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

Reducing Depression and Suicidal Ideation Among Elder Abuse Victims Using PROTECT

OBJECTIVE

Elder abuse is prevalent and often unaddressed despite poor health and high mortality outcomes. One third of victims suffer from depression. This study examined whether: 1) suicidal ideation (SI) is associated with victims' demographic or abuse characteristics; 2) PROTECT psychotherapy reduces depression regardless of suicidal ideation; and 3) it reduces suicidal ideation.

DESIGN

Partner agencies referred depressed victims and received PROTECT for 10 weeks. Depression severity and SI were measured at each visit.

PARTICIPANTS

A sample of 158 depressed EA victims (PHQ-9 ≥ 10) without cognitive impairment (Tele-MoCA ≥ 11).

INTERVENTION

PROTECT is a behavioral psychotherapy delivered in 45-minute sessions in person or remotely (phone or video) for 10 weeks.

MEASURES

Data on demographics and abuse were collected at baseline, and depression severity (PHQ-9) and SI (PHQ-9 item 9) weekly. We examined trajectories of response to PROTECT with mixed-effects models to compare response among SI and Non-SI participants and change in SI throughout treatment.

RESULTS

There was no association between victims' demographic or elder abuse characteristics and SI. PROTECT led to overall reduction in depression severity: the SI group showed an estimated mean improvement of 5.58 points on the PHQ-9 (95% CI: 4.11, 7.06), and non-SI group improved by 5.25 (95% CI: 4.53, 5.97) points. SI decreased over time, with 19% of participants endorsing SI at baseline and 5.7% at end of treatment.

CONCLUSIONS

Suicidal ideation is equally prevalent across EA victims from different backgrounds. PROTECT can reduce depression and suicidal ideation in elder abuse victims.

Certified nursing assistants' perceptions of and suggestions to prevent elder abuse in residential aged care facilities: a qualitative study in Hunan Province, China

BACKGROUND

Staff-to-resident abuse in institutional settings demands political attention and evidence-based interventions. Certified nursing assistants (CNAs) views and suggestions on preventing elder abuse can offer practical and policy-relevant insights. This study explores CNAs' perceptions and strategies to address elder abuse in institutional care.

METHODS

Sixteen CNAs from residential aged care facilities (RACFs) in Hunan Province, China, were purposively sampled. Semi-structured qualitative interviews were conducted, and transcripts were analysed using content analysis.

RESULTS

CNAs demonstrated a surface-level understanding of elder abuse, including its types, causes, and interventions. However, they provided detailed suggestions through an ecological-systems lens. At the microsystem level, strengthening staff professionalism and empathy was noted as critical, while the mesosystem involved enhancing institutional management. At the macrosystem level, suggested strategies included boosting social support, such as developing the senior care sector, increasing senior benefits, and strengthening legal safeguards.

CONCLUSION

This study highlights CNAs' limited understanding of elder abuse and presents actionable recommendations for policy and practice. The gap between their perceptions and the ability to ensure abuse-free care underlines the need for evidence-based training and standardised reporting systems. Strengthening staffing quality, institutional leadership, and community support within an ecological-systems framework is essential to reduce elder abuse and promote safe, respectful care environments for older adults.

"I Want to Tell You Something, but Not Here": Governmental Inspection teams' Challenges in Identifying Mistreatment in Nursing Homes

This study explores the challenges faced by the Ministry of Health's inspection teams in identifying mistreatment within Israeli nursing homes. Four focus groups with 19 multidisciplinary inspectors revealed two main themes. First, the interaction between nursing home management, staff, and inspectors ranged from denial and concealment of mistreatment to cooperation in reporting it. Second, inspectors adapted skills not part of their official duties, such as investigative techniques and organizational analysis, to identify mistreatment. The findings highlight the need to reassess inspection teams' roles, skills, and their relationship with nursing home staff to improve detection of mistreatment.

Alcohol Use and Abusive or Neglectful Behaviors Among Family Caregivers of Patients With Dementia

Importance

The increasing prevalence of dementia presents challenges for family caregivers. Understanding how alcohol use among caregivers relates to abusive and neglectful behaviors (ANBs) toward care recipients with dementia may inform interventions to improve the well-being of both.

Objective

To explore alcohol use patterns among family caregivers of relatives with dementia and investigate whether hazardous drinking and drinking on a given day are independently associated with increased odds of ANBs toward care recipients.

