stem the tide of this awful scourge on society, we must continue to train caregivers and healthcare workers in the proper care and treatment of our elder citizens. Healthcare workers, especially emergency medicine physicians and nurses, must take the lead in this endeavor. There must be organized programs in healthcare facilities to facilitate the training of medical personnel. Scientific literature suggests that the abusers appear to be family members and caretakers of the elderly. Goals for prevention include enhancing quality of life, preventing family breakdown, and keeping the elderly persons in their homes as long as possible, if this is their wish. Intervention appears to be one of the best ways of prevention.
Topics: Aged; Caregivers; Elder Abuse; Emergency Service, Hospital; Family; Health Personnel; Humans; United States
PubMed: 15719878
DOI: No ID Found -
Revista Da Escola de Enfermagem Da U S P 2022to map assessment tools for elder abuse and determine the psychometric properties of each one. (Review)
Review
OBJECTIVE
to map assessment tools for elder abuse and determine the psychometric properties of each one.
METHOD
scoping review developed according to recommendations of the JBI Institute Reviewer's Manual in databases and gray literature.
RESULTS
seventeen tools were identified for measuring situations of elder abuse. They were categorized into 1) Tools for assessment of risk for abuse, and 2) Tools for identification of abuse. According to risk for abuse, Vulnerability to Abuse Screening Scale was the most prevalent in the literature, with factorial analysis acceptable through four domains, and good internal reliability (0,74). Therefore, Assessment Tool for Domestic Elder Abuse comprises the assessment of six types of elder abuse; however, the study shows psychometric limitation since the internal structure was not evaluated by validity evidences.
CONCLUSION
seventeen tools to determine the occurrence or risk for elder abuse were identified with different psychometric properties. We recommend the use of more than one of the tools identified for an appropriate measurement of elder abuse situations given the complexity of the phenomenon and the lack of a single instrument that contemplates all its consequences and forms of expression.
Topics: Humans; Aged; Elder Abuse; Reproducibility of Results; Psychometrics
PubMed: 36490228
DOI: 10.1590/1980-220X-REEUSP-2022-0115en