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

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.

Assessing primary health care provider and organization readiness to address family violence in Alberta, Canada: development of a Delphi consensus readiness tool

BACKGROUND

Family violence, which includes intimate partner abuse, child abuse, and elder abuse, is a serious public health concern. Primary healthcare (PHC) offers a vital opportunity to identify and address family violence, yet barriers prevent the effective implementation of family violence interventions in PHC settings. The purpose of this study is to improve family violence identification and response in Alberta's PHC settings by exploring readiness factors.

METHODS

An integrated knowledge translation approach, combining implementation science and participatory action research, was employed to develop a readiness assessment tool for addressing family violence within PHC settings in Alberta. The research involved three phases: phase 1 involved a rapid evidence assessment, phase 2 engaged a panel of healthcare and family violence experts to explore readiness components in the Alberta context, and phase 3 utilized a 3-round Delphi consensus-building process to refine readiness indicators.

RESULTS

Phase 1 findings from a rapid evidence assessment highlighted five main models/tools for assessing readiness to implement family violence interventions in PHC settings. In phase 2, additional concepts were identified through exploration with healthcare and family violence expert panel members, resulting in a total of 16 concepts for assessing family violence readiness within the Alberta PHC context. The 3-round Delphi consensus-building process in Phase 3 involved nine panelists, who collectively agreed on the inclusion of all concepts and indicators, yielding a total of 60 items for the proposed readiness assessment tool for addressing family violence in PHC within Alberta.

CONCLUSION

The current study lays the groundwork for future family violence intervention programs, offering insights into key components that promote readiness for implementing comprehensive programs and supporting PHC organizations in effectively addressing family violence.

Domestic Violence, Mental Health, and Resilience Among Older Adults in the U.S. During COVID-19

OBJECTIVES

The current study based on the Stress Process Model investigated the impact of experiences of domestic violence on mental health as well as resilience against negative mental health outcomes among older adults in U.S. during COVID-19.

METHOD

Participants included 522 older adults (ages 51-80 and older) living in US at the time of the survey. Path analysis using Mplus was employed. Results:The experience of domestic violence among older adults during the pandemic was positively associated with loneliness and anxiety directly and indirectly. However, resilience acted as a protective factor between the experiences of domestic violence and anxiety. Conclusion: The experience of domestic violence may increase loneliness and anxiety among older adults during challenging times; however, resilience may weaken these negative psychological outcomes both directly and indirectly. Findings and implications are discussed.

The relationship of general, physical, and psychological violence with depressive symptoms and cognition in elders (cross-sectional study)

OBJECTIVES

to analyze the relationship of general, physical, and psychological violence with depressive symptoms and cognition in the elderly.

METHODS

quantitative, cross-sectional study, carried out with 323 elders from the Brazilian northeast. Data collection used a sociodemographic instrument; the Conflict Tactics Scales Form R; the Geriatric Depression Scale; and the Mini-Mental State Examination. The analysis employed descriptive and inferential statistics.

RESULTS

as violence increases, so do the depressive symptoms; the opposite was true when comparing violence with cognitive involvement. There is a correlation between physical and psychological violence and depressive symptoms; more depressive elders are from 1.96 to 3.00 times more likely to be the victims of psychological and physical violence, respectively.

CONCLUSIONS

general, physical, and psychological violence is associated with depressive symptoms; those with less cognitive alterations are more vulnerable to abuse. Elders with depressive symptoms are more likely to suffer psychological and physically violence.

Characterization and completeness of notification sheet of violence against the older adults in Niterói-RJ, 2011-2020

OBJECTIVE

to analyze the profile of violence against the elderly and the degree of completeness of event notification forms in Niterói, Rio de Janeiro, Brazil.

METHODS

this was a descriptive study having as its data source violence notification forms held on the Notifiable Health Conditions Information System for the period 2011-2020; analysis of form completeness was performed according to criteria proposed by the Ministry of Health.

RESULTS

of the 486 registered cases, physical violence was the most reported type of violence (48.1%), followed by psychological violence (22.2%) and self-harm (21.4%); the fields with the highest degree of incompleteness were victim's level of schooling (32.8%) and repeat violence (41.5%).

CONCLUSION

despite the increase in notifications in the period, predominantly of physical violence, completeness of some of the form fields continues to be poor, which reinforces the importance of training professionals to improve the reporting process and data quality.