Design, Setting, and Participants

This microlongitudinal cohort study included a baseline survey and 21 days of daily diary surveys among a convenience sample of family caregivers aged 18 years or older who coresided with and provided unpaid care to a community-dwelling relative with dementia across the US. Enrollment was from October 2019 to February 2023.

Exposures

Hazardous drinking at baseline, identified by the Alcohol Use Disorder Identification Test-Consumption screening tool, and daily alcohol consumption recorded in daily diary surveys.

Main Outcomes and Measures

Daily reports assessed engagement in physically aggressive, psychologically aggressive, and/or neglectful behaviors toward care recipients, categorized as binary outcomes. A generalized linear mixed model examined associations between caregivers' baseline hazardous drinking status and daily alcohol use and odds of ANBs.

Results

Of 453 family caregivers (394 of 451 [87.4%] female; mean [SD] age, 51.6 [14.0] years), 82 (18.1%) screened positive for hazardous drinking. Over the 21-day period, 38 (8.4%) consumed alcohol at least once and 341 (75.3%) engaged in abusive or neglectful behavior at least once. Baseline hazardous drinking was associated with higher odds of engaging in neglectful behaviors (odds ratio [OR], 2.89; 95% CI, 1.74-4.80; P < .001) and psychologically aggressive behaviors (OR, 2.32; 95% CI, 1.28-4.19; P = .006). Any alcohol use on a given day was associated with greater odds of physically aggressive (OR, 2.32; 95% CI, 1.10-4.88; P = .03) and neglectful (OR, 1.66; 95% CI, 1.31-2.10; P < .001) behaviors on the same day. No statistically significant interaction between baseline hazardous drinking and daily alcohol use was observed.

Conclusions and Relevance

In this microlongitudinal cohort study of family caregivers of relatives with dementia, hazardous drinking and daily alcohol consumption were significantly and independently associated with increased odds of ANBs, highlighting the need for personalized interventions that address caregiving complexities and alcohol use patterns.

Fighting Against Many Walls: The Help-Seeking Experience of Supporters of Older Abuse Victims

BACKGROUND

Elder abuse (EA) often remains hidden, and many victims do not interact with formal systems. Concerned persons (CPs) are family, friends, and neighbours who play an essential role in supporting EA victims.

OBJECTIVE

The aim of this study was to understand CPs' role and help-seeking experiences.

METHODS

Nineteen self-identified CPs shared their experience of being involved in an EA case via an interview and/or survey, with responses analysed qualitatively.

FINDINGS

CPs were primarily the victims' female relatives, often related to the perpetrator, and had sought help from a wide range of formal and informal sources, facing many barriers in protecting victims from harm. Challenges commonly related to formal services and EA perpetrators. Through knowing about the abuse and/or seeking help, participants experienced negative impacts, particularly psychological ones.

DISCUSSION

Findings suggest that CPs can play a key role in supporting EA victims but require further support and recognition from services to fulfil this role.

Utilizing SMOTE-TomekLink and machine learning to construct a predictive model for elderly medical and daily care services demand

This study aims to construct a prediction model for the demand for medical and daily care services of the elderly and to explore the factors that affect the demand for medical and daily care services of the elderly. In this study, a questionnaire survey on the demand for medical and daily care services of 1291 elderly was conducted using multi-stage stratified whole cluster random sampling. SPSS21.0 statistical analysis software was used to describe the basic data of the elderly statistically, and univariate analysis was used to screen variables for model construction and binary logistic regression analysis. The acquired dataset has class imbalance, and to handle this issue, Synthetic Minority Over Sampling Technique with TomekLink (SMOTE-TomekLink) was adopted to resample the dataset for class-balancing. To improve computational efficiency, we used three algorithms to develop prediction models, including Random Forest (RF), Gradient Boosting Decision Tree (GBDT), and Light Gradient Boosting Machine (LightGBM) algorithms. The performance of each model was measured, and the performance of the prediction model was obtained using the following performance metrics: accuracy (ACC), recall (R), precision (P), F1-score, and area under the receiver operating characteristic (AUC). The prediction models for the medical and daily care services demand of the elderly were developed and validated using 12 and 13 key features, respectively. The LightGBM algorithm emerged as the superior prediction model for estimating the service needs of the elderly. For the medical service demand prediction model, LightGBM achieved an AUC of 0.910 and F1-score of 0.841. In the daily care services demand prediction model, LightGBM demonstrated an AUC of 0.906 and an F1-score of 0.819. In the LightGBM model, the analysis of feature importance indicates that the number of chronic diseases, education level, and financial sources emerge as the most significant predictors for the demand of healthcare services, encompassing both medical and daily care services. Based on questionnaire information combined with feature selection, unbalanced data processing and machine learning methods, this study constructed a machine learning model for predicting the demand for medical and daily care services for the elderly, and analyzed the influencing factors of the demand for medical and daily care services for the elderly, providing a reference for the construction and verification of future prediction models for the demand for medical and daily care services for the elderly.

