A systematic review and meta-analysis of interventions designed to prevent or stop elder maltreatment

Elder abuse victimization, mental health, and protective factors

OBJECTIVES

This study investigated the association between elder abuse and depressive symptoms, as well as protective factors against adverse mental health outcomes from elder abuse.

METHODS

Participants were drawn from the 5928 graduates of the WLS, Wave 3 study (age range 70-73) who completed both in-person and telephone interviews. From this large group, 975 (16.4%) participants reported having experienced elder abuse and were included in the sample. Path analysis using Mplus was employed.

RESULTS

Elder abuse victimization was significantly associated with depressive symptoms, and those who had suffered multiple types of elder abuse experienced more severe mental health outcomes. However, both light physical activity conducted alone and having a friend as a confidant were negatively associated with depressive symptoms among older adults who had experienced elder abuse.

CONCLUSION

Given the significant association between elder abuse and negative mental health outcomes among older survivors, screening and prevention programs are recommended. Older adults who have experienced elder abuse may benefit from programs designed to increase physical activity and help older adults build and maintain close relationships with friends and confidants.

Effectiveness of interventions to prevent abuse in people living with dementia in community settings: A systematic review

OBJECTIVES

This review examined the evidence for interventions to prevent the abuse of people living with dementia in the community.

METHODS

The articles were retrieved from 2000 to 2023 from six databases, including MEDLINE via PubMed, CINAHL Plus via EBSCO, EMBASE, ProQuest Medical Library, Web of Science, and Scopus. The research articles that focused on finding the effectiveness of interventions for preventing abuse of people living with dementia in community settings were included in this review. The review included randomized controlled trials and pre-test post-test trials only. The quality appraisal of the eligible studies was done using ROB 2 and ROBINS II. The findings were tabulated and narratively synthesised.

RESULTS

Out of 1831 articles, only three were included in this review. Only two RCTs were included in this efficacy review. Both the studies showed that the interventions were not effective in reducing abuse. The studies utilised family caregiver interventions like psychological interventions and online supportive education. The review identified psychological interventions with some evidence. Another study was a quasi-experimental study that used dialectical behaviour therapy as an intervention to reduce abuse occurrence. The study showed low evidence and focused only on reporting of elder abuse as an outcome.

CONCLUSION

This review found very few studies and was not able to draw a conclusion on the effectiveness of interventions for abuse in people living with dementia. Given the paucity of research, there is a clear need to identify how to overcome the challenges faced in elder abuse research and further refine the development of approaches to reduce elder abuse among people living with dementia in community settings.

Development and validation of the short form domestic elder abuse assessment questionnaire (SF-DEAQ)

BACKGROUND

The present study aimed to design and determine the psychometric properties of a short-form questionnaire to investigate the domestic elder abuse.

METHODS

This study consisted of two phases: in phase 1 we employed a modified Delphi approach with 18 participants. Consequently, content and face validity, and item analysis were applied. In Phase 2 we evaluated structural validity and convergent validity. Reliability was assessed by looking at internal consistency, stability, and absolute reliability.

RESULTS

The findings led to the development of a 27-items short form of domestic elder abuse in four domains that jointly accounted for 74.14% of the variance observed. The short form showed high internal consistency (Cronbach's alpha = 0.93) and significantly correlated (r = 0.91; p < 0.001 for both scales) with the comprehensive (49-item) domestic elder abuse.

CONCLUSION

The short form of domestic elder abuse was found to be reliable and valid as the longer version. The short form of domestic elder abuse could lessen the burden on respondents.

The Context of Elder Maltreatment: an Opportunity for Prevention Science

Elder maltreatment (EM) has been understood as a worldwide major public health threat for decades, yet it remains a form of victimization receiving limited attention, resources, and research. EM, which includes caregiver neglect and self-neglect, has far-reaching and long-lasting impacts on older adults, their families, and communities. Rigorous prevention and intervention research has significantly lagged in proportion to the magnitude of this problem. With rapidly growing population aging, the coming decade will be transformative: by 2030, one in six people worldwide will be aged 60 or older, and approximately 16% will experience at least one form of maltreatment (World Health Organization, 2021). The goal of this paper is to raise awareness of the context and complexities of EM, provide an overview of current intervention strategies based on a scoping review, and discuss opportunities for further prevention research, practice, and policy within an ecological model applicable to EM.

Epidemiology of Homicide in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

BACKGROUND

Empirical research investigating older adult homicide is sparse and rarely accumulated for greater insights. This systematic review and meta-analysis quantifies the prevalence and characteristics of homicide victimization among older adults (65 years and older) compared with younger adults (18-64 years).

METHOD

We searched Cumulative Index to Nursing and Allied Health Literature, Cochrane, Criminal Justice Abstracts, EMBASE, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science for studies published before December 31, 2018 (International Prospective Register of Systematic Reviews registration: CRD42017054536). Included were English-language, original, peer-reviewed studies describing the homicide of older adults. Excluded were studies not meeting age criteria, residence as an institution, or with insufficient outcome variables. The review included 39 studies; 17 were included in the meta-analysis. Data were extracted via open access or from study authors. Heterogeneity was assessed through study-level random effects estimates.

RESULTS

Pooled homicide rates per 100,000 population were 2.02 (95% CI [1.23, 3.33]) for older adults (n = 35,325) and 3.98 (95% CI [2.42, 6.53]) for younger adults (n = 607,224; rate ratio = .51, 95% CI [0.37, 0.70], p < .001). Proportion estimates for older adults: victim female 46.3%, location home 71.4%, offender familiar 25.2%, compared to stranger, 24.2%, motive argument 36.1%, compared to felony 30.8%, and weapon firearm 24.5%. Older adults were significantly different to younger adult victims (p = <.001) for female (OR = 2.5, 95% CI [2.02, 3.10]), home (3.87, 95% CI [3.45, 4.35]), stranger (1.81, 95% CI [1.66, 1.98]), argument (0.33, 95% CI [0.28, 0.39]), felony (2.78, 95% CI [2.58, 2.99]), and firearm (0.38, 95% CI [0.36, 0.40]).

