ArticleLiterature Review

The prevalence of elder abuse and neglect: A systematic review

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Abstract

to perform a systematic review of studies measuring the prevalence of elder abuse or neglect, either reported by older people themselves, or family and professional caregivers or investigated using objective measures. we conducted a comprehensive literature search of multiple databases up to October 2006, supplemented by a search of the references of all relevant articles. Validity of studies was graded by two authors independently using a standardised checklist. forty-nine studies met our inclusion criteria, of which only seven used measures for which reliability and validity had been assessed. In the general population studies, 6% of older people reported significant abuse in the last month and 5.6% of couples reported physical violence in their relationship in the last year. In studies using valid instruments involving vulnerable elders, nearly a quarter reported significant levels of psychological abuse. Five per cent of family caregivers reported physical abuse towards care recipients with dementia in a year, and a third reported any significant abuse. Sixteen per cent of care home staff admitted significant psychological abuse. Rates of abuse recorded using objective measures (5%) or reported to home management or adult protective services (APS) (1-2%) were low. one in four vulnerable elders are at risk of abuse and only a small proportion of this is currently detected. Elders and family and professional caregivers are willing to report abuse and should be asked about it routinely. Valid, reliable measures and consensus on what constitutes an adequate standard for validity of abuse measures are needed.

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... increased dependence levels [27][28][29][30], all of which are well-recognized characteristics of patients with RMDs. Despite this, there is limited published evidence of any form of violence, as comorbid conditions of RMDs [12,17,19,20,22] and their relationship with the underlying diagnosis have not been explored. ...
... Patients attributed mistreatment to the underlying RMD (or RMD impact on their lives and families) in a variable percentage, from 13.3% for sexual mistreatment to 53.3% for psychological mistreatment. Mistreatment has been widely described, particularly in vulnerable elders, among whom nearly a quarter report significant levels of primarily psychological mistreatment [27]. In the realm of RMDs, a significant prevalence of mistreatment and any form of abuse has been documented, particularly among patients with fibromyalgia [12,22,24,25,[48][49][50][51], RA [12], and more recently, among patients with SLE [52]. ...
... Second, we observed that patients who reported some mistreatment were reluctant to identify the sex and the relationship of the abuser, as evidenced by the increase in the "I do not want to answer" responses from less than 1% in the items identifying mistreatment and its patterns, to up to 72.9% when referring to the relationship with the abuser. This result might reflect the isolated and secretive nature of abusive acts and question if we are detecting the most severe phenomenon [27]. Previous studies have mentioned potential reasons why violence victims can silence their traumatic experiences, including the fear of retaliation and not being believed, but also perpetrators employing strategies to silence their victims [56]. ...
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Background Mistreatment is a complex problem that impacts people’s quality of life, morbidity, and mortality. In aged people, it has been associated with female sex, poor general health, depression, functional and cognitive decline, and increased dependence levels, all of which are well-recognized characteristics of patients with rheumatic diseases (RMDs). The objective was to describe the mistreatment phenomenon in Mexican patients with RMDs. We additionally report the adaptation and validation of the Geriatric Mistreatment Scale (GMS) in the target population. Patients and methods This cross-sectional study was developed in two phases (June 28, 2023-February 2, 2024), and three convenience samples were used: S-1 (n = 30), S-2 (n = 260), and S-3 (n = 372). Phase 1 consisted of adapting the GMS to RMDs (RMD-MS) (experts’ agreement), followed by RMD-MS face validity (pilot testing, S-1), content validity (experts’ agreement), concurrent criterion validity (family APGAR score ≤3, S-2), construct validity (exploratory factor analysis and convergent validity, S-2), reliability (internal consistency and temporal stability, S-2) and feasibility (in S-1). Phase 2 consisted of the mistreatment description in S-3. Results Patients represented typical RMD outpatients with substantial disease duration. There were 187 (50.3%) patients with overall mistreatment, and psychological was the most frequent in 142 (75.9%) patients, followed by neglect mistreatment in 96 (51.3%), sexual in 30 (16%), physical in 23 (12.3%), and economic mistreatment in 20 (10.7%) patients. Patients’ perceived mistreatment was related to the underlying RMD in 13.3% of sexual mistreatment and 53.3% of psychological mistreatment. The number of "I do not want to answer" responses raised to 21.7%-67.7% for abusers’ sex and 40%-72.9% for the abusers’ relationship with the participant. The RMD-MS was valid, reliable, and feasible. Conclusions Half of the Mexican patients with RMDs perceived some mistreatment, most frequently psychological mistreatment, which is also often perceived as related to the underlying RMD.
... Ten systematic reviews aimed to capture prevalence estimates globally, 3,14,32,35,38,40,42---45 three in Iran, 36,37,39 one in Turkey, 33 one in China 34 and one in Brasil. 41 Nine systematic reviews reported EA only in community setting, 3,32,33,35,36,38,40,42,45 two only in care setting, 14,43 two in both, 34,44 and three did not report the setting of abuse. 37,39,41 One study focused on elderly women, 35 and one on intimate partner violence. ...
... 14,33 Reviews often reported heterogeneity and broad ranges of prevalence data. 3,14,32,35,37,42,44 The common explications for the source of heterogeneity were differences between sample sizes, 3,37 sampling methods, 32,37,40 data collection methods and instruments, 3,32,33,36,37,40,42,44,45 definitions of elder abuse, 32,36 and cultural or socioeconomic contexts. 3,32---34,36,37,45 There were differences observed in the prevalence measure period, for example, Yon et al. 3 reported that out of the 234 studies included in their systematic review, 84 reported a period ranging from one month to 5-years or did not report the prevalence period at all. ...
... 14,33 Reviews often reported heterogeneity and broad ranges of prevalence data. 3,14,32,35,37,42,44 The common explications for the source of heterogeneity were differences between sample sizes, 3,37 sampling methods, 32,37,40 data collection methods and instruments, 3,32,33,36,37,40,42,44,45 definitions of elder abuse, 32,36 and cultural or socioeconomic contexts. 3,32---34,36,37,45 There were differences observed in the prevalence measure period, for example, Yon et al. 3 reported that out of the 234 studies included in their systematic review, 84 reported a period ranging from one month to 5-years or did not report the prevalence period at all. ...
... While accurate estimates are challenging to obtain due to underreporting and the difficulties inherent in identifying abuse in dementia patients, research suggests that domestic violence is a significant problem within this population. Studies have reported prevalence rates ranging from 10% to 60%, highlighting the alarming extent of this hidden epidemic (Cooper et al., 2008;Selwood et al., 2007). The vulnerability of individuals with dementia, coupled with their dependence on caregivers, creates a fertile ground for abuse, often perpetrated by family members or intimate partners. ...
... Moreover, the consequences of domestic violence extend beyond the individual, affecting their overall well-being and quality of life. Victims may experience a decline in cognitive function, increased agitation and a heightened risk of institutionalization (Cooper et al., 2008). The cumulative impact of abuse can also accelerate the progression of dementia, leading to premature mortality. ...
... Despite the availability of several elder abuse measurement instruments, most of the studies only document part of the psychometric properties of these instruments (Cooper, 2008;Jackson, 2018;Sooryanarayana, 2013;Yan, 2015;Yon, 2017;Yon, 2019a;Zhang, 2022). Besides, adapting an existing elder abuse instrument to be used in another population is a common practice, yet information regarding the cross-cultural validity of the instrument remains sparse. ...
... The psychometric properties of elder abuse measurement instruments used in existing elder abuse prevalence surveys have not received enough attention (Cooper, 2008;Sooryanarayana, 2013;Yan, 2015;Yon, 2017;Yon, 2019a;Zhang, 2022). Selecting the best measurement instruments for elder abuse prevalence studies requires an instrument supported by evidence of reliability, validity and responsiveness . ...
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Background The psychometric properties of elder abuse measurement instruments have not been well‐studied. Poor psychometric properties of elder abuse measurement instruments may contribute to the inconsistency of elder abuse prevalence estimates and uncertainty about the magnitude of the problem at the national, regional, and global levels. Objectives The present review will utilise the COSMIN taxonomy on the quality of outcome measures to identify and review the instruments used in measuring elder abuse, assess the instrument's measurement properties, and identify the definitions of elder abuse and abuse subtypes measured by the instrument. Search Methods Searches will be conducted in the following online databases: Ageline, ASSIA, CINAHL, CNKI, EMBASE, Google Scholar, LILACS, Proquest Dissertation & Theses Global, PsycINFO, PubMed, SciELO, Scopus, Sociological Abstract and WHO Index Medicus. Relevant studies will also be identified by searching the grey literature from several resources such as OpenAIRE, BASE, OISter and Age Concern NZPotential studies by searching the references of related reviews. We will contact experts who have conducted similar work or are currently conducting ongoing studies. Enquiries will also be sent to the relevant authors if any important data is missing, incomplete or unclear. Selection Criteria All quantitative, qualitative (that address face and content validity), and mixed‐method empirical studies published in peer‐reviewed journals or the grey literature will be included in this review. Studies will be included if they are primary studies that (1) evaluate one or more psychometric properties; (2) contain information on instrument development, or (3) perform content validity of the instruments designed to measure elder abuse in the community or institutional settings. Studies should describe at least one of the psychometric properties, such as reliability, validity and responsiveness. Study participants represent the population of interest, including males and females aged 60 or older in community or institutional settings (i.e., nursing homes, long‐term care facilities, assisted living, residential care institutions, and residential facilities). Data Collection and Analysis Screening of titles, abstracts, and full texts of the selected studies will be evaluated based on the preset inclusion criteria by two reviewers. Two reviewers will be assessing the quality appraisal of each study using the COSMIN Risk of Bias checklist and the overall quality of evidence of each psychometric property of the instrument against the updated criteria of good measurement properties. Any dispute between the two reviewers will be resolved through discussions or consensus with a third reviewer. The overall quality of the measurement instrument will be graded using a modified GRADE approach. Data extraction will be performed using the data extraction forms adapted from the COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments. The information includes the characteristic of included instruments (name, adaptation, language used, translation and country of origin), characteristics of the tested population, psychometric properties listed in the COSMIN criteria, including details on the instrument development, content validity, structural validity, internal consistency, cross‐cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, responsiveness and interoperability. We will perform a meta‐analysis to pool psychometric properties parameters (where possible) or summarise qualitatively.
... In addition, there are different views concerning the degree of severity of the consequences [8][9][10]. Hence, a lack of knowledge and ambiguity as to what constitutes neglect have implications for both the detection and reporting of neglect [7,8,10,14,16,35,54,55]. ...
... Norway has a relatively open and non-hierarchical healthcare system, with laws that formally protect whistle-blowers compared to some other countries where one may be held personally accountable and risk facing a lawsuit when reporting individual or system failures [60]. Nevertheless, persistent challenges with underreporting in Norwegian nursing homes may lead to the possible introduction of anonymous reporting, which has been implemented successfully in some countries [9,54]. This strategy, which intends to protect the staff, can be questionable, and it may be argued that patient safety should be the main priority. ...
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Background: Research shows that nursing home residents' basic care needs are often neglected, potentially resulting in incidents that threaten patients' safety and quality of care. Nursing staff are at the frontline for identifying such care practices but may also be at the root of the problem. The aim of this study was to generate new knowledge on reporting instances of neglect in nursing homes based on the research question "How is neglect reported and communicated by nursing home staff?" Methods: A qualitative design guided by the principles of constructivist grounded theory was used. The study was based on five focus-group discussions (20 participants) and 10 individual interviews with nursing staff from 17 nursing homes in Norway. Results: Neglect in nursing homes is sometimes invisible due to a combination of personal and organizational factors. Staff may minimize "missed care" and not consider it neglect, so it is not reported. In addition, they may be reluctant to acknowledge or reveal their own or colleagues' neglectful practices. Conclusion: Neglect of residents in nursing homes may continue to occur if nursing staff's reporting practices are making neglect invisible, thus proceeding to compromise a resident's safety and quality of care for the foreseeable future.
... Maltreatment of the elderly is universally reported (Cooper et al. 2008). Public/governmental awareness of elder abuse has grown slowly (Podnieks et al. 2010). ...