"I (am) scared I will hurt him, then I will regret it forever": Singaporean caregiver perspectives and elder abuse risk

The global rise in aging populations presents concern about elder abuse risk. The caregiving burden for older adults predominately rests on informal caregivers, and caregiver stress and burnout are well-documented risk factors for elder mistreatment. In this qualitative study, we explored the perspectives of 19 informal caregivers in Singapore to better understand the contextual nature of the risk of elder abuse and mistreatment. Three themes explored: (i) the unbounded caregiver role and journey to caregiving; (ii) elder abuse risk, including relationship dynamics, caregiver emotions, and achieving compliance through fear, and (iii) protective strategies such as self-control, societal expectations, and external support. The findings present a nuanced picture of elder abuse, suggesting elder abuse risk is inherent in the caregiver role itself, with current prevention relying largely on caregiver self-regulation. Our study proposes that interventions to reduce elder abuse need to be integrated across individual, interpersonal, organizational, community, and societal levels.

Key professional stakeholders roles in promoting older people's autonomy in residential care

BACKGROUND

Older people's autonomy is an ethical and legal principle in everyday residential care, but there is a lack of clarity about the roles and responsibilities of the key professional stakeholder groups involved.

RESEARCH OBJECTIVES

This study aimed to identify and define the roles and responsibilities of the key professional stakeholder groups involved in promoting older people's autonomy in residential care settings.

RESEARCH DESIGN

We used a Delphi method with two iterative rounds of online group discussions and collected data from experts in older people's care in Finland in summer 2020. The data were analyzed using deductive-inductive content analysis methods.

ETHICAL CONSIDERATIONS

According to Finnish legislation, this type of research did not need approval from a research ethics committee. Informed consent from the participants was obtained and they were informed about the voluntary nature and confidentiality of the study and their right to withdraw at any time.

RESULTS

Key professional stakeholders had different roles and responsibilities, but their shared, integrated goal was to achieve older people's autonomy in residential care settings. Their combined roles and responsibilities covered all aspects of promoting older people's autonomy, from care and service planning and daily decision-making to service structures that included ethical competencies and monitoring. Multipronged, variable, coordinated strategies were required to identify, assess, and promote autonomy at different levels of care.

CONCLUSION

Key professional stakeholders need to work together to provide an unbroken chain of care that provides older people with autonomy in residential care settings. In future, more knowledge is needed about how to create structures to achieve the shared goal of older people's autonomy in these settings.

I care a lot: A political economic approach to aging

In this scholarly investigation, the discourse revolves around the phenomenon of aging, a salient concern within the realm of social policy and social services, as elucidated through the portrayal of older individuals in the films I Care a Lot, I, Daniel Blake, Lun Lok Yan, and Bizi Hatırla. Employing a qualitative research approach, the study's research design was structured as a case study, with the thematic content analysis method being employed for data examination. The underpinning theoretical framework of this research hinged upon Carroll Estes' political economy model. This comprehensive model scrutinizes the overarching concept of aging on a macroscopic scale, delving into its ideological, state-related, gender-based, post-industrial capitalist, and globalized dimensions, while concurrently delving into the interwoven systems of subjugation at a micro level, which encompass class, race/ethnicity, gender, and citizenship. Primarily, the study delves into aging and its multifaceted dimensions, encompassing demographic, societal, and historical facets. Subsequently, it elucidates the challenges that manifest during the aging process and elucidates prominent social theories pertaining to older people. The political economy theory, coupled with Estes' model, is elaborated upon expansively. The concluding segment, centered on film analysis, subjects the selected film to a detailed examination, aligning with five research inquiries fashioned in consonance with the aforementioned theoretical framework. The findings thus gleaned evinced a congruence between the cinematic portrayal of aging experiences and the precepts of the political economy theory, thus lending support to Estes' perspectives.

