Theories and measures of elder abuse

Violence, Abuse and Neglect in Older Women in Rural and Remote Areas: A Scoping Review and Prevalence Meta-Analysis

This systematic review addressed the issue of the abuse and neglect of older women (age 60 and over) in rural and remote areas, examining these phenomena's prevalence, risk and protective factors, consequences, and associated perceptions. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Arksey and O'Malley methodological framework, peer-reviewed articles published until September 2023 were identified in six electronic databases. Out of the manuscripts initially identified (n = 219), 28 articles met the selection criteria. The study's quality was assessed using the Mixed Methods Appraisal Tool. The included studies provided a comprehensive overview of this phenomenon, encompassing data from 6,579 older rural women. Prevalence rates of abuse and neglect exhibited wide variability, with an average of 27.3%. Among the risk factors, financial dependence and incapacity stood out, while higher income and education levels were protective factors, among others. Emotional/psychological abuse emerged as the most common form, with significant impacts on older women's physical and mental health. Cultural norms and gender expectations also influenced perceptions of abuse and victims' coping mechanisms. In a context in which access to specialized resources and services is hampered by significant limitations, community awareness and education prove vital to address this issue, which positions social work as key to addressing these challenges. The prevalence of abuse against older rural women is significant. Emotional abuse stands out as a major issue, underscoring the need for comprehensive interventions accounting for cultural and gender factors.

Does social participation make Thai psychologically abused elders happier? a stress-buffering effect hypothesis

This study investigates the influence of psychological elder abuse on life satisfaction levels in Thailand. This study also analyses the stress-buffering effect of social participation on the life satisfaction levels of Thai mentally abused elderly. Elder abuse has been proven to dramatically reduce Thai elders' levels of life satisfaction as their function in society shrinks owing to ageism. As a result, individuals are more likely to lose their independence and status and be forced to rely on others, increasing the danger of abuse. Elder abuse has a more significant negative impact on life satisfaction levels among Thai older women. Nonetheless, the mentally abused elderly who participate in social activities are happier than those who do not. Thai elders who live with their daughters are more satisfied in life than those who do not, but living with adult offspring does not assist psychologically abused elders in escaping their psychological suffering.

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.

Cross-cultural adaptation of the EAST and CASE screening tools for elder abuse in South Africa

Elder abuse is globally considered a hidden problem with great variations in its conceptualization across cultures, non-uniformity in understanding, and manifestations of abuse and neglect. Currently, there are no validated or culturally adapted screening measures for elder abuse in South Africa. The aim of this study was to test the cultural appropriateness of the Elder Abuse Screening Tool (EAST) and the Caregiver Abuse Screen (CASE) in two regions and four languages in South Africa. Using a cognitive interviewing methodology, 23 carers and 19 older adults were interviewed. Findings show that questions in the EAST and CASE are generally well understood, but that adaptations of both tools are necessary for use within South Africa. Fear, knowledge, and experience of crime also showed that strangers, like family, deliberately use deception to build trust and abuse. Further validation is needed to determine suitable scoring and use by health and social care practitioners.

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

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

Development and psychometric properties of the hospitalized elder abuse questionnaire (HEAQ): a mixed methods study

BACKGROUND

Older patients are more vulnerable and prone to abuse and neglect in hospitals and acute care settings. The present study aimed to develop and assess the psychometric properties of a questionnaire for screening abuse in hospitalized older adults.

METHODS

This study was conducted from October 2017 to September 2019 using the exploratory sequential mixed-methods research design. The participants were selected among those admitted to various wards of six teaching hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. In the qualitative phase of the study, using the inductive content analysis method, the concept of abuse in hospitalized older adults was extracted through individual in-depth semi-structured interviews with 16 older patients and 11 family caregivers. Based on qualitative findings and a review of existing literature, an initial version of the questionnaire was developed. In the quantitative phase of the study, the psychometric properties (face, content, construct, and convergent validity; internal consistency and stability) of the questionnaire were examined.

