Elder abuse and neglect in Ireland: results from a national prevalence survey

Determining patterns and types of violence against the elderly in the Kingdom of Saudi Arabia

Reports indicate an increase in the incidence of violence against the elderly in the Kingdom of Saudi Arabia (KSA). This study aimed to determine the types and risk factors of elder abuse in KSA. A cross-sectional observational study was conducted of abuse among the elderly (65 years and older; n  = 128) reported in the National Family Safety Registry (NFSR) between April 2017 and December 2021. Most cases involved women (65.6%) and married individuals (54.7%). Physical abuse was the most common type (44.5%), followed by neglect (34.4%). Men, married individuals, people without family support, and people with physical disabilities were more likely to experience physical abuse. Elderly people, single individuals, women, and those lacking family support showed an increased likelihood of neglect. Preventive strategies should be implemented through awareness raising, capacity building, resource allocation, and the exchange of multidisciplinary good practices across sectors.

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.

The relationship between social support and dimensions of elder maltreatment: a systematic review and Meta-analysis

INTRODUCTION AND AIMS

Many studies have investigated the relationship between social support and the prevention of elder abuse; however, their results are somehow inconsistent in terms of the association. This systematic review and meta-analysis aimed to investigate the published studies on the relationship between social support and the prevention of elder maltreatment.

MATERIALS AND METHODS

An electronic search was conducted until January 2023, using such databases as PubMed, Scopus, and Web of Science. The present research included cross-sectional, longitudinal, and case-control studies. Study selection, data extraction, and risk of bias assessment were conducted by two researchers independently. The Newcastle-Ottawa checklist was utilized to evaluate the quality of studies. The random effects model was employed to perform a meta-analysis.

RESULTS

In total, 32 studies were included in this systematic review, out of which 26 articles were eligible for meta-analysis. The results showed that 68.75% of the studies were of high quality, and there is a significant relationship between social support and elder maltreatment. Accordingly, the lack of social support increased overall maltreatment (odds ratio: 1.24, 95% confidence interval: 1.16-1.33; I2 = 92.3%, p = 0.000)). Moreover, lack of social support had an increasing effect on the level of psychological abuse (1.55, 1.18-2.04; 88.7%, p = 0.000), physical abuse (1.31, 0.42-4.11; 76.3%, p = 0.005), and neglect (2.02, 0.86-4.72; 87.9%, p = 0.000), which shows heterogeneities among the results of the included studies. On the contrary, the lack of social support showed a decreasing effect on financial abuse (0.92, 0.70-1.21; 62.1%, p = 0.022).

CONCLUSION

This systematic review provides evidence that social support in the form of structural or functional support may plays an important role in improving the quality of life of the elderly.

Exploring Factors Associated with Perceived Changes in Severity of Elder Abuse: A Population-Based Study of Older Adults in Korea

Elder abuse is a pressing problem that demands social attention in South Korea. This study aims to examine the characteristics of older adults and their family perpetrators that may influence the perceived severity of abuse by older adults using a nationally representative sample among older Koreans. We analyzed 952 community-dwelling older Koreans from a population-based survey of the Survey of Elderly Care and Welfare Need. The analytic sample of this study consisted of older adults who self-reported having been emotionally, physically, and financially abused or neglected by their family members or other primary caregivers. We used multinomial logistic regression models to predict perceived change in severity of abuse. Results showed that the abuse type and duration of abuse were significantly associated with the perceived change in the severity of abuse. Older victims' age, being female, and being married were also associated with greater risk for increased severity of abuse relative to no change, while older adults' better health status was associated with lower risk for increased severity of abuse. The findings of this study can help social work professionals identify older adults with heightened risk of abuse and protect the human rights of the most vulnerable aging population.

Challenges in Conducting Sexual Health and Violence Research in Older Adults Beyond the General Data Protection Regulation: A Belgian Case Study

Because of a growing older population, the sexual health (SH) of older adults, including sexual violence (SV), is becoming an increasingly important public health concern. Yet, reliable SV prevalence rates and risk factors are lacking, due to methodological shortcomings in current studies. SV research involves challenges regarding safety and disclosure, especially in older adults. In this paper, we reflect on the methods used in a sexual health and violence (SH&V) study in older adults balancing between privacy rules imposed by the General Data Protection Regulation (GDPR) and ethical and safety guidelines.To ensure the acceptability of the questionnaire, it was tested in a two-phase pilot study. To maximize SV disclosure, the questionnaire built up gradually towards the more sensitive SV modules. Interviewers were trained to approach participants in a non-judgmental manner. Due to GDPR, our data collection method was changed from a random sampling via the National Register to a cluster random probability sampling with a random walk finding approach.Older adults were willing to discuss SH&V during a structured face-to-face interview with trained interviewers. Following strict safety guidelines, no major incidents were reported. The cluster random probability sampling with random walk finding approach provided an adequate sampling frame, but was inefficient and time-consuming.Doing research on SH&V in older adults is feasible but requires a substantial investment of time and the challenges involved may incur greater costs. In order to guarantee further research on sensitive topics in older adults, we recommend that an interdisciplinary expert group consisting of researchers, donors, and policymakers investigates how GDPR and public health research in hard-to-reach populations can be better matched.

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.

Multimorbidity as a Risk Factor of Elder Abuse/Mistreatment in India: A Cross-Sectional Study

Globally, elder abuse/mistreatment is a common form of violence against the elderly. This study examines the association between multimorbidity and abuse/mistreatment among the elderly population (60+) in India. Cross-sectional data from the United Nations Population Fund (UNFPA)'s "Building Knowledge Base on Population Aging in India" (BKPAI, 2011) was analyzed. We generated a multimorbidity variable by combining 20 self-reported diagnosed chronic diseases. Bivariate analysis was used to understand the sample distribution and prevalence estimation of elder abuse/mistreatment by multimorbidity and state. Furthermore, multilevel mixed-effect logistic regression was used to examine the association between multimorbidity and elder abuse/mistreatment. The overall prevalence of elder abuse/mistreatment in the study population is 11.4%. The prevalence of elder abuse/mistreatment among elderly with no chronic diseases is 6.01% which increases to 22.7% among elderly with four or more chronic diseases. Furthermore, the result from the multilevel mixed-effect logistic regression showed a close association between multimorbidity and elder abuse. Elderly with two, three, and four or more chronic diseases are 3.02 (CI = 2.33, 3.91, p < .000), 4.16 (CI = 3.02, 5.74, p < .000), and 5.06 (CI = 3.50, 7.31, p <.000) times more likely to experience abuse/mistreatment than elderly with no chronic diseases, respectively. In specific, this association is stronger for the elderly population residing in the urban areas. Furthermore, economic status and educational attainment have a protective role in determining elder abuse/mistreatment in India. In conclusion, multimorbidity has emerged as a significant risk factor of elder abuse/mistreatment in India. Measures to prevent elder abuse should consider the role of multimorbidity.

