1
|
Alonso-Moreno FJ, Llisterri Caro JL, Martínez Altarriba MC, Segura-Fragoso A, Martín-Sánchez V, Miravet Jiménez S, Velilla Zancada S, Martínez García FV, Micó Pérez RM, Cinza Sanjurjo S, Sánchez Sánchez B. Prevalence of suspected abuse of non-institutionalized older people treated in primary care. PRESENCIA study. Semergen 2024; 50:102263. [PMID: 38838584 DOI: 10.1016/j.semerg.2024.102263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES To determine the prevalence of suspected abuse of non-institutionalised elderly people and the associated variables. PATIENTS AND METHOD Observational, descriptive, cross-sectional, multicentre study in patients aged 65 years or older, non-institutionalised, consecutively selected in primary care (PC). The EASI questionnaires (Suspected Elderly Abuse Index), the EAI questionnaire (Suspected Abuse Index in patients with cognitive impairment), the Barthel index, and the EUROQOL-5D questionnaire were used with patients, and the CASE questionnaire and the Zarit test were used with caregivers. Socio-demographic, health, and quality of life variables were analysed in all patients. RESULTS Eight hundred four patients were included, mean age 78.9±7.9 years, 58.3% women. The prevalence of suspected abuse was 11.3% (95% CI: 9.1%-13.9%). Suspected abuse was more frequent in women than in men (14.4% vs. 7.1%; odds ratio (OR)=1.97; 95% CI=1.1-3.4; p=0.016) and in those who lived with two or more people compared to those who lived alone (18.4% vs. 7.3%; OR=2.42; 95% CI=1.1-5.0; p=0.017). Among older patients, the lower their dependency, the lower the prevalence of suspected abuse (30.0% in highly dependent vs. 8.7% in non-dependent: p-trend=0.006); and the better the perceived health status, the lower the prevalence of suspected abuse (29.6% in poor health status vs. 6.9% in optimal health status; p-trend=<0.001). Among caregivers, the prevalence of suspected abuse was 20.4% (95% CI=12.8%-28.0%). A trend of higher prevalence of suspected abuse could be observed with higher scores on the CASE questionnaire (56.3% at high risk and 9.6% with no risk of abuse; p-trend=0.007). In the case of the ZARIT questionnaire with scores below 47, the prevalence of suspected abuse was 9.1%, and for scores above 55, it was 52.6% (p-trend<0.001). CONCLUSIONS The results of the PRESENCIA study show that approximately 1 in 10 patients aged ≥65 meet the criteria for suspected abuse. The probability of abuse increases in women, in patients with greater dependency and in patients with poorer perceived health status. Caregivers with greater overload and greater risk presented a greater suspicion of elder abuse.
Collapse
Affiliation(s)
| | | | | | - A Segura-Fragoso
- Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, Spain
| | - V Martín-Sánchez
- Institute of Biomedicine, University of Leon, Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Spain
| | | | | | | | | | | | | |
Collapse
|
2
|
Giorgetti A, Pelletti G, Fiorentini C, Mazzotti MC, Fais P, Pelotti S. On tackling abuse of older people: The forensic challenges in fatal cases investigation. Leg Med (Tokyo) 2024; 67:102398. [PMID: 38237384 DOI: 10.1016/j.legalmed.2024.102398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/11/2023] [Accepted: 01/07/2024] [Indexed: 03/01/2024]
Abstract
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.
Collapse
Affiliation(s)
- Arianna Giorgetti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - Guido Pelletti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - Clara Fiorentini
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | | | - Paolo Fais
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| | - Susi Pelotti
- Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy.
| |
Collapse
|
3
|
Franchetti G, Cestonaro C, Giordano R, Callegari E, Giraudo C, Viel G, Cecchetto G. Severe starvation and restraint in a 47-year-old woman: Clinical, autopsy and histopathological evidence of abuse and neglect. Forensic Sci Int 2024; 355:111941. [PMID: 38290228 DOI: 10.1016/j.forsciint.2024.111941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
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.
Collapse
Affiliation(s)
- Giorgia Franchetti
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy.
| | - Clara Cestonaro
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Renzo Giordano
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Enrica Callegari
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Chiara Giraudo
- Unit of Advanced Clinical and Translational Imaging, Department of Medicine - DIMED, Via Giustiniani 2, 35121 Padova, Italy
| | - Guido Viel
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| | - Giovanni Cecchetto
- Unit of Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35100 Padova, Italy
| |
Collapse
|
4
|
Fu YC, Pei MY, Liao JJ, Li N, Zhang FC, Liu HL. Prevalence and correlates of elder neglect in the community-dwelling Chinese population: New evidence from the CLHLS study. Front Public Health 2023; 11:1123835. [PMID: 36992875 PMCID: PMC10040648 DOI: 10.3389/fpubh.2023.1123835] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/14/2023] [Indexed: 03/15/2023] Open
Abstract
BackgroundThis study aimed to explore the prevalence of elder neglect (EN) and its associated factors among community-based Chinese older adults.MethodsWe used data from the 2018 phase of a nationwide cross-sectional study, the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which recruited 15,854 older adults to complete the study interviews that incorporated six dimensions of EN, namely, life neglect, social isolation, medical neglect, poor living situation, family neglect, and social neglect. Multivariate logistic regression was used to explore factors associated with EN.ResultsWe included demographic factors, chronic diseases, cognitive function, and daily activity function in our comprehensive analysis and showed that they had different effects on the six EN dimensions. Different demographic factors such as gender, age, marriage, education, occupation, residence, and household income were included in the comprehensive analysis, and the results showed that these factors had different effects on the six dimensions of EN. Next, we found that older adults with chronic diseases are prone to life neglect, medical neglect, and residential environment neglect. Older adults with better cognitive abilities were less likely to be neglected, and a decline in daily activity capacity has been linked to EN in older adults.ConclusionFuture studies are needed to identify the health effects of these associated factors, develop prevention strategies for EN, and improve the quality of life of older adults living in communities.
Collapse
Affiliation(s)
- Yi-cheng Fu
- Department of Geriatrics, Peking University Third Hospital, Beijing, China
| | - Min-yue Pei
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Jiao-jiao Liao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Fu-chun Zhang
- Department of Geriatrics, Peking University Third Hospital, Beijing, China
| | - Hui-lin Liu
- Department of Geriatrics, Peking University Third Hospital, Beijing, China
- *Correspondence: Hui-lin Liu
| |
Collapse
|
5
|
Mazzotti MC, Fais P, Amadasi A, Pelletti G, Giovannini E, Giorgetti A, Pelotti S. When the Hidden Issue of Elder Abuse Leads to Death: Do Not Neglect Elder Neglect. Am J Forensic Med Pathol 2022; 43:60-65. [PMID: 34334621 DOI: 10.1097/paf.0000000000000700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT It is well known that elder neglect entails a number of physical and psychological consequences, as well as being an independent risk factor for death. In the present study, we describe 5 forensic cases of death of older adults where the diagnosis of neglect only emerged postmortem through the combination of the scene investigation, the often-scarce circumstantial data, and the autopsy findings. The gathering of this information allowed the presence of risk factors-not previously assessed or reported-to be identified. Nevertheless, complete medical information was lacking both for the isolation of the victims with their caregivers and for the absence of every social and health support in self-neglect. More research is needed also in the forensic pathology field with standardized methods to contribute to prevention strategies and to avoid that victims of elder neglect remain hidden also after death.
Collapse
Affiliation(s)
- Maria Carla Mazzotti
- From the Unit of Legal Medicine, Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | |
Collapse
|