RESULTS

Based on qualitative findings and literature review, a pool of 154 candidate items was defined. These items were reduced to 37 after initial refinement, qualitative and quantitative face and content validity, and item analysis. The outcome of principal component analysis further reduced the number of items to 27, which were grouped into 5 components, namely "Shortcomings in management and care facility", "Neglect of professional commitments", "Physical and psychological abuse", "Protracted treatment process", and "Invasion of privacy". The explained variance of these 5 components was 50.09% of the overall variability of the questionnaire. The convergent validity of the questionnaire was acceptable (P < 0.00, r = - 0.44). Cronbach's alpha coefficient and intraclass correlation coefficient for the entire questionnaire were 0.89 and 0.92, respectively; indicating high reliability and stability of the questionnaire.

CONCLUSION

The hospitalized elder abuse questionnaire (HEAQ) has acceptable psychometric properties. It is recommended to use HEAQ to screen for suspected cases of abuse of hospitalized older adults.

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.

The incidence of elder abuse under East Asian cultural background: A systematic review and meta-analysis

OBJECTIVE

Elder abuse (EA) is a critical social, health, and economic issue worldwide. To date, there is limited information on EA in certain similar culture-specific subpopulations, especially in East Asia. This study aims to summarize EA incidence in East Asia through a systematic review and meta-analysis and identify its variations and heterogeneity in the incidence estimates.

METHODS/DESIGN

The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol. Systematic review registration number PROSPERO CRD42020197131. A systematic literature search was performed to identify relevant articles published before July 5th, 2020, from six electronic databases. Two reviewers screened for relevance of the studies against eligible criteria and assessed the bias of the included studies independently. A random-effect model was adopted to estimate the incidence of EA, followed by subgroup analyses and multi meta-regression. Sensitivity and publication bias tests were performed to verify the robustness of the meta-analysis by Stata version 15.1.

RESULTS

Twelve eligible studies were included in the meta-analysis, which involved 79,395 subjects from 3 East Asian countries (China, Japan, and South Korea) ranging from 2004 to 2020. The overall incidence of EA was 78.33 per 1000 person-year (95% CI: 39.12-156.87) with high between-study variability (χ²  = 15,568, d.f. = 11, p<0.001; I²  = 99.9%). The sampling method, sample size, scope, instrument, data collection method, income classification, types of participants, and urbanity are all the sources of heterogeneity, which can explain nearly 100% of the variance between studies.

CONCLUSIONS

The incidence of EA in this study is not as high as the global level. It may be furtherly underestimated in East Asia due to cultural norms. It is imperative to develop a culture-tailored EA assessment instrument to evaluate potential victims. Future studies should also identify more effective educational programs to raise the public's awareness and promote recognition ability.

Impacts of mistreatment on the psychological and physical health of older adults living in sheltered homes

OBJECTIVES

To assess the impact of the mistreatment on psychological and physical health among older adults living in sheltered homes.

METHODS

This cross-sectional study included 446 older adults living in 43 sheltered homes. The psychological effects questions screened for suicidal ideation, depression, anxiety, and sleep problems. The physical health effects questions assessed perceived physical health status and healthcare resource utilization.

RESULTS

All subtypes of mistreatment of older adults were associated with increased prevalence rates of anxiety symptoms, depressive symptoms, and sleep problems. Perceived poor physical health is common among older mistreated adults; it was self-reported by 74% who experienced physical mistreatment and 49% who experienced other types of mistreatment. Increased healthcare utilization was higher among older adults who experienced mistreatment.

DISCUSSION

Mistreatment of older adults living in sheltered homes is associated with negative impacts on physical and psychological health, as well as increased healthcare utilization compared to those who are not mistreated.

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.

Association between Caregiver Neurotic Personality Trait and Elder Abuse: Investigating the Moderating Role of Change in the Level of Caregiver Perceived Burden

OBJECTIVES

To investigate whether caregiver neuroticism affects the level of elder abuse and whether changes of caregiver perceived burden alter this relationship.

