Elder self-neglect and abuse and mortality risk in a community-dwelling population

Association between self-neglect and incident cognitive impairment among Chinese older adults and its subgroup differences

BACKGROUND

Population aging has led to growing concerns regarding self-neglect and cognitive impairment among older adults. However, research on the association between self-neglect and incident cognitive impairment remains limited. We aimed to investigate the association between self-neglect and incident cognitive impairment and variations in gender and age.

METHODS

A longitudinal study was conducted involving 2595 Chinese older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database. Self-neglect was assessed using 17 items from the CLHLS, and cognitive function was evaluated using the Mini-Mental State Examination. Participants with cognitive impairment at baseline were excluded, and incident cognitive impairment during the follow-up period was documented. Cox proportional hazards models, restrictive cubic spline analysis (RCS), and stratified analyses based on gender and age (with 80 as the threshold) were conducted.

RESULTS

The study sample comprised 1249 (48.1 %) men and 1346 (51.9 %) women, with an mean age of 79.7 ± 9.8 years. The risk of cognitive impairment was significantly higher for those in the third (Q3) and fourth (Q4) quartiles of self-neglect scores compared to those in the first quartile (Q1). The RCS analysis indicated a significantly linear relationship. The interaction between gender and self-neglect scores was significantly associated with incident cognitive impairment (P for interaction <0.001), suggesting that men are at a higher risk compared to women.

CONCLUSION

Self-neglect is identified as a significant risk factor for incident cognitive impairment among older adults, with a particular impact on men, highlighting the critical need to address self-neglect to prevent cognitive decline.

Self-neglect in older adults: an evolutionary concept analysis

Background

Self-neglect in older adults is a global public health concern, affecting millions of older adults. It is, therefore, important to define the concept of self-neglect to enable recognition and intervention.

Objective

The objective was to analyze the concept of older adults' self-neglect, providing a reference to help healthcare professionals understand it.

Methods

A systematic search of relevant literature on older adults' self-neglect was conducted in the Chinese National Knowledge Infrastructure, Wanfang database, Chinese Biomedical Literature Database, PubMed, Web of Science and CINAHL database. Rodgers' evolutionary method of concept analysis was used as a framework for the paper.

Results

A total of 68 articles were included. Older adults' self-neglect included four defining characteristics: failure or inability to meet basic needs, risky or unsafe behaviors, diagnostic challenges in recognition, and social isolation or lack of interaction. Antecedents included physical, psychological, socio-environmental, and other related factors. Consequences included effects on the older adults themselves and effects on others and society.

Conclusions

A theoretical definition and conceptual model of older adults' self-neglect was developed. The identified attributes, antecedents, and consequences can be utilized in nursing education, research, and intervention approaches.

Reducing Depression and Suicidal Ideation Among Elder Abuse Victims Using PROTECT

OBJECTIVE

Elder abuse is prevalent and often unaddressed despite poor health and high mortality outcomes. One third of victims suffer from depression. This study examined whether: 1) suicidal ideation (SI) is associated with victims' demographic or abuse characteristics; 2) PROTECT psychotherapy reduces depression regardless of suicidal ideation; and 3) it reduces suicidal ideation.

DESIGN

Partner agencies referred depressed victims and received PROTECT for 10 weeks. Depression severity and SI were measured at each visit.

PARTICIPANTS

A sample of 158 depressed EA victims (PHQ-9 ≥ 10) without cognitive impairment (Tele-MoCA ≥ 11).

INTERVENTION

PROTECT is a behavioral psychotherapy delivered in 45-minute sessions in person or remotely (phone or video) for 10 weeks.

MEASURES

Data on demographics and abuse were collected at baseline, and depression severity (PHQ-9) and SI (PHQ-9 item 9) weekly. We examined trajectories of response to PROTECT with mixed-effects models to compare response among SI and Non-SI participants and change in SI throughout treatment.

RESULTS

There was no association between victims' demographic or elder abuse characteristics and SI. PROTECT led to overall reduction in depression severity: the SI group showed an estimated mean improvement of 5.58 points on the PHQ-9 (95% CI: 4.11, 7.06), and non-SI group improved by 5.25 (95% CI: 4.53, 5.97) points. SI decreased over time, with 19% of participants endorsing SI at baseline and 5.7% at end of treatment.

CONCLUSIONS

Suicidal ideation is equally prevalent across EA victims from different backgrounds. PROTECT can reduce depression and suicidal ideation in elder abuse victims.

A Scoping Review of Elder Mistreatment and Abuse in Asian Americans

This scoping review examines elder abuse and mistreatment (EA/EM) among Asian American older adults, focusing on prevalence, perception, experience, and associated factors. A search of journal publications spanning from 1993 to 2024 through 14 databases identified 28 relevant studies. EA/EM prevalence ranged from 6% to 58.3%, averaging 23%. Despite awareness, help-seeking and reporting were low, with variations across subethnic groups. Cultural and immigration-related barriers significantly shaped perceptions and behaviors. Findings underscore the need for culturally sensitive, context-specific interventions to address the unique experiences of Asian American older adults.

Emotional abuse and depression as factors associated with suicidal ideation in community-dwelling older adults: mediation analysis

OBJECTIVE

The objectives of this study were to examine the factors associated with suicidal ideation in a community-dwelling older adult population in Korea. Specifically, the study focuses on the role of emotional abuse and depression, and investigates the mediating effect of depression in the relationship between emotional abuse and suicidal ideation.

METHODS

This study utilised data from 10 097 individuals aged 65 and older, based on a 2020 survey conducted by the Korea Institute for Health and Social Affairs.

RESULTS

In our study, 1.9% of older adults reported suicidal ideation, 4.4% reported experiencing emotional abuse, and 12.8% reported having depression (defined as a score of ≥8 on the short version of the Geriatric Depression Scale). Our results revealed that younger-older adults, older adults living without a spouse, poor social support, subjective health status, emotional abuse (odds ratio (OR) = 2.929), and depression (OR = 5.152) were found to be significantly associated with suicidal ideation after controlling for all confounding factors. Furthermore, the mediation analysis revealed that the OR for emotional abuse decreased from 3.284 to 2.929 after accounting for depression, suggesting that depression partially mediates the relationship between emotional abuse and suicidal ideation.

CONCLUSION

Emotional abuse and depression were found to be associated with suicidal ideation in community-dwelling Korean older adults. Notably, depression was found to buffer the relationship between emotional abuse and suicidal ideation, indicating a mediating effect.

A neglected geriatric syndrome: assessment of self-neglect in the shadow of COVID-19

BACKGROUND

We aimed to screen self-neglect in older adults before and after the COVID-19 pandemic, to evaluate the effect of the pandemic on self-neglect, and to evaluate the relationship between self-neglect and geriatric syndromes in this study.

METHODS

Older adults ≥65 years old and without dementia who applied to a single-centre geriatric outpatient clinic between December 2023 and May 2024 were included in the study. We performed self-neglect screening for the pre- and post-pandemic era with the Istanbul Medical School Elder Self-Neglect questionnaire. Additionally, comprehensive geriatric assessment data and quality of life data with the Euro-Quality of Life 5D-3L scales were evaluated.

RESULTS

A total of 104 patients, with a mean age of 76.8 ± 5.9 years and 70% female, were included in the study. Self-neglect was detected in 19 patients (18.3%) at the post-pandemic period. The older adults with self-neglect were more frail, more dependent, more depressed, had higher risk of sarcopenia, also had more common polypharmacy and urinary incontinence (all P < 0.05). Also, quality of life was found to be more impaired in the self-neglect group (P < 0.001). In multivariate Cox regression analysis, being dependent and having a high risk of sarcopenia were associated with self-neglect in the post-COVID-19 period (odds ratio (OR): 0.15; CI: 0.03-0.83; P = 0.030 and OR: 1.45; CI: 1.01-2.09; P = 0.048, respectively.).