CONCLUSIONS

Homicide against older adults differs from younger adults and warrants specific research and tailored prevention strategies.

The optimal intervention for preventing physical restraints among older adults living in the nursing home: A systematic review

AIM

This study aimed to evaluate the effectiveness of restraint reduction programs for nursing home care providers in enforcing physical restraint on residents and identify the best strategies for such programs.

DESIGN

Systematic Review.

METHODS

We searched for randomized controlled trials published until February 2021 for systematic review. The systematic review captured multifactorial interventions, education and consultation measures, including nursing home residents' and care providers' results. Study quality was assessed using the Cochrane Collaboration criteria.

RESULTS

In all seven trials, the interventions were led by a nurse specialist or unit leader and targeted at care providers. Five of the restraint reduction programs effectively reduced the rate of physical restraint use; two increased knowledge of restraint reduction for care providers; and one each promoted positive attitudes and behaviours. Duration of at least 6 weeks significantly improved the knowledge of care providers.

Knowledge, attitudes, detection, and reporting practices of elder abuse among orthopedists

PURPOSE

The purpose of the present study is to explore orthopedists' level of knowledge regarding laws and directives related to the detection and reporting of elder abuse, their attitudes towards the detection and reporting of elder abuse, detection and reporting practices, and the associations between these variables.

METHODS

In this cross-sectional study, 145 orthopedists employed in various Israeli hospitals-senior orthopedists, orthopedic residents, and orthopedic interns-completed a questionnaire.

RESULTS

The orthopedists had a medium level of knowledge and held positive attitudes on the detection and reporting of elder abuse, but the actual number of cases they detected and reported was low. Senior orthopedists had the highest level of knowledge and also the most positive attitudes, followed by orthopedic residents, and then orthopedic interns. Common reasons for unwillingness to report cases of elder abuse differed between levels of training. A minority of the orthopedists had received training on the detection and management of elder abuse. Higher knowledge and more positive attitudes were found associated with a higher number of detected and reported cases of elder abuse.

CONCLUSIONS

The importance of training orthopedists on the detection and management of elder abuse cannot be overemphasized. It seems that orthopedists should receive such training early in their career.

LEVEL OF EVIDENCE

IV.

A qualitative evaluation of the "RISE" elder abuse intervention from the perspective of adult protective services caseworkers: addressing a service system gap

Our understanding of effective elder abuse (EA) response interventions is limited. Adult Protective Services (APS), the primary agency responsible for responding to EA, lacks a coherent, conceptually driven, prolonged intervention phase. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields, the RISE EA intervention addresses this APS systems gap. Based on a three-year pilot project involving a partnership between RISE and Maine APS, the current study conducted a qualitative evaluation of RISE, from the perspective of APS caseworkers (n = 14) who worked with RISE, to understand RISE strengths and areas for improvement. Findings suggest APS workers perceive that RISE complements the scope and nature of APS, enhances APS caseworker well-being, and reduces repeat APS cases, while further APS/RISE collaboration and clarification on RISE role responsibilities and referral eligibilities are areas of growth. This study provides preliminary evidence for RISE as a community-based EA intervention in partnership with APS.

Factors shaping the global political priority of addressing elder abuse: a qualitative policy analysis

Background

Globally, 1 in 6 people aged 60 years and older experience elder abuse in the community annually, with potentially severe physical and mental health, financial, and social consequences. Yet, elder abuse remains a low global priority. We aimed to identify the factors accounting for the low global political priority of elder abuse.

Methods

We systematically searched relevant peer-reviewed literature and organisational reports in multiple databases and interviewed 26 key informants in the field of elder abuse. We used policy frameworks developed by previous research into the determinants of the priority of global health issues, and a qualitative methodology to thematically analyse the literature and interviews through triangulation of the data.

Findings

The main factors identified were related to the nature of the issue (the inherent complexity of elder abuse, pervasive ageism, insufficient awareness and doubts about prevalence estimates, and the intractability of the issue), the policy environment (the restricted ability in the field of elder abuse to capitalise on policy windows and processes), and the capabilities of the proponents of prevention of elder abuse (disagreements over the nature of the problem and solutions, challenges in individual and organisational leadership, and an absence of alliances with other issues).

Interpretation

Around 25 years ago, elder abuse started to register on the global agenda. Since then, the global priority for prevention of elder abuse has barely increased. This study identifies several inter-related factors that account for the issue's low priority and opportunities for overcoming these challenges. Chief among these opportunities is the UN Decade of Healthy Ageing 2021-2030, a unique 10-year-long policy window to increase the political priority of the prevention of elder abuse.

Funding

World Health Organization.

Developing a Comprehensive Understanding of Older Person Abuse in Canadian Immigrant Communities: An Integrative Review

Older immigrants represent 28% of the Canadian population who are over the age of 60. World-wide 1 in 6 older persons experiences abuse. Due to population aging, attention must be paid to the abuse and victimization of older immigrant persons, and the concept of elder abuse. The purpose of this integrative review was to understand elder abuse from the perspective of older immigrants, who came to Canada in their 60s or older as dependents of families or sponsors. Whittemore and Knafl’s (2005) method of review resulted in six articles that met the inclusion criteria. Results revealed three themes: conceptualization of abuse, post-immigration stressors and cultural factors, and barriers to access support and protection. The perpetrators were often close family members including intimate partners, spouses, children, children-in-laws and grandchildren. Contextual factors that influenced abuse included: power imbalance, change in social status from head of the families to legal and financial dependents due to immigration, culture, ethnicity, gender role expectations and language barrier. More research is needed to understand the diverse older immigrants experiences of elder abuse.

PROTOCOL: Global elder abuse: A mega-map of systematic reviews on prevalence, consequences, risk and protective factors and interventions

This is the protocol for a Campbell systematic review. The objectives are as follows: to produce a mega-map which identifies, maps and provides a visual interactive display, based on systematic reviews on all the main aspects of elder abuse in both the community and in institutions, such as residential and long-term care institutions.