Influence of Social Adversity on Perceived Health Status and Depressive Symptoms among Portuguese Older People

This study aims to investigate how exposure to poverty, food insecurity, and abuse at older ages relates to health outcomes. A questionnaire collecting data on sociodemographic and economic characteristics, health status, depressive symptoms, food insecurity, and abuse was administered to a sample of 677 older adults. Logistic regression was used to quantify the association of poverty, food insecurity, and abuse with perceived health status and depressive symptoms. If the older person only reported experiences of abuse, it was more likely to report the presence of depressive symptoms, even after adjustment for covariates. If it was only reported the experience of food insecurity, it was more likely to report a worse health status. Older people exposed to at least two factors of vulnerability were significantly more likely to report (very) poor perceived health status (OR: 7.11, 95% CI: 2.77–18.25) and the presence of relevant depressive symptoms (OR: 4.34; 95% CI: 2.04–9.22). Thus, the combined effect of vulnerabilities was significantly associated with worse health among older people. Public health policies to mitigate these adverse exposures should be developed to promote health and well-being in this population.

Examining the impact of economic abuse on survivors of intimate partner violence: a scoping review

Background

Economic abuse is a unique form of intimate partner violence (IPV) and includes behaviors that control a survivor’s ability to acquire, use, and maintain resources. These tactics can result in someone becoming economically dependent on their partner and may limit their ability to leave the relationship and establish independence. The aim of this study was to conduct a scoping review focused on the impact of economic abuse on survivors of IPV.

Methods

A total of 14 databases were reviewed, which resulted in 35 peer-reviewed manuscripts for inclusion in the study. Manuscripts were included if they were: written in English, published since the year 2000, focused specifically on the impact of economic abuse perpetrated by an intimate partner, economic abuse was measured as an independent variable, and if economic abuse was looked at separately from other forms of IPV. Both convenience and population-based samples were included in the review. Information was extracted using a data charting form. The data were analyzed using a combination of grouping techniques and constant comparison methods to identify key findings.

Results

Studies found significant associations between economic abuse and a range of outcomes, such as mental and physical health, financial impacts, parent-child interactions, and quality of life. The most frequently examined were mental health, followed by financial issues.

Conclusions

Limitations of these studies included a lack of longitudinal research and a focus on heterosexual relationships with male-perpetrated violence toward female survivors. Study findings highlight the wide-ranging potential impacts of economic abuse on survivors and the need for additional research to better understand potential outcomes and implement and evaluate interventions to address them.

Sexual Activity and Physical Tenderness in Older Adults: Prevalence and Associated Characteristics From a Belgian Study

BACKGROUND

Despite the World Health Organization calling for sexuality to be recognized as an aspect of well-being, no studies have explored sexual activity and physical tenderness in older adults aged ≥ 75 years in Belgium or those aged ≥ 85 years worldwide.

AIM

To assess the prevalence and predictors of sexual activity and physical tenderness in a sample of older adults.

METHODS

Using data from a Belgian cross-sectional study on sexual violence (UN-MENAMAIS), information on sexual activity, physical tenderness, and associated characteristics was collected during structured face-to-face interviews with older adults living in the community, assisted living facilities, or nursing homes. Cluster random probability sampling with a random route-finding approach was used to select the participants.

OUTCOMES

Current sexual activity and physical tenderness in the previous 12 months, sociodemographic characteristics, chronological age, subjective age, number of sexual partners, sexual satisfaction, attitudes toward sexuality in later life, quality of life, and lifetime sexual victimisation.

RESULTS

Among the 511 participants included, 50.3% were in a relationship, mainly living with their partner; 31.3% indicated they were sexually active; and 47.3% of sexually inactive participants reported having experienced forms of physical tenderness in the previous 12 months. Sexual activity was associated with the presence of a partner, satisfaction with sexual life, permissive attitudes regarding sexuality in later life, a younger age, and a lack of disability. Physical tenderness was associated with the presence of a partner, community residency, and permissive attitudes regarding sexuality in later life.

CLINICAL IMPLICATIONS

Raising awareness among the general population, healthcare professionals, and older adults about sexuality in later life could contribute to ending this taboo and should therefore be a priority for society.

STRENGTHS AND LIMITATIONS

Our study fills a gap in the literature regarding sexual activity and physical tenderness in older adults aged ≥ 70 years, including respondents aged up to 99 years. Additionally, we explored different forms of sexual expression beyond intercourse, and face-to-face interviews contributed to the quality of the collected data. The main limitation of this study was the sample size, although the findings were similar to recent statistical indicators in Belgium.

CONCLUSION

One in 3 older adults aged ≥ 70 years living in Belgium are sexually active. These findings provide an opportunity to inform the general public and older adults about later life sexuality and to educate healthcare professionals about aging sexuality to increase discussions and avoid assumptions of asexuality in later life. Cismaru-Inescu A, Hahaut B, Adam S et al. Sexual Activity and Physical Tenderness in Older Adults: Prevalence and Associated Characteristics From a Belgian Study. J Sex Med 2022;19:569-580.

Family Violence Associated with Self-Rated Health, Satisfaction With Life, and Health Service Use in Primary Care Older Adults

We aimed to document in primary care older adults the relationship between family violence (FV) and mental and physical health, satisfaction with life, and health service use, by gender. The study sample included data from 1,658 older adults recruited in primary care practices, in one of the largest health regions in the province of Quebec. The presence of FV (partner/spouse, adult child) was assessed with the 21-item Family Violence Scale (FVS) adapted from the conflicts Tactics Scale 2. Self-rated mental health (SRMH) and self-rated physical health (SRPH) were assessed with single-item measures. Satisfaction with life (SWL) was measured using a validated French version of the SWL scale. Health service use over a 2-year period included outpatient consultations (number), emergency department (ED) visits (yes/no), and hospitalizations (yes/no). Multi-level logistic and Poisson's regression models were conducted to assess study outcomes as a function of FV. Analyses were stratified by perpetrator and gender. There was an association between FV and SRMH in women (OR = 0.41, 95% CI = [0.27, 0.62]), and SWL in both men and women (B = -5.74, 95% CI = [-6.71, -4.76]; B = -10.07, 95% CI = [-14.16, -5.98], respectively). Significant associations were found in women between FV and ED visits (OR = 1.45, 95% CI = [1.12, 1.18]), hospitalizations (OR = 1.36, 95% CI = [1.32, 1.43]), and outpatient consultations (RR = 1.25, 95% CI = [1.19, 1.30]). SWL moderated the association between FV and likelihood of hospitalization. Gender differences were observed between FV and SRMH and SWL. FV was associated with increased health service use in women but not men. These gender differences may suggest stigma-related barriers to health service use. Victims of violence with higher SWL had a lower likelihood of being hospitalized. Public health programs aimed at increasing awareness of the different types of FV and interventions aiming to improve resilience in victims are needed.