CONCLUSION

Self-neglect in older adults is an important part of comprehensive geriatric assessment and should be screened with validated methods. As it is significantly related with other geriatric syndromes, it suggests that interventions in geriatric syndromes may prevent self-neglect.

Self-neglect, frailty and depression among older women living living in Southern Türkiye

BACKGROUND

This study aimed to assess the association between self-neglect, frailty, and levels of depression in older women.

METHODS

This cross-sectional study included 393 older women living in Southern Türkiye. The data were collected by face-to-face interview method, through a questionnaire. The questionnaire included questions describing socio-demographic and health-related features, Istanbul Medical School Elder Self-Neglect questionnaire (IMSelf-neglect), Frail Scale and Geriatric Depression Scale-15 (GDS-15).

RESULTS

It was determined that the prevalence of self-neglect in older women was 62.6%, the prevalence of frailty was 45.3% and 55% had mild to severe depression. In the correlation analyses, the frailty score was significantly positively associated with depression score (r = 0.624, p < 0.001) and negatively associated with self-neglect (r = -0.724, p < 0.001). Also, self neglect score was negatively associated with depression scores (r = -0.716, p < 0.001).

CONCLUSION

The results of this study showed that self-neglect, frailty, and depression were common among older women. Furthermore, as self-neglect increased, frailty and depression levels also increased. Application of appropriate screening tools may help identify individuals at risk and provide timely support and interventions.

The Relationship Between Depressive Symptoms and Self-Neglect in Chinese Older Adults Living Alone: A Latent Profile Analysis

Objectives: To clarify the latent profile of depressive symptoms in Chinese older adults living alone and to explore the relationship between this profile and self-neglect. Methods: Data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) were utilized to conduct a latent profile analysis for the identification of depressive symptoms. Logistic regression was employed to analyze the related factors. Generalized linear modeling was used to assess the impact of different profiles of depressive symptoms on self-neglect. Results: A total of 1822 older adults living alone, with a mean age of (83.60 ± 9.15) years, were included in the study. Three categories of depression were identified: the C1 mild depression-sleep disturbance group (29.36%), the C2 moderate depression-forcefulness group (55.22%), and the C3 major depression-loneliness loss group (15.42%). Logistic regression analysis indicated that gender, place of residence, annual household income, educational level, reason for living alone, self-rated health status, cognitive function, and emotional support were significant influencing factors (p < 0.05). The risk of experiencing higher levels of self-neglect in the C2 was 1.264 times greater than in the C1. Furthermore, the risk of higher levels of self-neglect in the C3 was 2.040 times greater than in the C1. Conclusions: Heterogeneity in depressive symptoms is evident among Chinese older adults living alone, with variations in self-neglect across different potential categories of these individuals. The focus should be on older adults in the C2 and C3 profiles. This study proposes targeted intervention strategies from family, community, and policy development perspectives to help improve self-neglect in older adults.

The Role of Social Support and Depressive Symptoms in Mediating the Association Between Hearing Loss and Self-neglect Among Older Adults in China

BACKGROUND

Hearing loss is highly prevalent among the older population, and elder self-neglect will become a prominent issue worldwide as the population ages. The purpose of this study was to examine if hearing loss is associated with self-neglect in old adults.

METHOD

Data are from the wave 3 (2494 participants) of the Ma'anshan Healthy Aging Cohort (MHAC) in China. Multiple linear regression models and structural equation models were adopted to examine the relationship between hearing loss, social support, depressive symptoms, and the self-neglect.

RESULTS

The results showed that hearing loss, social support, depression, and self-neglect were significantly correlated (P < 0.001). Hearing loss could not only have a direct positive impact on self-neglect older adults (β = 0.046; 95% CI, 0.036, 0.056), but also indirectly affect self-neglect through three pathways: an independent mediating effect of social support (β =  - 0.014; 95% CI, 009, 0.019), an independent mediating effect of depression (β = 0.029; 95% CI, 0.022, 0.037), and a chain mediating effect of social support and depression (β = 0.003; 95% CI, 0.002, 0.004).

CONCLUSION

Hearing loss is associated with self-neglect, in which social support and depressive symptoms partly mediate the association. The findings suggest that the measures such as preventing and controlling hearing loss are crucial for reducing the severity of self-neglect in older adults.

Prevalence and Factors Associated With Elder Self-Neglect Among Community-Dwelling Older Adults: A Cross-Sectional Study

PURPOSE

To report the prevalence and risk factors of elder self-neglect (ESN) among community-dwelling older adults (N = 604).

METHOD

The current cross-sectional study was conducted from July 2019 to October 2020 in Lanzhou City, China. ESN was determined by the Scale of Elderly Self-Neglect, which evaluates five dimensions: (a) medical health and care, (b) environmental sanitation and personal hygiene, (c) mental health, (d) safety, and (e) social engagement. Frailty was assessed using the Physical Frailty Phenotype scale. Participants were asked whether they had bothersome and activity-limiting pain over the past 1 month. Characteristics associated with ESN were identified through multiple linear regression analyses.

RESULTS

Mean age of participants was 71.34 years (SD = 7.15 years), and 255 (57.8%) were female. The prevalence of ESN among participants was 16.2%. Among the five dimensions of ESN, medical health and care accounted for the largest proportion (44%). Approximately 58% of participants were pre-frail and 11.4% were frail, and 45% reported experiencing bothersome pain. Older adults with a household monthly income per capita <2,000 RMB (β = -0.112, p < 0.05), larger waist circumference (β = 0.185, p < 0.001), pre-frailty (β = 0.176, p < 0.001), frailty (β = 0.420, p < 0.001), and pain (β = 0.102, p < 0.05) were more prone to ESN.

CONCLUSION

ESN is a prevalent issue among community-dwelling older adults. Frailty, pain, low economic status, and larger waist circumference are identified as independent risk factors for ESN. There is a need to improve the understanding of ESN among health care providers and policymakers. Personalized interventions aimed at preventing or addressing these risk factors may lead to improvements in ESN outcomes. [Journal of Gerontological Nursing, 51(3), 45-54.].

Mediating role of psychological resilience in the relationship between self-neglect and frailty among older adults

OBJECTIVE

This study aimed to examine the mediating effect of psychological resilience between self-neglect and frailty in older adults.

METHODS

Based on the data of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018, we selected 7094 eligible valid samples. Descriptive analysis, partial correlation analysis, linear regression, and mediation effect analysis were applied to examine the mediating role of psychological resilience in self-neglect and frailty in older adults.

RESULTS

Psychological resilience was negatively correlated with self-neglect (r = -0.142, P<0.001). Psychological resilience was negatively correlated with frailty index (r = -0.187, P<0.001). Self-neglect was positively correlated with frailty index (r = 0.243, P<0.001). Self-neglect and psychological resilience significantly impacted frailty (β = 0.199, P < 0.001; β = -0.135, P < 0.001). Psychological resilience partially mediated the effect of self-neglect on frailty in older adults (β = 0.020, P < 0.001).

CONCLUSION

Psychological resilience mediates the relationship between self-neglect and frailty in older adults, and enhancing psychological resilience can help mitigate the negative effects of self-neglect on frailty. Taking measures to improve the level of psychological resilience of the elderly is helpful to reduce the degree of frailty and promote the physical and mental health of the elderly.