METHODS

Using 2-year longitudinal data, a consecutive sample of 800 Chinese family caregivers and their care recipients with dementia were recruited from the geriatric and neurological departments of 3 grade-A hospitals in the People's Republic of China. All the participatory dyads were assessed between September 2015 and February 2016 and followed up for 2 years.

RESULTS

Significant increase in the prevalence was found for physical abuse, psychological abuse, and caregiver neglect. Caregiver neuroticism was associated with an increased level of physical and psychological abuse over the 2-year observation period; however, change in the level of caregiver perceived burden altered this association. Specifically, the absence and decrease of perceived care burden prevented an increase in the level of physical and psychological abuse among caregivers high in neuroticism. Although caregiver neuroticism was also associated with an increased level of caregiver neglect, caregiver perceived burden did not appear to have an impact on this relationship.

DISCUSSION

This study provided evidence that caregiver neuroticism was associated with an increased level of physical and psychological abuse, while changes in the level of caregiver perceived burden may alter this trajectory. These findings suggest the importance of implementing caregiver-centered intervention and prevention programs for elder abuse by specifically targeting caregivers' behaviors related to their neurotic personality trait and cognitive appraisal of caregiving stressors associated with such personality traits.

Breaking the Taboo: Sexual Assault in Late Life as a Multifaceted Phenomenon-Toward an Integrative Theoretical Framework

Sexual assault (SA) in late life has been receiving growing attention over the past two decades. It is directed primarily against older women and has been the least frequently reported form of abuse. Despite the growing awareness and body of knowledge on this phenomenon, the theoretical framework is still limited. Therefore, the aim of the present article is to suggest a theoretical conceptualization of the multifaceted phenomenon of sexual assault against women in late life (SAWLL). This conceptualization has been developed through several stages: (a) identification of three grounded fields of inquiry that are relevant to SAWLL: SA, elder mistreatment, and intimate partner violence; (b) classification of SAWLL along four paths: (1) ongoing SA in the context of lifelong IPV; (2) SA beginning in old age in the family within the community, involving spouses, family members, caregivers, dating mates, and so on; (3) ongoing SA, continuing in institutions, perpetrated by family members; and (4) SA in institutions, beginning in old age, relating to staff, residents, and family members; (c) We suggest three additional theoretical perspectives: trauma, a life-course perspective, and social constructionism, which provide further in-depth knowledge for understanding SAWLL. The combination of the three abovementioned stages composes an integrative theoretical framework, addressing SAWLL as a multifaceted phenomenon.

Elder Mistreatment and Psychological Well-Being among Older Americans

Elder mistreatment is a major public health issue both in the US and around the globe. While extensive research has elucidated the association between elder mistreatment and health in older adults, little is known about the relationship between elder mistreatment and more eudaimonic measures of psychological well-being. Using data from the 2011 wave of the Wisconsin Longitudinal Study, this project examined the association between older adults’ experience with varied forms of elder mistreatment and eudaimonic dimensions of psychological well-being including autonomy, environmental mastery, personal growth, positive relations with others, purpose in life, and self-acceptance. Ordinary least squares regression analyses found significant associations between experiences of elder mistreatment and psychological well-being. In particular, older adults who reported feeling that someone was too controlling over their daily lives and older adults who reported making donations to organizations they later worried were not legitimate reported significantly lower scores on all six psychological well-being dimensions. The results of this study suggest the negative effects of elder mistreatment can extend to more eudaimonic feelings of well-being, and programs designed to treat victims of elder mistreatment should incorporate strategies that help strengthen psychological well-being.

Prevalence of elder abuse among community-dwelling older adults in Turkey and its associated factors

BACKGROUND

This study was performed to determine the prevalence of elder abuse among community-dwelling older adults and its associated risk factors.

METHODS

The sample in this cross-sectional study consisted of 691 older adults. Data were collected with an elder abuse and neglect assessment form, which had been prepared by the researchers in accordance with the literature. Logistic regression analysis was used to identify factors related to subtypes of elder abuse.