Prevalence of Violence Perpetrated by Healthcare Workers in Long-Term Care: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to determine the prevalence of violence perpetrated by healthcare workers (HCWs) against patients in long-term care (LTC). For this purpose, five relevant databases were searched. Two reviewers extracted data from the included articles independently and assessed their quality. Overall and subgroup random-effects pooled prevalence meta-analyses were performed. A series of meta-analyses stratified by study quality were also performed due to high heterogeneity. Nineteen articles were included, physical restraint (22%; CI: 15-29), verbal abuse (22%; CI: 16-28), and neglect (20%; CI: 15-26) attained the highest overall prevalence, while sexual abuse was less reported (2%; CI: 1-3). The prevalence of witnessed violence is generally higher than those reported by HCWs, and patients and their relatives reported fewer cases of violence than HCWs. Differences in violence perpetrated among LTC settings were found. Neglect (64%; CI: 56-72) and financial abuse (7%; CI: 3-12) reported by HCWs were higher in home care, while verbal abuse (21%; CI: 7-39) reported by patients or their families was higher in nursing homes. Our findings highlight that violence perpetrated by HCWs toward patients represents a significant concern in LTC, suggesting the adoption of reliable monitoring approaches and provision of assistance to victims in reporting abuse.

OUP accepted manuscript

Background and Objectives

Adult Protective Services (APS) are the frontline agencies investigating elder mistreatment and providing/coordinating postinvestigation services. Yet, their effectiveness in reducing different types of mistreatment in relation to services is unknown. This study aimed to address the knowledge gap by identifying services provided by mistreatment type, and examining the associations of services with mistreatment reduction.

Research Design and Methods

A pretest–post-test design was implemented using the Identification, Services, and Outcomes (ISO) Matrix to assess mistreatment levels during case investigation and at case closure after services were provided. San Francisco and Napa APS participated in a 6-month data collection.

Results

The 4 most prevalent types of mistreatment were examined: emotional, physical, financial abuse, and neglect by others. On average, level of mistreatment decreased across mistreatment types after APS intervention. Care/case management, mental health, and other services were most common, while specific services differed depending on type of mistreatment. Care/case management services were associated with physical and emotional abuse reduction, legal services further correlated with emotional abuse reduction; financial planning services were associated with financial abuse reduction; care/case management and other services were associated with neglect reduction.

Discussion and Implications

This is the first study to address APS services by mistreatment type and the outcomes of services. Adoption of the ISO Matrix by APS programs opens the possibility of research and practice collaboration in APS outcomes research using a standardized approach.

Barriers to managing elder abuse in primary care services: experiences of healthcare providers in Mexico City

The purpose of this study was to analyze the barriers to managing elder abuse from the perspective of primary care health workers in Mexico City. We performed an ethnographic qualitative-descriptive study. Thirty semi-structured interviews were conducted with healthcare providers associated with three health centers located in areas with medium and high levels of poverty. A phenomenological approach was used to identify themes, subthemes and codes. Three main types of barriers were found: 1) institutional framework; 2) professional competency limitations and the dominance of a biomedical vision; and 3) the invisibilization of elder abuse. These barriers, described by healthcare workers, highlight the complexity involved in integrating the treatment of elder abuse into primary care health services. It is necessary to develop public educational and preventive public policies for elder abuse that are coordinated both with support services to treat such cases as well as with programs to strengthen healthcare providers professional competency.

Human Rights to Inclusive Living and Care for Older People With Mental Health Conditions

Although older persons wish to age at home, many older persons with mental health conditions and psychosocial disability (MHC-PSD) spend the last few years of their life in residential facilities. This paper will examine the impact of ageism and human rights violations manifested in environmental design, specifically regarding social isolation, loneliness, inadequate psychosocial, environmental, recreational and spiritual support. This is compounded by failure to meet basic care needs-nutrition, hydration, pain and medication support. This paper highlights two innovative initiatives from the Netherlands, which show that older persons' rights can be maintained in innovative, collective living arrangements. It is concluded that the creation of inclusive and safe environments for older persons with MHC-PSD can facilitate the enjoyment of Human Rights.

Estimated Incidence and Factors Associated With Risk of Elder Mistreatment in New York State

IMPORTANCE

Elder mistreatment is associated with major health and psychosocial consequences and is recognized by clinicians, policy makers, and researchers as a pervasive problem affecting a rapidly aging global population.

OBJECTIVE

To estimate the incidence of elder mistreatment and identify factors associated with the risk of new cases.

DESIGN, SETTING, AND PARTICIPANTS

This research is a 10-year, longitudinal, population-based, cohort study of the incidence of elder mistreatment in New York State households conducted between 2009 (wave 1) and 2019 (wave 2). At wave 1, random digit-dial (landline and cellular telephones) stratified sampling was done to recruit English-speaking and/or Spanish-speaking, cognitively intact, community-dwelling older adults (aged ≥60 years) across New York State. The current study conducted computer-assisted telephone interviews with older adults who participated in wave 1 and gave permission to be contacted again for wave 2 interviews (response rate, 60.7%). Data analysis was performed from October 2020 to January 2021.

EXPOSURES

Physical factors (health status, functional capacity, and age), living arrangement (coresidence), and sociocultural characteristics (sex, race/ethnicity, geocultural context, and household income).

MAIN OUTCOMES AND MEASURES

Ten-year incidence for overall elder mistreatment and subtypes (financial abuse, emotional or psychological abuse, physical abuse, and neglect) were measured using adapted versions of the Conflict Tactics Scale, the Duke Older Americans Resources and Services scale, and the New York State Elder Mistreatment Prevalence Study financial abuse tool.