Strides towards healthy longevity: Harnessing the power of sports and elements of Kathak, an Indian classical dance form through social participation to combat cognitive frailty among older adults

Aging brings with it many health issues that can make life challenging. As much of the attention is given to non-communicable diseases, there are others which are slowly becoming a matter of great concern. One such issue is cognitive frailty, which is a high risk factor for dementia, falls, fractures and hospitalization. Though not yet declared a public health concern, it deserves early detection and prevention strategies. As it is reversible if treated on time, there is a need to look into its prevention and cure. Physical activity has proven to be very effective in the treatment of cognitive frailty. This scoping review thus aims to study the impact of physical activity through social participation on cognitive frailty. The authors recommend that focussing on one's muscular fitness through participation in sports and elements of Indian classical dance form like Kathak in groups/ communities can be a very effective way of combating cognitive frailty among older adults.

Improved outcomes for depressed elder abuse victims with video-delivered psychotherapy during COVID-19

OBJECTIVE

There is a lack of evidence-based scalable therapies for elder abuse victims, with no current remotely delivered tailored psychotherapy. The purpose of this manuscript is to (a) examine the effectiveness of a brief therapy for depression for elder abuse victims, and (b) to compare remote intervention delivery via phone or video to the traditional in-person delivery.

METHOD

PROTECT, Providing Options to Elderly Clients Together, is a brief therapy developed in collaboration with partners at the Department for the Aging (DFTA) of New York City. During the COVID-19 outbreak, PROTECT delivery shifted from in-person to phone or video delivery. Depression severity was tracked using the Patient Health Questionaire-9 (PHQ-9). Reduction in depression severity was evaluated using a linear mixed effects model with non-inferiority test to compare the effectiveness of video vs in-person delivery of PROTECT.

RESULTS

PROTECT reduced depression (average 5.15 PHQ-9 points). Video and phone delivery were non-inferior to in-person delivery. The video group completed therapy more quickly than the in-person group and had a more rapid improvement in depression symptoms.

CONCLUSIONS

PROTECT therapy delivered remotely reduces depression among diverse elder abuse victims. Video delivery of PROTECT could increase reach and scalability to serve more vulnerable older depressed victims.

Machine learning-enabled risk prediction of self-neglect among community-dwelling older adults in China

BACKGROUND

Elder self-neglect (ESN) is usually ignored as a private problem and impairs the health outcomes of older adults. It is essential to construct a robust and efficient tool for risk prediction which can better detect and prevent self-neglect among older adults.

METHODS

This study included 2494 study participants from the Ma'anshan Healthy Ageing Cohort (MHAC). First, the group-based trajectory model (GBTM) was used to estimate ESN development trajectory groups. Then, feature selection methods were used to select variables; after that, we compared six machine learning models (Decision Tree Classifier (DT), K-Nearest Neighbour (KNN), Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM) and XGBoost (XGB)). In addition, Synthetic Minority Oversampling Technique (SMOTE) is used to address the data imbalance problem.

RESULTS

The results show that the ESN can be defined as two trajectory groups (rising and stable). After feature selection, the final model contains eight predictors. The area under the curve (AUC) of the raw dataset was 0.637-0.769. In the dataset with SMOTE, the AUC was 0.635-0.765 and RF was the optimal model. The top five most important characteristics were quality of life, psychological resilience, social support, education, and income.

CONCLUSIONS

The RF developed in this study may be considered a simple and scientific aid in the risk prediction of self-neglect among community-dwelling old adults.

Development and validation of the self-neglect questionnaire for Chinese hospitalized older adults

This study developed the Self-neglect Questionnaire for Chinese Hospitalized Older Adults (SNQ-CHOA) and evaluated its psychometric properties. The questionnaire development followed two phases. Phase 1 included item pool construction, content validity examination and pilot study. In phase 2, the validation and reliability were evaluated among 435 hospitalized older adults. The final questionnaire yielded six dimensions with 24 items: environmental neglect (3 items), medical neglect (8 items), psychological neglect (2 items), security neglect (3 items), socialization neglect (4 items), and nutritional neglect (4 items). Significantly positive correlations with the Abrams geriatric self-neglect scale (r= 0.68) supported the concurrent validity of the scale. The internal consistency and test-retest reliability were acceptable (Cronbach's α = 0.86, intraclass correlation coefficient [ICC] = 0.99). The SNQ-CHOA is a valid and reliable tool for assessing self-neglect among Chinese hospitalized older adults.

Elder Abuse in Older Adults With Dementia: Protective Factors and Adverse Effects

With the rapid increase in the aging population, more attention has been paid to studying older adults with dementia. Despite the fact that older adults with dementia are more likely to be abused compared to their cognitively intact counterparts, little attention has been paid to abuse within this population. This systematic review, conducted using the PRISMA model, aims to critically examine, evaluate, and synthesize literature on protective factors and adverse effects of elder abuse by informal caregivers among individuals with dementia. A search was undertaken using the Ageline, Medline, CINAHL, and PsycINFO databases for peer-reviewed articles published in English up to June 2023. A total of 291 articles were identified by the systematic search, and 8 articles were included in the review. The results showed that protective factors related to elder abuse are mainly examined at a perpetrator level, including caregiver-related, relational, and contextual factors. Adverse effects, specifically an increased risk of various medical conditions and poor medication adherence, were identified but less frequently discussed. The findings indicated future directions for practitioners, researchers, and policymakers to better serve older adults with dementia and their caregivers.

Perspectives on elder mistreatment screening and responding in emergency departments: A qualitative study with survivors

OBJECTIVE

Elder Mistreatment (EM) occurs in approximately 10% of older adults and is associated with trauma-related outcomes including depression, anxiety, posttraumatic stress disorder, and early mortality. Low screening and older adult self-reporting, especially within emergency departments, represent missed opportunities for identify and mitigate future EM occurrences and consequences. To date, no studies have obtained EM survivors' perspectives on EM screening and response practices in emergency departments.

METHODS

Semi-structured interviews with 19 EM survivors of those with Adult Protective Services validated EM were completed in older adults' homes. The Elder Mistreatment Emergency Department Screening and Response Tool (EM-SART) was used to guide the interview questions. All interviews were recorded, transcribed, and analyzed using qualitative thematic analyses.

RESULTS

The participants were mostly female (63%) and white (58%) with an average age of 74 years. Physical abuse accounted for 67% of the EM incidents. Three themes emerged indicating the survivor preference for (1) building rapport and approaching the older adult with compassion and care, (2) setting the context before asking the EM questions, and (3) allowing mutuality, collaborative work, and shared decision-making during the response.

CONCLUSIONS

Older adults are agreeable and willing to self-report and actively engage in the EM screening and response practices in the emergency department if trauma-informed care principles are utilized.

Social connection and self-neglect: A case for broader exploration

OBJECTIVE

Self-neglect (SN) is the most common report to Adult Protective Services (APS) and is associated with significant morbidity and mortality risks for older adults. Lack of instrumental support is a well-evidenced etiologic factor in the development and continuation of SN, but little is known about other modifiable social connection characteristics. The social connection framework provides evidence-based characteristics across structure, function, and quality missing from SN studies that could be identified if explored. These factors could provide prevention and intervention targets related to poor health.

METHODS

A narrative case study is presented using quantitative and qualitative data to explore social connection across structure, function, and quality in the context of SN.

RESULTS

The findings highlight the complexity of social connection that may be observed in SN cases reported to APS. Strategic utilization of direct and indirect social interventions to support social connection in this case are presented.

