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

Injury patterns and demographics in older adult abuse and falls: A comparative study in emergency department settings

BACKGROUND

Falls and interpersonal violence pose significant threats to older adults, leading to injuries, hospitalizations, and emergency department (ED) visits. This study investigates the demographics and injury patterns in older adults (aged 60 and above) who sought ED care due to assaults, comparing them with those who experienced falls to gain a deeper understanding of older adult abuse patterns.

METHOD

This study utilizes data from the National Electronic Injury Surveillance System (NEISS) All Injury Program (2005-2019) to examine injuries among older adults aged 60 years and above. Participants were categorized into two groups: older adult abuse and injuries due to falls. The differences between the groups by demographics, injury locations, patterns, and temporal trends were analyzed using statistical methods accounting for the weighted stratified nature of the data. Cosinor analysis and Joinpoint regression were used for temporal analysis.

RESULTS

Over 15 years, there were an estimated 307,237 ED visits for older adult abuse and 39,477,217 for falls. Older adults experiencing abuse were younger and had lower hospital admission rates compared to fall patients. Injuries associated with abuse included contusions/abrasions, penetrating injuries, and fractures to the head/neck, fingers, toes, ribs, and lower extremities. In contrast, fall patients had higher admission rates, with more fractures, including cervical spine and hip fractures. Temporal patterns showed a higher rate of assaults during the summer, whereas abuse demonstrated bimodal peaks in the summer and fall.

CONCLUSIONS

Injuries associated with abuse such as facial, upper trunk, and upper extremity fractures should raise suspicion even in the absence of severe symptoms. These findings emphasize the importance of early identification to connect older adults with support resources, as patients experiencing abuse often get discharged from the ED.

Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology

Frailty is an age-related clinical condition characterised by an increased susceptibility to stressors and an elevated risk of adverse outcomes such as mortality. In the light of global population ageing, the prevalence of frailty is expected to soar in coming decades. This narrative review provides critical insights into recent developments and emerging practices in frailty research regarding identification, management, risk factors, and prevention. We searched journals in the top two quartiles of geriatrics and gerontology (from Clarivate Journal Citation Reports) for articles published between 01 January 2018 and 20 December 2022. Several recent developments were identified, including new biomarkers and biomarker panels for frailty screening and diagnosis, using artificial intelligence to identify frailty, and investigating the altered response to medications by older adults with frailty. Other areas with novel developments included exercise (including technology-based exercise), multidimensional interventions, person-centred and integrated care, assistive technologies, analysis of frailty transitions, risk-factors, clinical guidelines, COVID-19, and potential future treatments. This review identified a strong need for the implementation and evaluation of cost-effective, community-based interventions to manage and prevent frailty. Our findings highlight the need to better identify and support older adults with frailty and involve those with frailty in shared decision-making regarding their care.

The Prevalence of Elder Abuse and its Association with Frailty in Elderly Patients at the Outpatient Department of a Super-Tertiary Care Hospital in Northern Thailand

Background and Objectives: The global population is undergoing rapid aging, resulting in an increase in geriatric syndromes and hidden health issues such as elder abuse. However, the prevalence of elder abuse varies across different settings. The objective of this study is to determine the prevalence and factors associated with elder abuse at the outpatient department of a super-tertiary care hospital in northern Thailand. Materials and Methods: This cross-sectional study involved 210 elderly patients who visited Maharaj Nakorn Chiang Mai Hospital between May and August 2022. The participants completed several assessments, including the Mini-Cog, Thai Geriatric Depression Scale-6, Core Symptom Index-15, FRAIL scale, Barthel Activities of Daily Living, Interview Guideline for Screening for Elder Abuse, and Diagnostic Criteria for Elder Abuse. Fisher's exact test was used to examine the association between the factors and elder abuse. Results: The Screening for Elder Abuse yielded noteworthy results, with 15.7% of the elderly patients having experienced psychological abuse. However, only a smaller subset of study participants, comprising five individuals or 2.38%, met the diagnostic criteria for elder abuse. Furthermore, statistical analysis revealed no significant correlation between elder abuse and the other factors examined in the study. Conclusions: As a result, it is crucial for hospitals to consider preventive measures and implement routine screening protocols.