... The Clearinghouse on Abuse and Neglect of the Elderly (CANE) bibliographies underscore the global nature of elder maltreatment and describe cultural similarities and differences defining maltreatment: causes, perceptions about what constitutes abuse and neglect, and impediments to identification and elimination. Cooper et al. (2008) pointed out the inherent difficulty in establishing the prevalence of abuse globally (range 3.2-27.5%), concluding the following: one in four dependent elders is at risk, but little abuse or neglect is detected. ...
... Rights reserved. Moreover, the negative impact of elder abuse on the quality of life observed in our study resonates with findings from international studies (Anetzberger, 2005;Cooper et al., 2008;Melchiorre et al., 2013;Mysyuk et al., 2015). For instance, Pillemer et al. conducted a comprehensive review and concluded that elder abuse not only diminishes quality of life but also increases mortality risk (Pillemer et al., 2016). ...
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Background Elder abuse is a significant public health concern that can severely impact the Quality of Life (QoL) of older adults. As the global population ages, the incidence of such abuses is increasingly concerning, particularly in countries like India, where societal transitions are affecting traditional familial structures and roles. This study aims to examine the association between elder abuse, age-related disabilities, and QoL among older adults in India, using data from the first wave of the Longitudinal Ageing Study in India (LASI). Methods This study analysed a nationally representative sample of 64,871 individuals aged 45 years and above from the LASI dataset. Elder abuse was assessed based on self-reports of ill-treatment in the past year, while QoL was measured using a composite index derived from principal component analysis, covering various domains such as physical health, social relationships, and environmental satisfaction. The analysis included descriptive statistics, chi-square tests, and multivariate linear regression to explore the relationships between elder abuse, sociodemographic factors, and QoL. Results The prevalence of elder abuse was found to be 4% among the sample population, with higher rates observed among adults aged 75 and above, males, and those living in rural areas. Multivariate analysis revealed that elder abuse is significantly associated with a reduction in QoL across all domains, even after adjusting for sociodemographic variables. Older adults with multimorbidity and those facing difficulties in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were particularly vulnerable to both elder abuse and reduced QoL. Conclusion The study provides compelling evidence that elder abuse is a critical determinant of reduced QoL among older adults in India. The findings highlight the need for targeted interventions to prevent elder abuse and improve the well-being of vulnerable populations, particularly those with multiple morbidities and functional disabilities. Addressing these issues is essential for enhancing the quality of life among the elderly and ensuring their dignity and safety in old age.
... It should also be recommended that Russian authorities investigate the cases, when alcoholics, disabled and other people were deprived of their apartments or houses as a result of criminal acts or fraud, having become homeless, and to help these people to obtain decent accommodation. For prevention, detection strategies such as whistle-blowing schemes should be maintained (Cooper et al. 2008). ...
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The problem of excessive alcohol consumption in the Russia is known; but there is a tendency to exaggerate it, aimed at disguising shortcomings of the healthcare, with responsibility for enhanced mortality especially in males shifted onto people as if it were self-inflicted by alcohol. Heavy drinking is a criminogenic factor; but again, the alcohol-related crime tends to be exaggerated. In this way the organized crime and corruption, often with participation of authorities or their members, is obfuscated. Alcohol is often mentioned by the literature and media in the context of family violence and child abuse. Without denying the problem, it should be commented that it is easier to denounce a socially unprotected perpetrator, in particular, an alcoholic. Otherwise, various tools are applied to prevent a disclosure: denial of facts, allegations of slander, threats and intimidation, appeals to preserve honor of the family or nation. During the anti-alcohol campaign (1985-1989), many distilleries producing vodka from grain and potatoes were dismantled. After the campaign, technical alcohol met no demand from the stagnating industry. It was generally known and smelled that technical liquids were used for production of beverages legally sold in bottles with usual labels. The astringent taste of technical alcohol is known as it was stolen from some factories and institutions. After the abolition of the state alcohol monopoly in 1992, the country was flooded by alcoholic beverages of poor quality, sold through shops and kiosks. Legally sold beverages caused poisonings up to lethal ones. After the campaign, the life expectancy in Russia decreased especially in men; in the period 1993-2001 it was estimated around 58-59 years. Among the causes has been the limited availability of modern healthcare, chronic diseases often left untreated, late detection of malignancies, poor quality of legally sold alcoholic beverages, crime against alcohol-depended people resulting in homelessness and premature death. Fortunately, the life expectancy tends to increase, while the per capita alcohol consumption and heavy binge drinking are declining. Certain Russian authors exaggerate the cause-effect relationships between alcohol and cardiovascular diseases, thus depicting the enhanced mortality as largely self-inflicted by alcohol. Furthermore, governmental policies and some alcohol-related topics (treatment of patients with supposed alcoholism, child and elder abuse, sexual and reproductive coercion) are discussed in this review. In conclusion, according to the principles of medical and common ethics, the society must care of its unprotected members, including aged persons suffering of alcohol use disorders.
... Due to an ageing global population, the costs and consequences of risks to health in older age will become more significant. The extent to which violence is experienced in later life in England is unclear (Cooper et al., 2008), as is the relationship between recent experience of violence and mental health in older age. The source of official statistics on prevalence of violence, the Crime Survey for England and Wales (CSEW), excluded respondents older than 59 from its self-completion (where detailed violence data are collected) until 2017, and since 2017 excluded those aged over 74 (Office for National Statistics, 2021). ...
... Overall, the majority of published tools were predicated on inadequate construct descriptions (abuse-focused tools) and tests of validity with older adults [24,25]. Many previously developed scales constituted components of generic older adults' abuse measurements [25][26][27]. ...
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Background Divergent cultural contexts and norms shape perceptions of elder abuse and neglect in Western and Arab societies. The psychometric properties of instruments measuring elder neglect and abuse in Arabic have not been previously examined. Validating these instruments can enhance the consistency of elder neglect and abuse (NA) prevalence estimates and contribute to a more comprehensive understanding of the issue at national, regional, and global levels. This study represents the first attempt to validate the Arabic version of the 11-item Neglect and Abuse Scale (NAS) and establish its psychometric soundness in a sample of Arabic-speaking Older Adults in the Community. Method A cross-sectional study encompassed 539 Arabic-speaking older Egyptians, with 50.3% being female and 60.7% aged between 65 and 75. Participants completed an anonymous Google form-based questionnaire that included the NAS, the Older People's Quality of Life-brief (OPQOL-brief) Questionnaire, 15-item Resilience Scale of Older Adults (RSOA), and sociodemographic inquiries. The forward-backward translation method was employed to ensure accurate translation. Results Exploratory Factor analysis with Varimax rotation unveiled two factors from the NAS, reflecting the multidimensional nature of the scale. Confirmatory factor analysis validated the two-factor solution, demonstrating a good fit to the data. Reliability assessments showed a satisfactory level of internal consistency for the overall score and the two factors (Cronbach’s α = .83 − .88 / McDonald’s ω = .83 − .89). Sex invariance tests indicated that male and female participants did not significantly differ in the measurement features, suggesting the scale's applicability and interpretability across sexes. Concurrent validity analysis revealed a moderate negative correlation between the Arabic NAS scores, RSOA (r =-.28, p < .001) and OPQOL-brief (r =-.41, p < .001) scores. Conclusion This study provides a valid and reliable tool to identify and evaluate older adults’ abuse and neglect in Arabic-speaking communities, supporting effective intervention and prevention efforts. It also facilitates cross-cultural comparisons of abuse and neglect rates, risk factors, and outcomes between Arabic-speaking community-dwelling older adults and other language groups, advancing the global understanding of this issue.
... Parents neglecting their children have been termed as either intentional or unintentional while some cases it is circumstantial, but outcome remains the same which is parental inaction depriving the child of its basic right [3], [4]. Similarly, when a child is neglecting his elderly parent, it is termed as inability to take care of the elderly which is the basic right of the victim at that age [5]. Generally, when it comes to legislations and regulations, most of the governing bodies have kept silent on such socially sensitive issues. ...
Article
Social interaction between humans occur across all ages and cultures, and is considered an essential element of humans' social ability. Humans when born are taken care of by parents and when they are about to die are expected to be taken care of their children. At times, these relations may not follow norms which is when an elderly starts being maltreated by those who are supposed to take his care. Elder abuse is prevalent among medical and dental outpatients and has been observed to affect treatment compliance. Interventions in elder abuse are primarily to prevent its occurrence by proper community education. We present a case of an elderly patient who reported with repeated fractures of his two prostheses (complete dentures) in a span of 6 months. Other features that indicated him being an elder abuse victim included not getting denture treatment for 4 years, unusual pattern of denture fractures and not having witnessed how the denture fractured. The patient was given a new complete denture prosthesis that was fabricated with a permanent metal denture base. The patient was satisfied with the treatment outcome.
... Studies have reported that the incidence of EA and neglect ranges from 2.2 to 62.3% internationally. 15,[34][35][36][37][38][39] In Iran, similar to many countries, various studies have been conducted in this area that reported the prevalence of EA to range from 17.1% to 90.4% in different regions. 4,28,[40][41][42][43][44][45][46] Most EA occurs at home by family members/ caregivers. ...
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Background: Elder abuse (EA) is a serious public health issue recognized as a healthcare priority. Personality traits can influence social behaviors. This study aimed to determine the prevalence of self-reported domestic EA and its relationship with personality traits of older people and their family caregivers. Methods: A cross-sectional study was conducted in 2022. The research population included older people living in the urban community of the Lorestan Province (in the western region of Iran) selected by multistage cluster sampling. In general, 998 older people and their family caregivers were sampled. The data collection tool was a three-part questionnaire: a. demographic characteristics of the older people, b. questionnaire on the incidence of elder abuse, and c. short version of the NEO Five-Factor Inventory-Revised (NEO-FFI-R) for measuring the personality traits of the older people or family caregivers. The statistical software used was Stata 14. Results: The present study reported that the prevalence of EA at home was 37.78%. In the present study, older age, female gender, unmarried/single status, lower education, unemployment, and rented house characteristics were predictors of EA. High agreeableness, high extroversion, and low neuroticism reduce conflict and tension in older people with their relatives and family, which appear to be protective factors against EA. Conclusion: Policymakers and health experts should prepare training and screening programs to consider these factors so that older people exposed to EA can be identified more quickly and early interventions can be used to improve their health status and increase their quality of life.
... The lack of nursing skills and improper attitude or behavior could lead to older adult abuse in the provision of older adult care (4). A 2020 meta-analysis showed that the incidence of older adult abuse in China was as high as 20.29% (5) while another study showed that a quarter of frail older adults were at risk of abuse and neglect, but only a small proportion could be identified (6). It is highly possible that such abuse is mostly ignored due to the lack of awareness of abuse among care workers. ...
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Background Neglect is a common form of abuse, and long-term care facilities record higher incidences of this abuse. Given that older adult care workers are the main workforce in these facilities, their neglectful behavior requires public health attention. Internal individual characteristics can lead to older adult abuse, and managing workers who abuse older adults may require various methods. This study aimed to identify the profiles of neglect among older adult care workers in long-term care facilities and explore the influencing factors of neglect. Methods In this cross-sectional study, a convenience sample of older adult care workers from 15 long-term care facilities in Shandong Province (N = 421) completed a questionnaire on the characteristics associated with neglect. Latent profile analysis was used to identify distinct neglect profiles and promote the understanding of individual characteristics associated with varying levels of neglect. One-way analysis of variance and multivariate logistic regression analyses were used to examine the population characteristic differences. Results Older adult care workers exhibited three neglect profiles, namely, the “low-risk group,” “medium-risk group,” and “high-risk group.” Males, participants with no employment qualification certificate, and those who did not attend regular training represented the majority of those in the “high-risk group.” Participants with a monthly income of more than ¥ 4,000 and nursing 1–2 older adults simultaneously represented the majority of those in the “low-risk group.” Conclusion Long-term care facility administrators should tailor interventions to individual care worker profiles to reduce neglect behaviors and improve care levels.
... Elder abuse and neglect are projected to affect 27.5% of people worldwide (Cooper et al., 2008). Estimates of elder abuse rates in the Asian region vary widely, from 0.22 per 1000 to 62% (Yan et al., 2015). ...
