Are frail older people less exposed to abuse in nursing homes as compared to community-based settings? Statistical analysis of Slovenian data

Prevalence of elder abuse: a narrative review

Elder abuse, a pervasive and distressing phenomenon, continues to pose a significant challenge globally, affecting older adults across diverse socioeconomic backgrounds. This article provides an overview of the prevalence of elder abuse, highlighting its multifaceted nature, risk factors and the imperative need for intervention and prevention strategies. A synthesis of empirical studies, meta-analyses and reputable sources is used to delineate the prevalence rates and patterns of elder abuse across various geographical regions.

Staff-to-resident abuse in nursing homes: a scoping review

BACKGROUND

Elder abuse in long-term care is an important public health concern with social, health-related, and economic implications. Staff-to-resident abuse is of particular interest since institutions should protect residents' rights and prevent harm. To provide an up-to date comprehensive overview of staff-to-resident abuse in nursing homes, we performed a scoping review considering types of abuse, their prevalence and associated factors, descriptions, experiences, and preventive interventions.

METHODS

We performed a scoping review following the framework provided by Arksey and O'Malley. We searched MEDLINE (via PubMed), CINAHL, PsycINFO via Ovid, and Cochrane Library. Additionally, we performed free web searching using Google Scholar and checked relevant reviews. Two reviewers independently selected studies. We narratively synthesised the results.

RESULTS

Out of 3876 references retrieved by our search, we included 46 studies in 47 reports. The prevalence rates of abuse varied widely, ranging from 0 to 93% depending on the type of abuse. Associated factors of abuse at the staff, resident, and nursing home level were evaluated inconsistently. Abuse was perceived ambiguous: even though it was considered unacceptable, it was underreported. We found only four studies addressing preventive interventions. Of these, four made recommendations for intervention development. Only one study with an experimental design examined a multi-component intervention including education and mutual support.

CONCLUSIONS

The review yielded heterogenous evidence not allowing a concrete conclusion on prevalence and associated factors. However, the results show the significance of the problem and indicate that there are associate factors of abuse that can be influenced by appropriate interventions. These are amongst other staff education, organisational culture, and conditions. Further research should investigate the composition and content of preventive interventions and their potential to reduce abusive behaviours.

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

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

Prevalence and Risk Factors of Elder Mistreatment in Sheltered Homes

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Relatives' experiences with abuse and neglect in Norwegian nursing homes. A qualitative study

Background

Elder abuse in nursing homes (NH) is a widespread and complex problem. Residents’ ability to share their experiences are impeded, due to a high degree of cognitive problems and frailty, and previous studies are thus mainly based on reports from staff. Therefore, we aimed to give voice to the residents by investigating their relatives’ experiences with elder abuse in NH.

Methods

Qualitative individual interviews were conducted with 16 relatives of residents with experience of abuse and/or neglect in NH. Content analysis was used to analyse the data.

Results

Relatives perceived neglect as most pervasive and staff-to-resident psychological abuse as a key problem. Physical abuse was mostly related to resident-to-resident aggression. Relatives perceived elder abuse in NH to be related to low competence among staff, low staffing, poor NH leadership, working cultures characterized by fear and loyalty to employer or co-workers, and a lack of individualized care for the residents. Furthermore, relatives themselves experienced maltreatment from NH, which caused them to suffer stress, anxiety and distrust. Relatives also expressed a need to compensate for lack of care.

Conclusions

Relatives of NH residents who had experienced abuse reported that neglect of basic care and individual rights was predominant and viewed organizational explanations as most important. Relatives perceive themselves as collaborators in care and are emotionally attached to their family member. Therefore, if relatives experience resident abuse or neglect, it inflicts a feeling of being mistreated themselves, particularly if they are not listened to or their notice of abuse on the part of the resident is ignored or trivialized. Including relatives in a committed partnership with NH in care practices is not only a valuable path to reduce the risk of abuse, but it also leads to a more sustainable healthcare with high standards of quality and safety.

[Violent behavior of staff towards nursing home residents: A systematic review of instruments to measure prevalence]

BACKGROUND

Reduction or prevention of violence is one of the fields of preventive interventions in nursing homes. To prove the effectiveness of appropriate interventions, valid instruments are crucial to measure violence.

METHODS

Between November 2019 and May 2020, a systematic search for studies and instruments was conducted in relevant databases and reference directories assessing violent behaviour by employees towards residents, by residents towards employees and resident-to-resident abuse.

RESULTS

24 instruments were identified. 8 instruments capture staff-to-resident violence, 14 capture resident-to-staff violence, 3 resident-to-resident aggression, and 5 instruments are not exactly attributable to the constellation of violence. No instrument covers all three situations of violence. Four of the instruments used to capture violence by staff cover all forms of personal violence. Validity and reliability data are inadequate.

DISCUSSION

At present, there is no tool that fully depicts violence in resident homes and is suitable for measuring the effectiveness of interventions. There are sufficient tools for the individual constellations of violence that represent all forms of violence. Not all instruments could be procured in their original form, and even available instruments did not always provide information on the development of the instruments and a possible review of their quality.

CONCLUSION

There is a lack of an internationally comparable instrument representing elder abuse in the inpatient setting with sufficient validity and reliability.

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

Background

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

Methods

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

Results

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

Conclusions

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

The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis

Background

A recent study has shown that close to one in six older adults have experienced elder abuse in a community setting in the past year. It is thought that abuse in institutions is just as prevalent. Few systematic evidence of the scale of the problem exists in elder care facilities. The aim of this review is to conduct a systematic review and meta-analysis of the problem in institutional settings and to provide estimates of the prevalence of elder abuse in the past 12 months.

Methods

Fourteen academic databases and other online platforms were systematically searched for studies on elder abuse. Additionally, 26 experts in the field were consulted to identify further studies. All studies were screened for inclusion criteria by two independent reviewers. Data were extracted, and meta-analysis was conducted. Self-reported data from older residents and staff were considered separately.

Results

Nine studies met the inclusion criteria from an initial of 55 studies identified for review. Overall abuse estimates, based on staff reports, suggest that 64.2% of staff admitted to elder abuse in the past year. There were insufficient studies to calculate an overall prevalence estimate based on self-reported data from older residents. Prevalence estimates for abuse subtypes reported by older residents were highest for psychological abuse (33.4%), followed by physical (14.1%), financial (13.8%), neglect (11.6%), and sexual abuse (1.9%).

Conclusions

The prevalence of elder abuse in institutions is high. Global action to improve surveillance and monitoring of institutional elder abuse is vital to inform policy action to prevent elder abuse.

Financial-patrimonial elder abuse: an integrative review

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

Can an active aging index (AAI) provide insight into reducing elder abuse? A case study in Rajshahi District, Bangladesh

We use data from respondents aged 60 years and above, collected during April 2009 in the Rajshahi district of Bangladesh, to examine whether high activeness, as captured by an AAI or in sub-domains, can help reduce the risk of elder abuse. The findings suggest that more than half of rural elderly and 14 percent of urban elderly were at some point abused. High activeness in health and security dimensions lowers the risk of being abused while those who are low active in community participation have the lowest risk of being abused in both rural and urban areas. Being literate (elderly with primary/secondary education) is revealed to be a significant factor that lowers the risk of abuse in both rural and urban areas. These results imply a need for educational programs that bolster positive and proper community interaction, in turn promoting a secure later life for elders, and reducing burden for families and society. High activeness in health and security dimensions should also be promoted to keep the elderly healthy and protect from abusive behavior.