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

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

Evaluation of frailty, abuse and depression among community-dwelling older adults in a nortwest city of Turkey

BACKGROUND

This study aimed to evaluate the frailty, abuse, and depression experienced by community-dwelling older adults and to raise awareness in society about the abuse of the elderly.

METHODS

This cross-sectional study was carried out in three family health centres in a city centre in the northwest of Turkey. The sample consisted of 429 older adults. Data were collected with Descriptive form, FRAIL Scale, Hwalek-Sengstock Elder Abuse Screening Test, and the Geriatric Depression Scale Short Form. In data analysis, percentage, mean ± SD, t-test, analysis of variance, Tukey test, Pearson correlation coefficient, and multiple regression analysis were used. The significance level in the tests was taken as P < 0.05.

RESULTS

In this study, 28.68% of the elderly were in the fragile group, 22.84% experienced abuse and 24.0% were depressed. The elders who participated in the study were evaluated according to the scale scores used. It was determined that they were in the fragile group with a score of 2.21 + 1.47; they were exposed to low level of abuse with 1.58 + 1.17 points and they were depressed with 5.15 + 4.82 points. There was a high and positive significant correlation between the frailty and abuse experienced by the elderly (P < 0.001; r: 0.621), there was a middle and positive significant correlation between frailty and depression (P < 0.001; r: 0.492), and high and positive correlation were found between abuse and depression in the elderly (P < 0.001; r: 0.647).

CONCLUSIONS

This study shows that frailty, abuse, and depression are important problems in community-dwelling older adults and there are significant relationships between them. In order to prevent the abuse that the elderly in the fragile group are exposed to, it is recommended that especially health workers should be trained on elder abuse in in-service training programs.

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.

Association between physical activity and physical and functional performance in non-institutionalized Mexican older adults: a cohort study

BACKGROUND

Aging is an independent risk factor for deterioration in functional capacity. Some studies have reported that physical activity (PA) improves functional capacity and physical performance among older adults (OA). Thus the objective of the present study was to assess the longitudinal association between PA and functional and physical performance in non-institutionalized OA.

METHODS

A longitudinal analysis using data from the Frailty, Dynapenia and Sarcopenia in Mexican adults (FRADYSMEX, by its Spanish acronym) cohort study was conducted. PA was assessed through the Community Healthy Activities Model Program for Seniors (CHAMPS) instrument. Functionality was measured with the Barthel index and the Lawton and Brody scale, while physical performance was measured with the Short Physical Performance Battery (SPPB). To evaluate the association between the level of PA and physical and functional performance as a continuous variable, a linear regression of mixed effects was performed. To assess PA and dependence in basic activities of the daily life (BADL), instrumental activities of the daily life (IADL), and low physical performance (PP), generalized estimation equation models [to compute odds ratios (OR) and 95% confidence intervals (95%CI)] were computed.

RESULTS

Older people who performed moderate to vigorous-intensity PA had a lower risk of dependence in IADL (OR = 0.17; 95%CI: 0.10, 0.80) and lower risk of low PP (OR = 0.18; 95%CI: 0.11, 0.58) compared to those in lower categories of PA.

CONCLUSIONS

Older adults living in the community who perform PA of moderate to vigorous intensity have a lower risk of dependence in BADL and IADL and have a lower risk of low PP.

The revictimization of older Mexican women: understanding the accumulation of multiple victimizations throughout a lifetime

Background

The victimization of women constitutes a human rights violation and a health risk factor. The central objectives of this study were to analyze the probability of revictimization among older adult Mexican women and to examine whether child abuse (CA) and/or intimate partner violence (IPV) are associated with a greater risk of elder abuse (EA) victimization.

