Elder abuse and neglect: an overview

Severe starvation and restraint in a 47-year-old woman: Clinical, autopsy and histopathological evidence of abuse and neglect

The recognition of abuse and/or neglect still represents a challenge for both clinicians and forensic pathologists. Whereas abusive behaviors have been largely described among pediatric and elderly populations, adults' abuse and neglect is less frequently encountered, and therefore investigated. We report a case of a middle-aged woman without any known organic or psychiatric disorders who died of a multiple organ failure (MOF) due to extreme cachexia and bed-resting syndrome. The integration of all clinical, autopsy and histopathological data highlighted a picture of severe malnutrition, restraint, and widespread traumatic injuries related to abuse and neglect. We believe that the case here presented could be useful for both clinicians and forensic pathologists as it underlines once again the importance of collecting and integrating all medical evidence (both in the ante- and post-mortem settings) for reconstructing the most probable pathophysiology of disorders and injuries, comparing that reconstruction with the allegations of the caregivers, and thus identifying any potential abuse and/or neglect behaviors.

The relationship between depression and risk of violence in portuguese community-dwelling older people

Background

Mental disorders are highly prevalent in older people, being depression a predominant disorder. Evidence points to a possible relationship between depression and violence against older people. Nonetheless, the role of the depressive symptomology severity in the risk of violence against older people remains unclear. Thus, this study’s main objective was to analyze the relationship between geriatric depressive symptomatology and the risk of violence against older people.

Methods

This exploratory study involved 502 community-dwelling older persons aged 65 to 96 years (73.3 ± 6.5). Measures were performed using the Geriatric Depression Scale and the Risk Assessment of Violence against the Non-Institutionalized Elderly scale.

Results

One hundred nineteen older people (23.7%) had mild/moderate depressive symptomology, and twenty-six (5.2%) had severe depressive symptomology. There were significant relationships between the severity of depressive symptomatology and the risk of violence (p < 0.05). The presence of depressive symptomatology increased the likelihood of being victims of violence, particularly among women (odds ratio: 2–8, p < 0.05).

Conclusions

The severity of depressive symptomatology plays an essential role in the risk of violence against community-dwelling older people. Moreover, it was found that older persons with depression symptomatology were at higher risk of being victims of violence. Our study findings support the need for protective measures within mental health national or regional policies to prevent depression and violence against community-dwelling older people.

Screening for domestic abuse and its relationship with demographic variables among elderly individuals referred to primary health care centers of Shiraz in 2018

BACKGROUND

Elder abuse is an important public health problem. The present study was aimed to determine the rate of domestic abuse and its relationship with demographic characteristics among elderly people referred to Primary Health Care (PHC) centers in Shiraz, Iran, 2018.

METHODS

This descriptive and cross-sectional study was conducted on 400 older people aged 60 years old and above who referred to 22 PHC centers of Shiraz. The data were collected using demographic characteristics questionnaire, Katz index, the domestic elder abuse questionnaire, and elder neglect checklist through face-to-face interview and observation methods. Backward linear regression model was used for analyzing the data.

RESULTS

The results indicated that 52.5% of the participants were female and 51.8% aged 60-69 years old. A total of 159 cases (39.8%) reflected at least one form of elder abuse or neglect. The results indicated that 21% of the participants (n = 84) were abused by their own children. Care neglect was the most reported form (42.8%), followed by psychological abuse (41.3%), emotional neglect (38.8%), and financial abuse (34.3%). The most common types of neglect were motion limitations (25%) followed by the dental problems (23.8%). The results also showed a significant relationship between domestic elder abuse and level of income (p = 0.017), having a house (p = 0.028), type of perpetrator (< 0.001), and insurance status (p = 0.027).

CONCLUSIONS

The results revealed a considerable rate of domestic abuse against elderly people, causing a serious risk for their health and security.

Elder abuse and associated factors in eastern romania

BACKGROUND

This article explores elder abuse in a hospitalised population. We wanted to identify details related to psychological and emotional abuse in the older population in our region and to determine the importance of the Elderly Abuse Suspicion Index (EASI^© ) in comprehensive geriatric assessments.