RESULTS

In this study, 13.6% of the elderly subjects (n = 94) were exposed to at least one instance of abusive behaviour within the last year; emotional abuse was the most frequently occurring type of abuse. Risk factors for abuse were being 75 years old or older (odds ratio (OR) = 1.993, 95% confidence interval (CI): 1.105-3.592), being illiterate (OR = 4.863, 95%CI: 2.809-8.417), lack of own income (OR = 2.189, 95%CI: 1.179-4.064), having bad family relationships (OR = 20.564, 95%CI: 5.453-77.554), and lack of own home (OR = 3.945,; 95%CI: 1.167-13.330).

CONCLUSIONS

The results of this study showed that abuse was an important problem for the elderly population. Therefore, elderly individuals, especially those who are 75 years old or older, have a low education level, lack their own home, and lack their own income, should be evaluated for abuse.

When Older People Are Violent or Abusive Toward Their Family Caregiver: A Review of Mixed-Methods Research

What happens when family caregivers experience violence and abuse from the older person for whom they care? Although this issue has received little global attention, it is relevant to researchers, practitioners, and policy makers working across the intersecting fields of older age care and medicine, adult protection and safeguarding, and domestic and intimate partner violence. To date, these fields have generated diverse explanations of violence and abuse in older age illness and how best to respond to it. This article reports the findings of a systematic literature review of 18 quantitative, qualitative, and mixed-methods studies that investigated violent and abusive behavior by older people toward their family caregivers. The review identified three central themes in the literature: (1) There are inconsistent definitions and measurements used in research about harmful, violent, and abusive behavior toward family caregivers. (2) Violent and abusive behavior toward caregivers is a sensitive and hidden topic that poses practical and methodological challenges for researchers. (3) There is some evidence to suggest that people who were violent and abusive in their earlier life-or who had a poor relationship with their family member in the past-are more likely to continue to experience violence and abusive behavior in later life. There were two central ways in which violence and abuse were conceptualized and investigated: as a "symptom of illness" or as an "act of abuse" and we present a visual map of the relationship between these two conceptualizations drawn from our analysis of the literature. We conclude by discussing the implications of the findings and recommend future directions for practice, research, and policy to support affected families.

Explanations around physical abuse, neglect and preventive strategies among older Yoruba people (60+) in urban Ibadan Southwest Nigeria: A qualitative study

Older people's views, experiences and explanations on abuse and neglect in later life is marginal in the literature. With more cases of physical abuse and neglect in old age in sub-Saharan Africa, this study explored the views and positions of older people and community stakeholders like religious leaders on why physical elder abuse and neglect and preventive measures within community settings in Nigeria. An exploratory research design that consisted of two focus group discussions with older Yoruba men and women (60+) and six semi-structured interviews with religious leaders (Christianity, Islam, and Traditional) guided the study. Based on thematic analysis, the findings revealed that older persons and religious leaders have multiple interpretations of physical elder abuse and neglect. Social ills, poor economic situation, evil machinations, and stereotypes and misconceptions of old age and spirituality are possible explanations for physical abuse and neglect. The intersecting nature of the factors promoting vulnerability to physical abuse and neglect in later life also emerged in the preventive measures suggested by older persons and community members. As such, the participants affirmed that most older persons are becoming conscious of vulnerability to abuse and do contest actions, relationships, and contexts that can reduce their vulnerability and earn more social acceptance. Nonetheless, the participants expressed worries over the absence of policies and legal frameworks that can protect older people against physical abuse and neglect. More worrisome was the growing spread of social ills, stereotypes around old age, poverty in old age, witchcraft accusations and ageism. These developments are compounding ageing experiences, including physical abuse and neglect in urban spaces in Nigeria.