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The purpose of this paper is to identify and summarize the body of research on elder abuse in order to offer a more thorough understanding of the topic. Specifically, the goal is to identify and discuss the situation, risks and preventive measures related to elder abuse in light of Nepal's aging population. This narrative review was conducted after searching the article databases including Google Scholar, PubMed and Nepjol. A total of twenty seven journal articles, four systematic review articles, five books, five reports, one dissertation, two national acts of Nepal, four webpage articles and one methodological journal article were reviewed during a period from September 2022 to June 2023. The narrative review in the area of elder abuse is reflected in this article. Studies have shown that several misuse hazards are higher for senior citizens. Elder abuse is any single or recurrent act that hurts or distresses an older person and takes place in any relationship where there is an expectation of trust. The aging populations of many nations, including Nepal, are growing quickly, as are the number of senior abuse incidents. There are numerous government organizations, international and national non-governmental organizations, and local bodies doing admirable work concerning the investigation of elder abuse and the provision of assistance to elder abuse victims through the sharing of research experiences and the practical implementation of various prevention strategies. However, much more needs to be done for this at-risk population group in our society. In addition to raising social security for all seniors, it is recommended that each municipality in Nepal build an Elderly Service Center.
... Every year in the UK, approximately 10% of children who present to the ED are victims of abuse [15,16]. In a global study of those aged 60 or over, a fifth of patients were found to have been neglected [17]. These patients require safeguarding, which means to "protect people's health, wellbeing and human rights, and enable people to live free from harm, abuse and neglect" [18]. ...
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Background Pharmacists with additional clinical skills now work in UK emergency departments. Known as Emergency Department Pharmacist Practitioners, the role was developed in response to a shortage of physicians and nurses. They carry out activities typical of traditional hospital pharmacists, but also novel ‘practitioner’ activities such as examining patients, and acting as designated care provider. The role includes a responsibility to safeguard patients from harm. Professional competence, i.e. to safeguard patients, is underpinned by knowledge of the subject, but also knowledge application. Aim To investigate what Emergency Department Pharmacist Practitioners know and understand about safeguarding vulnerable children and adults. Method Thirteen Emergency Department Pharmacist Practitioners were interviewed to explore their knowledge and understanding of safeguarding. Interview questions were developed from review of relevant literature, as were vignettes with variables identified and altered to produce different scenarios. Template analysis was used to code data to a priori themes for each of the stages of the initial safeguarding process, and new themes that emerged throughout the process. Results Six themes were identified in addition to the four a priori themes. Overall, participants frequently described how safeguarding concerns are both recognised and responded to, but seemed more comfortable when responding to medicines related concerns. Factors thought to influence the safeguarding process included: resources and setting; and education, training and experiential learning; and culture. Conclusion While Emergency Department Pharmacist Practitioners interviewed were aware of the safeguarding process, there were some misconceptions as to the roles of different healthcare workers in this process.
... In acknowledgment of the prevalence of elder abuse among the aging population, the International Network for the Prevention of Elder Abuse, which holds Economic and Social Council status with the United Nations, was established in 1997 to increase international awareness of elder abuse in both developed and developing countries (Sooryanarayana, Choo, and Hairi 2013). And thus, more recently, the term elder abuse has been refined to refer to both the intentional and unintentional behavior perpetrated against the elderly that causes physical or mental distress, violates their personal rights, exploits them financially, and generally neglects them or disregards their needs (Cooper, Selwood, and Livingston 2008;Daly, Merchant, and Jogerst 2011;Yan, Chan, and Tiwari 2015). ...
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The authors focus on a traditional culture in which the elderly tend to live with their children, aiming to shed light on whether the education of own children within the same household helps reduce the chances of elderly parents’ being mentally and physically abused by family members. Using multivariate analysis to investigate the association between children’s education and domestic elder abuse from the Vietnam Aging Survey 2011, comprising 2,700 elderly individuals aged 60 years and older, the authors find that the higher the education level of an elderly person’s children living in the same household, the lower the risk for the elderly person’s being abused. Those facing the highest risk for violence are women aged 80 years and older, those who have some difficulty with daily activities, and those who live in urban areas. The authors call for policy attention to an issue that is rarely investigated, especially in traditional households where elderly parents live with their children.
... For example, physical abuse affects about 1 in 11 children in the UK every year and 10% of children who present to the ED are victims of abuse [12,13]. In a global study of the elderly (those over 65 years of age), a fth of patients were found to have been neglected [14]. These patients require safeguarding, which means to "protect people's health, wellbeing and human rights, and enable people to live free from harm, abuse and neglect" [15]. ...
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Background Pharmacists with additional clinical skills now work in UK emergency departments. Known as Emergency Department Pharmacist Practitioners, the role was developed in response to a shortage of doctors and nurses. They carry out activities typical of traditional hospital pharmacists, but also novel ‘practitioner’ activities such as examining patients, and acting as designated care provider. The role includes a responsibility to safeguard patients from harm. Professional competence, i.e. to safeguard patients, is underpinned by knowledge of the subject, but also the ability to apply that knowledge. Objective To investigate what Emergency Department Pharmacist Practitioners know and understand about safeguarding vulnerable children and adults. Methods Emergency Department Pharmacist Practitioners were interviewed to explore their knowledge and understanding of safeguarding. Interview questions were developed from review of relevant literature, as were vignettes with variables identified and altered to produce different scenarios. Template analysis was used to code data to a priori themes for each of the stages of the initial safeguarding process, and new themes that emerged throughout the process. Results Six themes were identified in addition to the four a priori themes. Overall, participants frequently described how safeguarding concerns are both recognised and responded to, but seemed more comfortable when responding to medicines related concerns. Factors thought to influence the safeguarding process included: resources and setting; and education, training and experiential learning; and culture. Conclusions While Emergency Department Pharmacist Practitioners interviewed were aware of the safeguarding process, there were some misconceptions as to the roles of different health workers.
... Over recent years estimated prevalence of elder abuse has rapidly increased, from figures of around 6% of the general older population (Cooper et al., 2008) to the figure provided earlier in this chapter of 15.7% (Yon et al., 2017). These numbers may be higher for people with additional vulnerabilities, including physical disabilities (Hughes et al., 2012), or decision-making issues such as dementia (Dong et al., 2014), and people living in residential care settings (Castle et al., 2015). ...
Chapter
This chapter examines the historical development of the abuse of older people as a social issue. It focuses primarily on the current social policy context in Australia, with additional information provided from Canada and New Zealand to compare and contrast these three settings. Elder abuse social policy is interrogated using Carol Bacchi’s (Engaging with Carol Bacchi: strategic interventions and exchanges. University of Adelaide Press, Adelaide, 2012) ‘What’s the Problem Represented to be?’ approach in order to critique common understandings of the issue and examine the social policy effects, ambiguities and silences. Alternative social policy approaches to understanding the abuse and mistreatment of older people are considered to address perceived gaps.KeywordsSocial policyDomestic and family violenceAbuse of older peopleElder abuse
... An estimated 3 million individuals in the United States are affected by elder abuse annually. (Cooper et al., 2008). Turkey does not have a national database on elder abuse. ...
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geriatric eye emergencies
... The data collection tool included the demographic characteristics checklist and the Hwalek-sengstock elder abuse screen test (HS-EAST) and the inventory among older Iranians 10-item personality inventory (TIPT). Tenitem personality inventory (TIPT) was used to collect information related to the variable of personality traits [7] and according to the results of Gosling et al.'s studies, the norm of each of the big-five personality traits was adjusted for the elderly population [8]. Hwalek-sengstock elder abuse screen test has 15 items (with yes/no answers) and the range of points obtained from completing the questionnaire is between 0 and 15. ...
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Objectives This study aims to investigate the relationship between the big-five personality traits (extroversion, neuroticism, agreeableness, conscientiousness, and openness to experience) and elder abuse. Methods & Materials In this cross-sectional study, 304 older adults (60 years old and older) were selected by convenience sampling method based on the inclusion criteria among older adults who were referred to the health centers of Marand City, Iran in 2021. To collect data, Hwalek-sengstock elder abuse screen test (HS-EAST) and 10-item personality inventory (TIPI) were used. The data were analyzed using SPSS software version 23 with t test, chi-square, and logistic regression. Results The mean age of the participants was 70.5±7.7 years with almost equal gender distribution. Among the older adults studied, the prevalence of elder abuse was calculated to be 34.2%. The results of logistic regression indicated that the five-big personality traits, especially low conscientiousness, low extroversion, low agreeableness, and high neuroticism after controlling the variables of sex, age, marital status, housing status, education level, employment status, and chronic disease significantly predicts elder abuse (P<0.001, df=12, X2=76.64). Conclusion Based on the findings of the present study, it is suggested to pay more attention to the five-big personality traits in the screening and early identification programs of older adults at risk of elder abuse.
... Additionally, we discovered a positive correlation between older persons' psychological well-being and their cognitive function. This agrees with the findings of further research [71,72]. In comparison to their cognitively similar-aged contemporaries, older individuals with high psychological well-being may have higher environmental mastery, a sense of purpose in life, and pleasant relationships with others [71]. ...
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Background: In view of the rapidly accelerating aging process in China, this study looked at the associations between vegetables and fruits intake pattens and cognitive function among the oldest old in China using the genetic sub study from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Methods: This study screened respondents who participated in all four surveys of longitudinal data from the CLHLS, and a total of 2454 participants were ultimately included. The relationships of cognitive function with vegetables and fruits intake patterns were examined using Generalized-estimating equations. Results: The prevalence range of mild cognitive impairment (MCI) was 14.3% to 16.9% at T1 to T3 and 32.7% at T4. There was a significant increase in the prevalence of MCI from T1 to T4 (β = 0.054; 95% CI, 0.037 to 0.070; p < 0.001; adjusted). The V+/F+ pattern significantly improved cognitive function in Chinese older adults compared with the V-/F- pattern (OR, 1.026; 95% CI, 1.001-1.053; p < 0.05). Conclusion: Older adults who frequently consume both fruits and vegetables experience a reduction in MCI risk relative to those consuming these food groups infrequently-emphasizing the critical importance of the regular intake of both fruits and vegetables in maintaining cognitive function.
... Although few professionals admit to committing abuse, a high number of abuses have been observed by home care professionals suggesting institutionalized abuse copping. 2 Due to the current reality of the aging population and the increase in health service demand and complex treatments, it is foreseeable that taking proper care of an older person must guide the current education and training of future dentists. ...
Article
Purpose: The aim of this study is to investigate the literature to evaluate dental students' attitudes regarding the treatment of older adults. Methods: A scoping review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses/PRISMA guidelines to identify articles from four electronic databases: MEDLINE via the PubMed interface, Embase, Cumulative Index to Nursing and Allied Health Literature, and AgeLine. Gray literature searches were also performed in Scopus, Web of Science, and ProQuest Dissertations and Theses-Health and Medicine. Results: Eleven articles were assessed. The majority (72, 72%) were published between 2011 and 2020, evidencing various contexts of dental students, such as different countries and cultures, and levels of education. The most commonly used tool/instrument to survey dental students' attitudes was the Aging Semantic Differential Scale. Student age, race, and marital status did not seem to interfere with dental students' attitudes regarding the treatment of older adults. Conclusions: Dental students tend to have a positive attitude toward older people. In this context, female students, students who interact with older people, and clinical students have more positive attitudes than male and nonclinical students.
... Although the victim's report is the most accurate way to identify some types of socioeconomic vulnerability such as violence (Cooper et al. 2008), fear of retaliation and shame are impediments to vulnerable groups sharing their problems or making a complaint (Fogarty et al. 2002;Wanderbroocke & Moré 2013). Thus, the use of indicators based on the assessment of the environmental and family context can be essential to identify socioeconomic vulnerability. ...