METHODS

This cross-sectional study conducted between March 2015 and May 2016 included 386 consecutive hospitalised patients over 65 years of age. All patients underwent a geriatric assessment, data were collected about their medical history, and the EASI^© was administered to each. The main outcome was identifying the presence, the type of abuse and the factors associated with abuse.

RESULTS

There were 21.5% of patients who suffered any form of abuse. Women were more frequently abused than men. Emotional abuse was the most common (60.2%) followed by neglect (53%) and physical abuse (22.91%); sexual abuse was absent in our study group. The abused patients had an impaired cognitive function (P = 0.034). They were also malnourished (P ≤ 0.001) and depressed (P = 0.001). The presence of peripheral artery disease, stroke, pneumonia, chronic kidney disease, musculoskeletal diseases and anxiety correlated with the presence of abuse. No statistically significant correlation was found between the degree of independence in instrumental activities of daily living and the presence of abuse (r = 0.105, P = 0.051).

CONCLUSIONS

EASI is a tool for detecting elder abuse and should be included in the standard geriatric assessment to prevent ageism. The number of abused elderly patients is significant, and the multiple factors associated with abuse are diverse.

Maltrato a las personas mayores: una revisión narrativa

El maltrato a las personas mayores es un tema de interés creciente, tanto así que se considera un problema de salud pública. Hay particularidades que hacen del entorno colombiano un ambiente propicio para generar situaciones de maltrato: la exposición a la “violencia a gran escala”, la diferencia de género y el cambio de la pirámide poblacional. Según el estudio SABE Colombia, el 12,9 % de las personas mayores informó haber sufrido maltrato, del cual el más común es el psicológico, seguido por el físico, el financiero y el sexual. A pesar de que el Estado reconoce al adulto mayor como “sujeto de especial protección”, aún hay desconocimiento por parte de los profesionales de la salud a la hora de enfrentar estos casos. Este debería ser un tema de obligatoriedad moral, por lo que se debe abordar a profundidad para así identificarlo oportunamente y proponer estrategias de prevención de una manera contextualizada. Esta revisión de la literatura tiene por objetivos sintetizar la información epidemiológica disponible, los factores de riesgo y las estrategias de evaluación y plantear las rutas de atención idóneas asentadas en los aspectos legales alrededor del maltrato hacia los ancianos en Colombia.

The prevalence of elder abuse in institutional settings: a systematic review and 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.

The Iranian version of geriatric anxiety inventory (GAI-P): a validation study

BACKGROUND

Anxiety is one of the most common mental health problems experienced by the elderly that affects quality of life. This study aimed to assess the psychometric properties of the Persian version of the Geriatric Anxiety Inventory (GAI-P) in order to provide a valid instrument for measuring anxiety in this population.

METHODS

Forward-backward translation was used to translate the Geriatric Anxiety Inventory from English into Persian and was tested by 10 elderly to assess its face validity. Then a sample of elderly people attending health centers in Dezful, Iran completed the questionnaire. Validity was assessed using both exploratory and confirmatory factors analysis, known-groups comparison (abused and non-abused elderly) also was administered. The internal consistency of the instrument was assessed using Kuder-Richardson 20 coefficients (KR-20). Afterwards, the reliability and validity through assessing the correlation between the Persian version of the GAI-P and the SF-36, were measured.

RESULTS

In all 720 elderly completed the questionnaire. Of these data from 420 elderly were used for exploratory factor analysis and the data from the remaining 300 elderly were used for confirmatory factor analysis. The exploratory factor analysis showed a three-factor solution (cognitive, arousal and somatic) for the questionnaire that jointly explained 59.48% of the overall variance observed. The confirmatory factor analysis supported the three-factor solution and the second-order latent factor model. The findings indicated a positive and significant correlation between the two measures lending support to its concurrent validity (r = 0.67, p < .001).Ultimately, the Geriatric Anxiety Inventory was found to have a favorable internal consistency.

CONCLUSION

This study confirmed that the GAI-P is a valid measure of anxiety in elderly population and now can be used in geriatric studies in Iran.