RESULTS

The analytical sample included 628 older adults (mean [SD] age at wave 1, 69.20 [6.95] years; age at wave 2, 79.40 [6.93] years; 504 non-Hispanic White individuals [80.9%]; 406 women [64.6%]). Ten-year incidence rates were 11.4% (95% CI, 8.8%-14.3%) for overall elder mistreatment, 8.5% (95% CI, 6.3%-10.9%) for financial abuse, 4.1% (95% CI, 2.6%-5.7%) for emotional abuse, 2.3% (95% CI, 1.2%-3.6%) for physical abuse, and 1.0% (95% CI, 0.3%-1.8%) for neglect. Poor self-rated health at wave 1 was associated with increased risk at wave 2 of new overall mistreatment (odds ratio [OR], 2.86; 95% CI, 1.35-5.84), emotional abuse (OR, 3.67; 95% CI, 1.15-11.15), physical abuse (OR, 4.21; 95% CI, 1.14-13.70), and financial abuse (OR, 2.80; 95% CI, 1.16-6.38). Compared with non-Hispanic White participants, Black participants were at heightened risk of overall mistreatment (OR, 2.61; 95% CI, 1.16-5.70) and financial abuse (OR, 2.80; 95% CI, 1.09-6.91). A change from coresidence to living alone was associated with increased risk of financial abuse (OR, 2.74; 95% CI, 1.01-7.21).

CONCLUSIONS AND RELEVANCE

These findings suggest that health care visits may be important opportunities to detect older adults who are at risk of mistreatment. Race is highlighted as an important social determinant for elder mistreatment requiring urgent attention.

Is multimorbidity associated with risk of elder abuse? Findings from the AHSETS study

BACKGROUND

With an increasing number of older adults in low- and middle-income countries (LMIC), the burden of multimorbidity and functional dependence is on the rise. At the same time, a higher prevalence of elder abuse is observed in these populations. There is scarce evidence on the interplay between elder abuse and multimorbidity with no reports from LMIC settings yet. Present study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India.

METHODS

The data for this study was collected as a part of our AHSETS study comprising of 725 older adults residing in rural Odisha, India. Multimorbidity was assessed by the MAQ PC tool while Hwalek-Sengstock elder abuse screening test (HS-EAST) was used to assess the risk of elder abuse. Functional dependence was measured by the Lawton IADL questionnaire. We used ordinal logistic regression models to identify the correlates of elder abuse and test for mediation by functional dependence.

RESULTS

Around 48.8 % (95 % CI:45.13-52.53 %) older adults had multimorbidity while 33.8 % (95 % CI:30.35-37.35 %) had some form of dependence. Out of 725, 56.6 % (CI 52.85-60.19 %) were found to be at low-risk elder abuse and 15.9 % (CI 13.27-18.72 %) being at high-risk. The prevalence of higher risk of elder abuse was greater among females, non-literates, widowed persons, those not currently working and those belonging to lower socio-economic strata. The risk of elder abuse was significantly associated with multimorbidity (AOR = 1.68; 95 %CI: 1.11-2.57) and functional dependence (AOR = 2.08; 95 %CI: 1.41-3.06). Additionally, we found a partial mediation mechanism of functional dependency between the pathway of multimorbidity and elder abuse.

CONCLUSIONS

Elder abuse and multimorbidity are emerging as issues of significant concern among rural elderly in Odisha, India. Multimorbidity and functional dependence are associated with significantly higher odds of elder abuse among rural older adults. Further, we report the role of functional dependence as a partial mediator between multimorbidity and elder abuse. Therefore, potential interventions on reducing the economic, physical and care dependence among multimorbid patients may reduce the risk of elder abuse.

Nonfatal Assault Injury Trends in California, 2005 to 2015

Interpersonal violence is a major global public health problem, and the burden of nonfatal assault injuries is far greater than that of homicides. To understand trends and inform prevention priorities, we sought to describe nonfatal assault injury trends across demographic groups from 2005 to 2015 in California, USA. Comprehensive hospitalization and emergency department discharge records were used to estimate annual rates of nonfatal assault injury overall and by means and age group and age-standardized annual rates by race/ethnicity, gender, and county. The overall rate of assault injury was stable in California from 2005 to 2015 (mean = 364 per 100,000), but there was substantial heterogeneity across demographic groups, including increases among African Americans (900 to 1,194), American Indian/Alaskan Natives (423 to 572), older individuals (age 25-29 = 697 to 727; 30-39 = 495 to 557; 40-49 = 352 to 404; 50-59 = 194 to 313; 60+ = 66 to 106), and women (199 to 252). Assault injury rates increased among several demographic groups, warranting the attention of professionals involved in violence prevention efforts. Epidemiologic examination to better understand causes of increases can inform prevention efforts. Similar analyses should be applied to other settings to determine how broadly these patterns are observed.

The Effectiveness of Psychosocial Interventions for Elder Abuse in Community Settings: A Systematic Review and Meta-Analysis

As a global public health concern, elder abuse negatively affects health, psychosocial wellbeing, and mortality among elders. Research and practice efforts made to explore effective prevention and intervention strategies are growing. Despite the growing number of intervention studies on elder abuse, research synthesis on the empirical literature seems lacking. This study aims to identify the pooled effect size of prevention and interventions targeted ultimate and intermediate outcomes for elder abuse that occurred in community settings. Following the Cochrane guideline, our team searched across eight electronic databases and manually searched reference lists of eligible studies and existing systematic reviews for all potentially eligible studies. A random-effects model of 51 effect size estimates reported an overall positive and statistically significant treatment effect of psychosocial interventions for elder abuse, d = 0.63, p < 0.05. The overall treatment effect was approaching statistical significance at 0.1 level for ultimate outcomes, d = 0.32, p = 0.09, and intermediate outcomes, d = 0.75, p = 0.1. An overall significant effect size was found among family-based interventions, d = 0.59, p < 0.05, and interventions targeting older adults and their caregivers, d = 0.45, p < 0.05. Existing evidence supports an overall significant effect for psychosocial interventions for elder abuse. Interventions that used a family-based model, combined education and supportive services, and targeted both caregivers and elders, showed significant effect size, suggesting such features being considered in elder abuse intervention design. Future intervention research is needed to shed light on the link between intervention activities and ultimate change in elder abuse behaviors.

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.

Interventions to prevent elder abuse in the community: a mixed-methods systematic review

OBJECTIVE

To identify the interventions proposed in the literature aimed at preventing elder abuse among community-residing elders.

METHOD

This was a mixed-methods systematic review that followed the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols checklist. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews. We included studies published between January 2004 and December 2019 in the databases: LILACS, IBECS, CUMED, CINAHL, MEDLINE and SciELO. The methodological quality of each study included was performed using the Mixed Methods Appraisal Tool.