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A One Welfare approach allows intervention to resolve problems related to the human-animal-environment interface. However, in Brazil and many other countries, there is poor communication between human and animal welfare services. In this research we considered a One Welfare approach in cases of abuse involving dogs and cats. When investigating pet abuse, professionals from the Animal Welfare Division of Pinhais, Brazil, can enter the home environment. During routine animal abuse investigations, the demographic profile of pet owners and their socioeconomic vulnerability was also recorded. Results from forty-five cases with (n = 30) and without (n = 15) suspicion of socioeconomic vulnerability were sent to the Department of Social Assistance of Pinhais, Brazil for confirmation. Socioeconomic vulnerability was suspected if socioeconomic problems were reported by the pet owners under investigation or their neighbours, as well by assessment of the socioeconomic environment of the families during home visits. Economic disadvantage was the most prevalent socioeconomic vulnerability. Cohen’s Kappa coefficients support the ability of animal welfare service professionals to detect socioeconomic vulnerability. Almost half of all families considered to have socioeconomic vulnerability had not previously participated in social programmes. In all cases involving families already being assisted by the Department of Social Assistance, pets were found to be suffering abuse. Families with socioeconomic vulnerability confirmed were included in the social programmes. These results support the need for a multi-disciplinary approach to improve the well-being of families with dogs and cats. This study can help guide the development of an interdisciplinary approach to address animal abuse cases.
... Estimates of the prevalence of elder abuse also vary widely, ranging between 3.2-27.5% (Cooper et al., 2008). In addition, child to parent physical FV is estimated to occur in 10% of families , and aggression from adolescents towards their parents represents 1-7% of FV episodes reported to police in Australia (Moulds et al., 2019). ...
Thesis
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In recent decades Family Violence (FV) researchers have developed risk assessment instruments to enable practitioners to identify the people who are most likely to commit FV in the future, and the families who are most likely to experience ongoing harm. Indeed, risk assessments have become a standard procedure for FV practitioners who are frequently required to make decisions with potential ramifications for families’ safety and wellbeing. Yet, despite considerable developments in risk assessment research and practice, risk assessment instruments have limitations that curb their value to FV practice. In addition, such instruments should be empirically validated, but there is limited evidence for the validity of risk assessment instruments used by agencies that respond to FV in Aotearoa New Zealand. Therefore, in this thesis, we examined the risk assessment procedures that New Zealand Police and the Integrated Safety Response (ISR) used for FV, with the purpose of contributing to the evidence base about risk assessment for FV in New Zealand and identifying strengths, weaknesses, and opportunities for improvement. This thesis contains three manuscripts either published in or submitted to peer-reviewed academic journals; as well as supplementary chapters that support, extend, and integrate the research findings. In the first manuscript, we examined the predictive validity of risk categories from the Dynamic Risk Assessment for family violence (DYRA) and Static Assessment of Family Violence Recidivism (SAFVR)—the two risk assessment instruments that New Zealand Police use when responding to FV cases—for a sample of 2,115 cases with FV episodes reported to police in Waikato and parts of Canterbury between 1 November – 9 December 2018 (1,817 of which had complete risk categories). We examined the instruments’ ability to predict recurrence (i.e., a further FV-related call for police service) at three intervals (3 days, 12 weeks, and 24 weeks), and found both instruments had a poor ability to discriminate between aggressors who had a recurrence and those who did not, with the SAFVR outperforming the DYRA, and the DYRA performing especially poorly for non-intimate partner cases, and aggressors who were Māori or women. In the second manuscript, we explored the risk assessments that Integrated Safety Response (ISR) triage team members conducted for a sub-sample of 842 cases with FV episodes reported to police between 1 – 14 November 2018. We examined the relationship between the factors triage teams recorded during their risk assessments and the risk categories the teams assigned, then tested the association of both the factors and categories with recurrence and physical recurrence within 24 weeks. The predictive validity of ISR triage teams’ risk categories was comparable to the results produced for the DYRA and SAFVR in manuscript one. The ISR risk categories again performed poorly for aggressors who were women, Māori, and for non-intimate partner cases; and overall, fewer than half of the factors triage teams recorded were associated with recurrence or physical recurrence. Then, in an additional chapter, we explored the triage teams’ factors’ utility for case management and found the factors could be used to create three sub-groups of cases with potential implications for their treatment and management. Finally, in the third manuscript, we modeled the behavioral patterns of 2,115 aggressors with a FV episode reported to police in Waikato and parts of Canterbury between 1 November – 9 December 2018, by collecting reports for further FV episodes involving those aggressors during the two years after the index episode. We used this information to describe three latent states behind the information reported to police and identified four common pathways through the latent states over time. We concluded this manuscript by discussing changes that could contribute to improvements in how risk for FV aggressors is conceptualized, assessed, and communicated in practice. In each chapter, we discussed the theoretical and practical implications of the findings, before integrating those findings and implications in a general discussion chapter. Taken together, the results presented herein indicate that the risk assessment instruments used in New Zealand can predict risk for FV recurrence better than chance, but that those assessments should be further developed to improve their value to FV practice and ensure they adequately capture risk for different types of FV cases and groups of people. This thesis advanced our understanding of the limitations of—and opportunities in—risk assessment research and contributed to the evidence base for risk assessment for FV in New Zealand.
... Elder abuse is a common phenomenon in many countries. In a review of 44 studies around the world, the average prevalence of elder abuse was 15.7% (ranging from 3.2% to 27.5%) (7). In another study, the average prevalence of elder abuse in 28 countries was 14.1% in 2017 (8). ...
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Introduction: Elder abuse is a major public health concern worldwide. Considering the high prevalence of misbehavior towards the elderly, this study investigated the prevalence of elder abuse and its related factors among the elderly people in Yasouj, Iran in 2021. Methods: Using a convenience sampling method, this cross-sectional study included 299 older adults aged over 60 years referring to the Social Security Outpatient Clinic in Yasouj. To collect data, we used the Domestic Elder Abuse Questionnaire. To analyze the data, chi-square and multiple logistic regression statistical tests were used. Results: Of the participants, 55.2 % reported at least one type of misbehavior. While psychological misbehavior had the highest prevalence (41.8 %), rejection had the lowest prevalence (10.7 %). Multiple regression analysis showed that elder abuse was statistically associated with higher educational status (p = 0.002), lower economic status (p = 0.002), and single people reported a higher rate of elder abuse (p = 0.001). Conclusion: According to our results, more than half of the participants reported at least one type of elder abuse, and psychological abuse was the most common type of abuse experienced by the elderly. Since elder abuse can have serious effects on the health and well-being of the elderly, it is critical to identify the related risk factors. Furthermore, it is essential to implement screening programs to increase the awareness of the elderly and caregivers.
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Among the phenomena that threaten the aged population, one is abuse, which leads to serious physical and psychological consequences, cognitive decline, and even premature death. Therefore, the present study was conducted to investigate the effectiveness of mindful self-compassion (MSC) intervention on cognitive ability in aged individuals who have experienced abuse. The research method was quasi-experimental with a single group pretest-posttest-follow-up design. The statistical population included all abused individuals living in nursing homes in Rasht, Iran in 2023, among whom 12 (60 to 80 years old) were selected by the convenience sampling method and based on the eligibility criteria. To collect data, Rodriguez & Carrasco's Geriatric Mistreatment Scale and Nejati's Cognitive Ability questionnaire were used. The participants underwent Germer and Neff's MSC intervention for 8 weekly 90-minute sessions. The data were analyzed using repeated measures analysis of covariance and Bonferroni post hoc test in SPSS-24 software. The results illustrated that the MSC intervention increased the cognitive ability of the abused individuals (P<.05). In other words, the MSC intervention is effective in increasing the cognitive ability of the abused aged population. According to the findings of this study, therapists and centers specializing in geriatrics can use the MSC intervention as an effective solution to increase cognitive ability and prevent its decline in combination with other methods in older adults.
Article
Introducción: El maltrato de personas mayores ha sido reconocido sólo en los últimos años como un importante problema de salud pública. Existen diversas formas de abuso y esta situación puede darse tanto en el contexto familiar como institucional. Objetivo: Describir y sintetizar la evidencia disponible sobre el maltrato en el adulto mayor. Método: Revisión sistemática de bibliografía disponible en bases de datos especializadas, excluyeron los artículos en los que el título o su contenido no tengan relación con el objetivo de este trabajo. Resultados: Las prevalencias a nivel internacional oscilan entre el 3,2 y el 27,5%. En nuestro país, corresponde al 1,2% del total de denuncias por violencia intrafamiliar. Es probable que estas cifras estén subestimadas. Los factores de riesgo incluyen antecedentes de patología psiquiátrica, antecedentes de abuso de drogas y/o alcoholismo en la víctima, historia familiar de violencia, eventos estresantes recientes y estrés asociado a la dinámica del cuidado. El abordaje incluye medidas de prevención primaria y secundaria. Discusión: Ante la existencia de diferentes tipos de maltrato en personas mayores y de la gran variedad de patologías que esto puede desencadenar, se hace imperativo establecer medidas de prevención primaria, así como emplear métodos estandarizados de detección precoz. Es necesario que todo el equipo de salud esté involucrado en la evaluación. Conclusión: Es necesario implementar modificaciones legales y sociales que permitan satisfacer las necesidades de los adultos mayores, en especial de quiénes sufren de maltrato.
Chapter
Maltreatment of older adults is a worldwide social issue that is only beginning to emerge as a forensic entity that requires medicolegal adjustments to recognise, and investigate fatal. Like other segments of the population that are dependent on others, such as children, become vulnerable to abuse and neglect. Older adults can become reliant on others for care and subsequently vulnerable to maltreatment because of the high prevalence of age-related changes, diseases, and associated complex polypharmacy that can result in physical and cognitive decline. The abuse of older people is slowly emerging as a public health and criminal justice concern. In cases of datal elder maltreatment, the forensic pathologist, in partnership with the death investigation team, may be tasked with the detecting and the investigation of these deaths. This is challenging because the criteria of detecting elder maltreatment have not been established, the social isolation that is more frequent in this cohort and the unique pathophysiology due to age-related changes and diseases.
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There has been limited research on the association between elder abuse and depression, as well as elder abuse and suicidal ideation concurrently. Therefore, the present study aimed to investigate this association using the dataset from a nationally representative elderly sample in Korea. This study analyzed the dataset from the 2020 National Survey of Older Koreans. Elderly participants (aged over 65 years, n=9920) were included. Multivariate regression analysis was utilized to explore the risk factors associated with depression and suicidal ideation in the context of elder abuse. In this study, 5.1% of the elderly reported having elder abuse in the past year, while 12.8% and 1.9% reported having depression and suicidal ideation, respectively. In addition, among the elderly with depression, 8.4% had experienced elder abuse, while among those reporting suicidal ideation, 17.6% had suffered from elder abuse. Multiple logistic regression revealed that elder abuse is independently associated with both depression [odds ratio (OR) for elder abuse=1.642] and suicidal ideation (OR for elder abuse=3.237). Besides elder abuse, poor subjective health status and poor social support were linked to higher risk of depression and suicidal ideation. Our findings revealed that elder abuse represented a substantial risk factor associated with both depression and suicidal ideation. Implementing preventive interventions to address these risk factors could have significant implications for public mental health.
Article
Violence in family caregiving, once a social taboo, is now emerging as a topic of scientific inquiry. Engaging with a non‐normative approach to care and critical reflection on research of abusive caregiver behaviour and elder abuse, this study argues that as caregiver violence is increasingly addressed in research, it is crucial to understand it as a complex issue within its social context. The study adds to this understanding by conducting a discourse analysis of violence prevention programmes in Finland, where third sector organisations have taken the initiative in addressing caregiver violence. Based on analysis of project materials, media texts and expert interviews related to two such violence prevention programmes, the study illuminates how caregiver violence is made intelligible through a combination of three kinds of understanding: institutional, humane and therapeutic. It is suggested that these understandings offer a way forward in thinking about the complex, sensitive topic of caregiver violence in sociological research on care.