Methods

We conducted a secondary data analysis of 18416 women 60 and older, based on data from the National Survey on the Dynamics of Household Relationships (2016), which is national and subnational representative. A descriptive analysis was carried out using retrospective self-reports of victimization experiences (CA, IPV, and EA). The prevalence of victimization and multiple victimizations in the various stages of the lives of women, as well as of revictimization among older adult women were obtained. Bayesian logistic regression models were used to examine the associations between victimization, multiple victimization, and EA victimization.

Results

A total of 17.3% of the older adult women reported EA in the last year; of these, 81.0% had been revictimized and 14.0% reported CA, IPV, and EA. The risk of EA rose among women who reported a combination of psychological and sexual CA, and psychological, physical and sexual CA and psychological and sexual IPV, and a psychological, economic, physical and sexual IPV. EA was higher among women who had suffered more than one type of violence.

Conclusion

CA and IPV, particularly sexual abuse and psychological violence, can be risk factors for EA. Screening tools used to prevent and detect EA should include questions about domestic violence over the course of a person’s lifetime.

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.

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.

Retrospective study of older patient characteristics that increase the likelihood that a fracture was associated with abuse

Searching for clinical manifestations of elder abuse may help healthcare professionals identify cases of elder abuse. The aim of the present study was to explore characteristics of older patients with fractures that increase the likelihood that the fracture was associated with abuse. This is a retrospective chart review study of 1,000 patients aged 65 and older who presented to an emergency department in northern-central Israel with a fracture during 2019. The chart review included participant characteristics - sociodemographic data, medical data, data regarding the fracture, and data on the presence of forensic markers of elder abuse in individual patients. Descriptive statistics and regression models were used for the analyses. Older age, presence of dementia, and hand and facial fractures were associated with the presence of forensic markers, and were also found to predict having at least one forensic factor. This study provides further support for the creation of clinical guidelines for identification of elder abuse.

The Effects of the BAILAMOSTM Dance Program on Physical Activity Levels and Cognition of Older Latino Adults: A Pilot Study

Objective: To investigate the effects of the BAILAMOS^TM dance program on physical activity (PA), cardiorespiratory, and cognitive health. Methods: A parallel, two-armed pilot study was conducted with 57 older Latinos randomized to the BAILAMOS^TM dance program (n = 28) or health education (HE) (n = 29). We conducted two- and three-way repeated-measures ANOVAs. Results: BAILAMOS^TM participants increased participation in leisure moderate-to-vigorous PA (LMVPA) (F[1,53] = 3.17, p = .048, η²_G = .01) and performance in global cognition relative to HE participants (F[1,52] = 4.19, p = .045, η²_G = .01). Attendance moderated increases in moderate PA, MVPA, LMVPA, and total PA (p < .05). Participants of both groups with ≥75% attendance increased participation in PA. Among participants with <75% attendance, BAILAMOS^TM participants increased PA relative to HE. Discussion: BAILAMOS^TM positively impacted self-reported PA and global cognition in older Latinos. Even smaller doses of dance appear to impact self-reported PA levels.

Frailty and Perceived Financial Exploitation: Findings from the Finance, Cognition, and Health in Elders Study

Objective: Many older adults who are cognitively intact experience financial exploitation (FE), and the reasons for this are poorly understood. Methods: Data were gathered from 37 older adults (M age = 69.51, M education = 15.89, 62% female) from the Finance, Cognition, and Health in Elders Study (FINCHES). Twenty-four older adults who self-reported FE were demographically-matched according to age, education, race, and MoCA performance to thirteen older adults who denied experiencing FE. Participants completed the Tilburg Frailty Inventory. Results: FE participants reported greater total frailty (t = 2.06, p = .04) when compared to non-FE participants. Post-hoc analyses revealed that FE participants endorsed greater physical frailty (U = 89, p = .03), specifically poorer sensory functioning (hearing and vision). Discussion: Findings suggest frailty is associated with FE in old age and may represent a target for intervention programs for the financial wellbeing of older adults.