"Time Does Not Heal All Wounds": Sexual Victimisation Is Associated with Depression, Anxiety, and PTSD in Old Age

Sexual violence (SV) has an important impact on mental health. Childhood sexual abuse is linked to internalising disorders in later life. In older adults, SV occurs more often than previously believed. Moreover, health care workers lack the skills to address SV in later life. Studies researching the mental health impact of lifetime SV, i.e., SV during childhood, adulthood, and old age, are lacking. Between July 2019 and March 2020, 513 older adults living in Belgium participated in structured face-to-face-interviews. Selection occurred via a cluster random probability sampling with a random walk finding approach. Depression, anxiety, and posttraumatic stress syndrome (PTSD) were measured using validated scales. Participants were asked about suicide attempts and self-harm during their lifetime and in the past 12 months. SV was measured using behaviourally specific questions based on a broad SV definition. We found rates for depression, anxiety, and PTSD of 27%, 26%, and 6% respectively, while 2% had attempted suicide, and 1% reported self-harm in the past 12 months. Over 44% experienced lifetime SV and 8% in the past 12 months. Lifetime SV was linked to depression (p = 0.001), anxiety (p = 0.001), and PTSD in participants with a chronic illness/disability (p = 0.002) or no/lower education (p < 0.001). We found no link between lifetime SV and suicide attempts or self-harm in the past 12 months. In conclusion, lifetime SV is linked to mental health problems in late life. Tailored mental health care for older SV victims is necessary. Therefore, capacity building of professionals and development of clinical guidelines and care procedures are important.

Abuse among Portuguese older people at a time of economic crisis recovery: findings from the Harmed study

This study aimed to assess the prevalence of abuse against Portuguese older people after an economic crisis and to assess how it has influenced health. A cross-sectional study was carried out including 677 older adults (≥60 years) during 2017. Results show that overall, 23.9% of older people reported being a victim of abuse in the last 12 months. The prevalence of psychological abuse was 19.9%, financial abuse 5.8%, physical abuse 2.5% and sexual abuse 1.9%. Older people who report abuse were more likely to have perceived insufficient income and low social support. The abuse was also significantly associated with poor health status and depressive symptoms. Even in an auspicious period, more than a fifth of older people experiences abuse which is associated with social and health vulnerabilities. These results support that an investment should be made in terms of policies toward an age-friendly environment.

Prevalence and Risk Factors of Elder Mistreatment in Sheltered Homes

Elder mistreatment is common in both community and institutional settings. However, the prevalence of elder mistreatment and its association with risk factors in sheltered homes are unknown. The primary objective of this study was to determine the prevalence and types of mistreatment among elderly living in sheltered homes. A second objective was to compare socio-demographics and other characteristics between elderly groups with or without a history of mistreatment. This cross-sectional study was conducted in 43 sheltered homes and utilized a face-to face, self-reporting interview with residents to complete structured question regarding each participant's previous 12 months. The questionnaires included seven sections, including one section for demographics, five sections for subtypes of mistreatments (physical, psychological, financial, sexual, and neglect), and one section about health status and functional capacity. Among the 446 elderly participants, 81% of all participants experienced at least one type of mistreatment. Psychological was the most common type of elder mistreatment (71%), followed by neglect (67%), financial mistreatment (54%), and physical mistreatment (13%). Sexual mistreatment was rarely reported by the participants (0.01%). The most common risk factors associated with elder mistreatment were female gender and chronic illnesses. Elder mistreatment is common among the elderly living in sheltered homes, particularly in woman and those with chronic illness. Further studies are needed to better understand the risk factors that lead to the high prevalence of mistreatment in these settings.

Prevalence and Factors Associated With Elder Abuse in Community-Dwelling Elderly in Korea: Mediation Effects of Social Support

OBJECTIVE

The objectives of this study were to investigate the factors associated with elder abuse and the mediation effects of social support in a community-dwelling elderly population in Korea.

METHODS

This study analyzed a dataset of 10,674 individuals aged 65 years and older in Korea. Data were reviewed from a study conducted by the Korea Institute for Health and Social Affairs in 2011.

RESULTS

In our study, 12.6% of the elderly reported elder abuse, and 29.2% reported having depression (a score ≥8 on the short version geriatric depression scale). Our results revealed that younger age, low economic status, poor social support (odds ratio [OR]=1.448) and depression (OR=2.039) were significantly associated with elder abuse after controlling for all confounding factors. In addition, mediation analysis showed that the OR for depression was reduced from 2.124 to 2.039 after social support was controlled, which indicates that the association between depression and elder abuse is partially mediated by social support.

CONCLUSION

Depression and lack of social support were associated with abuse in community-dwelling Korean elderly. In particular, social support was revealed to buffer the association between depression and elder abuse.

Sexual violence in older adults: a Belgian prevalence study

Background

Sexual violence (SV) is an important public health problem which may cause long-lasting health problems. SV in older adults remains neglected in research, policies and practices. Valid SV prevalence estimates and associated risk factors in older adults are currently unavailable. In this study we measured lifetime and past 12-months sexual victimisation in older adults living in Belgium, its correlates, assailant characteristics and the way that victims framed their SV experiences.

Methods

SV was measured using behaviourally specific questions based on a broad definition of SV. Participants were selected via a cluster random probability sampling with a random route finding approach. Information on sexual victimisation, correlates, assailant characteristics and framing was collected via structured face-to-face interviews with adults aged 70 years and older living in Belgium (community-dwelling, assisted living and nursing homes).

Results

Among the 513 participants, the lifetime SV prevalence was 44% (55% F, 29% M). Past 12-months prevalence was 8% (9% F, 8% M). Female sex and a higher number of sexual partners were associated with lifetime SV (p < .05), non-heterosexual sexual orientation with past 12-months SV (p < .05). Correlates identified to be linked to elder abuse and neglect in previous studies were not linked with SV in our sample. ‘Someone unknown’ was identified as most common assailant.

Conclusions

Sexual victimisation appears to be common in older adults in Belgium. Both correlates and assailant characteristics seem to differ from previous studies on elder abuse and neglect. Recognizing older adults as a risk group for sexual victimisation in research, policies and practices is of the utmost importance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02485-3.

High Rate of Elder Abuse in the Time of COVID-19-A Cross Sectional Study of Geriatric and Neurology Clinic Patients

The ongoing COVID-19 pandemic is believed to have caused a sharp increase in the incidence of elder abuse (EA), including as a result of isolation, social distance combined with increased interpersonal stressors. Thus, the aim of this study is to determine the impact of the COVID-19 pandemic on the elder abuse rates and the characteristics of risk factors. A total of 347 patients hospitalized in the Department of Neurology and Department of Geriatrics at University Hospital No. 1 in Bydgoszcz were selected as subjects for the analysis. The tools used in the study are: Authors-Designed Questionnaire, the Vulnerability to Abuse Screening Scale, the Geriatric Depression Scale and the Activities of Daily Living Scale. Descriptive statistics, chi-squared tests, Spearman's rank correlation test, and logistic regression analyses were used. In the studied population, nearly 45% of the elderly were victims of violence. This represents an increase of more than 6 percent compared to the pre-pandemic. The most common type of EA was psychological abuse (72.3%). In the final models, the risk factors include, among others, low income (OR = 3.60, 95% CI = 1.93-6.72), chronic diseases (OR = 2.06, 95% CI = 1.28-3.31), poor relationship with the family (OR = 3.26, 95% CI = 1.96-5.43), and moderate and severe depression (OR = 18.29, 95% CI = 10.24-32.69; OR = 18.49, 95% CI = 3.91-87.30, respectively). Moreover, moderate functional impairment 5.52 times more often and severe functional impairment 21.07 times more likely to predispose to EA. People who suffered from COVID-19 are 1.59 times more likely to be victims of EA (95% CI = 1.03-2.46). In this study, we saw significant increases in EA rates during the COVID-19 pandemic.