Sexual Violence Against Older People: A Review of the Empirical Literature

Aging and sexual violence are both established areas of research, but little attention has been paid to research into sexual violence against older people. This article presents a critical review of the literature reporting empirical research in three overlapping fields of inquiry: elder abuse, domestic violence, and sexual violence, identifying points of theoretical and methodological similarity and difference across academic disciplines. Using a range of search terms combining age, sexual violence, and elder abuse, the following databases were searched: EBSCOHOST, Ingenta-Ingenta connect, and JSTOR. In total, the databases searches returned 31 relevant articles and an additional 9 relevant articles were found through manual searches of bibliographies and Google searches, which were grouped into three categories: elder abuse, domestic violence in later life, and sexual violence against older people. Four themes common across these fields emerged: prevalence, characteristics of victims and risk factors, impacts and coping strategies, and perpetrator and assault characteristics. The findings in each area are discussed in detail, exposing gaps in knowledge and understandings of sexual violence against older women. The article ends by defining a future research agenda for this underexplored phenomenon that is of increasing importance in a context of global aging.

Elder abuse in Europe's "most elderly" city: an assessment of the phenomenon and an analysis of the data from the Penal Court of Genoa from 2010 to 2015

INTRODUCTION

In Italy, 5% of the elderly are estimated to have suffered abuse. While the Penal Code refers to generic types of abuse, such as physical and psychological maltreatment, abandonment and financial fraud, it does not specifically protect the elderly as a category.

AIMS

To assess the frequency and modalities of elder abuse in Genoa and its Province, and to compare these data with those reported in the literature, in order to provide a picture of the current situation that can be used by the authorities to combat this phenomenon.

METHODS

We analysed the first-degree verdicts issued by the Court of Genoa regarding accusations of physical, psychological and moral abuse and maltreatment of elderly subjects (over 65 years) in the period 2010-2015.

RESULTS

Only 85 of the 4028 court verdicts analysed involved elderly persons: 19 cases of domestic maltreatment, 3 of abuse of the means of correction or discipline, 18 of personal injury, 5 of abandonment and 40 of circumvention (deceiving someone, especially an elderly or mentally impaired person, to obtain a profit).

DISCUSSION AND CONCLUSIONS

A gap was observed between the number of crimes reported to the judicial authorities (tip of the iceberg) and the estimated prevalence of the phenomenon in the literature. There is a need both to create a network of protection for the elderly involving medical and judicial specialists and to train healthcare professionals to better recognise and report cases of maltreatment.

Social Isolation in Chinese Older Adults: Scoping Review for Age-Friendly Community Planning

Chinese older adults may be at increased risk of social isolation and loneliness, and a fragmented understanding exists about the challenges they face for social participation in their neighbourhoods and communities. A scoping review was undertaken to describe the current knowledge on social isolation and loneliness in urban-dwelling Chinese older adults living in Western societies to inform future research, practice, and policy in Canada. Nineteen articles met the inclusion criteria. The World Health Organization's age-friendly community framework contextualized the study findings. Studies identified issues related to (1) social participation; (2) community support and health services; (3) housing; (4) community and information; (5) respect and social inclusion; (6) outdoor spaces and public buildings; (7) civic participation and employment; and (8) transportation. Social isolation and loneliness is a growing concern in this population in Canada, and additional research is needed to identify its scope and effective interventions.

Abuse of Older Men in Seven European Countries: A Multilevel Approach in the Framework of an Ecological Model

BACKGROUND

Several studies on elder abuse indicate that a large number of victims are women, but others report that men in later life are also significantly abused, especially when they show symptoms of disability and poor health, and require help for their daily activities as a result. This study focused on the prevalence of different types of abuse experienced by men and on a comparison of male victims and non-victims concerning demographic/socio-economic characteristics, lifestyle/health variables, social support and quality of life. Additionally, the study identified factors associated with different types of abuse experienced by men and characteristics associated with the victims.

METHODS

The cross-sectional data concerning abuse in the past 12 months were collected by means of interviews and self-response during January-July 2009, from a sample of 4,467 not demented individuals aged between 60-84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain and Sweden). We used a multilevel approach, within the framework of an Ecological Model, to explore the phenomenon of abuse against males as the complex result of factors from multiple levels: individual, relational, community and societal.