Polyvictimization and Recurrent Falling in Older Ecuadorian Adults: The Mediation Role of Depressive Symptoms

Objective: To assess depressive symptoms as a mediator in the association between polyvictimization and recurrent falling. Methods: Using data from the Salud, Bienestar y Envejecimiento (Health, Well-being, and Aging) Ecuador Study, we analyzed community-dwelling adults 60 years and older (n = 5227). Recurrent falling was determined as ≥2 falls during the prior 12 months. Polyvictimization was determined as a history of ≥2 types of abuse. The mediator was depressive symptoms. Mediation analyses were based on the VanderWeele method. Results: Polyvictimization was significantly associated with higher odds of recurrent falling, and odds ratio (OR) = 1.45 (95% confidence intervals [CI] 1.20-1.76). Higher depressive symptoms increase the odds for recurrent falling (OR = 1.09 and 95% CI 1.07-1.11). Moreover, depressive symptoms were a significant mediator between polyvictimization and recurrent falling. The mediating effect was 28.4%. Discussion: Polyvictimization was associated with higher odds of recurrent falling, and this association was mediated by depressive symptoms.

Effect of long-term moderate-exercise combined with metformin-treatment on antioxidant enzymes activity and expression in the gastrocnemius of old female Wistar rats

Oxidative stress is known to be involved in the etiology of sarcopenia, a progressive loss of muscle mass and force related to elderly incapacity. A successful intervention to prevent this condition has been exercise-based therapy. Metformin (MTF), an anti-diabetic drug with pleiotropic effects, is known to retain redox homeostasis. However, the combined use of MTF with exercise has shown controversial experimental results. Our research group has shown that MTF-treatment does not limit the benefits provided by exercise, probably by inducing a hormetic response. Hence, our aim was to evaluate the effect of exercise in combination with MTF-treatment on the redox state of old female Wistar rats. Animals were divided into six groups; three groups preformed exercise on a treadmill for 5 days/week for 20 months and the other three were sedentary. Also, two groups of each, exercised and sedentary animals were treated with MTF for 6 or 12 months correspondingly, beside the untreated groups. Rats were euthanized at 24 months. Muscular functionality was analyzed as the relation between the lean mass free of bone with respect to the grip strength. Superoxide dismutase, catalase, and glutathione peroxidase content, enzymatic activity and redox state were determined in the gastrocnemius muscle. Our results showed that the exercised group treated with MTF for 12 months presented higher GSH/GSSG rate and high antioxidant scavenging power in contrast to the MTF-treatment for 6 months, where the beneficial effect was less noticeable.

Association of functional limitations and disability with elder abuse in India: a cross-sectional study

Background

Globally, elder abuse is a common form of violence against the elderly. This study examines the association of disability and functional ability measures with elder abuse in India.

Methods

Cross-sectional data from the UNFPA’s ‘Building Knowledge Base on Population Ageing in India’ (BKPAI 2011) have been analysed. Bivariate and multivariate logistic regression analyses have been used to examine the association of measures of disability and functional ability with elder abuse/mistreatment.

Results

The overall prevalence of elder abuse in the study population is 11.4%. The prevalence of elder abuse experienced by study participants in the month before the survey is 6%. The prevalence of disability/functional ability increases the likelihood of elder abuse. Furthermore, the association between functional ability and abuse is stronger and consistent among the elderly who experienced abuse in the month preceding the survey. In addition, the association between disability and elder abuse is stronger in urban areas. Another observation is that gender introduces considerable disparities in the association of disability and functional ability measures with elder abuse. While elderly men with more than two disabilities are 1.85 times (95% CI: 1.23, 2.77, p < 0.003) more likely to experience abuse/mistreatment, women are 3.16 times (CI: 2.22, 4.49, p < .001) more exposed to it.

Conclusions

The results of this study suggest a significant association of disability and functional ability with elder abuse. The association differs considerably by place of residence and gender. Measures to improve the functional health of the elderly population and measures to protect the elderly with disability and functional limitations are important in preventing abuse/mistreatment in old age.