Elder maltreatment in Europe and the United States: a transnational analysis of prevalence rates and regional factors

We investigated the association between type and frequency of elder maltreatment (EM) and residential setting (rural, suburban, and urban settings in the U.S. and northern and southern cities in Europe). We used data on 7,225 participants from European and U.S. cross-sectional studies to estimate rates of EM in three domains in the five settings in logistic-linear models that included setting and demographic variables and tested prespecified contrasts on settings. Northern Europe is similar to the U.S. in rate of financial exploitation; the Mediterranean has higher rates than either of the other two. For emotional and physical maltreatment, the Mediterranean is similar to the U.S; Northern Europe has higher rates. EM differs between and within settings in the U.S. and Europe. There is a need for rigorous research to examine the effects of residential settings and environment on EM. Interventions to reduce EM should be explored.

Global Research Activity on Elder Abuse: A Bibliometric Analysis (1950-2017)

Elder abuse is an emerging worldwide public health, human right, and social priority for governments and health policy makers. The aim of the current study was to provide an in-depth quantitative analysis of literature on elder abuse published in academic journals. A bibliometric method was implemented using Scopus database for the study period from 1950 to 2017. The search strategy utilized specific keywords to retrieve relevant documents. One thousand eight hundred seventy-two documents appeared in Scopus when using the search strategy. The annual number of publications showed a fluctuating pattern in the past four decades. Publications on elder abuse originated mainly from Northern America and Western Europe. International research collaboration on elder abuse was relatively low. The mean number of authors per document was 1.4. The Journal of Elder Abuse and Neglect published almost one third of the retrieved documents. The Rush University was the most active institution and Professor Dong, X.Q. was the most active author in this field. The most frequently encountered keywords were risk factors, prevalence, intervention, prevention, dementia, and nursing homes. Physical abuse was the most common type of elder abuse studied followed by psychological and financial abuse. Elder abuse is under-researched and of limited priority in most world regions. Governments need to take into consideration preventive policies of elder abuse based on research findings.

The association between elder abuse and childhood adversity: A study of older adults in Malaysia

OBJECTIVES

Childhood adversity has been linked with later victimization of young and middle-aged adults, but few studies have shown persistence of this effect among elders, especially outside of North America. This research examined the association between adverse childhood experiences (ACEs) and elder abuse among older adults aged 60 years and over in Malaysia.

DESIGN

Cross sectional data were collected via face-to-face interview from June to August 2019.

SETTING

Eight government community health clinics in Kuala Pilah, a district in Negeri Sembilan state approximately 100km from Malaysian capital city Kuala Lumpur.

PARTICIPANTS

Older adults aged 60 years and above (N = 1984; Mean age 69.2, range 60-93 years) attending all eight government health clinics in the district were recruited for a face-to-face interview about health and well-being.

MEASUREMENT

The Adverse Childhood Experience International Questionnaire (ACE-IQ) and the Revised Conflict Tactics Scale (CTS) were utilized to estimate childhood adversity and elder abuse respectively.

RESULTS

Multiple logistic regression analysis revealed a significant relationship between the number of cumulative ACEs and elder abuse. Compared to older adults with no self-reported adversity, those reporting three ACEs (OR 2.67, 95% CI 1.84,3.87) or four or more ACEs (OR 1.7, 95% CI 1.16, 2.48) had higher risk of any elder abuse occurrence since age 60 years. The effect was most prominent for financial and psychological elder abuse. The associations persisted in multivariate logistic regression models after adjusting for sociodemographic and health factors.

CONCLUSION

Early life adversities were significantly associated with victimization of older adults. Social and emotional support to address elder abuse should recognize that, for some men and women, there is a possibility that vulnerability to maltreatment persisted throughout their life course.

Screening for Abuse of Older Adults: A Study Done at Primary Health Care Level in Punjab, India

BACKGROUND

Little is known about elder abuse in the domestic environment. In lower-middle income countries like India, the demographic transition is throwing novel challenges. The older adults are relatively more vulnerable because of coexisting medical and psychological problems. Any form of abuse affects mental health and increases the chances of anxiety and depression among the older adults. The study aimed to assess the burden of abuse amongst older adults visiting a primary health care center of north India.

METHODS

This is secondary data analysis conducted on the data collected in the primary study between September 2017 and June 2018 in northern India among 311 older adult patients attending the noncommunicable disease clinic. Diabetes mellitus and hypertension were diagnosed as per standard guidelines. Vulnerability to Abuse Screening Scale (VASS) was used to assess elder abuse. Depression, anxiety, and loneliness were assessed by using the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, and University of California, Los Angeles (UCLA) loneliness 20-item scale, respectively. Multiple logistic regression was carried out to explore the factors associated with elder abuse after ruling out collinearity between independent variables.

RESULTS

About 24% of older adults experienced abuse in the last 12 months. One-fourth of the older adults reported vulnerability, nearly half reported coercion and dejection, and most of them reported experiencing dependence. Participants also had a high prevalence of anxiety (39%), depression (54%), and features suggestive of loneliness (38.6%). Multiple logistic regression analysis showed that abuse was predicted by educational status, per-capita income, and loneliness.

CONCLUSION

About one-fourth of the older adults experience abuse. This highlights the importance of routine screening of older adults at the primary care level.

Prevalence of elder abuse and victim-related risk factors during the COVID-19 pandemic in China

Background

With the accelerated aging of the Chinese population, elder abuse has become a serious social problem. As COVID-19 has had a very large impact on economic development and lifestyle in China, it has also affected elder abuse. The purpose of this study is to estimate the prevalence of elder abuse in China during the COVID-19 pandemic, and to identify changes in risk factors for elder abuse in the context of COVID-19.

Methods

We designed a cross-sectional study. In Hunan Province, a face-to-face questionnaire survey was conducted among elderly people over 65 years of age. To ensure the consistency of the measurement standards, we used the elder abuse questionnaire from the “Third Survey on Chinese Women’s Social Status.” According to related research, we selected 10 victim-related risk factors as independent variables. A logistic regression model was established to analyze the relationship between the independent variables and the four kinds of abuse.

Results

We collected 10,362 samples from Hunan Province. During the COVID-19 pandemic, the prevalence of financial abuse and neglect was significantly higher than that in 2010. Income had a significant impact on the four types of abuse. The lower the income was, the greater the risk of abuse. Moreover, factors such as an older age, being a woman, a lower cognitive ability, and not having a cohabiting spouse increased the possibility of abuse. The greater the number of children was, the greater the risks of physical abuse, financial abuse, and elder neglect. Seniors with higher education levels, those who frequently participated in social activities, and those with religious beliefs were less likely to suffer abuse.

Conclusions

During the COVID-19 epidemic, the prevalence of elder abuse in China has increased, which may be related to economic instability and social distancing measures. Increasing the income of the elderly and giving them more social support are important measures to reduce the prevalence of elder abuse.