RESULTS

Multivariate analyses showed that older men educated to higher levels, blue-collar workers and men living in a rented accommodation were more often victims than those educated to lower levels, low-rank white-collar workers and home owners, respectively. In addition, high scores for factors such as somatic and anxiety symptoms seemed linked with an increased probability of being abused. Conversely, factors such as increased age, worries about daily expenses (financial strain) and greater social support seemed linked with a decreased probability of being abused.

CONCLUSIONS

Male elder abuse is under-recognized, under-detected and under-reported, mainly due to the vulnerability of older men and to social/cultural norms supporting traditional male characteristics of stoicism and strength. Further specific research on the topic is necessary in the light of the present findings. Such research should focus, in particular, on societal/community aspects, as well as individual and family ones, as allowed by the framework of the Ecological Model, which in turn could represent a useful method also for developing prevention strategies for elder abuse.

The shifting conceptualization of elder abuse in the United States: from social services, to criminal justice, and beyond

A variety of forces have shifted the conceptualization of elder abuse over time to where it is almost unrecognizable when compared to its original conceptualization. The field has adopted or embraced whatever social problem is in vogue in an attempt to elevate elder abuse to a recognizable social problem that to date has eluded the field. This paper traces the various influences on the shifting conceptualizations of elder abuse and how those conceptualizations have shaped society's response. The paper concludes by suggesting that multiple conceptualizations can and must co-exist, a framework which is consistent with the multidisciplinary team approach becoming prevalent in the field.

Multidimensional measurement within adult protective services: design and initial testing of the tool for risk, interventions, and outcomes

This study describes the development, field utility, reliability, and validity of the multidimensional Tool for Risk, Interventions, and Outcomes (TRIO) for use in Adult Protective Services (APS). The TRIO is designed to facilitate consistent APS practice and collect data related to multiple dimensions of typical interactions with APS clients, including the investigation and assessment of risks, the provision of APS interventions, and associated health and safety outcomes. Initial tests of the TRIO indicated high field utility, social worker "relevance and buy-in," and inter-rater reliability. TRIO concurrent validity was demonstrated via appropriate patterns of TRIO item differentiation based on the type of observed confirmed abuse or neglect; and predictive validity was demonstrated by prediction of the risk of actual APS recurrence. The TRIO is a promising new tool that can help meet the challenges of providing and documenting effective APS practices and identifying those at high risk for future APS recurrence.

Cross-sectional and longitudinal risk of physical impairment in a cohort of postmenopausal women who experience physical and verbal abuse

BACKGROUND

Exposure to interpersonal violence, namely verbal and physical abuse, is a highly prevalent threat to women's health and well-being. Among older, post-menopausal women, several researchers have characterized a possible bi-directional relationship of abuse exposure and diminished physical functioning. However, studies that prospectively examine the relationship between interpersonal abuse exposure and physical functioning across multiple years of observation are lacking. To address this literature gap, we prospectively evaluate the association between abuse exposure and physical functioning in a large, national cohort of post-menopausal women across 12 years of follow-up observation.

METHODS

Multivariable logistic regression was used to measure the adjusted association between experiencing abuse and physical function score at baseline in 154,902 Women's Health Initiative (WHI) participants. Multilevel modeling, where the trajectories of decline in physical function were modeled as a function of time-varying abuse exposure, was used to evaluate the contribution of abuse to trajectories of physical function scores over time.

RESULT

Abuse was prevalent among WHI participants, with 11 % of our study population reporting baseline exposure. Verbal abuse was the most commonly reported abuse type (10 %), followed by combined physical and verbal abuse (1 %), followed by physical abuse in the absence of verbal abuse (0.2 %). Abuse exposure (all types) was associated with diminished physical functioning, with women exposed to combined physical and verbal abuse presenting baseline physical functioning scores consistent with non-abused women 20 years senior. Results did not reveal a differential rate of decline over time in physical functioning based on abuse exposure.