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Background The examination of psychometric properties in instruments measuring abuse of older people (AOP) is a crucial area of study that has, unfortunately, received relatively little attention. Poor psychometric properties in AOP measurement instruments can significantly contribute to inconsistencies in prevalence estimates, casting a shadow of uncertainty over the magnitude of the problem at national, regional, and global levels. Objectives This review rigorously employed the Consensus‐based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline on the quality of outcome measures. It was designed to identify and review the instruments used to measure AOP, assess the instruments' measurement properties, and identify the definitions of AOP and abuse subtypes measured by these instruments, ensuring the reliability and validity of the findings. Search Methods A comprehensive search was conducted up to May 2023 across various online databases, including AgeLine via EBSCOhost, ASSIA via ProQuest, CINAHL via EBSCOhost, EMBASE, LILACS, ProQuest Dissertation & Theses Global, PsycINFO via EBSCOhost, PubMed, SciELO, Scopus, Sociological Abstract via ProQuest, Chinese National Knowledge Infrastructure (CNKI), Google Scholar and WHO Global Index Medicus. Additionally, relevant studies were identified by thoroughly searching the grey literature from resources such as Campbell Collaboration, OpenAIRE, and GRAFT. Selection Criteria All quantitative, qualitative (addressing face and content validity), and mixed‐method empirical studies published in peer‐reviewed journals or grey literature were included in this review. The included studies were primary studies that (1) evaluated one or more psychometric properties, (2) contained information on instrument development, or (3) examined the content validity of the instruments designed to measure AOP in community or institutional settings. The selected studies describe at least one psychometric property: reliability, validity, and responsiveness. Study participants represent the population of interest, including males and females aged 60 or older in community or institutional settings. Data Collection and Analysis Two reviewers evaluated the screening of the selected studies' titles, abstracts, and full texts based on the preset selection criteria. Two reviewers assessed the quality of each study using the COSMIN Risk of Bias checklist and the overall quality of evidence for each psychometric property of the instrument against the updated COSMIN criteria of good measurement properties. Disagreements were resolved through consensus discussion or with assistance from a third reviewer. The overall quality of the measurement instrument was graded using a modified GRADE approach. Data extraction was performed using data extraction forms adapted from the COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments. The extracted data included information on the characteristics of included instruments (name, adaptation, language used, translation and country of origin), characteristics of the tested population, instrument development, psychometric properties listed in the COSMIN criteria, including details on content validity, structural validity, internal consistency, cross‐cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, responsiveness, and interoperability. All data were synthesised and summarised qualitatively, and no meta‐analysis was performed. Main Results We found 15,200 potentially relevant records, of which 382 were screened in full text. A total of 114 studies that met the inclusion criteria were included. Four studies reported on more than one instrument. The primary reasons for excluding studies were their focus on instruments used solely for screening and diagnostic purposes, those conducted in hospital settings, or those without evaluating psychometric properties. Eighty‐seven studies reported on 46 original instruments and 29 studies on 22 modified versions of an original instrument. The majority of the studies were conducted in community settings (97 studies) from the perspective of older adults (90 studies) and were conducted in high‐income countries (69 studies). Ninety‐five studies assessed multiple forms of abuse, ranging from 2 to 13 different subscales; four studies measured overall abuse and neglect among older adults, and 14 studies measured one specific type of abuse. Approximately one‐quarter of the included studies reported on the psychometric properties of the most frequently used measurement instruments: HS‐EAST (assessed in 11 studies), VASS‐12 items (in 9 studies), and CASE (in 9 studies). The instruments with the most evidence available in studies reporting on instrument development and content validity in all domains (relevance, comprehensiveness and comprehensibility) were the DEAQ, OAPAM, *RAAL‐31 items, *ICNH (Norwegian) and OAFEM. For other psychometric properties, instruments with the most evidence available in terms of the number of studies were the HS‐EAST (11 studies across 5 of 9 psychometric properties), CASE (9 studies across 6 of 9 psychometric properties), VASS‐12 items (9 studies across 5 of 9 psychometric properties) and GMS (5 studies across 4 of 9 psychometric properties). Based on the overall rating and quality of evidence, the psychometric properties of the AOP measurement instruments used for prevalence measurement in community and institutional settings were insufficient and of low quality. Authors' Conclusions This review aimed to assess the overall rating and quality of evidence for instruments measuring AOP in the community and institutional settings. Our findings revealed various measurement instruments, with ratings and evidence quality predominantly indicating insufficiency and low quality. In summary, the psychometric properties of AOP measurement instruments have not been comprehensively investigated, and existing instruments lack sufficient evidence to support their validity and reliability.
Article
With the rapid increase in the aging population, more attention has been paid to studying older adults with dementia. Despite the fact that older adults with dementia are more likely to be abused compared to their cognitively intact counterparts, little attention has been paid to abuse within this population. This systematic review, conducted using the PRISMA model, aims to critically examine, evaluate, and synthesize literature on protective factors and adverse effects of elder abuse by informal caregivers among individuals with dementia. A search was undertaken using the Ageline, Medline, CINAHL, and PsycINFO databases for peer-reviewed articles published in English up to June 2023. A total of 291 articles were identified by the systematic search, and 8 articles were included in the review. The results showed that protective factors related to elder abuse are mainly examined at a perpetrator level, including caregiver-related, relational, and contextual factors. Adverse effects, specifically an increased risk of various medical conditions and poor medication adherence, were identified but less frequently discussed. The findings indicated future directions for practitioners, researchers, and policymakers to better serve older adults with dementia and their caregivers.
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While the number of older adults is increasing worldwide, abuse of them is also growing. However, these two phenomena take different paths in economically developed and developing countries. The existing literature indicates that while developing countries are aging very quickly, they are not prepared to handle the issues related to older adults, particularly the abuse of older adults. This paper underscores the urgency of implementing effective strategies to address elder abuse in this context. The primary objective of this paper is to evaluate the applicability of prevailing theories formulated initially to explain elder abuse in developed countries when applied to the unique circumstances of developing nations. Analyzing existing literature, this paper shows that although some theories are dominantly used to explain the phenomenon in developed countries, they need to explain the issue more adequately in the context of developing countries. Therefore, a different approach is required to explain the phenomenon in the context of developing countries. This paper argues that the political-economic perspective explains the abuse of older adults in developing countries better.
Chapter
Medical-psychiatric-legal issues are often inescapable in the treatment of geriatric patients. An elderly patient’s capacity to make decisions about a work-up ranges in risk, for example, from whether to pursue a X-ray with radio-opaque, contrast medium with adverse impact on kidney function, to a brain biopsy. Treatment decisions can range, for example, from capacity to give informed consent to an antidepressant that can interfere with libido, to open heart surgery to repair an expanding aortic aneurysm. Although some of these tasks fall within the purview of social workers or other specialists, early recognition by the clinicians who diagnose and direct medical treatment can help avoid more complicated medical-legal problems later and can facilitate smooth delivery of necessary medical and psychiatric care. The specific statutes that control medical practice, standard of care, definitions of capacity, guardianship, informed consent, involuntary psychiatric treatment, mandatory reporting, and other issues differ between jurisdictions; this chapter offers an overview of the basic concepts behind these topics and principles common to the majority of jurisdictions across the USA and other countries that strive to adhere to an individual’s right to make decisions over one’s own body. Topics discussed here also include decision-making capacity over financial matters and estates (testamentary capacity), surrogate decision-making such as conservatorships and guardianships, identification of elder abuse, recognition of vulnerability to undue influence, and mandatory reporting requirements.
Article
This article examines carers’ potential to care for older adults with disabilities in Trinidad. Quantitative data on willingness, availability and skills, together with qualitative data on factors affecting care potential, were collected from a large, nationally representative sample of Trinidadians. About 68 per cent of Trinidadians were willing to care for older relatives with disabilities, 42 per cent were available and 31 per cent perceived having the required skills. Factors affecting care potential include personal views, potential of social network, competency and constraints. Integrated results indicate the importance of evaluating existing governmental programmes, targeted support for various ethnic groups and to older carers, and skills training.
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This study was carried out to determine whether individuals' financial literacy levels are exposed to financial exploitation and to determine the relationship between sub-dimensions of financial exploitation and financial literacy. Within the scope of the study, a questionnaire was applied to 130 people. For the financial exploitation survey questions, the survey responses were first subjected to factor analysis. As a result of the factor analysis, the factors are divided into 3 dimensions and it is observed that the reliability levels are above the determined limits. Factors were determined as financial anxiety, financial fragility and financial dependency. Correlation analysis was performed for the relationship between financial literacy and financial exploitation, and regression analysis was performed to measure the effect of financial literacy on financial exploitation. Correlation and regression analyzes were performed separately for the relationship and effect levels between the sub-dimensions of financial exploitation and financial literacy. Looking at the results of the research, it was seen that individuals' financial literacy levels negatively affect their financial exploitation levels. As the level of financial literacy increases, the exposure of individuals to financial exploitation decreases. In addition, it has been observed that individuals' financial literacy levels negatively affect their financial anxiety and financial fragility levels, and their financial dependency levels are positively insignificant. In other words, as individuals' financial literacy levels increase, financial anxiety and financial fragility levels decrease, and it has been observed that there is no effect on the level of financial dependency.
Article
Elder abuse is related to numerous adverse health and mental health conditions in older adults and some studies indicated higher rates of elder abuse in ethnic and racial minority populations than non-Hispanic Whites. This current study aims to summarize the risk and protective factors associated with elder abuse in community-dwelling racial minorities. A systematic review was conducted following Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. AgeLine, Medline, PsycINFO, and CINAHL were searched without limitation on time periods of publication. Two authors independently screened the search results and assessed the eligibility and quality of the retrieved articles. A total of 718 articles were screened and 25 articles were included in the review. The 25 included studies’ publication dates range from 1989 to 2019. Five racial categories were generated: African Americans, Asian Americans, Native Americans, Hispanic Americans, and racial minorities in Canada. Risk and protective factors of elder abuse and its subtypes (e.g., physical and psychological abuse) for these racial groups were summarized. There are some common risk factors across racial minorities, such as dependence on caregivers and health issues. The review identified gaps and conflicting findings regarding culture and education that are worthy of further investigation. In particular, there is a lack of current research on elder abuse in racial minority older women, race minority subgroups, and protective factors of elder abuse. The results guide helping professionals to consider the role of traditional culture and identify warning signs of potential abuse among racial minority older adults.
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Background: Immunization is one the most successful public health initiative and it prevents estimated 2-3 million deaths around the world from Vaccine-Preventable Diseases. As per National Family Health Survey (2015-2016) full immunization coverage for India was 62%, for Gujarat it was 50.4% and for Rajkot district, it was 51.4%. Construction site workers are in general migratory population and Migrant population due to nature of their work might be more affected to get their child immunized. Objective: (1) The objective of the study is to study full immunization coverage among children (1–5 years) of construction workers (2) To find out reasons for Partial Immunization/Unimmunization (3) To see the effect of migratory pattern on full immunization coverage. Materials and Methods: Cross-sectional study was conducted at Construction sites in Rajkot city from January to December 2017 on 400 children who were residing at construction sites. Results: Full immunization coverage was 38.0% and left out children were 8.2%. Main reason for partial/unimmunization was parents does not know where to go to immunize their child and they were unaware about time and vaccination site for next doses of vaccine. There is a statistical significant correlation (P < 0.05) between migratory pattern and immunization coverage which suggest that as number of migration increases immunization coverage of child decreases. Conclusions: Immunization coverage in construction site workers is improved in compared to past with the efforts of government and implementation of different programs but still Full immunization coverage in children residing at construction sites is lower than the general population coverage so, more focus should be done on them with keeping in mind various factors which are affecting them and taking them into consideration at planning phase.
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This study examined the prevalence of elder abuse of Chinese in Hong Kong and also assessed its impact on their psychological functioning. A total of 355 (120 males, 235 females) elderly Chinese residing in Hong Kong responded to a questionnaire administered individually. Results indicated prevalence rates of 2% for physical abuse and 20.8% for verbal abuse. These rates were higher than those reported by a telephone survey of similar respondents. Rates did not differ significantly for men and women. Data from the General Health Questionnaire showed that abused elders, as compared with nonabused elders, scored significantly higher on overall psychological distress. Abused participants were also significantly more dependent on their caregivers than nonabused participants. This difference did not, however, predict the level of psychological distress after accounting for physical abuse and verbal abuse.