CONCLUSION

The results from this case give rise to considerations that may be generalizable to other SN cases. Recommendations for future research on social connection in this population are provided.

Elder abuse victimization, mental health, and protective factors

OBJECTIVES

This study investigated the association between elder abuse and depressive symptoms, as well as protective factors against adverse mental health outcomes from elder abuse.

METHODS

Participants were drawn from the 5928 graduates of the WLS, Wave 3 study (age range 70-73) who completed both in-person and telephone interviews. From this large group, 975 (16.4%) participants reported having experienced elder abuse and were included in the sample. Path analysis using Mplus was employed.

RESULTS

Elder abuse victimization was significantly associated with depressive symptoms, and those who had suffered multiple types of elder abuse experienced more severe mental health outcomes. However, both light physical activity conducted alone and having a friend as a confidant were negatively associated with depressive symptoms among older adults who had experienced elder abuse.

CONCLUSION

Given the significant association between elder abuse and negative mental health outcomes among older survivors, screening and prevention programs are recommended. Older adults who have experienced elder abuse may benefit from programs designed to increase physical activity and help older adults build and maintain close relationships with friends and confidants.

Screening for Elder Abuse in the Veterans Health Administration: Varied Approaches Across a National Health System

BACKGROUND

Elder abuse (EA) is common and has devastating health consequences yet is rarely detected by healthcare professionals. While EA screening tools exist, little is known about if and how these tools are implemented in real-world clinical settings. The Veterans Health Administration (VHA) has experience screening for, and resources to respond to, other forms of interpersonal violence and may provide valuable insights into approaches for EA screening.

OBJECTIVE

Describe EA screening practices across a national integrated healthcare system serving a large population of older adults at risk for EA.

DESIGN

Survey of all 139 VHA medical centers from January to August 2021.

PARTICIPANTS

Surveys were completed by the Social Work Chief, or delegate, at each site.

MAIN MEASURES

The survey assessed the presence and characteristics of EA-specific screening practices as well as general abuse/neglect screening conducted with patients of all ages, including older adults. Follow-up emails were sent to sites that reported screening requesting additional details not included in the initial survey.

KEY RESULTS

Overall, 130 sites (94%) responded. Among respondents, 5 (4%) reported screening older adults for EA using a previously published tool, while 6 (5%) reported screening for EA with an unstudied or locally developed tool. Forty-eight percent reported screening patients of all ages for general abuse/neglect using unstudied questions/tools, and 44% reported no EA screening at their site. Characteristics of screening programs (e.g., frequency, clinical setting, provider type) varied widely between sites, as did respondents' understanding of the definition of screening.

CONCLUSIONS

High variability in screening practices for abuse/neglect and lack of EA-specific screening in a system that has successfully deployed other standardized screening approaches present an important opportunity to standardize and improve EA detection practices. Lessons learned in VHA could help advance the evidence base for EA screening more broadly to increase overall detection rates for EA nationally.

Factors associated with self-neglect from a salutogenic perspective among community-dwelling older adults: A cross-sectional correlational study

OBJECTIVES

To identify the associated factors of self-neglect in older adults from a salutogenic perspective.

METHODS

A cross-sectional correlational study was conducted in two communities in Beijing with 486 older adults recruited from April to December 2022. Data were collected by a set of questionnaires.

RESULTS

Sense of coherence (β=-0.138), socio-demographic generalized resistance resources (GRRs) (smoking: β=0.156), social GRRs (living alone: β=0.093), psychological GRRs (self-esteem: β=-0.126), and motivational GRRs (powerful others locus of control: β=-0.199, chance locus of control: β=0.119) were all associated with self-neglect among older adults (p<0.05).

CONCLUSIONS

Sense of coherence and GRRs are vital to improve self-neglect in older adults. It is suggested to increase the level of self-esteem and the tendency of the health locus of control to largely facilitate self-neglect management in older adults.

Self-neglect as a significant public health issue: exploring the responsibility of the SPCDN

Self-neglect is a recognised form of abuse affecting individuals across the lifespan. Gaps are evident within current data to support its prevalence; thus, it is considered to be an under-researched and under-reported phenomenon. Evidence suggests that there are multiple risk factors which contribute to self-neglect and sources recognise it leads to poorer health outcomes. Specialist Community Practitioner District Nurses (SCPDNs) deliver care across a diverse demographic and continuously assess risk for individuals in complex environments leading and managing the care of individuals who self-neglect. It is therefore essential that SCPDNs are equipped with the knowledge and skills required to therapeutically assess the health needs of this patient group and lead on the coordination of care. This article aims to explore the subject of self-neglect as a public health concern and appraise the role and responsibilities of the SCPDN within community nursing practice.

Screening for elder mistreatment in a Swiss emergency department: a prospective cohort study

AIM OF THE STUDY

The mistreatment of older adults is a global and complex problem with varying prevalence. As there are no data on the prevalence of elder mistreatment in European emergency department populations, we aimed to translate and culturally adapt the Emergency Department Senior Abuse Identification (ED Senior AID) tool for German use, assess the positive screen rate for elder mistreatment with the German version, and compare characteristics of patients who screened positive and negative.

METHODS

To assess the prevalence of elder mistreatment, we created a German version of the ED Senior AID tool. This tool identifies intentional or negligent actions by a caregiver or trusted person that cause harm or risk to an older adult. Then, the German ED Senior AID tool was applied to all consecutively presenting patients aged ≥65 years at our academic emergency department in the Northwest of Switzerland from 25 April to 30 May 2022. Usability was defined as the percentage of patients with completed assessments using the German ED Senior AID tool.

RESULTS

We included 1010 patients aged ≥65 years, of whom 29 (2.9%) screened positive with the ED Senior AID tool. The patients who screened positive were older, more severely cognitively impaired, hospitalised more frequently, and presented with higher frailty scores than those who screened negative. Mortality up to 100 days after presentation was comparable in all patients (p = 0.861), regardless of their screening result. The tool showed good usability, with 73% of assessments completed.

CONCLUSION

This is the first prospective investigation on the prevalence of elder mistreatment in a European emergency department setting. Overall, 2.9% of patients screened positive using a validated screening tool translated into German.

TRIAL REGISTRATION

This study was registered with the National Institute of Health on ClinicalTrials.gov with the registration number NCT05400707.

Enhancing healthcare access for an older population: The age-friendly emergency department

Healthcare systems face significant challenges in meeting the unique needs of older adults, particularly in the acute setting. Age-friendly healthcare is a comprehensive approach using the 4Ms framework-what matters, medications, mentation, and mobility-to ensure that healthcare settings are responsive to the needs of older patients. The Age-Friendly Emergency Department (AFED) is a crucial component of a holistic age-friendly health system. Our objective is to provide an overview of the AFED model, its core principles, and the benefits to older adults and healthcare clinicians. The AFED optimizes the delivery of emergency care by integrating age-specific considerations into various aspects of (1) ED physical infrastructure, (2) clinical care policies, and (3) care transitions. Physical infrastructure incorporates environmental modifications to enhance patient safety, including adequate lighting, nonslip flooring, and devices for sensory and ambulatory impairment. Clinical care policies address the physiological, cognitive, and psychosocial needs of older adults while preserving focus on emergency issues. Care transitions include communication and involving community partners and case management services. The AFED prioritizes collaboration between interdisciplinary team members (ED clinicians, geriatric specialists, nurses, physical/occupational therapists, and social workers). By adopting an age-friendly approach, EDs have the potential to improve patient-centered outcomes, reduce adverse events and hospitalizations, and enhance functional recovery. Moreover, healthcare clinicians benefit from the AFED model through increased satisfaction, multidisciplinary support, and enhanced training in geriatric care. Policymakers, healthcare administrators, and clinicians must collaborate to standardize guidelines, address barriers to AFEDs, and promote the adoption of age-friendly practices in the ED.