CONCLUSIONS

Taken together, our findings suggest a need for increased awareness of the prevalence of abuse exposure among postmenopausal women; they also underscore the importance of clinician's vigilance in their efforts toward the prevention, early detection and effective intervention with abuse exposure, including verbal abuse exposure, in post-menopausal women. Given our findings related to abuse exposure and women's diminished physical functioning at WHI baseline, our work illuminates a need for further study, particularly the investigation of this association in younger, pre-menopausal women so that the temporal ordering if this relationship may be better understood.

Resident-to-resident physical aggression leading to injury in nursing homes: a systematic review

BACKGROUND

resident-to-resident aggression (RRA) is an understudied form of elder abuse in nursing homes.

OBJECTIVE

the purpose of this systematic review was to examine the published research on the frequency, nature, contributing factors and outcomes of RRA in nursing homes.

METHODS

in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, this review examined all original, peer-reviewed research published in English, French, German, Italian or Spanish between 1st January 1949 and 31st December 2013 describing incidents of RRA in nursing homes. The following information was extracted for analysis: study and population characteristics; main findings (including prevalence, predisposing factors, triggers, nature of incidents, outcomes and interventions).

RESULTS

eighteen studies were identified, 12 quantitative and 6 qualitative. The frequency of RRA ranged from 1 to 122 incidents, with insufficient information across the studies to calculate prevalence. RRA commonly occurred between exhibitors with higher levels of cognitive awareness and physical functionality and a history of aggressive behaviours, and female targets who were cognitively impaired with a history of behavioural issues including wandering. RRA most commonly took place in the afternoon in communal settings, was often triggered by communication issues and invasion of space, or was unprovoked. Limited information exists on organisational factors contributing to RRA and the outcomes for targets of aggression.

CONCLUSIONS

we must continue to grow our knowledge base on the nature and circumstances of RRA to prevent harm to an increasing vulnerable population of nursing home residents and ensure a safe working environment for staff.

Sexual abuse of older nursing home residents: a literature review

Despite an increasing literature related to elder abuse, sexual abuse of older persons in general and of vulnerable adults living in nursing homes in particular is still sparsely described. The purpose of this study was to assess the state of knowledge on the subject of sexual abuse against older nursing home residents through a literature review. Systematic searches in reference databases including Cinahl, Medline, OVID Nursing Database, ISI Web of Science, PsycINFO, Cochrane Library, and SveMed + were conducted. Through several phases of selection of the articles, using strict inclusion and exclusion criteria, six articles were chosen for a deeper examination. Findings from the review show that sexual abuse occurs in nursing homes and that both older women and men are victims of sexual abuse. Perpetrators appear mainly to be staff and other residents and mainly to be men, but also women abuse both older men and older women. Findings from the literature review show that there is a need for knowledge and further research on the topic of sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step in seriously addressing sexual abuse against older persons.

An Investigative Tool for Detecting Elder Abuse

Elder abuse is estimated to affect one in ten individuals 60 years of age and older and has been significantly associated with an increased risk of mortality. However, no clear data exist on the number of deaths that result from elder abuse or neglect. The potential contribution of abuse and neglect to the death of an elder is rarely investigated, as natural deaths are expected with advancing age. Elders are often reliant on others for care making them a vulnerable population. Although the deaths of other vulnerable populations, including children, are routinely investigated, no protocols for elder death investigation have been enacted. We propose the implementation of an investigative tool to assess the elder decedent and residence for indicators of abuse or neglect. Investigations may assist in differentiating self-neglect and caretaker neglect. Decedent observations include: evidence of injuries, personal hygiene, malnutrition and/or dehydration, decubitus ulcers, evidence of restraint, unexplained vaginal or anal bleeding, and previous reports with Adult Protective Services. To differentiate between self-neglect and caretaker neglect, an assessment of the level of dependence on others for activities of daily living and the level of involvement of the caretaker are determined. The decedent's living condition assessment includes evidence of forced isolation; lack of food, water or utilities; soiled clothing and/or bedding; filthy or unsafe living conditions; and inappropriate administration of medications. With proper training, medical examiners can easily implement these protocols. Such information is extremely valuable for determining whether further investigation and examination of the decedent is warranted.