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This article describes a revised Conflict Tactics Scales (the CTS2) to measure psychological and physical attacks on a partner in a marital, cohabiting, or dating relationship; and also use of negotiation. The CTS2 has (a) additional items to enhance content validity and reliability; (b) revised wording to increase clarity and specificity; (c) better differentiation between minor and severe levels of each scale; (d) new scales to measure sexual coercion and physical injury; and (e) a new format to simplify administration and reduce response sets. Reliability ranges from .79 to .95. There is preliminary evidence of construct validity.
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This study aimed to establish preliminary estimates and related risk factors for elder abuse among Hong Kong Chinese families. A total of 276 elder Chinese participated in the study, among which 27.5% reported having experienced at least one abusive behavior committed against them by their caregivers during the surveyed year. The most common form of abuse was verbal abuse (26.8%), whereas physical abuse (2.5%) and violation of personal rights (5.1%) were relatively less common. There was no gender difference in the prevalence of elder abuse. Overall and verbal abuse were best predicted by participants'' poor visual and memory abilities, dependence on the caregivers, and caregivers'' nondependence on them. Physical abuse was best predicted by caregivers'' nondependence on the participants as well as participants'' dependence on the caregivers. Participants'' age was the only significant predictor for violation of personal rights. Results, limitations, and implications of the study were also discussed.
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(1) To assess the prevalence and the consequences of chronic verbal aggression, physical aggression, financial mistreatment, and neglect in a community-based sample; (2) to investigate the circumstances that led to the abuse and the ways in which the victims handled the problem. Prevalence was assessed in a population-based sample of 1797 older people living independently in Amsterdam, the Netherlands. In a follow-up study 1 year later, the victims were questioned again about the background and consequences of the abuse. The 1-year prevalence of elder abuse was 5.6%. The prevalence of the various types of elder abuse was: verbal aggression 3.2%, physical aggression 1.2%, financial mistreatment 1.4%, and neglect 0.2%. Most victims reported emotional reactions immediately after the abuse. Seven of 36 victims experienced physical or financial damage as a consequence of the abuse. More than 70% of the victims were able to stop the abuse, either by themselves or with the help of others. The rate of occurrence and the consequences of elder abuse in the Netherlands was established. Elder abuse is more widely spread if not only close relatives or people with whom the older person lives are considered as possible perpetrators but other familiar and trusted people are considered as well. Intervention should be focused on the roughly 40% of victims who were not able to stop the abuse.
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Although elder mistreatment is suspected to be life threatening in some instances, little is known about the survival of elderly persons who have been mistreated. To estimate the independent contribution of reported elder abuse and neglect to all-cause mortality in an observational cohort of community-dwelling older adults. Prospective cohort study with at least 9 years of follow-up. The New Haven Established Population for Epidemiologic Studies in the Elderly cohort, which included 2812 community-dwelling adults who were older than 65 years in 1982, a subset of whom were referred to protective services for the elderly. All-cause mortality among (1) elderly persons for whom protective services were used for corroborated elder mistreatment (elder abuse, neglect, and/or exploitation), or (2) elderly persons for whom protective services were used for self-neglect. In the first 9 years after cohort inception, 176 cohort members were seen by elderly protective services for verified allegations; 10 (5.7%) of these were for abuse, 30 (17.0%) for neglect, 8 (4.5%) for exploitation, and 128 (72.7%) for self-neglect. At the end of a 13-year follow-up period from cohort inception, cohort members seen for elder mistreatment at any time during the follow-up had poorer survival (9%) than either those seen for self-neglect (17%) or other noninvestigated cohort members (40%) (P<.001). In a pooled logistic regression that adjusted for demographic characteristics, chronic diseases, functional status, social networks, cognitive status, and depressive symptomatology, the risk of death remained elevated for cohort members experiencing either elder mistreatment (odds ratio, 3.1; 95% confidence interval, 1.4-6.7) or self-neglect (odds ratio, 1.7; 95% confidence interval, 1.2-2.5), when compared with other members of the cohort. Reported and corroborated elder mistreatment and self-neglect are associated with shorter survival after adjusting for other factors associated with increased mortality in older adults.
Article
: This study explored the state and the correlated factors of psychological abuse behavior among caregivers in long-term care facilities in Taiwan. A cross-sectional design utilizing a descriptive-correlational approach was conducted. A sociodemographic sheet, Caregiver Psychological Elder Abuse Behavior Scale (CPEAB), and Caregiver's Burden Scale (CBS) were employed to collect data. A total of 114 caregivers completed the study, of whom 16.1% returned an CPEAB score greater than 40. The potential range of CPEAB scores ranged from 20 to 80, with the highest score indicating the greatest tendency toward psychological abuse behavior. Among the total of 20 CPEAB indicators, "Accuse him/her verbally", "Ignore his/her request", and "Insult him/her" received the highest item mean scores (M = 2.18, 2.12, 2.02; SD = 0.83, 0.84, 0.91). Significant relationships between the CPEAB and subject age, professional status, educational level, geriatric care training, and CBS score were found (p < .05-.001). These results indicate that caregivers who are younger in age, less educated and lacking in geriatric training had a greater burden and displayed a tendency toward more abusive behavior. Another important finding was that nurses displayed more abusive behavior than their care attendant counterparts. Results of this study provide important information that may be used in medical and social interventions and policies aimed at improving quality of life for the institutionalized elderly. (C) 2005 Lippincott Williams & Wilkins, Inc.
Article
Although there is a strong negative relationship between age and spousal violence of both sexes, spouse abuse is one of the more common forms of elder abuse. Causal theories and perspectives on domestic violence provide the framework for an analysis of older married participants in the National Family Violence Resurvey. Cross tabulations were used to compare violent and non-violent couples in both age groups. Results suggest that many of the risk factors present in abusive couple relationships are the same regardless of age. Logit analysis employed to estimate the effects of various risk factors on couple violence in the elderly produced a final model including: verbal aggression, marital conflict, and perceived stress.
Article
There are growing numbers of Adult Day Health Care (ADHC) programs providing needed health services to community-dwelling elderly. Therefore, ADHC staff are in an opportune position to identify and to intervene in suspected elder mistreatment (EM) cases. In this paper, prevalence estimates of EM are reported for a probability sample of ADHC clients in New York State, using data provided during a social worker informant interview. The abuse “signs and symptoms” items in the social worker informant interview schedule were divided into two categories: (1) physical indicators and (2) client's behavioral indicators. Physical indicators included unexplained bruises and welts, unexplained burns, unexplained lacerations or abrasions, human bite marks, and frequent injuries that are “accidental” or “unexplained.” Client's behavioral indicators included apprehension, being frightened, and afraid to go home. EM prevalence for all 8 items was 12.3 percent. When “apprehensive” was excluded, the EM prevalence was 3.6 percent in this sample. These findings suggest that ADHC provides a point of contact for the assessment and intervention of EM that might otherwise be overlooked among elders who are often isolated or homebound.
Article
A questionnaire survey on elder abuse and neglect in residential settings was conducted among a convenience sample of 80 people working in German nursing homes. Data on nursing staffs experiences of stress and conflict at their workplaces, self-reported incidents of abuse and neglect of nursing home residents, incidents observed as witnesses and subjective theories about causes and motives underlying violence in nursing homes are reported. Whereas 59% report physical or verbal aggression by residents during the previous 2 months, 79% indicate having abused or neglected a resident at least once during that period; 66% witnessed victimizations of residents by colleagues. Different types of neglect and verbal/psychological abuse are most common. Subtypes of elder abuse and neglect show differential correlation patterns with measures of work stress. Subjects attribute abuse and neglect not only to staff shortage and work overload hut also to a number of factors in the offender's personality on the one hand and at the political and social level on the other. From a motivational point of view, abuse and neglect are regarded as instrumental acts to reduce workload and as effects of pent-up aggression and inner tensions. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: 〈[email protected] /* */〉 Website: 〈http://www.HaworthPress.com〉
Article
Evidence concerning the incidence and nature of abuse of the elderly comes mainly from North America. We explored the experiences of abuse of older women and caretakers in three European countries and investigated services available to abused older women. Just less than 20% of our sample of women older than the age of 59 had experienced some form of financial, psychological, or physical abuse. Of those mistreated, 24% reported abuse ongoing over years, and 39% reported distressing effects persisting for years. European support services are only beginning to focus on this problem, and further research is needed to define the best practices.
Article
Background and objective We determined the prevalence and associated risk factors in the suspicion of elder abuse in the old population. Patients and method We included a total of 209 patients = ≥ 72 years of age without cognitive deterioration (score in test of Pfeiffer = ≤ 4 points). The questionnaire of suspicion of elder abuse used was one recommended by the Canadian Task Force and the American Medical Association; it consists of 9 questions and the presence of a positive answer is considered as indicative of suspicion of abuse. Results The prevalence of suspicion of elder abuse was 52.6% (at least one positive answer to the questionnaire). 8.6% affirmatively responded to 2 questions and 2% to 3. Female gender, widowhood, deficiency of studies, living alone or in institutions and having exerted a remunerated work were the associated variables in the bivariant analysis with regard to the suspicion of abuse. In the model of logistic regression, there was a significant association with the civil status and the coexistence of the familiar nucleus, with a greater risk of elder abuse in unmarried and/or widowers (p < 0.001) and in those living alone (p < 0.0001). Conclusions There is a high prevalence of suspicion of elder abuse in the old population.
Article
Although there is a strong negative relationship between age and spousal violence of both sexes, spouse abuse is one of the more common forms of elder abuse. Causal theories and perspectives on domestic violence provide the framework for an analysis of older married participants in the National Family Violence Resurvey. Cross tabulations were used to compare violent and non-violent couples in both age groups. Results suggest that many of the risk factors present in abusive couple relationships are the same regardless of age. Logit analysis employed to estimate the effects of various risk factors on couple violence in the elderly produced a final model including: verbal aggression, marital conflict, and perceived stress.
Article
As stated in the first issue of Evidence-Based Mental Health, we are planning to widen the scope of the journal to include studies answering additional types of clinical questions. One of our first priorities has been to develop criteria for studies providing information about the prevalence of psychiatric disorders, both in the population and in specific clinical settings. We invited the following editorial from Dr Michael Boyle to highlight the key methodological issues involved in the critical appraisal of prevalence studies. The next stage is to develop valid and reliable criteria for selecting prevalence studies for inclusion in the journal. We welcome our readers contribution to this process. You are a geriatric psychiatrist providing consultation and care to elderly residents living in several nursing homes. The previous 3 patients referred to you have met criteria for depression, and you are beginning to wonder if the prevalence of this disorder is high enough to warrant screening. Alternatively, you are a child youth worker on a clinical service for disruptive behaviour disorders. It seems that all of the children being treated by the team come from economically disadvantaged families. Rather than treating these children on a case by case basis, the team has discussed developing an experimental community initiative in a low income area of the city. You are beginning to wonder if the prevalence of disruptive behaviour disorders is high enough in poor areas to justify such a programme. Prevalence studies of psychiatric disorder take a sample of respondents to estimate the frequency and distribution of these conditions in larger groups. All of these studies involve sampling, cross sectional assessments of disorder, the collection of ancillary information, and data analysis. Interest in prevalence may extend from a particular clinical setting (a narrow focus) to an entire nation (a broad focus). In …
Article
The purposes of this study were to determine associated characteristics of community-dwelling older persons, their access to care and social provisions, and self-reported elder abuse, and to assess how having help in completing a questionnaire affected these associations. A questionnaire was mailed to 1,017 randomly selected elders in the Iowa Medicaid Waiver Program. The overall prevalence of self-reported abuse was 20.9%. Fifty-nine percent of respondents had help completing the questionnaire. Abuse was associated with low social provisions, more emergency room visits, being alone, and not having enough money. For those having help completing the questionnaire, abuse was associated with older age, low social provisions, being alone, and not having enough money. For those having no help completing the questionnaire, abuse was associated with depression, being alone, more emergency room visits, and low social provisions. Among community-living elders needing services in their homes, the prevalence of abuse was higher than that found in general population studies.