Training Senior Companion Volunteers to Identify and Report Adult Abuse, Neglect, and Exploitation

Elder abuse is a national public health challenge that can have dire consequences for the older adults who experience it in any form. The Senior Companion Program presents a unique opportunity to address this public health challenge. An in-person training for Senior Companion volunteers across Ohio on how to recognize and report elder abuse was developed, implemented, and evaluated prior to the COVID-19 pandemic. Evaluation consisted of surveys distributed prior to and at the conclusion of the training. A total of 302 volunteers were trained with a survey response rate of 76%. While there was significant knowledge improvement in one of the five knowledge items (p < .000, all other ps ≥ .065), volunteers' subjective rating of their knowledge on abuse significantly improved (p = .029). Training older adult volunteers working with other community-dwelling adults is likely a valuable strategy to educate and protect against elder abuse.

The impact of elder abuse training on subacute health providers and older adults: study protocol for a randomized control trial

BACKGROUND

Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers' recognition, response, and referral of elder abuse.

METHODS

This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e. clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training programme for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are change in health providers' knowledge of responding to elder abuse and older people's sense of safety and quality of life. We will include all inpatients at participating sites, aged 65 + (or aged 50 + if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses.

DISCUSSION

This will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral.

TRIAL REGISTRATION

ANZCTR, ACTRN12623000676617p . Registered 22 June 2023.

Preventive and Sexual Health in LGBTQ+ Older Adults

Sexual health is an important but often overlooked health concern of LGBTQ + older adults. Multiple factors influence sexual health including intersecting identities; adverse life events; coping mechanisms; and psychological, social, and physical health domains. Thus, the use of a culturally competent and comprehensive person-centered approach to sexual health is warranted. In this review, we discuss approaches to engaging LGBTQ + older adults to ensure they are able to achieve their sexual health priorities and prevent new human immunodeficiency virus infections. We also discuss doxycycline postexposure prophylaxis to prevent other sexually transmitted infections and the impact of chemsex.

On tackling abuse of older people: The forensic challenges in fatal cases investigation

The World Health Organization recently presented the priorities for tackling abuse of older people in a coordinated and strategic way. However, data on the forensic scenario is still lacking. In this context, the aim of the present work was to provide a comprehensive literature review of this inherently complex phenomenon in the post-mortem setting, in order to better characterize it from a forensic point of view. A comprehensive literature search was performed in three electronic databases following the PRISMA guidelines. Sociodemographic and medical data of victims and perpetrators, post-mortem data, types of abuse and risk factors were extracted from non-aggregated data. Forty-eight papers dealing with abuse in the post-mortem setting were included, with a predominance of case reports and case series. The review showed that neglect was the most common type of abuse and victims are predominantly older women who are abused in a domestic setting by trusted family member. To generate more and better data, expanded research in the forensic field requires standardized methods and the raise of professional awareness about abuse of older people.

Risk Factors for Post-Discharge Adverse Outcomes Following Hospitalization Among Older Adults Diagnosed With Elder Mistreatment

Using 100% Medicare data files, this study explored whether primary elder mistreatment (EM) diagnosis, EM type, and facility type were associated with 3-year mortality and 1-year unplanned hospital readmission among older patients diagnosed with EM with hospital discharge from 10/01/2015 through 12/31/2018 (n = 11,023). We also examined outcome differences between older patients diagnosed with EM and matched non-EM patient controls. Neglect by others was the most common EM diagnosis. Three-year mortality was 56.7% and one-year readmission rate was 53.8%. Compared to matched non-EM patient controls, older EM patients were at an increased risk of mortality and readmission. Among patients diagnosed with EM, patients with a secondary (vs. primary) diagnosis and those discharged from a skilled nursing facility (vs. acute hospital) were at an increased risk for both mortality and readmission. Compared to other EM types, patients diagnosed with neglect by others had a greater risk for mortality following discharge.

Global Approaches to Primary, Secondary, and Tertiary Elder Abuse Prevention: A Scoping Review

Public health professionals use a three-pronged approach to address broad-reaching issues of societal concern: primary prevention, secondary prevention, and tertiary prevention. Applying this framework to the study of elder abuse, the purpose of this review is to describe the status of elder abuse prevention research on a global scale. Elder abuse prevention articles published between 2015 and 2021 were identified through electronic bibliographic searches (PubMed, Medline, CINAHL, APA PsycINFO, and AgeLine). After removing articles based on inclusion and exclusion criteria, articles were sorted into the three main prevention types and further divided into subcategories for a more in-depth review. Most of the studies identified were conducted in North America (n = 42). Of the 72 articles identified, 13 articles focused on primary prevention (agism, education, and intervention), 35 articles focused on secondary prevention (developing and evaluating screening tools, identifying and reporting abuse, and barriers to detecting and reporting abuse), and 21 focused on tertiary prevention (professional response to cases of abuse, intervention methods, and impact of policy). Collectively, findings bring greater understanding of elder abuse as a public health problem and identify ways of addressing the complexities of elder abuse. Several gaps were identified in the elder abuse prevention literature including the need for global research that includes older adults as stakeholders, evidence-based education and intervention programs, and cultural sensitive and valid tools to identify elder abuse.

A Systematic Review: Risk and Protective Factors of Elder Abuse for Community-Dwelling Racial Minorities

Elder abuse is related to numerous adverse health and mental health conditions in older adults and some studies indicated higher rates of elder abuse in ethnic and racial minority populations than non-Hispanic Whites. This current study aims to summarize the risk and protective factors associated with elder abuse in community-dwelling racial minorities. A systematic review was conducted following Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. AgeLine, Medline, PsycINFO, and CINAHL were searched without limitation on time periods of publication. Two authors independently screened the search results and assessed the eligibility and quality of the retrieved articles. A total of 718 articles were screened and 25 articles were included in the review. The 25 included studies' publication dates range from 1989 to 2019. Five racial categories were generated: African Americans, Asian Americans, Native Americans, Hispanic Americans, and racial minorities in Canada. Risk and protective factors of elder abuse and its subtypes (e.g., physical and psychological abuse) for these racial groups were summarized. There are some common risk factors across racial minorities, such as dependence on caregivers and health issues. The review identified gaps and conflicting findings regarding culture and education that are worthy of further investigation. In particular, there is a lack of current research on elder abuse in racial minority older women, race minority subgroups, and protective factors of elder abuse. The results guide helping professionals to consider the role of traditional culture and identify warning signs of potential abuse among racial minority older adults.

Effect of an elder abuse and self-neglect intervention on repeat investigations by adult protective services: RISE project

BACKGROUND

Adult Protective Services (APS) is the primary agency responsible for investigating elder abuse and self-neglect (EASN) allegations in the United States. The harms of EASN are well established; however, APS lacks a conceptually derived evidenced-based intervention phase. RISE is a community-based intervention designed to complement APS that provides enhanced services and a longer intervention phase. The objective of this study was to test whether exposure to the RISE/APS collaboration was associated with reducing the case outcome of recurrence (repeat investigations) compared to usual care APS only services.

METHODS

A retrospective observational study (n = 1947) of two counties in Maine where RISE was available to provide enhanced services to persons referred from APS. An extended regression endogenous treatment Probit model using APS administrative data was used to predict case recurrence.