Prevalence and Risk Factors for Self-Neglect among Older Adults Living Alone in South Korea

This study aimed to explore the prevalence of and risk factors for self-neglect among older adults who live alone. Data were obtained through face-to-face interview responses of 1,023 older adults living alone in a metropolitan area in South Korea, selected via stratified random sampling, which considered the population variables gender, age group, and district. Descriptive statistics were used to characterize the prevalence of self-neglect, and hierarchical multiple regression analysis was conducted to identify significant risk factors of self-neglect. At least 22.8% of the participants could be considered to have one form of elder self-neglect. Consistent with previous research, self-neglect was more prevalent in the older people living alone who had higher levels of depressive symptoms or a lack of family social support. Unexpectedly, self-neglect was more prevalent among respondents with higher levels of education and cognitive abilities, lower levels of medical comorbidities, and more children. Additionally, social networks of friends and use of social services (formal social support) did not affect the frequency of self-neglect. The findings have implications for gerontological practice and policy, especially for older people living alone in South Korea.

A review on the prevalence and measurement of elder abuse in the community

OBJECTIVES

Aging is a rising phenomenon globally and elder abuse is becoming increasingly recognized as a health and social problem. This review aimed to identify the prevalence of elder abuse in community settings, and discuss issues regarding measurement tools and strategies to measure elderly abuse by systematically reviewing all community-based studies conducted worldwide.

METHOD

Articles on elder abuse from 1990 to 2011 were reviewed. A total of 1,832 articles referring to elders residing at home either in their own or at relatives' houses were searched via CINAHL and MEDLINE electronic databases, in addition to a hand search of the latest articles in geriatric textbooks and screening references, choosing a total of 26 articles for review.

RESULTS

Highest prevalence was reported in developed countries, with Spain having 44.6% overall prevalence of suspicion of abuse and developing countries exhibiting lower estimates, from 13.5% to 28.8%. Physical abuse was among the least encountered, with psychological abuse and financial exploitation being the most common types of maltreatment reported. To date, there is no single gold standard test to ascertain abuse, with numerous tools and different methods employed in various studies, coupled with varying definitions of thresholds for age.

CONCLUSION

Current evidences show that elder abuse is a common problem in both developed and developing countries. It is important that social, health care, and legal systems take these findings into consideration in screening for abuse or reforming existing services to protect the health and welfare of the elderly.

Theories and measures of elder abuse

Elder abuse is a pervasive phenomenon around the world with devastating effects on the victims. Although it is not a new phenomenon, interest in examining elder abuse is relatively new. This paper aims to provide an overview of the aetiological theories and measures of elder abuse. The paper briefly reviews theories to explain causes of elder abuse and then discusses the most commonly used measures of elder abuse. Based on the reviewed theories, it can be concluded that elder abuse is a multifactorial problem that may affect elderly people from different backgrounds and involve a wide variety of potential perpetrators, including caregivers, adult children, and partners. The review of existing measurement instruments notes that many different screening and assessment instruments have been developed to identify elders who are at risk for or are victims of abuse. However, there is a real need for more measurements of elder abuse, as the current instruments are limited in scope.

Screening for Elder Mistreatment among Older Adults Seeking Legal Assistance Services

Introduction: The aging population is a rapidly growing demographic in the United States. Isolation, limited autonomy, and declining physical and mental health render many older adults vulnerable to elder mistreatment (EM). The purpose of this study was to assess the prevalence and correlates of EM among a sample of older adults using legal assistance services in Atlanta, Georgia.

Methods: Researchers administered surveys to consenting older adults (aged 60+) in 5 metro Atlanta community centers that hosted legal assistance information sessions as part of the Elderly Legal Assistance Program. The surveys screened for risk factors and prevalence of EM risk using valid and reliable measures and included additional questions regarding demographics characteristics and healthcare use behaviors.

Results: Surveys were completed by 112 participants. Findings reveal that 32 (28.6%) respondents met the criteria for elder abuse / neglect risk; 17 (15.2%) respondents met criteria for depression; and 105 (93.7%) had visited a healthcare provider during the past 6 months.

Conclusion: The rates of EM risk in this sample were higher than those previously reported in research. Findings support continued examination of unique risks that may be present among older adults who may be possibly facing legal issues. Additionally, the reported frequency of healthcare visits among participants reveals a promising opportunity to examine development of a more widespread EM screening approach to be conducted in non-emergency settings. Interdisciplinary collaboration is required to inform screening approaches that account for complexities that EM cases present.