Adverse childhood experiences and elder abuse victimization nexus: A systematic review and meta-analysis

Adverse childhood experiences (ACEs) are important life course events that can influence elder abuse victimisation (EAV) among older adults. This systematic review and meta-analysis aimed to provide synthesised and consolidated evidence on the existing associations between ACEs and EAV. A systematic search was conducted across six databases, including PubMed, PsycINFO, CINAHL Complete, Scopus, Google Scholar, and the Web of Science. All studies that addressed associations between ACEs, in singular or multiple form, and EAV were included in the review. Meta-analysis of the extracted odds ratios (ORs) and confidence intervals (CIs) was conducted using the common-effect inverse-variance model. Nine studies (cross-sectional design = 7; cohort design = 2) met the inclusion criteria. Included studies examined multiple ACEs and multiple EAVs associations (N = 3); at least single ACE and multiple EAVs (N = 3); any single form of ACE and multiple EAVs (N = 3); multiple ACEs-any single form of EAV nexus (N = 2); multiple ACEs-financial elder abuse association (N = 2); and multiple ACEs-physical elder abuse nexus (N = 2). Pooled ORs and CIs showed statistically significant results for all ACEs and EAVs associations whether in singular or multiple form. The results indicate that interventions designed to reduce ACEs, in singular or multiple form, early in life targeting residential and community-dwelling older adults may be relevant in reducing the incidence of EAV. The life course perspective s be integrated into the planning for support services for children, families, and older adults to prevent EAV in singular or multiple forms in later life.

COVID-19 Pandemic and Racial and Ethnic Disparities in Long-Term Nursing Home Stay or Death Following Hospital Discharge

IMPORTANCE

Long-term nursing home stay or death (long-term NH stay or death), defined as new long-term residence in a nursing home or death following hospital discharge, is an important patient-centered outcome.

OBJECTIVE

To examine whether the COVID-19 pandemic was associated with changes in long-term NH stay or death among older adults with sepsis, and whether these changes were greater in individuals from racial and ethnic minoritized groups.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used patient-level data from the Medicare Provider Analysis and Review File, the Master Beneficiary Summary File, and the Minimum Data Set. Community-dwelling individuals aged at least 65 years hospitalized with sepsis between January 2016 and June 2021 were included. Data were analyzed from May to November 2024.

EXPOSURE

Race and ethnicity and the COVID-19 pandemic.

MAIN OUTCOMES AND MEASURES

Patients discharged alive experienced long-term NH stay or death if they resided in a nursing home more than 100 days after hospital discharge and had no period at home greater than 30 days, or died more than 30 days following hospital discharge. Interrupted time series analysis was used to evaluate the association between long-term NH stay or death and the pandemic and race and ethnicity.

RESULTS

A total of 2 964 517 hospitalizations for sepsis of community-dwelling patients discharged alive (1 468 754 [49.5%] female; 19 549 [0.7%] American Indian or Alaska Native, 95 308 [3.2%] Asian or Pacific Islander, 282 646 [9.5%] Black, 279 011 [9.4%] Hispanic, 2 288 003 [71.2%] White individuals; mean [SD] age, 76 [8.3] years) were included. Compared with non-Hispanic White individuals, Black individuals were more likely to experience long-term NH stay or death (adjusted odds ratio [aOR], 1.33; 95% CI, 1.30-1.37; P < .001), while Asian or Pacific Islander (aOR, 0.79; 95% CI, 0.75-0.83; P < .001), Hispanic (aOR, 0.72; 95% CI, 0.70-0.74; P < .001), and American Indian or Alaska Native (aOR, 0.79; 95% CI, 0.72-0.87; P < .001) individuals were less likely to experience long-term NH stay or death. Long-term NH stay or death declined from 13.5% in the first quarter of 2016 to 6.9% in the first quarter of 2020. After adjustment, long-term NH stay or death decreased each quarter (aOR, 0.958; 95% CI, 0.957-0.959; P < .001) before the pandemic. The pandemic was associated with increased risk of long-term NH stay or death over time (aOR, 1.03; 95% CI, 1.02-1.04; P < .001 [each quarter]) compared with before the pandemic for non-Hispanic White individuals. The pandemic was not associated with differential changes in long-term NH stay or death for minoritized individuals compared with non-Hispanic White individuals.