RESULTS

Between July 2019 and October 2021, 154 cases participated in RISE and 1793 received usual APS only services. 49% of cases in RISE had 2 or more prior substantiated allegations versus 6% for those receiving usual APS care, and 46% of cases in RISE had a recurrence during the observation period versus 6% for usual care group. However, after accounting for the non-random treatment assignment, RISE was associated with a significantly lowered likelihood of recurrence compared to persons receiving usual care provided by APS (probability of recurrence reduced by 0.55 for the Average Treatment Effect on the Treated and 0.26 for the Average Treatment Effect).

CONCLUSIONS

A reduction in recurrence carries important implications for APS clients, costs, resources, and workflow. It may also serve as a proxy indicating a reduction in revictimization and harm for EASN victims.

A population-based cross-sectional study examining homicides among community-dwelling older adults in Victoria, Australia: A study protocol

BACKGROUND

There is a need for both descriptive and analytical evidence on the factors associated with older adult homicide. The current landscape is insufficient because most published research is confined to the United States, and contains insufficient data about the homicide context. This study protocol describes the proposed method for examining the characteristics and factors associated with older adult homicide in the Australian state of Victoria, using data generated for the criminal and coronial investigation into these deaths stored in the Victorian Homicide Register (VHR). Outcomes will support practitioners, policy makers and other key stakeholders to strengthen prevention strategies to reduce the risk of future homicides among older Victorians.

METHODS

This study will comprise a single-jurisdiction population-based cross-sectional design to analyse consecutive cases of homicide among community-dwelling older adults in Victoria, Australia for the period 2001 to 2015. All homicides of adults aged 18 years and older, and where the Coroner's investigation is completed at data extraction will be included. Variables will be selected in accordance with elements of the social-ecological model (i.e., individual, interpersonal, incident, and community). This will include: socio-demographic characteristics; presence of mental or physical illness; deceased-offender relationship; nature of any abuse between the deceased and offender; incident location and weapon used; the presence of alcohol or drugs; and criminal justice outcomes. Homicide rates per 100,000 population will be calculated for older adults (aged 65 years and older) and younger adults (aged 18-64 years), and compared as rate ratios using Poisson regression. Descriptive statistics and cross-tabulation will be generated for factors associated with homicide for older compared to younger adults. Homicide typologies based on deceased-offender relationship and motive will be explored within group and family homicides will be compared between older and younger adults.

Adaptation and validation of the Abrams geriatric self-neglect assessment scale among older Chinese people admitted to the hospital

OBJECTIVES

Elder self-neglect is a global public health problem, and older people admitted to the hospital may have a higher risk of self-neglect due to their deteriorating health conditions. This study aimed to translate, adapt and validate the Abrams geriatric self-neglect assessment scale (AGSS) among older Chinese people admitted to the hospital.

METHODS

Data were derived from a cross-sectional survey of a convenience sample of 452 older people admitted to a general hospital. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine the structural validity of the AGSS. Content validity, criterion validity, internal consistency reliability, and test-retest reliability were also conducted to assess the psychometric properties of the scale.

RESULTS

EFA yielded a 6-item one-factor model, which was supported by CFA and explained 44.74% of the total variance. The internal consistency was acceptable (Cronbach α = 0.740), and the test-retest reliability with a 14-day interval was good (intraclass correlation coefficient, ICC = 0.966). Significantly positive correlations with the caregiver-rated elder self-neglect assessment scale (r = 0.648) supported the concurrent validity of the scale. Significant differences in scores between respondents with different ages, marital statuses, educational levels and numbers of chronic diseases demonstrated the discriminative validity.

CONCLUSION

The Chinese version of the AGSS is an easy-to-use, reliable and valid measure with satisfactory psychometric properties. Future studies should recruit a more representative sample of older people in China to verify the applicability of the scale.

IMPLICATIONS FOR PRACTICE

The Chinese version of the AGSS enables clinical staff to accurately screen for and assess elder self-neglect upon hospital admission, which can inform the development of specific interventions and assignment of additional guardianship to those at risk of elder self-neglect.

Health Conditions in Older Adults Suspected of Being Maltreated: A 20-Year Real-World Study

Older adult maltreatment (OAM) is a global problem that has attracted increasing attention due to the ageing population and its severe impact on victim health. Thus, this study aims to analyse the prevalence of certain health conditions in people ≥ 60 years old whom physicians from a local healthcare unit suspected to be victims of maltreatment. The specific objectives are to determine the prevalence rates of health-related risk factors, traumatic injuries and intoxications, mental disorders, and physical disorders. We conducted a real-world, retrospective, observational, and cross-sectional study based on secondary data analyses of electronic health records and healthcare registers of patients at the Local Healthcare Unit of Matosinhos (2001-2021). Information was obtained based on codes from the International Classification of Diseases, codes from the International Classification of Primary Care, and clinical notes (according to previously defined keywords). We identified 3092 suspected victims of OAM, representing 4.5% of the total population analysed. This prevalence is lower than the known rates. We also found that some health risk factors, traumatic injuries and intoxications, mental health disorders, and physical disorders presented higher rates in the suspected victims than among the total population. In this age group, we cannot assume that these health problems are only related to a possible current victimisation process; they could also be associated with adverse childhood experiences or intimate partner violence, among other forms of violence, all of which can lead to cumulative effects on the victim's health. This evidence increases healthcare providers' responsibility in detecting and reporting all cases of suspected maltreatment.

Conceptualizing Person-Centered Care in Elder Mistreatment Intervention: Use of a Well-Being Framework

BACKGROUND AND OBJECTIVES

Person-centered care (PCC) applied to elder mistreatment interventions is an approach to include victim priorities. Although PCC may improve outcomes by supporting choice, victim preferences are often difficult to support, especially in high-risk situations. We studied the adaptation of PCC structures and process to a pilot intervention, aimed at including client preferences in a multidisciplinary team's plans to address complex elder mistreatment.

RESEARCH DESIGN AND METHODS

Case study analysis was used to examine the process of integrating client priorities into a risk-reduction plan. A well-being framework was used to understand the relationship between safety and preferences. Purposive sampling identified a case study of a high-risk victim with history of refusing help who agreed to work with the Service Advocate, a member of a multidisciplinary team.

RESULTS

PCC required a relationship of trust, honed over several weeks by prioritizing the clients' perspective. Client preferences included remaining at home, continuing the relationship with the abuser, and maintaining a sense of mastery. Individualized definitions of "safety" were unrelated to elder mistreatment risk. Assistance included working with the suspected perpetrator, which is not offered by most elder mistreatment interventions, and resulted in some risk reduction. Reasons for refusing help were a desire for control and fear of loss of well-being assets.

DISCUSSION AND IMPLICATIONS

Individualized definitions of well-being should be considered in measuring intervention success. Future research could determine guidelines on what levels of elder mistreatment risk are acceptable, and how to monitor clients for safety while supporting autonomy.

Frailty predicts referral for elder abuse evaluation in a nationwide healthcare system-Results from a case-control study

BACKGROUND

Elder abuse (EA) is common and has devastating health impacts. Frailty may increase susceptibility to and consequences of EA for older adults, making healthcare system detection more likely, but this relationship has been difficult to study. We examined the association between a recently validated frailty index and referral to social work (SW) for EA evaluation in the Veterans Administration (VA) healthcare system.