Socio-economic inequality in the prevalence of violence against older adults - findings from India

BACKGROUND

Violence against older adults is a well-recognised socio-psychological and public health problem. It is uncared-for, undiagnosed, and an untreated problem that is widespread across both developed and developing countries. The present paper aims to understand the extent of the socio-economic status related inequality in violence against older adults in India.

METHODS

The study uses data from Building a Knowledge Base on Population Aging in India (BKPAI). Violence against older adults is the outcome variable for the study and is defined as older adults who faced any abuse or violence or neglect or disrespect by any person. Bivariate analysis and regression-based decomposition technique is used to understand the relative contribution of various socio-economic factors to violence against older adults (N = 9541).

RESULTS

The prevalence of violence faced by older adults was 11.2%. Older adults aged 80+ years [OR: 1.49; CI: 1.14-1.93] and working [OR: 1.26; CI: 1.02-1.56] had higher likelihood to face violence than their counterparts. On the other hand, older adults who were currently in union [OR: 0.79; CI: 0.65-0.95], lived with children [OR: 0.53; CI: 0.40-0.72] and who belonged to richer wealth quintile [OR: 0.35; CI:0.24-0.51] had lower likelihood to suffer from violence than their counterparts. The decomposition results revealed that poor older adults were more prone to violence (Concentration index: - 0.20). Household's wealth status was responsible for explaining 93.7% of the socio-economic status related inequality whereas living arrangement of older adults explained 13.7% of the socio-economic related inequality. Education and working status of older adults made a substantial contribution to the inequalities in reported violence, explaining 3.7% and 3.3% of the total inequality, respectively.

CONCLUSION

Though interpretation of the results requires a cautious understanding of the data used, the present study highlights some of the relevant issues faced by the country's older adults. With no or meagre income of their own, older adults belonging to the poorest wealth quintile have little or no bargaining power to secure a violent free environment for themselves. Therefore, special attention in terms of social and economic support should be given to the economically vulnerable older population.

F. Soares J. The prevalence, severity and chronicity of abuse towards older men: Insights from a multinational European survey

BACKGROUND

Elder abuse is a growing public health question among policy makers and practitioners in many countries. Research findings usually indicate women as victims, whereas male elder abuse still remains under-detected and under-reported. We aimed to investigate the prevalence, severity and chronicity of abuse (psychological, physical, physical injury, sexual, and financial) against older men, and to scrutinize factors (e.g. demographics) associated with high chronicity of any abuse.

METHODS

Randomly selected older men (n = 1908) aged 60-84 years from seven European cities (Ancona, Athens, Granada, Kaunas, Stuttgart, Porto, Stockholm) were interviewed in 2009 via a cross-sectional study concerning abuse exposure during the past 12 months.

RESULTS

Findings suggested that prevalence of abuse towards older men varied between 0.3% (sexual) and 20.3% (psychological), with severe acts between 0.2% (sexual) and 8.2% (psychological). On the whole, higher chronicity values were for injury, followed by psychological, financial, physical, and sexual abuse. Being from Sweden, experiencing anxiety and having a spouse/cohabitant/woman as perpetrator were associated with a greater "risk" for high chronicity of any abuse. For men, severity and chronicity of abuse were in some cases relatively high.

CONCLUSIONS

Abuse towards older men, in the light of severe and repeated acts occurring, should be a source of concern for family, caring staff, social work practice and policy makers, in order to develop together adequate prevention and treatment strategies.

Perspectives of elder abuse in Lebanon

Elder abuse is a preventable problem. Presently, little is known about this phenomenon in Middle Eastern settings. The purpose of this study was to explore elder abuse in Beirut, Lebanon from different stakeholders' points of view with a focus on identifying behaviors that are considered to be abusive to older adults and predisposing factors. Focus group discussions were carried out with 88 home- and institution-based older adults, their family members and caregivers, and with 49 stakeholders (medical professionals, institution directors, government officials). Results showed that behaviors considered abusive among Lebanese participants were comparable to reports from international studies. The most commonly mentioned risk factors were history of abuse in a seemingly dysfunctional family followed by caregivers' lack of acceptance of the physical changes that accompany aging. The response to elder abuse requires a multidimensional approach that spans protective policies to increase care providers' awareness about the physiologic changes of aging as well as concerted efforts to correct misinformation about the hidden problem of elder abuse.

Perceptions of Elder Abuse From Community-Dwelling Older Persons and Professionals Working in Western Switzerland

Older persons' perspectives regarding elder abuse remain little studied. However, definitions of elder abuse and effective prevention strategies require adaptation to the needs and cultures of targeted populations. This study explored the views of older persons and professionals to evaluate their converging and diverging perspectives toward elder abuse and its prevention. The study employed a qualitative approach where six focus groups were held in Western Switzerland (the French-speaking part of the country). Four focus groups with 25 older persons from varying socioeconomic backgrounds, and the other two focus groups were carried out with 16 professionals working in the field of elder abuse prevention. For the focus groups, we used the technique of free associations to begin the discussions and vignette-like statements to explore participants' attitudes toward elder abuse. These were followed by open-ended questions. The transcripts from the focus groups were analyzed thematically and resulted in four main themes: (a) varied associations of the term "abuse," (b) judging elder abuse situations in terms of abuse and severity, (c) self-identification with elder abuse, and (d) prevention of elder abuse. Study findings demonstrated that older persons hold views that are partly different from the views of professionals. Furthermore, perceptions of older persons could be stratified based on the socioeconomic status of the participants. These diverging perspectives reflect the heterogeneity of the senior citizen population and highlight the need for research cognizant of these differences. The results of this study provide strategies for improved targeting of preventive measures, underline the importance of integrating the perspectives of older persons, and reveal the need to expand the commonly accepted definitions of elder abuse so that they better reflect the affected individuals.

Exploring the Correlates to Depression in Elder Abuse Victims: Abusive Experience or Individual Characteristics?

Depression and depressive symptoms have been studied both as risk factors and consequences of elder abuse, even though the most common cross-sectional design of the studies does not allow inferring cause or consequence relationships. This study estimates the proportion of older adults who screened positive for depressive symptoms among those self-reporting elder abuse and examines whether individual characteristics and/or abusive experience aspects are associated with self-reported depressive symptoms. Participants were 510 older adults self-reporting experiences of abuse in family setting enrolled in the cross-sectional victims' survey of the Aging and Violence Study. Depressive symptoms were assessed through the abbreviated version of the Geriatric Depression Scale (GDS-5). Poisson regression was used to determine the prevalence ratio (PR) of screening depressive symptoms according to individual and abusive experience covariates: sex, age group, cohabitation, perceived social support, chronic diseases, functional status, violence type, perpetrator, and number of conducts. Women (PR = 1.18, 95% confidence interval [CI] = [1.04, 1.35]) individuals perceiving low social support level (PR = 1.36, 95% CI = [1.16, 1.60]) and with long-term illness (PR = 1.17, 95% CI = [1.02, 1.33]) were found to be associated with increased risk for screening depressive symptoms. In regard to abusive experience, only the number of abusive conducts increased the PR (PR = 1.07, 95% CI = [1.05, 1.09]). Routine screening for elder abuse should include psychological well-being assessment. Interventions toward risk alleviation for both mental health problems and elder abuse should target women perceiving low social support level and with long-term illness.