Factors associated with staff-to-resident abuse in Norwegian nursing homes: a cross-sectional exploratory study

BACKGROUND

Elder abuse is a public health problem that is gaining attention due to its serious impacts on people's health and well-being, and it is predicted to increase along with the world's rapidly ageing population. Staff-to-resident abuse in nursing homes is a complex and multifaceted phenomenon associated with multiple factors on different levels of the ecological model. This study aimed to explore individual, relational, and institutional characteristics associated with perpetrated staff-to-resident abuse in nursing homes, using a multilevel hierarchical approach.

METHODS

This was a cross-sectional exploratory study of 3693 nursing staff (response rate 60.1%) in 100 randomly selected nursing homes in Norway. We explored the characteristics of nursing staff, their relationship with residents, and institutional features associated with three types of abuse: psychological abuse, physical abuse, and neglect. These were modelled using multilevel mixed-effects logistic regression analyses.

RESULTS

Individual staff factors found to be associated with all three types of abuse were 1) being a registered nurse/social educator (OR 1.77-2.49) or licensed practical nurse (OR 1.64-1.92), 2) reporting symptoms of psychological distress (OR 1.44-1.46), 3) intention to leave the job (OR 1.35-1.40), and 4) reporting poor attitudes towards people with dementia (OR 1.02-1.15). Also, staff who reported poorer quality of childhood were more likely to perpetrate neglect (OR 1.14). Relational factors such as care-related conflicts (OR 1.97-2.33) and resident aggression (OR 1.36-2.09) were associated with all three types of abuse. Of institutional factors, lack of support from a manager was associated with perpetrating psychological abuse (OR 1.56).

CONCLUSIONS

We found several predictors of staff-to-resident abuse on different levels of the ecological model, which underlines the importance of using a multifaceted approach to identify risk factors of elder abuse in nursing homes. However, future studies should explore the underlying mechanism and causes with a prospective or qualitative design and target the multifaceted nature of risk factors when designing preventive interventions.

Mediação de conflito: soluções propostas em atendimento a casos de violência contra a pessoa idosa

Resumo Objetivo Descrever os motivos da violência contra pessoas idosas e as soluções propostas na mediação de conflito em um ambulatório especializado em geriatria e gerontologia do Distrito Federal, Brasil, entre os anos de 2008 a 2018. Método Estudo retrospectivo, documental, descritivo, com abordagem quantitativa, desenvolvido através da análise de informações obtidas em livros-ata da unidade, com registro de reuniões de mediação de conflito de casos de violência contra a pessoa idosa. A coleta abrangeu os motivos de violência contra a pessoa idosa e as soluções propostas na mediação de conflitos. Resultado: Foram analisados 111 casos. Os principais motivos da violência foram: sobrecarga do cuidador principal (77,4%); filhos acharem que os pais idosos eram capazes de se cuidarem sozinhos (27%); ressentimento dos filhos para com o idoso (24,3%); e desconhecimento da doença do idoso (14,4%). As principais soluções propostas foram: acompanhamento regular com médico (82,8%), assistente social e/ou psicólogo (58,5%); comprometimento de todos os filhos com a divisão dos cuidados e despesas dos pais idosos (52,2%); introdução da pessoa idosa em atividades sociais da comunidade (27%); e contratação de um cuidador formal (24,3%). Conclusão A sobrecarga do cuidador foi o principal motivo de conflito encontrado e as propostas apontadas se relacionavam a maior necessidade de cuidados em saúde com a pessoa idosa e seu cuidador, acerca disto, percebeu se a importância da disponibilidade de uma equipe multidisciplinar frente as situações de violência. A mediação de conflito permitiu o estabelecimento de estratégias reais e direcionadas para alcance de resultados frente aos casos de violência.

Análise do risco direto e indireto de violência intrafamiliar contra pessoas idosas

