An overview of elder abuse and neglect in Australia

Domestic Violence in Residential Care Facilities in New South Wales, Australia: A Text Mining Study

BACKGROUND AND OBJECTIVES

The police are often the first to attend domestic violence events in New South Wales (NSW), Australia, recording related details as structured information (e.g., date of the event, type of incident, premises type) and as text narratives which contain important information (e.g., mental health status, abuse types) for victims and perpetrators. This study examined the characteristics of victims and persons of interest (POIs) suspected and/or charged with perpetrating a domestic violence related crime in residential care facilities.

RESEARCH DESIGN AND METHODS

The study employed a text mining method that extracted key information from 700 police recorded domestic violence events in NSW residential care facilities.

RESULTS

Victims were mostly female (65.4%) and older adults (median age 80.3). POIs were predominantly male (67.0%) and were younger than the victims (median age 57.0). While low rates of mental illnesses were recorded (29.1% in victims; 17.4% in POIs), 'dementia' was the most common condition among POIs (55.7%) and victims (73.0%). 'Physical abuse' was the most common abuse type (80.2%) with 'bruising' the most common injury (36.8%). The most common relationship between perpetrator and victim was 'carer' (76.6%).

DISCUSSION AND IMPLICATIONS

These findings highlight the opportunity provided by police text-based data to provide insights into elder abuse within residential care facilities.

Addressing elder abuse through integrating law into health: What do allied health professionals at a Community Health Service in Melbourne, Australia, think?

This research looked at the attitudes of Community Health Service (CHS) staff regarding the integration of a lawyer into their CHS both before and after the integration occurred. It assessed their confidence in identifying and addressing elder abuse at each point. A written survey was distributed to staff before the lawyer commenced (n = 126), and approximately 12 months afterwards (n = 54). The preliminary survey demonstrated widespread agreement that legal issues can affect older people and supported having a lawyer in a CHS. Respondents were not confident about their capacity to identify abuse and provide referrals to a lawyer, but this improved in the follow‐up survey. These CHS staff were aware of the potential impacts of elder abuse and supported embedding a lawyer in the health service. Information and training as part of this service model should focus on the skills needed for CHS staff to play their role in such a partnership.

Epistemological erasure: The subject of abuse in the problematization of 'elder abuse'

The academic field of literature pertaining to elder abuse emerges largely from gerontology with contributions from a variety of disciplines including geriatric medicine, nursing, public health, law, psychology, sociology and social work. This paper presents a critical review of articles drawn from this literature to identify current directions leading the development of empirical research in this field. The objective measurement of prevalence, the identification and correlation of psycho-social risk factors and practice-based research oriented to intervention and prevention are identified as privileged sites for scientific investigation. These sites are critically analysed in terms of their underpinning rationalities to reveal the operation of a hegemonic post-positivist epistemological framework. This framework enables an expert professional discourse to structure knowledge and the field of inquiry through constructions of the 'subject of abuse' as a statistical figure, a factorial subject of risk and universally vulnerable. These modes of representation preclude subjective lived experience and, in doing so, inaugurate an 'epistemological erasure' of the embodied subject of abuse. The review attends to the limited body of qualitative research in the field, some of which claims a politicized empiricism of 'voice'. However, whilst the findings produced by this research suggest theoretically and conceptually fertile lines of inquiry, these have not disrupted or extended the dominant discourses in the field. This paper argues that an epistemological gulf, riven through a politics of evidence, ensures the reproduction of dominant discourses and their attendant limitations in ways that forestall the conceptual and theoretical advancement of the field.

Interventions for preventing abuse in the elderly

BACKGROUND

Maltreatment of older people (elder abuse) includes psychological, physical, sexual abuse, neglect and financial exploitation. Evidence suggests that 10% of older adults experience some form of abuse, and only a fraction of cases are actually reported or referred to social services agencies. Elder abuse is associated with significant morbidity and premature mortality. Numerous interventions have been implemented to address the issue of elder maltreatment. It is, however, unclear which interventions best serve to prevent or reduce elder abuse.

OBJECTIVES

The objective of this review was to assess the effectiveness of primary, secondary and tertiary intervention programmes used to reduce or prevent abuse of the elderly in their own home, in organisational or institutional and community settings. The secondary objective was to investigate whether intervention effects are modified by types of abuse, types of participants, setting of intervention, or the cognitive status of older people.