RESULTS

Seven studies formed the final sample. Two groups emerged after the analyses: the primary level intervention group, which used health education and coexisting elder abuse groups; and the secondary intervention level, focused mostly on the mental health care of victims of elder abuse.

CONCLUSION

There is still a shortage of intervention studies to prevent elder abuse. All the studies selected had a positive outcome, and all interventions can be implemented in nursing care practice.

Research priorities for elder abuse screening and intervention: A Geriatric Emergency Care Applied Research (GEAR) network scoping review and consensus statement

The Geriatric Emergency Care Applied Research (GEAR) Network (1) conducted a scoping review of the current literature on the identification of and interventions to address elder abuse among patients receiving care in emergency departments and (2) used this review to prioritize research questions for knowledge development. Two questions guided the scoping review: What is the effect of universal emergency department screening compared to targeted screening or usual practice on cases of elder abuse identified, safety outcomes, and health care utilization?; and What is the safety, health, legal, and psychosocial impact of emergency department-based interventions vs. usual care for patients experiencing elder abuse? We searched five article databases. Additional material was located through reference lists of identified publications, PsychInfo, and Google Scholar. The results were discussed in a consensus conference; and stakeholders voted to prioritize research questions. No studies were identified that directly addressed the first question regarding assessment strategies, but four instruments used for elder abuse screening in the emergency department were identified. For the second question, we located six articles on interventions for elder abuse in the emergency department; however, none directly addressed the question of comparative effectiveness. Based on these findings, GEAR participants identified five questions as priorities for future research - two related to screening, two related to intervention, and one encompassed both. In sum, research to identify best practices for elder abuse assessment and intervention in emergency departments is still needed. Although there are practical and ethical challenges, rigorous experimental studies are needed.

Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence

BACKGROUND

Coercive treatment comprises a broad range of practices, ranging from implicit or explicit pressure to accept certain treatment to the use of forced practices such as involuntary admission, seclusion and restraint. Coercion is common in mental health services.

AIMS

To evaluate the strength and credibility of evidence on the efficacy of interventions to reduce coercive treatment in mental health services. Protocol registration: https://doi.org/10.17605/OSF.IO/S76T3.

METHOD

Systematic literature searches were conducted in MEDLINE, Cochrane Central, PsycINFO, CINAHL, Campbell Collaboration, and Epistemonikos from January 2010 to January 2020 for meta-analyses of randomised studies. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was classified using quantitative umbrella review criteria, and credibility of evidence was assessed using the GRADE approach.

RESULTS

A total of 23 primary studies (19 conducted in European countries and 4 in the USA) enrolling 8554 participants were included. The evidence on the efficacy of staff training to reduce use of restraint was supported by the most robust evidence (relative risk RR = 0.74, 95% CI 0.62-0.87; suggestive association, GRADE: moderate), followed by evidence on the efficacy of shared decision-making interventions to reduce involuntary admissions of adults with severe mental illness (RR = 0.75, 95% CI 0.60-0.92; weak association, GRADE: moderate) and by the evidence on integrated care interventions (RR = 0.66, 95% CI 0.46-0.95; weak association, GRADE: low). By contrast, community treatment orders and adherence therapy had no effect on involuntary admission rates.

CONCLUSIONS

Different levels of evidence indicate the benefit of staff training, shared decision-making interventions and integrated care interventions to reduce coercive treatment in mental health services. These different levels of evidence should be considered in the development of policy, clinical and implementation initiatives to reduce coercive practices in mental healthcare, and should lead to further studies in both high- and low-income countries to improve the strength and credibility of the evidence base.

Identifying Interventions and Their Efficacy as Used by a Community Agency Managing and Responding to Elder Abuse

Limited research has been conducted to identify how elder abuse (EA) can be managed and prevented. Interventions employed by a community agency multidisciplinary team across 164 EA cases were examined. Results identified the largest number (N = 369) and widest variety of EA interventions to date. Using content analysis, interventions with similar proximal goals were grouped into 30 intervention strategies to evaluate efficacy and 12 higher-order intervention categories to guide practice. Intervention outcomes were rated as positive, negative, neutral, could not implement, or unknown. Positive outcomes were the most common (35%), and also included novel and/or effective interventions aimed at perpetrators such as physical treatment, social support, and communication. Few (1%) interventions had negative outcomes. Many interventions could not be implemented (21%), often due to a lack of funding or victim refusal. Results suggest changes to policy, practice, and research methodology, which could increase positive outcomes through facilitation of intervention implementation and improved data access.

Determinants of Non-emergency Use of Control Interventions in Older Canadian Psychiatric Inpatients: Analysizing the InterRAI Mental Health Electronic Health Records

Background: The use of control interventions (CIs; acute control medications, physical/mechanical restraint) is associated with negative physical and psychological outcomes, particularly in older adults who are physically vulnerable. The aims of this study were to: (i) report the rates of CI use in older psychiatric inpatients (age 65 - 84 and age 85+), and compare them with younger age groups (18 - 44, age 45 - 64); and (ii) identify the factors associated with non-emergency CI use in older psychiatric inpatients. Methods: Routinely collected interRAI Mental Health assessments from 2005 - 2018 in Ontario, Canada, were analyzed to determine the rates of CI use. Logistic regression models were used to examine the sociodemographic and clinical determinants of non-emergency and any CI use. Results: There were 226,119 (female: 48.6%) interRAI assessments, and 85% of those assessed were under 65 years of age. The rates of non-emergency CI use in the four age groups were: 18 - 44 = 9.4%, 45 - 64 = 8.3%, 65 - 84 = 9.9%, 85+ = 13.2%. The most significant determinants of non-emergency CI use in older adults were highest impairments in activities of daily living (ADL Short Form score 8-16: OR = 2.72, 95% CI = 2.42 - 3.06), highest levels of aggression (Aggressive Behavior Scale score 4 - 6: OR = 1.76, 95% CI = 1.57 - 1.98), and highest levels of positive psychotic symptoms (Positive Symptoms Scale score 9+: OR = 1.65, 95% CI = 1.43 - 1.90). Delirium, cognitive disorder diagnosis, cognitive impairment, and falls were also associated with increased CI use odds, as were having the reasons for admission be danger to self, danger to others or inability to care for self. Females were less likely to have non-emergency CI use (OR = 0.84, 95% CI = 0.73 - 0.95). Patients admitted from long-term care homes had significantly greater odds of non-emergency CI use compared with community admissions (OR = 1.18; 95% CI = 1.07 - 1.29). Conclusion: The higher rates of non-emergency CI use in older psychiatric inpatients is concerning. Alternative non-pharmacological and person-centered management strategies should be considered to support older psychiatric inpatients with functional impairment, positive symptoms, aggressive behavior, cognitive impairment and delirium. The use of CIs could be incorporated as a quality improvement activity to monitor changes at various service provision levels.