METHODS

We conducted a case-control study of veterans aged ≥60 years evaluated by SW for suspected EA between 2010 and 2018 (n = 14,723) and controls receiving VA primary care services in the same 60-day window (n = 58,369). We used VA and Medicare claims data to measure frailty (VA Frailty Index) and comorbidity burden (the Elixhauser Comorbidity Index) in the 2 years prior to the index. We used adjusted logistic regression models to examine the association of frailty or comorbidity burden with referral to SW for EA evaluation. We used Akaike Information Criterion (AIC) values to evaluate model fit and likelihood ratio (LR) tests to assess the statistical significance of including frailty and comorbidity in the same model.

RESULTS

The sample (n = 73,092) had a mean age 72 years; 14% were Black, and 6% were Hispanic. More cases (67%) than controls (36%) were frail. LR tests comparing the nested models were highly significant (p < 0.001), and AIC values indicated superior model fit when including both frailty and comorbidity in the same model. In a model adjusting for comorbidity and all covariates, pre-frailty (aOR vs. robust 1.7; 95% CI 1.5-1.8) and frailty (aOR vs. robust 3.6; 95% CI 3.3-3.9) were independently associated with referral for EA evaluation.

CONCLUSIONS

A claims-based measure of frailty predicted referral to SW for EA evaluation in a national healthcare system, independent of comorbidity burden. Electronic health record measures of frailty may facilitate EA risk assessment and detection for this important but under-recognized phenomenon.

Increasing disclosures of older adult maltreatment: a review of best practices for interviewing older adult eyewitnesses and victims

The current article provides a contemporary review of the best practices for interviewing older adults about crimes they witnessed or experienced. Specifically, we provide a detailed overview of how investigators can use a range of interviewing adaptations and procedures to acquire detailed and accurate maltreatment disclosures from older adults. In addition to discussing well-established investigative interviewing practices (e.g. rapport building, free-recall, cognitive instructions and prompts), this article also summarizes more recent literature on the benefits of multidisciplinary investigations, use of assistive technology and interview accommodations, along with effective practices for working with minority and marginalized older adults. Lastly, several research, professional and policy recommendations are provided for supporting older adults during investigative interviews.

The role of frailty, social networks, and depression in self-neglect in an older Chinese population: A cross-sectional descriptive study

OBJECTIVES

To identify the role of frailty, social networks, and depression in self-neglect in an older Chinese population.

METHODS

The study was conducted in 521 older adults recruited from four community healthcare centers in a district in Beijing, China. Participants were investigated by a set of questionnaires.

RESULTS

Frailty (β=0.150, p=0.759) was not associated with self-neglect of older adults. Social isolation (β=1.980, p<0.001) and depression (β=3.606, p<0.001) were both factors associated with self-neglect in older adults.

CONCLUSION

Management of depression and improvement of social networks of older adults should be incorporated into interventional strategies to effectively control self-neglect. Understanding self-neglect and its associated factors will ultimately contribute to the intervention development and well-being of older adults.

Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool

Elder abuse (EA) is common and has devastating health impacts, yet most cases go undetected limiting opportunities to intervene. Older Veterans receiving care in the Veterans Health Administration (VHA) represent a high-risk population for EA. VHA emergency department (ED) visits provide a unique opportunity to identify EA, as assessment for acute injury or illness may be the only time isolated older Veterans leave their home, but most VHA EDs do not have standardized EA assessment protocols. To address this, we assembled an interdisciplinary team of VHA social workers, physicians, nurses, intermediate care technicians (ICTs; former military medics and corpsmen who often conduct screenings in VHA EDs) and both VHA and non-VHA EA subject matter experts to adapt the Elder Mistreatment Screening and Response Tool (EM-SART) to pilot in the Louis Stokes Cleveland VA Medical Center geriatric ED (GED) program. The cornerstone of their approach is an interdisciplinary GED consultation led by ICTs and nurses who screen high-risk older Veterans for geriatric syndromes and unmet needs. The adapted EM-SART was integrated into the electronic health record and GED workflow in December 2020. By July 2022, a total of 251 Veterans were screened with nine (3.6%) positive on the prescreen and five (2%) positive on the comprehensive screen. Based on the first-year pilot experience, the interdisciplinary team was expanded and convened regularly to further adapt the EM-SART for wider use in VHA, including embedding flexibility for both licensed and nonlicensed clinicians to complete the screening tool and tailoring response options to be specific to VHA policy and resources. The national momentum for VHA EDs to improve care for older Veterans and secure GED accreditation offers unique opportunities to embed this evidence-based approach to EA assessment in the largest integrated health system in the United States.

Meeting the challenges in conducting research in vulnerable older adults with self-neglect-notes from a field team

Gaining a systematic understanding of possible ways to increase the quality and lifespan of older adults experiencing self-neglect has unique challenges. These challenges include identifying self-neglect in the community and navigating levels of cognitive, physical, and/or psychological difficulties in this population that impact recruitment, consent, and accurate data collection. Conducting quality research under some of the environmental self-neglect conditions such as squalor, animal and insect infestations and no utilities can also challenge planned study protocols and study validity. This manuscript presents details of these overarching challenges and some of the workable solutions noted and implemented by research field-team members who have enrolled over 300 adults experiencing self-neglect for various studies. Usual research methodology must overcome these barriers to work to create consciousness about the self-neglect population. The classic series of cases is still a good alternative when describing self-neglect. Considerations for conducting future self-neglect research are presented.

Prevalence and predictors in self-neglect: A cross-sectional study of domestic migrant older adults in China

Insufficient information is available on the prevalence and predictors of self-neglect among Chinese domestic migrant older adults resulting from rapid aging and mass population migration. This cross-sectional study was conducted on 597 older adults in four districts of Wenzhou from May to November 2020. A self-neglect scale was used to assess the prevalence of self-neglect among such adults. Sixteen potential predictors were considered in the domains of sociodemographic, health condition, socioeconomic, social isolation, intergenerational relationship, and filial piety. The prevalence of self-neglect within this population was 72.7%. Social isolation (OR = 0.823; 95%CI 0.684-0.990), physical health (OR = 0.966; 95%CI 0.941-0.992), intergenerational ambivalence (OR = 1.240; 95%CI 1.013-1.519), and affective-cognitive solidarity (OR = 0.796; 95%CI 0.719-0.880) were found to be independent predictors of self-neglect in this population. We suggest that community health service organizations should prioritize migrant older adults with a poor health status and those with intergenerational ambivalence to reduce self-neglect in migrant older adults. Such older adults should also be encouraged to participate in community activities for more social integration.

Critical Age Theory: Institutional Abuse of Older People in Health Care

Theories of elder abuse focus on the characteristics of the victim, the perpetrator, and the context of abuse. Although all three factors play a role, we are biased to notice individual misbehavior as the primary and sole cause of abuse. We see individuals as responsible for abuse. By examining abuses across a spectrum of healthcare services, abuse is more likely to be due to the institutional culture that includes the use of medications, Assisted Living, Skilled Nursing Facilities/nursing homes, hospices, hospitals, and Medicare Advantage programs. This study highlights multiple and consistent institutional abuses that result in harm and death of older adults on a consistent basis. The results show that when profit is increased, standards of care are diminished, and abuse ensues. Assigning responsibility to the management of healthcare becomes a priority in reducing this level of abuse. However, there are biases that stop us from assigning blame to institutions. Individual healthcare workers adhere to work protocol and rationalize the negative outcomes as inevitable or due to the vulnerability and frailness of older people. This culture is socialized for new employees that develop a culture of diminishing the needs of the individual patient in favor of the priorities dictated by the management protocol. In addition, the public is focused on assigning blame to individuals. Once an individual is assigned blame then they do not look beyond that to understand the context of abuse. A context that is generated by healthcare facilities maximizing profit and denigrating patient care. Regulatory agencies such as the U.S. DHHS, CDC, State Public Health Agencies, State/City Elder Abuse units, and Ombudsmen Programs all collude, for multiple reasons, in diminishing institutional responsibility.