Screening for Multiple Types of Family Violence: Development and Validation of the Family Polyvictimization Screen

Objective: Different types of violence tend to co-occur within a family where the members often share common family characteristics, a situation described as family polyvictimization. In response to the lack of a validated screening tool, this study developed and validated the Family Polyvictimization Screen (FPS), the first brief screening tool applicable to members of the same family with up to three generations. Methods: The FPS was designed to screen family polyvictimization by assessing and capturing different types of violence, including child abuse and neglect (CAN), intimate partner violence (IPV), and elder abuse. The FPS was compared with the Criterion Standard scales. It is suitable for use as a self-report for individual family members for specific violence or as a proxy report for an adult family member to serve as informant. In this study, a community sample of 445 households was recruited from Hong Kong (n = 250) and Shanghai (n = 195). One adult parent from each three-generation family was selected as the informant to report all family polyvictimization experiences in the preceding year. Results: Moderate to high agreement (79.1-99.8%) was found between the FPS and the standard measurements, such as the revised Conflict Tactics Scales (CTS2) and the Conflict Tactics Scales: Parent-Child Version (CTSPC). Exceptions appeared in regard to physical assault on elders due to the rarity of reported cases. The specificity was high, while the sensitivity estimates appeared low, especially for the more sensitive sexual abuse cases. Conclusion: The validated FPS demonstrated its potential utility as a brief tool for screening family polyvictimization in clinical settings with substantial agreement and satisfactory accuracy in the Chinese population.

The Relationship between Nurses’ Recognition Regarding Elder Abuse and their Attitudes and Performance in Dealing with Elder Abuse Induced by Iranian Family Caregivers

Introduction:

Knowledge of nurses regarding elder abuse can be helpful in decisions about on-time and appropriate interventions. Our aim was to assess the relationship between recognition of nursing staff toward elder abuse and their attitudes, and performance in dealing with elder abuse induced by Iranian family caregivers.

Methods:

In this descriptive study, 400 nurses were selected, using cluster sampling, from nurses working in public or private hospitals in Iran. Data collection was performed using questionnaires measuring elder abuse symptom recognition, attitudes, and performance.

Results:

There is a significant relationship between the total scores for recognition of symptoms and elder abuse potential risk factors (p=0.05) and the nurses’ attitudes and performance scores (p = 0.001). There was no significant difference between the nurses’ performance and recognition scores (p = 0.14).

Conclusion:

Interventions to promote nurses’ recognition via in-service educational programs can improve nurses’ performance in different levels of abuse prevention and the quality of nursing care for the elderly.

Exploring Elder Neglect: New Theoretical Perspectives and Diagnostic Challenges

Background and Objectives

Neglect of older adults is a complex and important social problem which is difficult to detect. The aim of this review is to explore and categorize different characteristics of elder neglect, to facilitate a uniform conceptualization and provide recommendations for identification of the phenomenon.

Research Design and Methods

Articles published between January 1990 and February 2019, both from developed and developing countries, were taken into consideration. The literature search was performed in PubMed, Web of Science, and CINAHL using keywords related to elder abuse and neglect. Articles regarding the concept of elder neglect, identifying or measuring this phenomenon were reviewed. The identified indicators were presented according to the Maslow’s hierarchy of needs.

Results

From 7,207 articles found in the initial search, 63 relevant studies were selected for the final analysis. Indicators most frequently used by researchers (functionality, physical appearance and health, social and psychological background, mental health, and environment) correspond to different aspects of needs. Caregiver’s responsibility, satisfaction of needs, and risk of harm are the core elements to consider in identification of neglect.

Discussion and Implications

The identified elements and categories of indicators provide the framework for developing standard definitions and measures of elder neglect. The proposed diagram demonstrates gaps in identification and can be useful in detecting potential neglect in various categories of needs. Further research on perceptions and prevalence of elder neglect in different countries would be helpful for cross-country analysis as well as for adaptation of the instruments to cultural specifics.

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.

Development and Spanish translation of the Weinberg Center Risk and Abuse Prevention Screen (WC-RAPS)

Barriers for enhanced detection, identification, and reporting of elder abuse include the paucity of appropriate, valid, easily administered screening tools. This article describes the qualitative methods used in the development of the Weinberg Center Risk and Abuse Prevention Screen (WC-RAPS), and of its Spanish version. Focus groups and cognitive interviews were instrumental in identifying problematic items, underscoring potential response errors, and informing about putative causes for divergent interpretations of item-intent. Seven of the 11 original items were modified, a double-barreled item was segregated into two, one item deleted, and three additional items included to create the final 13 WC-RAPS items. The multi-step approach implemented for the Spanish conversion evidenced deviation from the original intended meaning for one item. The readability for English and Spanish versions was also assessed. Screening for elder abuse, if implemented systematically can be instrumental in identifying unrecognized abuse and preventing reoccurrence.