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, older adults hospitalized with sepsis experienced an approximately 50% reduction in long-term NH stay or death over a 5-year period before the pandemic. These results suggest that during the pandemic, all individuals, regardless of race and ethnicity, experienced increased long-term NH stay or death compared with before the pandemic.

Safeguarding adults: A concept analysis

AIMS

This article aimed to examine the concept of safeguarding adults and establish an operational definition for application to practice, research and policy.

DESIGN

Rodgers' evolutionary and inductive method of concept analysis was used.

DATA SOURCES

A systematic search was conducted across four electronic databases, CINAHL, PsycINFO, Scopus and PubMed, covering the period from January 2014 to May 2023. This systematic database search aimed to gather a broad spectrum of research and scholarly literature to inform and support the concept analysis. A total of 10 peer-reviewed articles were reviewed using a data chart to identify the context, definitions, antecedents, attributes and consequences of safeguarding adults.

RESULTS

The analysis of the included articles helped to develop a better understanding of safeguarding adults by offering a practical operational definition tailored to the specific needs of practising nurses. The implications for practice, research and policy are discussed, highlighting the potential for improving the quality of care and ensuring the well-being of adults at risk of abuse.

CONCLUSION

By employing Rogers' evolutionary concept analysis method, we developed a deeper insight into safeguarding adults in health care. A synthesis of literature revealed the intricate layers and adaptations within safeguarding practices. This concept analysis lays the groundwork for future research, policy development and educational initiatives, enhancing the well-being and safety of adults at risk of abuse within care.

IMPACT

By undertaking a concept analysis of the term safeguarding adults' nurses can be more prepared to engage in and reinforce the key principles of safeguarding adults, providing guidance to ensure the protection and well-being of adults at risk of abuse.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

WHAT THIS PAPER CONTRIBUTES TO THE WIDER BODY OF KNOWLEDGE

This concept analysis helps to define and clarify the conceptual term 'safeguarding adults' promoting a shared understanding of the key components of adult protection and providing a comprehensive framework for assessment and management of adults at risk of abuse in this field of practice.

Prevalence and influencing factors of elder abuse tendency among Chinese caregivers working in Gansu Province nursing homes: A cross-sectional study

BACKGROUND

Elder abuse is a global public health and human rights concern that is predicted to increase with the rapid increase in the elderly population in China.

OBJECTIVES

To investigate the incidence of elder abuse tendency and factors related to such a tendency among caregivers working in nursing homes.

METHODS

A cross-sectional study comprising 412 caregivers from nursing homes was conducted.

RESULTS

The results indicated that the prevalence of elder abuse tendency among caregivers working in nursing homes was 73.5%. This rate was influenced by gender, marital status, work experience, employment modes, whether one had participated in relevant training, caregiver burden and the level of perceived social support (P < 0.05).

CONCLUSION

The study revealed the factors influencing elder abuse tendency among caregivers working in nursing homes and the relationships between elder abuse tendency, caregiver burden, and perceived social support.

Examination of Elder Abuse and Death Anxiety in Older Adults With a Chronic Disease

AIM

This study was conducted to examine elder abuse and death anxiety in older adults who had chronic diseases.

DESIGN

The present study is a cross-sectional and correlational study.

METHODS

This study was conducted with 200 patients who met the research criteria and agreed to participate in the study and who were admitted to the internal medicine outpatient clinics of a university hospital in Elazig, eastern Turkey. Data were collected by using 'Descriptive Information Form' Hwalek-Sengstock Elderly Abuse Screening Test (H-S/EAST) 'Death Anxiety Scale (DAS)'.

RESULTS

The mean DAS score of 8.66 ± 2.87 was evaluated as high and the mean H-S/EAST score of 6.41 ± 3.78 was evaluated as moderate risk of abuse. It was found that the independent variable H-S/EAST total score affected DAS total score positively (β = 0.633) and explained 38% (p < 0.001). Among the variables included in the model, gender, age and employment status were found to be positive (β = 0.243, β = 0.222, β = 0.222) statistically significant predictors of H-S/EAST total score. In addition, it was found that gender was a positive (β = 0.318) and statistically significant predictor of DAS total score (p < 0.05).