Resumo Objetivo Analisar o risco direto e indireto da violência intrafamiliar contra a pessoa idosa, na cidade de Manaus, AM, Brasil. Método Estudo epidemiológico de base populacional, quantitativo, de natureza transversal, descritivo e analítico, desenvolvido em seis zonas urbanas dessa cidade, no período de novembro de 2019 a abril de 2021. A amostra foi composta por 2.280 pessoas idosas, utilizando-se margem de erro de 5% e Coeficiente de Confiança de 95%. Utilizou-se o Instrumento Hawlek Sengstock Elder Abuse Screening Test (H-S/EAST), adaptado para o Brasil. Resultados 67,4% eram mulheres, idade média de 69 anos (± 6,9), 48,6% casados e 79,9% ganhavam menos que dois salários mínimos; 73,6% dividiam as despesas da casa e 60,9% corresidiam com filhos e netos; identificou-se que 99,8% sofreram violência (direta e indireta) e 88,8% estão constantemente em elevado risco para algum tipo de violência; 44,7% não têm alguém que lhes faça companhia; 95,3% sustentam alguém; 66% sentem-se tristes ou sós; 42,6% relatam uso excessivo de bebida alcoólica por familiares; 45,8% foram recentemente magoados ou machucados por familiares. As mulheres e os mais longevos foram os mais violentados. Conclusão evidenciou-se que a experiência da corresidência intergeracional trouxe à tona a realidade da violência intrafamiliar praticada contra as pessoas idosas, presente em 99,8% dos entrevistados, ligados, principalmente, à negligência, omissão e abuso financeiro. Os entrevistados foram capazes de apontar problemas originados dos relacionamentos intrafamiliares, possivelmente proveniente da ausência de um melhor vínculo afetivo, que os colocam em situação de violência direta e indireta.

O cenário do mercado de trabalho para idosos e a violência sofrida

Resumo Objetivo analisar sistematicamente as publicações referentes ao cenário do mercado de trabalho para idosos e às situações de violência enfrentadas pelos idosos ativos. Método foi realizada uma revisão integrativa da literatura nas bases de dados Web of Science, Scielo (Scientific Electronic Library Online) PubMed e Science Direct. Resultados foram encontrados 19 trabalhos, 89,4% dos casos de origem internacional, sendo 52,6% com abordagem quantitativa; 31,5%, qualitativa; e, 15,7%, mista. As áreas do conhecimento que concentraram a maioria dos estudos foram saúde, psicologia e gerontologia com 15,7%, sendo a maior parte dos estudos publicados nos anos de 2019, com 31,5% e 26,3% de recorrências respectivamente. Conclusão os estudos evidenciaram que os idosos encontram dificuldades de se manterem no mercado de trabalho pelas inadequações do local de trabalho e pela condição de saúde do idoso. Por outro lado, existem iniciativas governamentais que visam melhorar as condições de trabalho dos longevos, sendo a presença do idoso benéfica para sua saúde e também para o mercado. Em relação à violência sofrida no trabalho, os estudos são escassos, e os existentes destacam as dificuldades de entrada e permanência dos longevos no mercado em detrimento do ageismo e dos estereótipos ligados ao envelhecimento. Finalmente, com o envelhecimento da população considera-se importante pensar políticas públicas que proporcionem ao idoso condições adequadas de se manter ativo com a proteção de sua saúde e qualidade de vida.

Intervenções fisioterapêuticas direcionadas à pessoa idosa em situação de violência: uma revisão de escopo

Resumo Objetivo Identificar as intervenções fisioterapêuticas direcionadas à pessoa idosa em situação de violência. Método Trata-se de uma revisão de escopo, em que foram acessadas as seguintes bases de dados/bibliotecas/buscadores e literatura cinzenta: BVS, PubMed, Web of Science, Scopus, CINAHL, PEDro, BDTD, OpenGrey, OpenThesis, RCAAP, Portal de Teses e Dissertações da CAPES, DART-Europe E-theses Portal e Theses Canada Portal. As buscas utilizaram os descritores e palavras-chave, que foram combinados por meio dos operadores booleanos OR e AND: Fisioterapeutas, Fisioterapia, “Physical Therapists”, Physiotherapy, “Physical Therapy”, “Physical Therapy Specialty”, “Physical Therapy Modalities”, Rehabilitation, Reabilitação, “Elder Abuse”, “Maus-tratos ao Idoso”, “Physical Abuse”, “Elder Neglect”, “Aged Abuse” e “Elder Mistreatment”. Resultados Dos 601 registros encontrados, 46 foram excluídos por serem duplicados, sendo selecionados 555 para leitura dos respectivos títulos e resumos. Foram excluídas 548 publicações por não se adequarem aos critérios de inclusão, sendo pré-selecionados 7 trabalhos. Pela estratégia Snowballing um foi identificado, originando um resultado final de 8 estudos. Conclusão As intervenções fisioterapêuticas direcionadas à pessoa idosa em situação de violência compreendem: educação em saúde, medidas no estresse do cuidador, recursos comunitários, rastreamento/triagem, avaliação, identificação, plano terapêutico/reabilitação e denúncia. Diante dos achados, observa-se que, apesar da lacuna no conhecimento dessa temática, o fisioterapeuta desempenha um papel imprescindível na condução de casos de violência contra a pessoa idosa.