Elder abuse and its impact on quality of life in nursing homes in China

There are limited available data on elder abuse and its impact on quality of life (QOL) in China. This study investigated the prevalence of elder abuse in nursing homes and its associated demographic, clinical factors and QOL in Macau and Guangzhou, China. A total of 681 subjects (244 in Macau and 437 in Guangzhou) were consecutively recruited. The prevalence of elder abuse was 11.48% and 8.24% in Macau and Guangzhou, respectively. Multivariate analyses revealed that having a religion and depressive symptoms were independently and positively associated with elder abuse. No significant association between elder abuse and any QOL domain was found. Elder abuse is common in nursing homes in both Macau and Guangzhou. Appropriate strategies and educational programs should be developed for health professionals to reduce the risk of elder abuse.

Design and implementation of an empowerment model to prevent elder abuse: a randomized controlled trial

Background

Older adults are more vulnerable to health risks than younger people and may get exposed to various dangers, including elder abuse. This study aimed to design and implement an empowerment educational intervention to prevent elder abuse.

Methods

This parallel randomized controlled trial was conducted in 2014–2016 for 18 months on 464 older adults aged above 60 years who visited health houses of 22 municipalities in Tehran. Data were collected using standard questionnaires, including the Elder Abuse-Knowledge Questionnaire, Health-Promoting Behavior Questionnaire, Health-Promoting Lifestyle Profile II, Barriers to Healthy Lifestyle, Perceived Social Support, Perceived Self-Efficacy, Loneliness Scale, Geriatric Depression Scale, Multidimensional Health Locus of Control Scale, and the SCARED (stress, coping, argument, resources, events, and dependence) tool. The intervention was done in twenty 45- to 60-minute training sessions over 6 months. Data analysis were performed using χ² tests, multiple linear and logistic regression, and structural equation modeling (SEM).

Results

The frequency of knowledge of elder abuse, self-efficacy, social support and health promoting lifestyle before the intervention was similar in the two groups. However, the frequency of high knowledge of elder abuse (94.8% in the intervention group and 46.6% in the control group), high self-efficacy (82.8% and 7.8%, respectively), high social support (97.0% and 10.3%, respectively) and high health promoting lifestyle (97.0% and 10.3%, respectively) was significantly higher (P<0.001) and the frequency of elder abuse risk (28.0% and 49.6%, respectively) was significantly less in the intervention group after the intervention. SEM standardized beta (Sβ) showed that the intervention had the highest impact on increase social support (Sβ=0.80, β=48.64, SE=1.70, P<0.05), self-efficacy (Sβ=0.76, β=13.32, SE=0.52, P<0.05) and health promoting behaviors (Sβ=0.48, β=33.08, SE=2.26, P<0.05), respectively. The effect of the intervention on decrease of elder abuse risk was indirect and significant (Sβ=−0.406, β=−0.340, SE=0.03, P<0.05), and through social support, self-efficacy, and health promoting behaviors.

Conclusion

Educational interventions can be effective in preventing elder abuse.

Functional Decline and Emotional Elder Abuse: A Population-Based Study of Older Korean Adults

OBJECTIVES

Elder abuse is an increasingly prevalent issue in South Korea. The current study examines the association between functional impairment and emotional abuse victimization in Korean adults 65 and older. We also examines the mediating roles of diverse aspects of family resources (i.e., older adult's self-esteem, family cohesion, family assistance, contact with friends/neighbors, and participation in social activities) in the aforementioned association.

METHODS

We analyzed 9,691 community-dwelling older Koreans from a population-based survey of the 2009 Survey of Elderly Care and Welfare Need. We conducted a path analysis to analyze the mediational hypothesis.