Abuse of Vulnerable Older Adults by Designated Surrogate Decision Makers

Abuse perpetrated by designated surrogates has become highly visible nationally, yet no reliable data exist on its nature or extent. Because vulnerable older adults needing surrogate decision makers typically rely upon others for care, they may be unable to advocate for themselves and are susceptible to abuse. We prospectively gathered Adult Protective Services (APS) data from six geographically diverse counties on over 400 substantiated cases of abuse by perpetrators (53% non-surrogates; 47% documented or claimed surrogate) of vulnerable adults 65+ living in community settings. Most perpetrators (85%) were designated power of attorney, while approximately 8% were guardians, and 7% were representative payees; most perpetrators were family members. Polyabuse occurred frequently. Almost 25% of cases involved a prior substantiated APS report. This presentation highlights how surrogates perpetuate abuse and outcomes on older adult victims. Our findings inform practice and policy for better prevention, detection, investigation, and intervention in these challenging cases.

Elder Abuse Assessment Tools and Interventions for use in the Home Environment: a Scoping Review

Background and Aim

Caregivers in the home environment have an important role in timely detecting and responding to abuse. The aim of this review was to provide insight into both the existing tools for the assessment of and interventions for elder abuse by formal and informal caregivers in the home environment, and to categorize them according to a public health perspective, into primary, secondary, tertiary or quaternary prevention.

Methods

We selected the assessment tools and interventions that can be used by caregivers in the home environment included in previous reviews by Gallione et al (2017) and Fearing et al (2017). To identify published studies after these reviews, a search was performed using PubMed, Cochrane Database, CINAHL and Web of Science.

Results

In total, fifteen assessment tools and twelve interventions were included. The number of assessment tools for elder abuse for use in the home environment is increasing; however, tools must be validated over different cultures and risk groups. In addition, the tools lack attention for the needs of vulnerable older persons such as persons with dementia. Existing interventions for caregivers in the home environment lack evidence for addressing elder abuse and do not address potential adverse effects (quaternary prevention).

Conclusion

Assessment tools for elder abuse need further testing for validity and reliability for use by caregivers in the home environment. For interventions, meaningful outcome measures are needed. Important to note is that quaternary prevention requires more attention. This argues for taking into account perspectives of (abused) older persons and caregivers in the development of assessment tools and interventions protocols.

Do interventions to prevent or stop abuse and neglect among older adults work? A systematic review of reviews

Abuse and neglect among older adults impact everyone and are recognized internationally as significant and growing public health issues. A systematic review of reviews was conducted to identify effective strategies and approaches for preventing abuse and neglect among older adults. Eligible reviews were systematic or meta-analyses; focused on the older population as reported in the publications; reviewed prevention interventions; included relevant violence and abuse outcomes; written in English; and published in a peer-reviewed journal between January 2000 and May 2020. Eleven unique reviews (12 publications) met the eligibility criteria, including one meta-analysis. Included reviews mainly focused on general abuse directed toward older adults; and educational interventions for professional and paraprofessional caregivers, multidisciplinary teams of health care and legal professionals, and families. Interventions were implemented in a variety of community and institutional settings and addressed primary, secondary, and tertiary prevention. The reviews indicated weak or insufficient evidence of effectiveness in preventing or reducing abuse, yet several promising practices were identified. Future research is needed to evaluate emerging and promising strategies and approaches to prevent abuse among older adults. Effective interventions are also needed to prevent or reduce abuse and neglect among older adults.

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.

Elder Abuse in the Out-of-Hospital and Emergency Department Settings: A Scoping Review

This scoping review aimed to synthesize the available evidence on the epidemiology, patient- and caregiver-associated factors, clinical characteristics, screening tools, prevention, interventions, and perspectives of health care professionals in regard to elder abuse in the out-of-hospital or emergency department (ED) setting. Literature search was performed with MEDLINE, EMBASE, the Cumulative Index of Nursing and Allied Health, PsycINFO, and the Cochrane Library. Studies were eligible if they were observational or experimental and reported on elder abuse in the out-of-hospital or ED setting. A qualitative approach, performed independently by 2 reviewers, was used to synthesize and report the findings. A total of 413 citations were retrieved, from which 55 studies published between 1988 and 2019 were included. The prevalence of elder abuse reported during the ED visit was lower than reported in the community. The most commonly detected type of elder abuse was neglect, and then physical abuse. The following factors were more common in identified cases of elder abuse: female sex, cognitive impairment, functional disability, frailty, social isolation, and lower socioeconomic status. Psychiatric and substance use disorders were more common among victims and their caregivers. Screening tools have been proposed, but multicenter validation and influence of screening on patient-important outcomes were lacking. Health care professionals reported being poorly trained and acknowledged numerous barriers when caring for potential victims. There is insufficient knowledge, limited training, and a poorly organized system in place for elder abuse in the out-of-hospital and ED settings. Studies on the processes and effects of screening and interventions are required to improve care of this vulnerable population.

Review of Programs to Combat Elder Mistreatment: Focus on Hospitals and Level of Resources Needed

BACKGROUND

Elder mistreatment is common and has serious social and medical consequences for victims. Though programs to combat this mistreatment have been developed and implemented for more than three decades, previous systematic literature reviews have found few successful ones.

OBJECTIVE

To conduct a more comprehensive examination of programs to improve elder mistreatment identification, intervention, or prevention, including those that had not undergone evaluation.