Elder abuse in residential long-term care: an update to the 2003 National Research Council report

A synthesis of the last decade of literature on elder abuse in residential long-term care (i.e., Nursing Homes and Assisted Living) is discussed. Presented are definitions of abuse, theoretical and conceptual models, prevalence rates of abuse, outcomes and costs, and sources of abuse. The synthesis represents an update to the literature in the influential 2003 National Research Council report. We identify many of the same issues and concerns exist that were surfaced in this prior report. Many theoretical and conceptual models need further elaboration. Conflicting definitions of abuse are pervasive. Rates of abuse are generally inaccurate, and probably under-reported. However, we also identify progress in many areas. An increase in empirical studies that exist in this area (although very few in Assisted Living). Other forms and types of abuse have also been identified as important, such as resident-to-resident abuse. These areas are discussed, along with potential suggestions for additional research.

Inadequate care in Norwegian nursing homes--as reported by nursing staff

Studies have shown that inadequate care, also referred to as abuse, violence, neglect and maltreatment occur in nursing homes in many countries. The aim of this study was to describe the frequency and types of inadequate care committed by staff in nursing homes. Another aim was to investigate if nursing staff reported differently depending on age, education level and years of experience working at nursing homes. A questionnaire survey was conducted among nursing staff (n = 616) in 16 nursing homes in the central part of Norway. Twenty items concerned staff behaviour in forms of acts of inadequate care. The respondents were asked to report how often they had observed colleagues commit acts and how often they themselves had committed such acts. The response rate was 79%. All in all, 91% of the nursing staff reported that they had observed at least one act of inadequate care and 87% reported that they had committed at least one act of inadequate care. Acts of negligent and emotional character were most frequently reported, both as observed and committed. Depending on the higher educational level that the nursing staff had more acts of all types were observed and committed. The oldest staff and those with longest experience at the present nursing home reported more observed and committed acts of physical character than did the others. The extent of inadequate care confirms that this is a common part of activities in nursing homes. Because emotional and negligent acts can be just as harmful as physical acts, more knowledge is needed about the reasons in order to take preventive actions.

Identifying, preventing, and reporting elder abuse

Elder abuse and neglect is a national public health problem with a profound negative impact on community health. Neglect is its most common manifestation, but other types of overt abuse are frequent. National initiatives are underway to use trained professionals, physicians and others, to act as community sentinels to uncover and help unknown victims. Pharmacy, with high visibility and easy access to seniors, must join other professions in this initiative to protect the vulnerable elderly. Reporting suspected abuse-the major tool of prevention-is a simple and time-efficient, though an often misunderstood, process. This article will teach community and consultant pharmacists to identify, prevent, and report senior abuse and discuss how patients benefit from such action. Abuse in institutionalized settings, which has wide coverage in the literature, will not be reviewed here.

Rompendo o silêncio e suas barreiras: um inquérito domiciliar sobre a violência doméstica contra idosos em área de abrangência do Programa Médico de Família de Niterói, Rio de Janeiro, Brasil

O objetivo do estudo é estimar a prevalência da violência física contra idosos no ambiente doméstico em população adstrita ao Programa Médico de Família de Niterói, Rio de Janeiro, Brasil. Por meio de um inquérito de base populacional, foram entrevistados 322 indivíduos com 60 anos ou mais, selecionados através de amostragem aleatória simples a partir do censo de idosos adstritos a seis equipes de saúde da família. Para detecção de violência física contra idosos, utilizou-se a versão em português da Conflict Tactics Scales (CTS1). A violência física de qualquer gravidade foi relatada por 10,1% (IC95%: 6,7; 13,4) dos entrevistados, enquanto que 7,9% (IC95%: 4,9; 10,8) referiram ter sido vítimas de violência física grave no ano anterior à entrevista. A violência esteve mais presente entre os mais novos, os que moram com maior número de indivíduos, os com história de diabetes e/ou doença articular. A grande magnitude do evento, sua maior prevalência entre indivíduos que apresentam outras vulnerabilidades e suas conseqüências negativas à saúde impõem que a Estratégia Saúde da Família incorpore ações para o enfrentamento da violência física contra idosos às suas atividades de rotina.