SEARCH METHODS

We searched 19 databases (AgeLine, CINAHL, Psycinfo, MEDLINE, Embase, Proquest Central, Social Services Abstracts‎, ASSIA, Sociological Abstracts, ProQuest Dissertations & Theses Global, Web of Science, LILACS, EPPI, InfoBase, CENTRAL, HMIC, Opengrey and Zetoc) on 12 platforms, including multidisciplinary disciplines covering medical, health, social sciences, social services, legal, finance and education. We also browsed related organisational websites, contacted authors of relevant articles and checked reference lists. Searches of databases were conducted between 30 August 2015 and 16 March 2016 and were not restricted by language.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), cluster-randomised trials, and quasi-RCTs, before-and-after studies, and interrupted time series. Only studies with at least 12 weeks of follow-up investigating the effect of interventions in preventing or reducing abuse of elderly people and those who interact with the elderly were included.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the studies' risk of bias. Studies were categorised as: 1) education on elder abuse, 2) programmes to reduce factors influencing elder abuse, 3) specific policies for elder abuse, 4) legislation on elder abuse, 5) programmes to increase detection rate on elder abuse, 6) programmes targeted to victims of elder abuse, and 7) rehabilitation programmes for perpetrators of elder abuse. All studies were assessed for study methodology, intervention type, setting, targeted audience, intervention components and intervention intensity.

MAIN RESULTS

The search and selection process produced seven eligible studies which included a total of 1924 elderly participants and 740 other people. Four of the above seven categories of interventions were evaluated by included studies that varied in study design. Eligible studies of rehabilitation programmes, specific policies for elder abuse and legislation on elder abuse were not found. All included studies contained a control group, with five of the seven studies describing the method of allocation as randomised. We used the Cochrane 'Risk of bias' tool and EPOC assessment criteria to assess risk of bias. The results suggest that risk of bias across the included body of research was high, with at least 40% of the included studies judged as being at high risk of bias. Only one study was judged as having no domains at high risk of bias, with two studies having two of 11 domains at high risk. One study was judged as being at high risk of bias across eight of 11 domains.All included studies were set in high-income countries, as determined by the World Bank economic classification (USA four, Taiwan one, UK two). None of the studies provided specific information or analysis on equity considerations, including by socio-economic disadvantage, although one study was described as being set in a housing project. One study performed some form of cost-effectiveness analysis on the implementation of their intervention programmes, although there were few details on the components and analysis of the costing.We are uncertain whether these interventions reduce the occurrence or recurrence of elder abuse due to variation in settings, measures and effects reported in the included studies, some of which were very small and at a high risk of bias (low- and very low-quality evidence).Two studies measured the occurrence of elder abuse. A high risk of bias study found a difference in the post-test scores (P value 0.048 and 0.18). In a low risk of bias study there was no difference found (adjusted odds ratio (OR) =0.48, 95% 0.18 to 1.27) (n = 214). For interventions measuring abuse recurrence, one small study (n = 16) reported no difference in post-test means, whilst another found higher levels of abuse reported for the intervention arms (Cox regression, combined intervention hazard ratio (HR) = 1.78, alpha level = 0.01).It is uncertain whether targeted educational interventions improve the relevant knowledge of health professionals and caregivers (very low-quality evidence), although they may improve detection of resident-to-resident abuse. The concept of measuring improvement in detection or reporting as opposed to measuring the occurrence or recurrence of abuse is complicated. An intervention of public education and support services aimed at victims may also improve rates of reporting, however it is unclear whether this was due to an increase in abuse recurrence or better reporting of abuse.The effectiveness of service planning interventions at improving the assessment and documentation of related domains is uncertain. Unintended outcomes were not reported in the studies.

AUTHORS' CONCLUSIONS

There is inadequate trustworthy evidence to assess the effects of elder abuse interventions on occurrence or recurrence of abuse, although there is some evidence to suggest it may change the combined measure of anxiety and depression of caregivers. There is a need for high-quality trials, including from low- or middle-income countries, with adequate statistical power and appropriate study characteristics to determine whether specific intervention programmes, and which components of these programmes, are effective in preventing or reducing abuse episodes among the elderly. It is uncertain whether the use of educational interventions improves knowledge and attitude of caregivers, and whether such programmes also reduce occurrence of abuse, thus future research is warranted. In addition, all future research should include a component of cost-effectiveness analysis, implementation assessment and equity considerations of the specific interventions under review.

Prevalence of Elder Abuse and Neglect: Findings from First Macedonian Study

OBJECTIVES: One of the study objectives was to explore the prevalence of elder abuse and neglect in the country.METHOD: Total of 960 respondents aged 65 years and above (44.7% of male and 55.3%) in private households, from all eight statistical regions participated in the study. Respondents were sampled through three staged national representative sampling procedure. Data were collected using a cognitively validated questionnaire for investigating elder abuse and neglect (psychological abuse, physical abuse, physical injury; financial abuse; sexual abuse and neglect) and Geriatric Depression Scale. The MMSE test was used as a pre-selection method. Statistical significance was set up at p < 0.05.RESULTS: Three hundred seven (32.0%) respondents reported experience of any type of abuse and neglect.  A single form of abuse was reported by 56.4% of participants, and two types of abuse by 27.4% of participants reporting abuse. Data showed that psychological abuse was the most prevalent form of abuse (25.7%), followed by financial abuse (12.0%), physical abuse (5.7%), physical injury (3.1%) and sexual abuse, and reported only by females (1.3%). Some type of neglect was reported by 6.5% of respondents.CONCLUSIONS: Defining the phenomenon of elder abuse and neglect in the context of our country can facilitate support of abused older people and, most importantly, may help develop policy and programmes based on evidence-based practices, targeting prevention and response.