Article
To investigate frequencies and types of elder abuse occurring in residential settings in two municipal areas of Sweden, nursing staff were asked to answer a questionnaire; 499 responded. The findings indicated that elder abuse involving the staff did occur. Eleven percent of the staff knew of situations of elder abuse and two percent admitted that they themselves had been abusive towards an elderly resident. Psychological and physical abuse related to caring activities were most common. In the specific situations reported, the abusers were mostly characterised as hot-tempered, exhausted, and burned out. The abused people were often mentally and/or physically handicapped and generally over 80 years old. Feelings such as powerlessness, anger towards the abuser, and compassion for the abused person were reported. To cope with the situation, they talked to each other or to the manager. They recommended more education and support as the main preventive strategy.
Article
There are growing numbers of Adult Day Health Care (ADHC) programs providing needed health services to community-dwelling elderly. Therefore, ADHC staff are in an opportune position to identify and to intervene in suspected elder mistreatment (EM) cases. In this paper, prevalence estimates of EM are reported for a probability sample of ADHC clients in New York State, using data provided during a social worker informant interview. The abuse “signs and symptoms” items in the social worker informant interview schedule were divided into two categories: (1) physical indicators and (2) client's behavioral indicators. Physical indicators included unexplained bruises and welts, unexplained burns, unexplained lacerations or abrasions, human bite marks, and frequent injuries that are “accidental” or “unexplained.” Client's behavioral indicators included apprehension, being frightened, and afraid to go home. EM prevalence for all 8 items was 12.3 percent. When “apprehensive” was excluded, the EM prevalence was 3.6 percent in this sample. These findings suggest that ADHC provides a point of contact for the assessment and intervention of EM that might otherwise be overlooked among elders who are often isolated or homebound.
Article
It is anticipated that older adults who seek professional intervention may be more at risk of abuse and neglect. This paper reports a prevalence study that focused on older adults who accessed health and social service organizations over a three month period. Respondents ranged from 55 to 100 with a mean age of 73.8 years. Over a quarter of the sample reported at least one form of violence during their lifespan. Higher prevalence rates than in the general population were found. Attempted material abuse was most frequent, followed by verbal abuse, physical abuse, unintentional neglect, actual material abuse, and intentional neglect.
Article
The occurence of abuse in old age, the types and places of abuse, and the factors related to it were investigated by interviewing a population aged 65 years or over living in a semi-rural Finnish community. Three percent of the men and 9% of the women said that they had been abused after the age of retirement. Forty-six percent of the abused men and 75% of the abused women had been ill-treated by their spouse, child or other relatives. Friends and unknown persons were more often the abusers in the male cases (54%) but not in the female ones (22%). A common place for this abuse to occur was the elderly person's own home, both among the men (46%) and the women (82%); another 46% of the abused men said that it had happened in the streets, a shop, or an official building. Physical and psychological violence were the most prevalent types of abuse for both sexes. The abused individuals were characterized by poor health, lack of confidants, loneliness, poor satisfaction with life, and poor family relations.
Article
Objectives: To examine the association between various characteristics of community-based older people and a constructed measure of potential elder abuse. Design: Cross-sectional design. Setting: Public community-based long-term care programs in Michigan. Participants: Individuals aged 60 and older seeking home and community-based services in Michigan between November 1996 and October 1997 (N = 701). Measurements: Data were collected using the Minimum Data Set for Home Care (MDS-HC) assessment. The dependent variable is a constructed measure of potential elder abuse reflecting physical and emotional abuse and neglect. Independent variables include demographic characteristics; diagnoses; behavioral measures; and cognitive, physical, and social functioning. Results: Several measures of social support and social function were strongly associated with the signs of a potentially abusive environment: brittle support (odds ratio (OR) = 3.5, 90% confidence interval (CI) = 1.5-8.1), older person feels lonely (OR = 2.4, 90% CI = 1.3-4.5), and older person expresses conflict with family/friends (OR = 2.3, 90% CI = 1.2-4.3). Home care participants' alcohol abuse, psychiatric illness, lack of ease interacting with others, and short-term memory problems were also significantly associated with the signs of potential elder abuse. Conclusions: The results of this study suggest that the signs of potential elder abuse are associated with a diminishing social network and poor social functioning, although some characteristics of the older person's health are contributing factors. Improved understanding of the link between those characteristics and potential abuse will help healthcare providers, case managers, and others identify older people at high risk of abuse.
Article
Nach einer Darstellung zentraler definitorischer Merkmale innerfamiliärer Gewalt und ihrer Bedingungsfaktoren werden erste Ergebnisse einer postalischen Befragung der “Bonner HsM-Studie” vorgestellt. Die gefundenen Ergebnisse können aufgrund des geringen Rücklaufs nur als erste Hinweise für ein sehr komplexes Problemfeld gelten. Es zeigte sich, daß ca. 10% der alten Menschen in den letzten fünf Jahren Gewalterfahrungen gemacht haben. In erster Linie wurden seelische Mißhandlungen und finanzielle Schädigungen berichtet. Die Folgen der Gewaltereignisse lagen vorwiegend auf psychisch-emotionaler Ebene. Zur Unterstützung wurden, wenn überhaupt, Personen aus dem sozialen Nahraum des Opfers herangezogen. Verheiratete und gesundheitlich eingeschränkte Menschen waren häufig von Gewalterfahrungen betroffen. Ferner zeigten sich Unterschiede zwischen gewaltbetroffenen und -nichtbetroffenen Personen im Hinblick auf ihre Lebenszufriedenheit, die Qualität außerfamiliärer Kontakte und den sozioökonomischen Status. Central aspects of intra-familiar violence and of their causes are discussed. The first results of the study “Handeln statt Mißhandeln” (HSM, Action against Violence) are presented. Data were collected in Bonn, Germany, by the means of a postal questionnaire. Approximately 10 percent of old people reported experiences of violence in their families during the past five years. Most often mental violence and financial deceit were mentioned. Experiences of violence mainly caused psychological and emotional problems. If at all, victims searched for support in their immediate social network. Persons who were married or of bad physical health had often experiences of violence. Significant difference between victims and non-victims were detected for experiences of violence, the victims' subjective well-being, the quality of the families' external relations and the victims' socio-economic status.
Article
This study describes the prevalence of violence and the putative risk factors for violence in 184 Alzheimer patients and their primary caregivers living in the community. Analysis of the severe violence subscale of the Conflict Tactics Scale indicated that 15.8% of patients had been violent in the year since diagnosis. A total of 5.4% of caregivers reported being violent toward the patient. The overall prevalence of violence was 17.4%. The variables most associated with violence were caregiver depression and living arrangement.
Article
Despite persistent allegations that abuse of nursing home residents is widespread, the topic has received only limited research attention. Data are presented from a survey of a random sample of 577 nurses and nursing aides working in long-term care facilities. Rates of abuse based on staff self-reports are presented, and subgroups of staff who are more likely to engage in abusive behaviors are identified.
Article
In this first large-scale random sample survey of elder abuse and neglect, interviews were conducted with 2020 community-dwelling elderly persons in the Boston metropolitan area regarding their experience of physical violence, verbal aggression, and neglect. The prevalence rate of overall maltreatment was 32 elderly persons per 1000. Spouses were found to be the most likely abusers and roughly equal numbers of men and women were victims, although women suffered more serious abuse. Implications for public policy are discussed.
Article
This study describes the extent of verbal and/or physical aggression as reported by caregivers and correlates of each type of aggression against the demented care recipient. The extent of verbal aggression alone was 30.2% and of physical aggression, 10.7%. Verbal and physical aggression were associated with sharing the same household with the care recipient, caring for a male and caring for an elderly person more severely impaired in cognitive functioning and more dependent in Instrumental Activities of Daily Living. Verbal aggression was also associated with proving more care, and physical aggression with caring for a spouse and more psychological complaints of the caregiver. Accordingly, physical aggression does not seem to be a mere extension of verbal aggression, and different intervention strategies may be required for verbally and physically aggressive caregivers.
Article
To establish the prevalence of elder abuse in community-dwelling patients with dementia and to test the hypothesis that there is no difference in carer and patient characteristics between the abused and non-abused populations. A cohort of consecutive referrals was formed and subdivided by the presence or absence of abuse and the two groups compared. A rural psychiatry of old age service in N. Ireland. Each case had been newly referred, was 65 years old or over, lived at home, had an identifiable carer and met DSMIII-R criteria for a diagnosis of dementia. There were 49 such cases; 38 carers agreed to be interviewed. The General Health Questionnaire 28, the Gilleard Pre-Morbid Relationship Rating Scale and Gilleard's Problem Checklist were administered to the carer and the information/orientation sub scale of the Clifton Assessment Procedure for the Elderly used to measure cognitive impairment in the patient. Abuse was elicited in 14 (37%) cases; four (10.5%) of physical and 13 (34%) of verbal abuse. No cases of abuse by neglect were detected. A poor premorbid relationship, verbal or physical abuse by the dependant, problem behaviours in the dependant, the carer's level of anxiety and a perception of not receiving help were significantly associated with abuse. Alcohol consumption of the carer, physical dependence, severity of cognitive impairment or financial or social circumstances were not associated with elder abuse. Elder abuse is associated with aspects of the patient/carer relationship and should be regarded as a significant problem in patients with dementia referred to an old age service.
Article
To describe the results of an international trial of the home care version of the MDS assessment and problem identification system (the MDS-HC), including reliability estimates, a comparison of MDS-HC reliabilities with reliabilities of the same items in the MDS 2.0 nursing home assessment instrument, and an examination of the types of problems found in home care clients using the MDS-HC. Independent, dual assessment of clients of home-care agencies by trained clinicians using a draft of the MDS-HC, with additional descriptive data regarding problem profiles for home care clients. Reliability data from dual assessments of 241 randomly selected clients of home care agencies in five countries, all of whom volunteered to test the MDS-HC. Also included are an expanded sample of 780 home care assessments from these countries and 187 dually assessed residents from 21 nursing homes in the United States. The array of MDS-HC assessment items included measures in the following areas: personal items, cognitive patterns, communication/hearing, vision, mood and behavior, social functioning, informal support services, physical functioning, continence, disease diagnoses health conditions and preventive health measures, nutrition/hydration, dental status, skin condition, environmental assessment, service utilization, and medications. Forty-seven percent of the functional, health status, social environment, and service items in the MDS-HC were taken from the MDS 2.0 for nursing homes. For this item set, it is estimated that the average weighted Kappa is .74 for the MDS-HC and .75 for the MDS 2.0. Similarly, high reliability values were found for items newly introduced in the MDS-HC (weighted Kappa = .70). Descriptive findings also characterize the problems of home care clients, with subanalyses within cognitive performance levels. Findings indicate that the core set of items in the MDS 2.0 work equally well in community and nursing home settings. New items are highly reliable. In tandem, these instruments can be used within the international community, assisting and planning care for older adults within a broad spectrum of service settings, including nursing homes and home care programs. With this community-based, second-generation problem and care plan-driven assessment instrument, disability assessment can be performed consistently across the world.
Article
Central aspects of intra-familiar violence and of their causes are discussed. The first results of the study "Handeln statt Misshandeln" (HSM, Action against Violence) are presented. Data were collected in Bonn, Germany, by the means of a postal questionnaire. Approximately 10 percent of old people reported experiences of violence in their families during the past five years. Most often mental violence and financial deceit were mentioned. Experiences of violence mainly caused psychological and emotional problems. If at all, victims searched for support in their immediate social network. Persons who were married or of bad physical health had often experiences of violence. Significant difference between victims and non-victims were detected for experiences of violence, the victims' subjective well-being, the quality of the families' external relations and the victims' socio-economic status.
Article
To determine the prevalence of suspected ill treatment of the elderly (ITE) in the population cared for in a health district and to analyse the associated variables. Cross-sectional study.Setting. Les Planes (Sant Joan Despí, Barcelona). Urban Health District. 307 patients over 70 years old seen in the Health District. The study had 39 losses, 31 exclusions because of cognitive disorder and 18 because it was impossible to hold the interview. 219 completed the study. The Pfeiffer test was administered through an interview, social and demographic variables were collected, a questionnaire on ill treatment was filled in (a positive reply was considered ITE), and physical dependence was evaluated (Katz index). Prevalence of ITE was 26 people or 11.9% (95% CI, 7.6-16.2), breaking down into 6 physically ill-treated, 20 psychologically, one sexually, 3 by negligence and 3 by neglect. Nine people suffered more than one kind of ill treatment. Significant associated variables were: being a woman 18% (p < 0.01), receiving social assistance 46% (p < 0.001), being a widow/widower 21% (p < 0.01), not having had paid employment 20% (p < 0.04) and having a rotating residence 28% (p < 0.003). On application of multivariate analysis, being a woman (OR 4.99) and receiving social assistance (OR 7.55) maintained their significance. The presumed perpetrators were son/daughter (57%), spouse (8%), son/daughter-in-law (23%). 19% of these were drug-dependent and 15% suffered psychiatric disorders. The high prevalence of ITE is clear. These results should alert doctors to a previously under-rated health problem.