CM, Moraes CL. Adaptação transcultural para o português (Brasil) do instrumento Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) utilizado para identificar risco de violência contra o idoso

Este artigo descreve a adaptação transcultural para uso no Brasil do instrumento Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST) utilizado para identificar risco de violência doméstica em idosos. Avaliando-se as equivalências conceitual e de itens, concluiu-se pela pertinência delas no contexto brasileiro. A equivalência semântica contemplou a correspondência de significado referencial/denotativo de termos e a geral/conotativa dos itens em si. A equivalência de mensuração foi investigada por intermédio de propriedades psicométricas. Semelhante ao encontrado no instrumento original em inglês, a análise fatorial revelou três dimensões. Seis dos sete itens carregaram satisfatoriamente no fator 1 (escala de "situação de abuso potencial"). A consistência interna mostrou-se razoável e reprodutibilidade intra-observador discreta. O segundo fator representando a dimensão de "violação de direitos pessoais ou abuso direto" teve desempenho semelhante. Ainda assim, identificou-se troca de itens entre estas escalas e cargas cruzadas. Uma terceira escala que deveria abarcar as "características de vulnerabilidade" não teve o mesmo desempenho. Conclui-se que mesmo sem mostrar equivalência completa, o H-S/EAST já poderia ser recomendado para uso no contexto brasileiro, pelo menos em parte.

Recognition and perception of elder abuse by prehospital and hospital-based care providers

The purposes of this study were to evaluate the extent of exposure, knowledge and attitudes of prehospital care providers (PCPs) and hospital care providers (HCPs) to elder abuse and neglect. A 20-question survey was designed to determine the providers' perception, knowledge and ability to identify patients that were potential victims of elder abuse and/or neglect. The surveys were distributed at four Maryland statewide conferences during 2006. A total of 645 surveys were distributed at the start of the individual conferences and 400 completed surveys were returned. Of the respondents, 272 (68.2%) were PCP (emergency medical services=EMSs) and 127 (31.8%) were HCP. During the past 12 months, 51.3% of those surveyed did not have reason to suspect any patients were exposed to abuse or neglect, although 60.5% admitted little or no contact with the elderly. In an attempt to determine respondent's ability to recognize potential abuse and neglect patients, scenario-type questions were used. Respondents believed a decubital ulcer (bedsore) was a positive indicator (83.5%) of abuse/neglect and 92.8% indicated that the elderly could suffer from injuries similar to "shaken-baby syndrome". When questioned about skin bruises as a possible indicator of abuse, only 69.3% of the respondents identified it as a possible sign of abuse. Seventy-one percent of respondents indicated that burns are not common in the elderly and could be another sign of elder abuse. One-in-three providers indicated they would suspect other reasons (dementia, depression, etc.) for the report of a sexual assault in an elderly patient. Eighty-nine percent of providers were aware that healthcare providers in the State of Maryland are required to report suspected elder and vulnerable patient abuse and/or neglect to law enforcement or social services' agencies. When asked to define elder abuse as a medical or social problem, 25.0% of providers stated that it was a social problem. Over 95% of the providers suspected the existence of abuse, neglect and domestic violence among the elderly were not rare events. In Maryland, there are a limited number of specific educational programs dealing with abuse and neglect of the elderly. A statewide training program is needed to ensure PCP and HCP can recognize the signs and symptoms of elder abuse and neglect, and to ensure that the providers are aware of their legal requirements for reporting the abuse to the proper state or local agencies.

Upholding Dignity in Hospitalized Elders

Caring for the elderly in today's acute care setting can be a challenging and complex process. Regardless of whether the interventions provided by caregivers are physical or psychosocial, one of the basic tenets of caring for elderly is to uphold their dignity. The concept of dignity is defined and challenges to maintaining dignity for elderly in the acute care setting are described. Strategies and recommendations for education, practice, research, and policy development are outlined to assist nurses in ensuring that elders receive the dignified care that they deserve.