Community-based system, reports, and substantiated cases of elder abuse: disparities between municipalities and relating factors in Japan

This study examines (1) the staffing and financial characteristics of systems for elder abuse detection and intervention in the municipal governments of Japan and (2) the relationship among the development of detection and intervention systems, the reporting rates of suspected elder abuse cases, and substantiated abuse rates in 927 municipalities across Japan. Progressive systems for the detection and intervention of elder abuse were significantly associated with a larger number of public officers than in non-progressive systems. Furthermore, greater rates of both suspected and substantiated cases of abuse were associated with progressive systems for elder abuse detection and intervention. Per capita annual expenditures on the comprehensive support project and the community general support center's catchment under the Long-Term Care Insurance (LTCI) program showed no significant association with the development of systems, the rate of suspected cases, or the number of substantiated cases. National social policy makers should examine strategies that would help municipalities assign sufficient staff to elder abuse detection and intervention programs.

Elder abuse an international perspective: exploring the context of elder abuse

The understanding of elder abuse and neglect, also called elder mistreatment, is at an interesting juncture, both empirically and conceptually. Since 2000 there has been a significant growth in prevalence studies, including major studies from the United Kingdom, Spain, Germany, Ireland, Israel, Finland, Canada, and the United States, with further studies planned in India and Hong Kong (see, for instance, Pillemer and Finkelhor, 1988; McDonald et al., 1991; Comijs et al., 1995; Penhale, 2008; Biggs et al., 2009; Goergen et al., 2009; Lowenstein et al., 2009; Naughton et al. 2010). And while development is still uneven, there is now a World Elder Abuse Awareness Day, held in June every year, with a network of grassroots support in a wide number of countries. At the International Congress of Gerontology and Geriatrics in Bologna, Italy (held on 14–17 April 2011, see http://iaggbologna2011.com), there were, for the first time, six symposia devoted to the topic, and in the Netherlands, a country with some of the first internationally recognized studies, the Leyden Academy in 2011 called the inaugural meeting of an international working group to critically consider interdisciplinary responses to this area of increasing professional concern.

Developing an empirical profile for elder abuse research in Canada

The aging population of Canada and the associated caregiving demands highlight the need for elder abuse research. The objectives of this article are to provide a review of literature while identifying recommendations and directions for future research. Significant gaps in the knowledge base are identified that preclude the development of effective programming and policies. Future research directions include prevalence studies in community and institutional settings; studies on correlates, risk, and protective factors; research to clarify definitional issues and to develop psychometrically sound measurements; qualitative studies; and the need to support elder abuse research through capacity building and appropriate resource strategies.

Elder abuse

Five types of elder abuse (physical, psychological, sexual, neglect and financial) are recognized. They are not new, occur worldwide and are associated with persistent morbidity and mortality. The forensic clinician has responsibilities to: (i) the patient, with competent history taking and examination, (ii) interpret findings and recognize patterns of harm and (iii) promulgate this issue in wider professional and public forums. Research into elder abuse is relatively recent; standardized terminology remains unsettled, and small-scale, local studies are hard to generalize. Cross-sectional, population-based studies of elder abuse should be possible, and standardized endpoints will require forensic science contributions.

Challenges in handling elder abuse in community care. An exploratory study among nurses and care coordinators in Norway and Australia

AIM AND OBJECTIVE

The aim of this study was to explore how nurses and care coordinators in community care in Norway and Australia experienced and handled cases of abused older clients, including the support they received in clinical interventions.

BACKGROUND

Norway and Australia base their approaches to elder abuse problems on similar philosophies. The Australian Government, however, has taken a more active position on this issue by focusing on structures and policies that might influence professionals' handling of abuse cases. The organisation and funding of community care services in the two countries are different, although common concerns are client-centeredness, equal access to services and enabling the client to live at home as long as possible.

DESIGN

Explorative design with a qualitative hermeneutic approach.

METHOD

Twenty participants, nurses, auxiliary nurses and care workers in Norway and Australia, were recruited by purposeful sampling. They participated in in-depth interviews.

RESULTS

The similarity of the information given in the two countries was striking. The interventions differed based on the type and seriousness of the abuse and the client's cognitive capacity. Financial abuse was a more prominent issue in Australia than in Norway. The handling of neglect cases in both countries followed much the same pathway and the intervention usually involved long-lasting processes. The managers' support and the elder protective services were of great importance to the nurses.

CONCLUSIONS

Community care agencies in both countries struggle with similar problems in handling cases of abuse. The participants' concerns were securing and supporting the older victim by individualising the intervention.

RELEVANCE TO CLINICAL PRACTICE

Community care agencies in both countries need to be aware of the huge impact of the managers' involvement and the services' responsibility and capacity to support professionals in the handling of elder abuse.