CONCLUSIONS

Older individuals with chronic illness have a moderate risk of abuse and a high level of death anxiety. As the risk of elder abuse increases, death anxiety also increases. In addition, gender is an important predictor of elder abuse and death anxiety. In line with these results, it is recommended to identify groups with high potential for abuse, to organise awareness-raising training programs to prevent abuse and to conduct evaluations for abuse and death anxiety at regular intervals. Also, the results of this research will contribute to nursing literature and will be useful for future interventional research.

PUBLIC CONTRIBUTION

There is no public contribution.

Elder abuse in Flanders, Belgium: perspectives from home care nurses

The present study focuses on elder abuse in the home care setting. The aim of this study was to explore home care nurses' definition, general perspectives and experiences of elder abuse, and the barriers they experience to avoid elder abuse. Individual qualitative interviews were held with Flemish home care nurses (N = 17), employed by a Dutch home nursing organization. Data analysis was performed using reflexive thematic analysis. Results showed that (1) participants' understanding of elder abuse was based on intuition and daily practice. (2) Participants highlighted several institutional barriers to avoid elder abuse. (3) The participating home care organizations did not have a standard protocol to report or handle elder abuse. Institutional structures, procedures and decisions should be critically reviewed as to how they lead to staff abusing older adults.

Where Do We Draw the Line? Perceptions of Abuse of Older Adults and Their Association With Ageism

OBJECTIVES

Violence against older adults is a prevalent global harm, and there is evidence that perceptions of violence toward older adults may affect reporting and intervention. The present study examines the perception of violence against older adults in contrast to violence against other age groups and investigates the role of ageism in those perceptions.

METHODS

A total of 290 participants were surveyed and asked to indicate whether they perceived 15 abusive behaviors reflecting physical, psychological, sexual, and financial abuse and neglect to be abuse toward either an older adult (age 60+), adult, or child. Ageism was measured using the Ambivalent Ageism scale.

RESULTS

On average, 25% of participants did not consider the abusive behaviors to be abuse. Perceptions of abuse were relatively stable across the 5 types of abuse examined (range: 25%-27%). Perceptions of the 15 abusive behaviors only varied due to older age in 3 instances, differences were sometimes between older adults and adults and sometimes children. Regression analyses showed increased ageism to be predictive of disagreement that behaviors were abusive in the older age group, explaining 8%-14% of the variance in perception. Regression models were not significant in the adult or child groups.

DISCUSSION

Results raise serious concern about the perception of abuse toward older adults. Future studies should investigate the reasons for such perceptions and other contributing factors in order to identify effective mechanisms for change.

Experiences of the Older Adults After Being Abused: A Qualitative Meta-synthesis

Elder abuse is a global public health problem with severe social costs. Research on elder abuse has gradually increased; however, less attention has been paid to older adults' perceptions and experiences of abuse. This review aimed to integrate older adults' perceptions and experiences of abuse to provide a theoretical basis for developing interventions that meet their authentic needs. Six electronic databases were searched to include qualitative studies examining perceptions and experiences of abuse among adults aged 60 years or older, and 22 studies were included. This study used the Joanna Briggs Institute meta-aggregation approach to integrate the qualitative findings, which identified four themes: (a) changes resulting from elder abuse, (b) causes of abuse, (c) barrier factors and facilitating factors to the disclosure of abusive behavior, and (d) adopting different response strategies. The findings revealed that older adults experience persistent physical and psychological burdens and financial stress following abuse. Multiple factors influence the emergence of abuse and older adults search for help from the outside world, especially social support and perceptions of abuse. Older adults can deal with abuse by accepting the status quo or taking steps to change it. These findings have important implications for helping older adults prevent and cope with abuse experiences.

Intervention accelerator to prevent and respond to abuse of older people: insights from key promising interventions

Globally, abuse of older people (AOP) affects one in six individuals aged 60 years and older every year. Despite the widespread prevalence of AOP, evidence-based interventions for preventing and responding to this issue are insufficient. To address this gap, WHO proposed an initiative to accelerate the development of effective interventions for AOP across all country income levels. In the first phase, the initiative identified 89 promising interventions across a total of 101 evaluations or descriptions, which led to the creation of a public database. Most interventions targeted physical, psychological, and financial abuse and neglect, were implemented in the USA, and focused on victims or potential victims. These interventions were primarily delivered by social workers and nurses, usually in health-care facilities and community centres. Face-to-face delivery was common. Additionally, 28 (28%) of the 101 evaluations used randomised controlled trial designs. The results of this Review can be used to identify interventions that are ready for a rigorous outcome evaluation.