Development of an intrinsic health risk prediction model for camera-based monitoring of older adults living alone

The number of older adults in Korea is increasing, along with the number of depressed older patients. The causes of depression in older adults include social isolation with negligible interaction with others, irregular nutritional habits, and self-negligence, i.e., they do not engage in any activity. These factors, self-negligence, social isolation, and irregular nutritional habits, are defined as inherent health risks, and in this study, we detected them. These factors can only be derived through long-term monitoring, but the current monitoring system for older adults is severely limited as it focuses only on emergencies, such as "falls." Therefore, in this study, the goal was to perform long-term monitoring using a camera. In order to capture the physical characteristics of the older adults, the ETRI-Activity3D data were used for training, and the skeleton-based action recognition algorithm Posec3d was used. By defining 90 frames as the time taken for one action, we built a monitoring system to enable long-term monitoring of older adult by performing multiple action detection in one video. A reliable monitoring system, with 98% accuracy, 98% precision, 99% recall, and 98% F1, was successfully established for health monitoring of older adults. This older adult monitoring technology is expected to improve the quality of medical services in a medical environment as well as the objective, activities of daily living test, which does not depend on the observer through daily life detection.

Psychological elder abuse among older Saudi adults: A cross-sectional study

The research examining elder abuse in diverse cultural contexts, such as in Saudi Arabia, remains limited. This study examined the extent of psychological elder abuse among older Saudi adults and investigated the characteristics of the victims that increase the risk of such abuse and its impact on older adults' self-rated health. Between December 2021 and April 2022, a sample of 444 older adults were recruited from 25 primary health care centers in Saudi Arabia and completed a structured interview. Of those surveyed, 88.3% reported at least one symptom or suspected symptom of psychological elder abuse. Age, gender, income, living arrangements, functioning, and social networking predicted vulnerability psychological elder abuse. Self-rated health was negatively impacted by psychological elder abuse, and this relationship is not moderated by social networking. These findings can provide insights about psychological elder abuse in Saudi Arabia and increase awareness of its impact.

The Chinese version of the Abrams geriatric Self-neglect scale:Translation, validity, and reliability

OBJECTIVES

To translate, cross-culturally adapt, and validate the Abrams Geriatric Self-neglect Scale (AGSS) for the older population in China.

METHODS

The performance of the Chinese version of AGSS (C-AGSS) was evaluated among 334 older adults recruited from three community healthcare centers in Beijing, China.

RESULTS

The Cronbach's α was 0.601 and the content validity index was 0.96 for the C-AGSS. The unidimensional model of the scale was supported by the confirmatory factor analysis with an excellent model fit. The concurrent validity was demonstrated by the significant correlation (r=0.614, p<0.001) between the C-AGSS and the Scale of the Elderly Self-neglect (Rural). The hypothesized validity and the discriminative validity of the C-AGSS were also approved.

CONCLUSIONS

The C-AGSS has acceptable validity and reliability on self-neglect assessment in the Chinese older population. It can be used to classify and quantify the self-neglect of older adults in China.

Elder abuse and hospitalization in rural Malaysia

Our study aims to describe and determine factors associated with hospitalization among victims of elder abuse and neglect (EAN) in rural Malaysia. A cross sectional study based on the baseline data of the Malaysian Elder Mistreatment Project (MAESTRO) collected from November 2013 until July 2014 involving 1927 older adults in Kuala Pilah, Negeri Sembilan was conducted. EAN was determined using the modified Conflict Tactics Scale (CTS) and hospitalization rates were determined based on self-report. The prevalence of overall EAN was 8.1% (95%CI 6.9–9.3). Among male respondents, 9.5% revealed history of abuse and among female respondents, 7.2% reported experiencing EAN. The annual hospitalization rates per 100 persons within the past one year among EAN victims and non-victims were 18 per 100 persons (SD = 46.1) and 15 per 100 persons (SD = 64.1) respectively. Among respondents with history of EAN, 16.0% (n = 21) had been hospitalized in the past 12 months while among respondents with no EAN experience, 10.2% (n = 153) were hospitalized. Multivariable analyses using Poisson regression did not show any significant association between EAN and hospitalization. This could be due to the complex interactions between medical and social circumstances that play a role in hospital admissions, factors affecting the health care system, and access to health care among EAN victims.

A Community-Based Exploratory Cross-Sectional Study of Elder Abuse Perpetration or Victimization Among Elders in Ethiopia, 2022

Background

Elderly abuse and comorbid problematic substance use, disability, and physical and mental illness have been major problems in low-income countries. In most countries, the elderly are the most neglected segment of the population, and there is insufficient information about elderly abuse perpetration or victimization in low-income countries like Ethiopia. Therefore, this study was aimed to assess elderly abuse perpetration or victimization among the elderly in Mizan Aman town, southwest Ethiopia.

Methods

A community-based cross-sectional study design was conducted among 268 elderly people from May to June, 2021, by using a systematic sampling technique. The elderly abuse and the ASSIST tools were used to assess the elderly abuse and khat, alcohol, cannabis, and tobacco use disorders, respectively. Moreover, multimorbidity and physical disability were also assessed. Data were entered into EpiData version 3.1 and exported to the Statistical Package for Social Science Version 23. A logistic regression model was used to identify independent predictors of elderly abuse.

Results

The prevalence of elder abuse was 41.8%, and the prevalence of poly substance, alcohol, khat, and tobacco use disorder was 32.5%, 19.4%, 12%, and 4.5%, respectively. Besides, the comorbidity of physical disability and multiple chronic diseases was 8% and 24.6%, respectively. Moreover, physical disability (AOR = 5.652, CI = 1.459, 21.894), multimorbidity (AOR = 3.972, CI = 1.898, 8.314), substance use disorder (AOR = 3.877, CI = 1.814, 8.286), age above 80 years (AOR = 8.452, CI = 2.273, 31.425), and poor social support (AOR = 3.372, CI = 1.043, 10.903) were positively associated with elderly abuse.

Conclusion

The magnitude of elder abuse and comorbid multimorbidity, physical disability, and substance use disorder was high, and having multiple chronic diseases, physical disability, substance use disorder, advanced age, and poor social support were risk factors for elderly abuse.

Mediating Role of Psychological Capital in the Relationship Between Social Support and Self-Neglect Among Chinese Community-Dwelling Older Adults

Objectives

Self-neglect in older adults has become an important public health issue and is associated with negative health outcomes and increased morbidity and mortality. Social support has been recognized as a prominent predictor of self-neglect, but the underlying mechanism is unclear. This study aims to investigate and illustrate the associations among social support, psychological capital, and self-neglect.

Methods

This study used a cross-sectional convenience sampling design. A total of 511 older adults were recruited in Chinese communities. Spearman’s correlation coefficient and hierarchical multiple regression analysis were performed to assess the influencing factors of self-neglect. A structural equation model was applied to test the hypothesized mediation model.

Results

Social support and psychological capital were found to be negatively related to self-neglect. Social support and psychological capital explained 5.1 and 11.9% of the incremental variances of older adults’ self-neglect, respectively. Psychological capital acts as a mediator between social support and self-neglect.

Conclusion

Self-neglect among older adults is a rising problem in China. Social support and higher psychological capital could decrease the risk of self-neglect in older adults. It is crucial to improve social networks and facilitate psychological interventions to reduce such self-neglect.