DESIGN

Systematic review.

SETTING

Ovid MEDLINE, Ovid EMBASE, Cochrane Library, PsycINFO Elton B. Stephens Co. (EBSCO), AgeLine, CINAHL.

MEASUREMENTS

We abstracted key information about each program and categorized programs into 14 types and 9 subtypes. For programs that reported an impact evaluation, we systematically assessed the study quality. We also systematically examined the potential for programs to be successfully implemented in environments with limited resources available.

RESULTS

We found 116 articles describing 115 elder mistreatment programs. Of these articles, 43% focused on improving prevention, 50% focused on identification, and 95% focused on intervention, with 66% having multiple foci. The most common types of program were: educational (53%), multidisciplinary team (MDT) (21%), psychoeducation/therapy/counseling (15%), and legal services/support (8%). Of the programs, 13% integrated an acute-care hospital, 43% had high potential to work in low-resource environments, and 57% reported an attempt to evaluate program impact, but only 2% used a high-quality study design.

CONCLUSION

Many programs to combat elder mistreatment have been developed and implemented, with the majority focusing on education and MDT development. Though more than half reported evaluation of program impact, few used high-quality study design. Many have the potential to work in low-resource environments. Acute-care hospitals were infrequently integrated into programs.

Extent of Elder Abuse Training in Dental Hygiene Curricula and Program Directors' Perceptions of Importance of and Barriers to Implementation

Research published in 2002 reported limited elder abuse training in U.S. dental hygiene curricula although its importance has increased with an aging population. The aims of this study were to determine the current extent of elder abuse training in U.S. dental hygiene curricula and to explore dental hygiene program directors' perspectives on the topic. A 25-item online survey was distributed to all 361 program directors, coordinators, and/or department chairs of Commission on Dental Accreditation (CODA)-accredited dental hygiene programs via email in August 2017. A response rate of 27.2% (n=98) was achieved. A large percentage of the respondents (83.3%) included elder abuse training in their program curricula; for most (58.7%), one to three curriculum hours were spent on the topic. A large percentage (89%) agreed the topic was at least somewhat important to include, and 29.5% said a personal or professional elder abuse experience influenced the depth of instruction at their program. Various barriers to inclusion were identified. At least 40% of these educators perceived their graduates to be appropriately competent in their ability to recognize elders' oral neglect (63.5%) and general neglect (48.7%) and to document potential signs of elder abuse (43.8%). Lower percentages perceived that their graduates were competent in the areas of communication regarding elder abuse (21.9%) and reporting suspected abuse (32.4%). Despite rising awareness about elder abuse among dental hygienists and widespread incorporation of the subject in dental hygiene curricula, these results suggest that there are still deficiencies in training. To prepare dental hygiene graduates to confidently recognize and respond to elder abuse, educators should seek to overcome barriers by modifying instruction and embracing interprofessional collaboration.

[The forensic medical aspects of the problem of victimization of the elderly persons as exemplified by a case of suicide of an oncological patient]

The frequency of suicides is an indirect indicator of the social welfare without distinction as to the social and political system. This problem is of special importance as regards the well-being of elderly people whose numbers grow steadily all over the world. The extending life expectancy at older ages in the combination with the resulting demographic disproportions have widespread repercussions on the older generation because they are associated with the increase of the negative social trends as exemplified by a case of suicide of the 89 year-old man A who had for a long time suffered from an oncological disease and was entirely dependent upon the assistance from other people. The authors emphasize that the most important factors responsible for the currently enhanced frequency of suicidal attempts among the elderly persons include the life below the poverty line, permanent stress, poor housing conditions, family conflicts, the ever increasing prevalence of somato-neurological and psychic pathologies, etc. The comprehensive forensic medical and socio-hygienic analysis of all cases of suicide and numerous relevant risk factors may be instrumental in the systematization of the statistical information on the nosological forms of specific pathologies, and the development of the adequate measures for the prevention of the deviant behaviour among the old-age subjects at the regional level. Such analysis may contribute to the reduction of the mortality among the populations of the advanced age especially in the high-risk groups including the elderly people.

“Build Rapport, Otherwise No Screening Tools in the World Are Going to Help”: Frontline Service Providers’ Views on Current Screening Tools for Elder Abuse

Background and Objectives

Without an effective screening tool, accompanied by clear guidelines of what to do when elder abuse is suspected, health workers may face challenges when asking questions about elder abuse. This study aimed to find the most effective and acceptable existing elder abuse screening tool and to create guidelines for using the tool.

Research Design and Methods

A rapid review of the literature identified existing validated elder abuse screening tools. Then, 5 tools (Vulnerability to Abuse Screening Scale [VASS], Elder Abuse Suspicion Index [EASI], Elder Assessment Instrument [EAI], Caregiver Abuse Screen [CASE], and Brief Abuse Screen for the Elderly [BASE]), selected based on their internal rigor, were presented to health professionals to assess the tools’ relevance to their practice. Three focus groups were held with 23 health professionals in Victoria, Australia, in 2017. Data were thematically analyzed.

Results

None of the tools were deemed suitable by participants for use in their practice. Criticisms of the tools included: using outdated terminology, asking binary questions, asking multiple questions at once, failure to consider the older person’s cognitive status, failure to consider how culture mediates elder abuse, and failure to outline a referral pathway to those administering the tool. Participants emphasized that the screening tool must promote trust and rapport between the assessor and the older person to solicit a story on this sensitive subject.

Discussion and Implications

A successful elder abuse screening tool must be concise, easy to use, account for the older person’s health and social vulnerabilities, and outline a referral pathway if elder abuse is suspected.

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

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

Addressing the measurement challenge in elder abuse interventions: need for a severity framework

The field of elder abuse is evolving toward an emphasis on intervention research. However, researchers currently rely on binary approaches to measure elder abuse phenomena, which fail to capture changes in problem status over the course of intervention. This commentary develops a case for severity as a framework to operationalize and measure elder abuse in intervention research and practice. A severity framework provides enhanced elder abuse measurement responsiveness and aligns with the dominant client-centered, harm-reduction clinical approach to intervening with elder abuse cases.