RESULTS

About 11% of the study sample reported experiencing emotional abuse by a family member in the past year (n = 1,082). The results of the mediational analysis showed that greater ADL/IADL limitations were associated with a) reduced self-esteem and b) receiving more assistance from family, which were ultimately associated with increased risk of emotional abuse victimization.

DISCUSSION

Elder abuse is a family crisis that may occur as a result of maladaptation to the heightened long-term care needs of older family members. Practitioners should take into account older adults' vulnerability in terms of the loss of adaptive resources in the face of functional decline. This study further supports the importance of relieving the burden of family caregivers to avoid the incidence of emotional elder abuse.

Elder abuse as a risk factor for psychological distress among older adults in India: a cross-sectional study

OBJECTIVES

This study examines the association between elder abuse and psychological distress among older adults in India and explores whether this association varies by the level of psychosocial and material resources.

DESIGN

The study uses a cross-sectional survey design.

SETTING

The data are drawn from a representative sample of 9589 adults aged 60 and above in seven Indian states-Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala and Tamil Nadu-in 2011.

STATISTICAL ANALYSES

Secondary analysis, using bivariate and multivariate logistic regression models, is conducted using the United Nations Population Fund project Building Knowledge Base on Ageing in India survey. Elder abuse (physical and/or emotional) emanating from family members in the previous month before the survey is examined. Multivariate models are run on the total analytical sample and for men and women separately.

RESULTS

The overall prevalence of psychological distress among persons aged 60 and over living in the seven Indian States is 40.6%. Among those older persons who experienced some form of physical or emotional abuse or violence in the last month, the prevalence of psychological distress is much higher than that in the general older population, at 61.6% (p<0.001). The results show that the experience of abuse is negatively associated with the mental health of older adults, and this relationship persists even after controlling for demographic and socioeconomic factors (OR=1.60, 95% CI 1.22 to 2.09). The findings also suggest that household wealth has an inverse relationship with mental health, with the association between experiencing elder abuse and reporting poor mental health being strongest among older people in wealthy households.

CONCLUSIONS

Elder abuse in India is currently a neglected phenomenon, and greater recognition of the link between abuse and mental health is critical to improve the well-being of vulnerable older adults, some of whom may be 'hidden' within well-off households.

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.

Caregiver Abuse of Chicago Chinese Older Adults in a Community-Dwelling Population

OBJECTIVES

This study aimed to examine the prevalence and correlates of elder abuse reported by adult children among U.S Chinese populations.

METHOD

A community-based participatory research approach was implemented. A total of 548 Chinese adult children aged 21 years and over participated in this study. Elder abuse reported by adult children was assessed using Caregiver Abuse Screen (CASE).

RESULTS

This study found a prevalence of 59.8%for elder abuse among 548 adult children. Younger age (r = -0.10, p < .05), higher level of education (r = 0.20, p < .001), higher income (r = 0.14, p < .01), more years in the U.S. (r = 0.12, p < .05), not born in Mainland China (r = -0.13, p < .01), and English-speaking (r = 0.16, p < .001) were positively correlated with elder abuse reported by adult children.

DISCUSSION

Elder abuse by adult children is prevalent among U.S. Chinese populations. It is necessary for researchers, health care providers and policy makers to put more attention on elder abuse by adult children. Longitudinal research is needed to explore the risk factors associated with elder abuse by adult children. Health care providers should improve detection of elder abuse and support at-risk caregivers. Policy makers may consider cultural sensitive approaches to address elder abuse.

Emotional function in dementia patients

Behavioural and psychological symptoms of dementia, which can be considered as hyperreactivity of the emotional functioning of dementia, can be alleviated or aggravated by the behavioural and psychological symptoms of the caregiver. Comfortable stimulations of emotional function through sensory stimulations are effective methods for alleviating behavioural and psychological symptoms of dementia. Although cognitive function deteriorates with age, emotional function is often retained even in advanced years. Thus, it is recommended that care in patients with dementia be focused mainly on the stimulation of emotional function (e.g. sympathy and empathy, which are human traits), rather than relying solely on the stimulation of cognitive function.