Reducing the risks of maltreatment of older adults with intellectual and developmental disabilities: Development of a research-based intervention

BACKGROUND

Although older adults with intellectual and/or developmental disabilities face high risks of maltreatment, there are few interventions available to reduce these risks. This study describes the development of a research-based intervention that aims to reduce the risks of maltreatment for this population.

METHOD

The development involved close collaboration with a program advisory board (PAB). It used a three-phase approach with a cross-cultural perspective: (1) performing a needs assessment, (2) determining content and design, and (3) evaluating the usability of the intervention.

RESULTS

The needs assessment results and input from the PAB yielded critical information that helped shape the intervention's development. Feedback from the trainers confirmed the intervention's usefulness and revealed suggestions for enhancing its usability.

CONCLUSIONS

The intervention developed appears to be promising for enhancing the knowledge and skills of older populations to reduce their exposure to maltreatment risks; future research should be conducted to assess its efficacy.

A Scoping Review of Sexual Violence Events Perpetrated Against Older People

Although 9 million older adults are estimated to be victims of sexual violence and abuse (SVA) globally each year, this population is largely overlooked in criminological research. Given the known impacts of SVA, particularly for older victims, enhanced understanding of incident characteristics, and how these events unfold, is crucial to improving prevention and response. Guided by environmental criminology perspectives, a scoping review was conducted to assess the extent to which SVA events against older people have been empirically examined to gain an understanding of the immediate circumstances in which incidents occur and how this can inform early intervention and prevention. Eight databases were searched, with records included if they reported characteristics of SVA events occurring in older adulthood, were original, peer-reviewed, empirical research, and published in English. After screening 1,278 records, 33 studies were included for review. Findings demonstrate that considerable attention has been given to understanding who is involved in SVA events and what typically occurs, however, there is a dearth of information regarding when and how these crimes are perpetrated, and the situational factors influencing offending. Resultingly, prevention recommendations largely focus on actors (e.g., victims, perpetrators, witnesses), rather than the environment in which abuse occurs, emphasizing significant gaps in understanding and response to this growing issue.

Relative-to-resident abuse in Norwegian nursing homes: a cross-sectional exploratory study

BACKGROUND

In community settings, relatives often provide care to their older family members, which is sometimes perceived as a high burden, overwhelming and stressful, contributing to an increased risk of elder abuse. In most countries, relatives have no legal obligation to provide care when family members are admitted to nursing homes; nevertheless, studies have shown that relatives continue to provide emotional, instrumental, and personal care after admission, often related to the understaffing and high workload of nursing staff. Despite the growing interest in elder abuse in nursing homes, most studies have concentrated on the abuse perpetrated by nursing staff or co-residents, but few studies have explored the abuse that relatives may perpetrate.

METHODS

This study was a cross-sectional survey of 3,693 nursing staff members recruited from 100 nursing homes in Norway, to examine the extent of relative-to-resident abuse in Norwegian nursing homes, as observed by nursing staff.

RESULTS

The findings indicate that 45.6% of the nursing staff had observed one or more episodes of relative-to-resident abuse during the past year. Among the subtypes of abuse, 44.8% of the nursing staff had observed psychological abuse, 8.4% had observed physical abuse, 2.7% had observed financial/material abuse, and 0.7% had observed sexual abuse at least once during the past year.

CONCLUSIONS

This is the first large study exploring the extent of relative-to-resident abuse in nursing homes, which is a phenomenon that is significantly less addressed than abuse committed by staff and co-residents. The findings in our study illustrate that abuse committed by relatives needs more awareness and attention to improve the well-being of nursing home residents. Further research is recommended to enhance our understanding of such abuse and should include other approaches measuring the proportion of relative-to-resident abuse, as relying solely on staff observations is insufficient for determining the prevalence in this case. Future studies should also examine the cumulative impact of victimization in nursing homes and should include an analysis of how cases of abuse are reported and handled.

Violence against older people and associations with mental health: A national probability sample survey of the general population in England

BACKGROUND

Official estimates of violence prevalence in England exclude older people. There are few studies of elder abuse and these excluded violence from acquaintances and strangers and lack comparability with younger adults.