Article
Caring for a sick or disabled relative has been linked to compromised caregiver health, and risk factors for negative caregiver outcomes have been studied extensively, but little attention has been given to care recipient and caregiver health as risk factors for potentially harmful behavior by informal caregivers. This article explores such risk factors. Structured interviews from baseline assessment of the Family Relationships in Late Life Study. Three U.S. communities. Referred, volunteer sample of 265 caregiver/care recipient dyads. Caregivers were primarily responsible for care of an impaired, community-residing family member aged 60 and older and providing help with at least one activity of daily living (ADL) or two instrumental activities of daily living (IADLs). Self-reported care recipient demographics, cognitive status, need for care, and self-rated health; self-reported caregiver demographics, cognitive status, amount of care provided, self-rated health, physical symptoms, and depression. Care recipient reports of potentially harmful caregiver behavior, including screaming and yelling, insulting or swearing, threatening to send to a nursing home, and withholding food, were the main outcome variable. The following were significant risk factors for potentially harmful caregiver behavior: greater care recipient ADL/IADL needs (odds ratio (OR)=1.12, 95% confidence interval (CI)=1.03-1.22), spouse caregivers (vs others; OR=8.00, 95% CI=1.71-37.47), greater caregiver cognitive impairment (OR=1.20, 95% CI=1.04-1.38), more caregiver physical symptoms (OR=1.07, 95% CI=1.01-1.13), and caregivers at risk for clinical depression (OR=3.47, 95% CI=1.58-7.62). Potentially harmful caregiver behavior is more likely in spouse caregiving situations and when care recipients have greater needs for care and caregivers are more cognitively impaired, have more physical symptoms, and are at risk for clinical depression. This risk profile is similar to that for negative caregiver outcomes.
Article
This study investigates the state of elder abuse in Korea, and its related factors in a population-based survey. A total of 15,230 persons were interviewed at their homes in 1999. The rate of old people who experienced any one category of abuse was 6.3%, and emotional abuse was the most frequent while physical abuse was least prevalent. The experience of abuse seemed to be associated with personal characteristics such as age, gender, educational level, and economic dependency as well as the physical and mental health status. In addition, family characteristics such as the type of household, the family's economic level, and the quality of family relations were found to be associated with the presence of abuse.
Article
We determined the prevalence and associated risk factors in the suspicion of elder abuse in the old population. We included a total of 209 patients > or = 72 years of age without cognitive deterioration (score in test of Pfeiffer (3/4) 4 points). The questionnaire of suspicion of elder abuse used was one recommended by the Canadian Task Force and the American Medical Association; it consists of 9 questions and the presence of a positive answer is considered as indicative of suspicion of abuse. The prevalence of suspicion of elder abuse was 52.6% (at least one positive answer to the questionnaire). 8.6% affirmatively responded to 2 questions and 2% to 3. Female gender, widowhood, deficiency of studies, living alone or in institutions and having exerted a remunerated work were the associated variables in the bivariant analysis with regard to the suspicion of abuse. In the model of logistic regression, there was a significant association with the civil status and the coexistence of the familiar nucleus, with a greater risk of elder abuse in unmarried and/or widowers (p < 0.001) and in those living alone (p < 0.0001). There is a high prevalence of suspicion of elder abuse in the old population.
Article
Neglect of older adults accounts for 60% to 70% of all elder-mistreatment reports made to adult protective services. The purpose of this article is to report data from research, using a risk-and-vulnerability model, that captures the independent contributions of both the elder and the caregiver as they relate to the outcome of neglect. Between February 2001 and September 2003, older adults were screened and recruited through four emergency departments in New York and Tampa. The diagnosis of neglect was made by an expert neglect-assessment team. Elders and their caregivers were then scheduled for separate face-to-face interviews after discharge. Constructs within the risk-and-vulnerability model were examined for scale-score significance based on the outcome diagnosis of neglect. In the risk domain, caregivers' functional status, childhood trauma, and personality were statistically significant. In the vulnerability domain, the elders' cognitive status, functional status, depression, social support, childhood trauma, and personality were significant. Findings from this study underscore the value of interdisciplinary assessment teams in emergency departments for screening elder neglect, with attention given to risk factors related to the caregiver and elder vulnerability factors, including reports of childhood trauma. The risk-and-vulnerability model may provide a link between the caregiving and neglect research. Data should be collected independently from both members of the elder-caregiver dyad in order for clinicians to understand factors related to elders who receive the diagnosis of neglect from interdisciplinary teams.
Article
This study examined the prevalence of psychological abuse and identified individual characteristics associated with different levels of psychological abuse in a group of randomly selected elderly Taiwanese. A cross-sectional design was performed that utilized a descriptive-correlational approach. Data for this study were gathered from several communities in southern Taiwan. The sample comprised 195 elderly Taiwanese aged 60 years or older, capable of verbal communication, and partially dependent on a caregiver. The Psychological Elder Abuse Scale (PEAS), the Short Portable Mental State Questionnaire (SPMSQ), and the Barthel's Index were used for data collection. The findings demonstrated that the PEAS score range was 0-24 (mean 6.32 +/- 4.6). Moreover, 44 subjects (22.6%) had scores of ten or greater. The most frequently reported indicators in the PEAS were "wishes to see family members unfulfilled" and "economic dependence on others". The analytical results also showed that the SPMSQ and Barthel's Index scores were strongly related to the PEAS score (p < 0.001), indicating psychological abuse appeared higher among elderly people with lower cognitive and physical functioning. The findings of this study are crucial in developing a national system for protecting the elderly, and a continuing educational plan is required for enforcing communication between caregivers and elders.
Article
This study explored the state and the correlated factors of psychological abuse behavior among caregivers in long-term care facilities in Taiwan. A cross-sectional design utilizing a descriptive-correlational approach was conducted. A sociodemographic sheet, Caregiver Psychological Elder Abuse Behavior Scale (CPEAB), and Caregiver's Burden Scale (CBS) were employed to collect data. A total of 114 caregivers completed the study, of whom 16.1% returned an CPEAB score greater than 40. The potential range of CPEAB scores ranged from 20 to 80, with the highest score indicating the greatest tendency toward psychological abuse behavior. Among the total of 20 CPEAB indicators, "Accuse him/her verbally", "Ignore his/her request", and "Insult him/her" received the highest item mean scores (M = 2.18, 2.12, 2.02; SD = 0.83, 0.84, 0.91). Significant relationships between the CPEAB and subject age, professional status, educational level, geriatric care training, and CBS score were found (p < .05 - .001). These results indicate that caregivers who are younger in age, less educated and lacking in geriatric training had a greater burden and displayed a tendency toward more abusive behavior. Another important finding was that nurses displayed more abusive behavior than their care attendant counterparts. Results of this study provide important information that may be used in medical and social interventions and policies aimed at improving quality of life for the institutionalized elderly.
Article
This study examined the extent and correlates of elder mistreatment among 400 community dwelling older adults aged 65 and above in Chennai, India. The prevalence rate of mistreatment was 14%. Chronic verbal abuse was the most common followed by financial abuse and the rate of physical abuse and neglect was similar. Among the mistreated, exactly half of them had experienced more than one type of mistreatment (multifaceted-mistreatment). With the exception of financial abuse, a significantly greater number of women experienced verbal and physical abuse as well as neglect compared to men. Adult children, daughters-in-law, spouses, and sons-in-law were the prominent perpetrators. The mistreated older adults were more depressed and less satisfied with life than those who were not mistreated. Logistic regression analysis revealed gender, social support, and subjective rating of physical health as significant factors associated with abuse.
Article
To evaluate the association of nursing home abuse reported by employees in Iowa licensed nursing homes with nursing home characteristics, inspection results, nursing staff hours, and census demographics. Mailed survey. Iowa's 409 Medicare-certified stand-alone nursing homes. Administrators and directors of nursing. The annual rate of abusive events was 20.7 per 1000 nursing home residents, with a rate of 18.4 reported events and 5.2 substantiated events. A higher number of residents and a higher number of certified beds were significantly associated with higher incident, report, and substantiation rates. Higher incident and report rates were associated with nursing homes in metropolitan areas. Higher substantiation rates were associated with for-profit nursing homes. Recognized abuse in nursing homes is not uncommon. Approximately 90% of events are reported to the state authorities with 29% of those being substantiated. Differences associated with nursing facility abuse rates are metropolitan area, ownership, occupancy rate, and number of residents and certified beds.
Article
The objective of this study was to determine crossnationally the prevalence of indicators of elder abuse and their relationship to putative risk factors, particularly depression, dementia, and lack of service provision. Nearly 4,000 people aged 65+ receiving health or social community services in 11 European countries were interviewed using the minimum dataset homecare (MDS-HC) interview, which includes an abuse screen used previously in elder abuse studies and questions about demographic, physical, psychiatric, cognitive, and service factors. One hundred seventy-nine (4.6%) people assessed had at least one indicator of abuse. The proportion screening positive increased with severity of cognitive impairment, presence of depression, delusions, pressure ulcers, actively resisting care, less informal care, expressed conflict with family or friends, or living in Italy or Germany, but not with having a known psychiatric diagnosis. Severity of cognitive impairment, depression, and delusions predicted screening positive for abuse in older adults, but having a known psychiatric diagnosis did not, indicating that screening for psychiatric morbidity might be rational strategies to combat elder abuse. People in Italy and Germany were most likely to screen positive for indicators of abuse, and the authors suggest that this might relate to higher levels of dependency in the participants looked after at home in these countries as a result of cultural and service provision differences.
Article
Several studies have investigated abusive behaviour by carers towards people with dementia, most using unvalidated scales; only two reported correlates of abuse after controlling for mediators and confounders, and these controlled for different factors. To investigate the acceptability and validity of the Modified Conflict Tactics Scale (MCTS) and abuse correlates. Eighty-six people with Alzheimer's disease and their family carers, originally recruited for a representative community study were interviewed. We asked carers about acceptability of the MCTS and investigated its validity by comparing scores to the Minimum Data Set (MDS) abuse screen (an objective measure) and testing hypotheses that MCTS score would correlate with the COPE dysfunctional coping scale but not carer education. Twenty-four (27.9%) were identified as abuse cases by interview. No care recipients (CRs) screened positive for abuse using the MDS screen. Seventy-two (83.7%) participants thought that the scale was acceptable, ten (11.6%) that it was neither acceptable nor unacceptable, and three (3.5%) that it was unacceptable. As hypothesised, MCTS scores correlated with dysfunctional coping scale score but not carer education. This is the most comprehensive study so far in this field. The MCTS was acceptable and had convergent and discriminant validity for measuring carer abuse. The MDS failed to identify cases of abuse. Carer male gender and burden, and greater CR irritability, cognitive impairment but less functional impairment predicted carer abusive behaviour. Our findings appear to refute UK government elder abuse reduction policy which assumes that few incidents of abuse arise from carer stress.
’No Secrets’ Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse
  • Department of Health
Department of Health. 'No Secrets' Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. 2000.
Older people as victims of family violence. Results of a German victimization survey
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Wetzels P, Greve W. Older people as victims of family violence. Results of a German victimization survey. Z Gerontol Geriatr 1996; 29: 191-200.
National survey on abuse of the elderly in Canada
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Podkieks E. National survey on abuse of the elderly in Canada. J Elder Abuse Negl 1992; 4: 5-58.
Elder abuse in people with dementia in Northern Ireland: prevalence and predictors in cases referred to a psychiatry of old age service
  • Compton
Violence against the aged within the family: results of studies by the “Bonner HsM (treating vs. mistreating Study
  • Hirseh