A systematic review on community-based interventions for elder abuse and neglect

Elder abuse and neglect is a societal issue that requires prevention and intervention strategies at the practice and policy level. A systematic review on the efficacy of community-based elder abuse interventions was undertaken to advance the state of knowledge in the field. The peer-reviewed literature between 2009 and December 2015 were searched across four databases. Two raters independently reviewed all articles, assessed their methodological quality, and used a modified Sackett Scale to assign levels of evidence. Four thousand nine hundred and five articles were identified; nine were selected for inclusion. Although there was Level-1 evidence for psychological interventions (n = 2), only one study on strategies for relatives (START) led to a reported decrease in elder abuse. There was Level-4 evidence for conservatorship, an elder abuse intervention/prevention program (ECARE), and a multidisciplinary intervention (n = 4), in which one study yielded significant decreases in elder abuse and/or neglect. The remaining three were classified as Level-5 evidence (n = 3) for elder mediation and multidisciplinary interventions. There are limited studies with high levels of evidence for interventions that decrease elder abuse and neglect. The scarcity of community-based interventions for older adults and caregivers highlights the need for further work to elevate the quality of studies.

Family caregiver mistreatment of the elderly: prevalence of risk and associated factors

BACKGROUND

The detection of elder mistreatment is emerging as a public health priority; however, abusive behaviors exercised by caregivers are little known and rarely detected among primary health care professionals. This study aims to estimate the prevalence of risk of abuse against community-residing elderly with moderate to severe dependency whose caregivers are relatives. In addition, we aim to describe the association between such a risk and socio-demographic variables, cognitive and dependency state of the victim, and the scale of the caregiver's anxiety, depression, and burden.

METHODS

Cross-sectional study developed in 72 Primary Health Care teams from Barcelona, Spain. Participants were caregivers and their dependent care recipients (N = 829). Home interviews included the Caregiver Abuse Screen (CASE); self-reported abuse from care recipient; activities of daily living and cognitive state of the care recipient; anxiety and depression in caregivers and Caregiver Burden Scale. The relationship prior to the dependency, positive aspects of caregiving, and social support for the caregiver were also assessed. Multivariate analysis was performed using logistic regression with risk of abuse as dependent variable.

RESULTS

Caregivers were mainly women (82.8%) with a mean age of 63.3 years. Caregivers and care recipients lived in the same household in 87.4% of cases, and 86.6% had enjoyed a good previous relationship. Care recipients were women (65.6%), with a mean age of 84.2 years, and 64.2% had moderate to severe cognitive impairment. CASE demonstrated a prevalence of 33.4% (95% CI: 30.3-36.7) of abuse risk by the caregiver. Logistic regression showed as statistically significant: caregiver burden (OR = 2.75; 95% CI: 1.74-4.33), caregiver anxiety (OR = 2.06; 95% CI: 1.40-3.02), caregiver perception of aggressive behavior in the care recipient (OR = 7.24; 95% CI: 4.99-10.51), and a bad previous relationship (OR = 4.66; 95% CI: 1.25-17.4).

CONCLUSIONS

Prevalence of risk of abuse is high among family caregivers. Our study has found risk factors in family caregivers that are preventable to an extent, namely: anxiety and feelings of burden. It is essential to become aware of these risk factors and their causes to intervene and help primary as well secondary prevention.

Prevalence and Correlates of Elder Abuse in São Paulo and Rio de Janeiro

OBJECTIVES

To assess the prevalence of elder abuse and to investigate potential sociodemographic, health behavior, and medical correlates.

DESIGN

Cross-sectional data were collected in face-to-face assessments.

SETTING

São Paulo and Rio de Janeiro, Brazil.

PARTICIPANTS

Individuals aged 60 to 75.

MEASUREMENTS

Information on elder abuse was obtained using the Brazil-adapted, nine-item Hwalek-Sengstock Elder Abuse Screening Test. Sampling design-adjusted descriptive statistics and logistic regression were used in analyses.

RESULTS

The overall prevalence of abuse was 14.4% (n = 46/259, 95% confidence interval (CI) = 9.82-20.61) in São Paulo and 13.3% (n = 27/197, 95% CI = 8.76-19.74) in Rio de Janeiro. Unadjusted analyses indicated that poor education, low physical activity, unemployment, heart disease, and psychiatric problems were associated with abuse, but in adjusted analyses, self-reported elder abuse was significantly associated only with psychiatric problems (São Paulo: OR = 4.48, 95% CI = 1.75-11.45; Rio de Janeiro: OR = 21.61, 95% CI = 6.39-73.14).

CONCLUSION

Elder abuse is prevalent in São Paulo and Rio de Janeiro, but whether concomitants of abuse are cause, effect, or both is unclear because this was a cross-sectional study. These findings highlight the importance of the problem, as well as the need to develop measures to increase awareness, facilitate prevention, and fight against abuse of elderly adults.

Interventions for preventing elder abuse: applying findings of a new Cochrane review

There is evidence that elder abuse is a significant public health problem that is destined to grow as population age. Countries are considering how best to act and this requires an understanding of the complex causal mechanisms contributing to its occurrence and the identification of effective interventions which can potentially make a difference. Previously, a high quality synthesis of evidence for policy and practice has been missing. In this paper, we describe a new Cochrane review of interventions to prevent the occurrence or reoccurrence of elder abuse. Overall, the quality of the evidence available for decision making is very low and there is little to guide practice. Amongst the interventions, there is some evidence that teaching coping skills to family carers of persons with dementia might make the situation better. We argue that poor quality and wasteful research needs to be avoided, and front-line agencies be supported in undertaking comparative evaluation of their services.

A Systematic Review of Financial Exploitation Measures in Prevalence Studies

The financial exploitation of older adults has garnered the attention of society as well as state and federal governments in a way that elder abuse has never been able to achieve. It is frequently asserted that financial exploitation deserves this attention in part because it is the most prevalent form of elder abuse. This article systematically reviews the measurement of financial exploitation in comparison with other forms of elder abuse and concludes that its measurement is considerably more variable than other forms of abuse. Consequently, improvements in the measurement of financial exploitation are warranted.