Elder abuse and its predictors: a cross-sectional study in a rural area of West Bengal, eastern part of India

BACKGROUND

Elder abuse is an important public health problem hidden from public view in spite of its detrimental effect on physical and mental health. In the last three decades, there is responsiveness toward abuse of children and spouses worldwide but even today abuse and neglect of aged people seem to be the matter of least concern. This study aims to reveal the magnitude of elder abuse and its predictors.

METHODS

This is a cross-sectional study carried out in a community setting among elderly people (60 years and older) from October 2015 to September 2017 in a rural area of West Bengal, eastern part of India. Elder abuse was elicited by questions adapted from the Actual Abuse Tool. Data were analysed using SPSS (version 16.0). Logistic regression analysis was performed to reveal the factors associated with elder abuse.

RESULTS

The study found that 25.6% of the respondents had experienced abuse, psychological abuse being the commonest type. Disability was the most common perceived risk for abuse. Univariate logistic regression showed higher age (70 years and older), female gender, who were Scheduled caste, living in a nuclear family, having more than three children, financially and functionally dependent, who was suffering from depression and multimorbidity had increased odds of being abused. In multivariable logistic regression, people aged above 70 years, living in a nuclear family and dependent for instrumental activities of daily living remained significant predictors of abuse.

CONCLUSION

Around one in four of the respondents was abused in a 1 year duration which implies the urgent need for action. Routine screening for elder abuse at ground level and abuse prevention campaigns can be an important measure to alleviate this hidden problem. Also, there is a need to explore culturally specific forms of elder abuse to provide an age-friendly environment.

[Violence perpetrated against the elderly and health-related quality of life: a populational study in the city of São Paulo, Brazil]

The scope of this work was to identify the prevalence of domestic violence against non-institutionalized elderly individuals, and to establish if violence is an independent factor associated with the Physical Component (PC) and Mental Component (MC) scores of the Health-Related Quality of Life (HRQOL) of these elderly individuals. It is a cross-sectional epidemiologic and population-based investigation that is part of the SABE (Wellbeing, Health and Aging) study. A sample of 1,126 elderly individuals filled out the Short-Form 12 (SF-12) Health Survey, namely a generic instrument that assesses HRQOL through the Physical and Mental components. The prevalence of domestic violence against of the elderly was 10% (CI 95% 9.1-13.6). In the multiple analyses, violence against the elderly was significantly associated to the MC (β = -3.03; p = 0.000) and to the PC (β = -1.69; p = 0.017) of HRQOL, independently of the sociodemographic, health, family support, and functional incapacity covariables. The prevalence of domestic violence was high and compromised the physical and mental health of the elderly.

Prevalence and Correlates of Sexual, Physical, and Psychological Violence Against Women and Men of 60 to 74 Years in Sweden

Past-year sexual, physical, and psychological violence against women and men aged 60 to 74 years was studied. The data derived from a nationally representative survey on violence in which approximately 2,800 women and men aged 60 to 74 years in Sweden participated. Women were significantly more likely to have been subjected to at least one form of violence in the past year. The prevalence of sexual violence as well as systematic and repeated psychological violence was found to be significantly higher for women than for men. Sexual violence was the most common form of violence against women. Systematic and repeated psychological violence was the most common form of violence against men. Additional gender differences were found in relation to victim characteristics. While associations among women were found between violence victimization and sociodemographic characteristics, health as well as social capital, only health-related characteristics were found to be associated with past-year violence victimization among men. Among women, economic problems, posttraumatic stress disorder (PTSD) symptoms, lack of trust in other people, and not having anyone to talk to were associated with violence victimization. Poor psychological health and an at-risk consumption of alcohol were found to be associated with violence victimization among men. The results highlight the importance of research on violence victimization to assess gender differences also when inquiring into the situation among persons in older generations. The results also indicate practical implications for caring professions; the need to inquire into the experiences of violence among older persons and to pay particular attention to these characteristics when encountering women and men in this age interval.

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.

Prevalence of elder abuse and neglect: screening in Poland families

PURPOSE

Elder abuse and neglect is one of the most important problems of social and health policy among countries around the world. Making a real and reliable assessment of the occurrence of abuse is difficult to implement. The aim of this work is to show the frequency of physical, psychological, sexual abuse and financial exploitation among older adults.

METHODS

Older adults, who were aged ≥ 60 years (N = 200) were qualified for the study. The studied population consisted of 112 women (56.0%) and 88 men (44.0%). The whole project procedure only included filling in the survey questionnaire. The verification of hypotheses was based on tests: Chi square test, Chi square test with continuity correction and logistic regression models.

RESULTS

Within the obtained own results, out of 200 older adults, 77 respondents (38.5%) experienced abuse and neglect during the last 12 months. Most of the respondents (68.8%) experienced various forms of abuse simultaneously. Among those who experienced abuse, 75.3% experienced psychological abuse, 68.8% financial exploitation, 48.1% physical abuse, and 22.1% experienced sexual abuse. The rate of physical (OR 2.48; 95% CI 1.13, 5.44; p = 0.02), verbal (OR 1.94; 95% CI 1.02, 3.67; p = 0.04), sexual (OR 4.05; 95% CI 1.13, 14.5; p = 0.03) and economic (OR 1.98; 95% CI 1.02, 3.83; p = 0.04) abuse is statistically significantly higher, respectively, in women than in men. The level of education is a risk fact for physical abuse (p = 0.02). It has also been shown that singles, people with the income < 233 EUR and people living in urban areas are most often victims of elder abuse and neglect.

CONCLUSIONS

The results suggest that elder abuse and neglect is a fairly common phenomenon. Our data also provide confirmation of other researches conducted in this area.

Addressing elder abuse in rural and remote communities: social policy, prevention and responses

This article reports the findings of an international scoping literature review focussed on social policy, prevention, and service responses to elder abuse in rural and remote communities. Forty-seven articles were included in the review, and fourteen types of prevention or service responses were identified in the literature, including several Indigenous-specific initiatives. The review highlighted the need for meaningful inclusion of rural and remote communities in elder abuse policy, as well as the importance of community consultation and consideration of the local context in developing prevention and response initiatives for these communities.

The Prevalence of Self-Reported Elder Abuse Among Older Women in Community Settings: A Systematic Review and Meta-Analysis

The abuse of older women appears to be a significant problem. Developing a better understanding of the extent of the problem is an important step toward preventing it. We conducted a global systematic review and meta-analysis of existing prevalence studies, in multiple languages, that occurred in the community settings from inception to June 26, 2015, in order to determine the extent of abuse against women aged 60 years and over. To disentangle the wide variations in prevalence estimates, we also investigated the associations between prevalence estimates and studies' demographic and methodological characteristics. A total of 50 studies were included in the meta-analysis. The combined prevalence for overall elder abuse in the past year was 14.1% (95% confidence interval (CI) [11.0, 18.0]). Pooled prevalence for psychological abuse was 11.8% (95% CI [9.2%, 14.9%]), neglect was 4.1% (95% CI [2.7%, 6.3%]), financial abuse was 3.8% (95% CI [2.5%, 5.5%]), sexual abuse was 2.2% (95% CI [1.6%, 3.0%]), and physical abuse was 1.9% (95% CI [1.2%, 3.1%]). The studies included in the meta-analysis for overall abuse were heterogeneous indicating that significant differences among the prevalence estimates exist. Significant associations were found between prevalence estimates and the following covariates: World Health Organization-defined regions, countries' income classification, and sample size. Together, these covariates explained 37% of the variance. Although robust prevalence studies are sparse in low- and middle-income countries, about 1 in 6, or 68 million older women experience abuse worldwide. More work is needed to understand the variation in prevalence rates and implications for prevention.

The Development and Psychometric Evaluation of a Questionnaire on the Nurses’ Recognition of Elder Abuse by Family Caregiver

Introduction:

Exploring the nurses’ recognition of elder abuse and related signs may lead to the knowledge development solutions through the In-Service programs. To develop an instrument for the assessment of nurses’ recognition of elder abuse by family caregivers within the Iranian context and psychometrically evaluate its reliability and validity.

Methods:

The sequential combination exploratory mixed methods design was used to develop the questionnaire format, which involved two sections: the quantitative and qualitative step. The qualitative step included probing the Nurses’ recognition of elder abuse by family caregivers in two steps including the literature and related tools review and semi-structured interviews with nurses. The quantitative step was accomplished in two parts. The validity of questionnaire was checked using face, content, construct, and formal validity; and the reliability was probed using cronbach’s alpha reliability. The analyzed data were categorized into 67 items (three main groups namely evident signs of abuse, elder’s potential to get abused, and family caregiver’s potential to abuse and 6 sub-groups including inadvertency, physical abuse, financial misconduct, psychological abuse, sexual abuse, and risk factors). Three components from the exploratory content analysis gained 58.8% variance totally. The cronbach’s alpha for the 3 components were 0.79, 0.76, and 0.78, respectively.

Results:

The questionnaire on the nurses’ recognition of elder abuse by family caregiver can be applied to a wide variety of settings because of the broad range of methods utilised to generate items and domains, its comprehensive consideration of the principles of elder abuse, and its initial reliability and validity.

Elder abuse and its sociocultural factors from the perspectives of Kurdish rural older people: Does gender matter?

We aimed to explore the meaning of elder abuse and its sociocultural factors from the perspectives of Kurdish older people. We purposively selected the participants, 38 female and 17 male, from a rural area in Boukan country, Iran. Data were collected using semi-structured interviews and focus group discussions and were analyzed applying conventional content analysis. Researchers finally characterized viewpoints of the participants into two themes including structural changes in family interactions and changes in sociocultural values. Public education about moral norms and enactment of supportive laws for elderly people may help minimize elder abuse.

Financial-patrimonial elder abuse: an integrative review

ABSTRACT Objective: to analyze the available evidence in the nursing literature about financial-patrimonial elder abuse. Method: integrative review of articles indexed in the databases CINAHL, Scopus, Web of Science, LILACS and MEDLINE, from 2007 to 2017. The combination of controlled and uncontrolled descriptors was used in Portuguese, English and Spanish. Results: 15 studies developed in seven countries were included. In the thematic analysis, three categories emerged: epidemiological data, risk factors and institutions providing services to the elderly. The occurrence of this type of violence concomitantly to the other subtypes was highlighted among the most frequent. Final considerations: the literature points to important epidemiological data, risk factors and characteristics of this type of violence, including within institutions providing services to the elderly, in different countries, essential aspects for structuring and rethinking public policies for protection and appreciation of the elderly.

Does abuse in late life worsen sleep quality? A two-year prospective cohort study among rural older adults

BACKGROUND

Elder abuse and neglect (EAN) is a growing public health problem, and numerous adverse health effects of abuse in late life have been documented. Little is known, however, about the impact of elder abuse on sleep quality. This study examines the longitudinal relationship between EAN and sleep quality.

METHODS

This was a 2-year prospective cohort study involving 1927 older adults in a rural Malaysian district, Kuala Pilah. A multi-stage cluster sampling strategy was employed. After 2 years, 1189 respondents were re-assessed. EAN was determined using the modified Conflict Tactic Scale, while sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

The prevalence of elder abuse was 8.1% (95% CI:6.9,9.3). Longitudinal analysis using generalized estimating equations showed that elder abuse contributed to higher PSQI scores (B:0.49, 95% CI:0.17,0.58). Sub-analyses demonstrated that psychological abuse and neglect had significant longitudinal relationships with increase of PSQI scores, while other subtypes did not.

CONCLUSION

Abuse in late life, particularly psychological abuse and neglect, result in greater PSQI scores. Even though this may imply decline in sleep quality, our findings were not considered clinically significant as they did not exceed the clinical cut-off score of five. Nevertheless, sleep quality is an important determinant of health and a predictor of mortality among older adults; thus, understanding its relationship with abuse is useful to health care providers and policy-makers in improving health services and upgrading preventive measures.

Factors associated with elder abuse: a systematic review of the literature

Elder abuse is a complex public health problem. It is of fundamental importance to ascertain which factors are associated with each specific type of abuse, as a way of enabling the creation of evidence-based public policies. The aim of the present study was to systematically review the literature regarding analytical epidemiological studies of factors associated with elder abuse. Four databases were used for the bibliographic search: Pubmed, Scopus, Web of Science and Lilacs, with no limitations regarding year of publication. Articles were selected by pairs of researchers in two stages: reading of abstracts (3.121) and reading of complete articles (64). The total number of articles selected was 27. The risk of bias was evaluated. The factors associated with general violence were age, sex, marital status, educational level, income, family arrangement, social support, solitude, mental disorder, depression, suicide attempt, dependence on others in daily activities, cognitive function, chronic diseases, alcohol or drug abuse, among others. Elder abuse was found to be a multifactorial and complex phenomenon that should not therefore be viewed in a partial one-dimensional manner, but in such a way as to take into account all dimensions and the interdependence of these.

Association Between Frailty and Elder Abuse in Community-Dwelling Older Adults in Mexico City

OBJECTIVES

To investigate the association between frailty and elder abuse in community-dwelling older adults.

DESIGN

Secondary cross-sectional analysis of a prospective cohort.

SETTING

The Frailty, Dynapenia and Sarcopenia in Mexican Adults study, a cohort of community-dwelling adults from 2 municipalities in Mexico City.

PARTICIPANTS

Community-dwelling adults aged 60 and older (N=487, mean age 73.2 ± 8.0, 80% female).

MEASUREMENTS

Elder abuse was assessed using the Geriatric Mistreatment Scale and frailty using the Frailty Phenotype. Abuse was then classified as total abuse (any subtype), conflict abuse (physical, psychological, sexual abuse), financial abuse, and caregiver neglect. Information was also obtained on sociodemographic characteristics, comorbidities, mental status, nutritional status, disability, and polypharmacy.

RESULTS

Prevalence of total abuse was 35.7%. Frailty was associated with total abuse (odds ratio (OR)=2.52, 95% confidence interval (CI)=1.22-5.21, p=.01) and conflict abuse (OR=2.50, 95% CI=1.18-5.33, p=.02) after adjusting for confounders but not with financial abuse or caregiver neglect. Depression was an effect modifier in the association between frailty and total abuse. Frailty was associated with total abuse in participants with depression (OR=5.23, 95% CI=1.87-14.56, p=.002) but not in those without (OR=0.55, 95% CI=0.10-2.87, p=.47).

CONCLUSION

Frailty is associated with total and conflict abuse in community-dwelling older adults. Further studies are needed to elucidate the effect of frailty on elder abuse and investigate the effectiveness of interventions for primary and secondary prevention.

Mental Health Correlates of Financial Mistreatment in the National Elder Mistreatment Study Wave II

Objective: Whereas prevalence of elder financial mistreatment has received increased attention over the past decade, health and mental health correlates are rarely studied. Thus, the potential relevance of financial abuse to mental health and perceived health is relatively unknown, and the objective of this article is to illustrate this relationship. Method: The second wave of the National Elder Mistreatment Study used random digit dialing telephone survey methodology to assess both recent financial mistreatment and its potential mental health correlates (i.e., diagnoses of depression, posttraumatic stress disorder [PTSD], generalized anxiety disorder [GAD], and self-ratings of physical health) in 774 older adults. Results: The study indicated that past-year Wave II financial mistreatment was associated with significantly increased likelihood of depression, PTSD, GAD, and poor self-rated health; and financial mistreatment perpetrated by family members was associated with particularly increased risk of depression. Discussion: Assessment of mental health is relevant and important in cases of financial abuse.

Elder Abuse and Chronic Pain: Cross-Sectional and Longitudinal Results from the Preventing Elder Abuse and Neglect Initiative

OBJECTIVES

To examine the cross-sectional and longitudinal relationships between elder abuse and neglect (EAN) and chronic pain in rural older Malaysians.

DESIGN

Two-year prospective cohort study.

SETTING

Kuala Pilah, a district in Negeri Sembilan approximately 100 km from the capital city, Kuala Lumpur.

PARTICIPANTS

Community-dwelling older adults aged 60 and older. Using a multistage cluster sampling strategy, 1,927 respondents were recruited and assessed at baseline, of whom 1,189 were re-assessed 2 years later.

MEASURES

EAN was determined using the modified Conflict Tactic Scale, and chronic pain was assessed through self-report using validated questions.

RESULTS

The prevalence of chronic pain was 20.4%. Cross-sectional results revealed 8 variables significantly associated with chronic pain-age, education, income, comorbidities, self-rated health, depression, gait speed, and EAN. Abused elderly adults were 1.52 times as likely to have chronic pain (odds ratio=1.52, 95% confidence interval (CI)=1.03-2.27), although longitudinal analyses showed no relationship between EAN and risk of chronic pain (risk ratio=1.14, 95% CI=0.81-1.60). This lack of causal link was consistent when comparing analysis with complete cases with that of imputed data.

CONCLUSION

Our findings indicate no temporal relationship between EAN and chronic pain but indicated cross-sectional associations between the two. This might indicate that, although EAN does not lead to chronic pain, individuals with greater physical limitations are more vulnerable to abuse. Our study also shows the importance of cohort design in determining causal relationships between EAN and potentially linked health outcomes.

Veterans Experiencing Elder Abuse: Improving Care of a High-Risk Population About Which Little Is Known

At least 10% of older adults experience abuse, neglect, or exploitation annually in the United States, and this problem is expected to grow as our population ages. Little is known about the prevalence and characteristics of elder abuse of veterans, but it is likely that this population is at high risk based on established elder abuse risk factors. Veterans who receive their care through the Veterans Health Administration (VHA) have a higher prevalence of poor psychological health, poor physical health, functional impairment, cognitive impairment, and social isolation than the general population. As the largest integrated healthcare system in the United States, the VHA has long been a leader in the development of innovative, integrated care programs for older adults. The VHA has another opportunity to lead by promoting research, clinical care, and education on elder abuse, furthering their mission of serving those who served. This article outlines the rationale for developing a research agenda for elder abuse in the VHA, as well as potential first steps toward understanding more about this complex problem affecting veterans.

Practitioner Views on the Impacts, Challenges, and Barriers in Supporting Older Survivors of Sexual Violence

Despite half a century of research on both sexual violence and elder abuse, the intersection between the two remains largely unexplored. Using theoretical lenses of feminist criminology and critical feminist gerontology, this article explores the intersection between age and sexual violence drawing on interviews with 23 practitioners supporting older survivors (aged 60 and over). They reported physical and emotional effects of sexual violence leading to limited lifestyles, disengagement from social networks, and reliance on pathogenic coping strategies. Provision of effective support was complicated by challenges associated with aging bodies and the social stigma associated with both sexual victimhood and older age. Additional challenges lay in supporting older male survivors and those living with dementia. The article ends by discussing implications for practice and an agenda for future research.

The prevalence and correlates of elder abuse and neglect in a rural community of Negeri Sembilan state: baseline findings from The Malaysian Elder Mistreatment Project (MAESTRO), a population-based survey

BACKGROUND

As Malaysia is fast becoming an ageing nation, the health, safety and welfare of elders are major societal concerns. Elder abuse is a phenomenon recognised abroad but less so locally. This paper presents the baseline findings from the Malaysian Elder Mistreatment Project (MAESTRO) study, the first community-based study on elder abuse in Malaysia.

DESIGN

Cross-sectional study, analysing baseline findings of a cohort of older adults.

SETTING

Kuala Pilah district, Negeri Sembilan state, Malaysia.

OBJECTIVES

To determine the prevalence of elder abuse among community dwelling older adults and its associated factors.

PARTICIPANTS

A total of 2112 community dwelling older adults aged 60 years and above were recruited employing a multistage sampling using the national census.

PRIMARY AND SECONDARY OUTCOME MEASURES

Elder abuse, measured using a validated instrument derived from previous literature and the modified Conflict Tactic Scales, similar to the Irish national prevalence survey on elder abuse with modification to local context. Factors associated with abuse and profiles of respondents were also examined.

RESULTS

The prevalence of overall abuse was reported to be 4.5% in the past 12 months. Psychological abuse was most common, followed by financial, physical, neglect and sexual abuse. Two or more occurrences of abusive acts were common, while clustering of various types of abuse was experienced by one-third of abused elders. Being male (adjusted OR (aOR) 2.15, 95% CI 1.23 to 3.78), being at risk of social isolation (aOR 1.96, 95% CI 1.07 to 3.58), a prior history of abuse (aOR 3.28, 95% CI 1.40 to 7.68) and depressive symptomatology (aOR 7.83, 95% CI 2.88 to 21.27) were independently associated with overall abuse.

CONCLUSION

Elder abuse occurred among one in every 20 elders. The findings on elder abuse indicate the need to enhance elder protection in Malaysia, with both screening of and interventions for elder abuse.