OBJECTIVES

To estimate prevalence of past-year violence victimisation in older people, identify factors associated with violence in older age, quantify the extent to which experience of violence in older people was associated with common mental disorder (CMD).

STUDY DESIGN/METHODS

Analysis of a 2014 general population probability sample survey of 2570 adults aged 60+ and 4484 16-59 year olds. Modified version of the Conflict Tactics Scale measured domestic violence and List of Threatening Experiences captured bullying and serious assault. CMD were assessed using the revised Clinical Interview Schedule. Associations were examined using regression models adjusted for childhood victimisation and other adversities.

RESULTS

2.0 % (n = 52,CI:1.4-2.6) of older people experienced violence in the past year, with intimate partner violence the most prevalent form. Older people of non-white ethnicity, those who were socially isolated or lonely, and the formerly married were more likely to experience violence. Violence was associated with CMD in older people (adjusted odds ratio 2.2, CI:1.0-4.8), controlling for impairments, adversities and other factors.

CONCLUSION

Violence, especially from an intimate partner, is evident in later life and strongly associated with poor mental health. Better instruments for the identification of violence and abuse in older people in research and safe enquiry in practice settings are needed, with recognition of and attention to ethnic and other inequalities among older people in exposure.

The mediating roles of psychological resilience and psychological well-being of caregivers for the older adults

Objective

This study aimed to investigate the mediating effects of psychological resilience and psychological well-being for caregivers at nursing homes on the relationship between insomnia and elder maltreatment. As the world is aging quickly and the number of older individuals cared for by formal caregivers has been increasing, this study's results could help create intervention programs to minimize the occurrence of older people's maltreatment.

Materials and Methods

A total of 431 care workers who met all criteria, from 21 care service centers for older adults in Fukuoka, Japan, completed the Conditions of Maltreatment Scale, Caregivers' Belief in Ideal Care, Insomnia Severity Index, WHO-5 Well-Being Index, and Connor-Davidson Resilience Scale-10.

Results

A multivariate analysis of variance revealed that participants with no insomnia had greater resilience, higher psychological well-being, and greater belief in ideal care and to treated older clients less roughly compared to participants with insomnia. Psychological resilience and well-being were significant mediators in the relationship between insomnia, rough care, and beliefs in ideal care.

Conclusion

As formal caregivers are in urgent demand, society should take care of them. The most effective and successful intervention for improving their physical and psychological well-being should be initiated at the individual and organizational levels.

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.

Elder Mistreatment Documentation by Prehospital Clinicians: An Analysis of the National Emergency Medical Services Information System Database

OBJECTIVES

Elder mistreatment (EM), encompassing abuse and neglect, is a significant public health issue, affecting up to 10% of community-dwelling older adults annually. Elder mistreatment is a growing concern with a higher prevalence in institutional settings and substantial associated healthcare costs. Prehospital clinicians (PHCs) such as emergency medical technicians and paramedics are uniquely positioned to detect and report EM during their interactions with older adults in their homes. The objective of the study is to describe the rate and characteristics of EM documented by PHCs using the National Emergency Medical Services Information System (NEMSIS) database.

METHODS

This study analyzed data from NEMSIS, which includes standardized information about PHC emergency response encounters across the United States. In 2018, 22,532,890 activations were included from 9,599 agencies in 43 states and US territories. Elder mistreatment was identified using specific International Classification of Diseases (ICD) codes related to EM. Demographic data, injury location, and associated physical findings were also examined.

RESULTS

Out of 9,605,522 EMS encounters for patients aged ≥60, EM was coded in 1,765 encounters (0.02%). Most EM cases were listed as the cause of injury (64%), followed by the clinician's first impression (25.4%). Physical abuse was the most common type of mistreatment reported (20.8%), followed by sexual abuse (18.2%), neglect (9.7%), and psychological/emotional abuse (0.34%). The median age of patients with documented EM was 72, and 62.3% were female. The most common anatomic locations of injuries were the lower extremities, head, and upper extremities.

CONCLUSIONS

Despite the high prevalence of EM, PHCs infrequently document EM in their encounters with older adults. Additional training and comprehensive protocols are needed to improve the identification and reporting of EM, mainly elder neglect. Empowering PHCs through education and protocol development can significantly impact the detection and intervention of EM.

Unravelling elder abuse through a human rights lens: a case study

This article examines the connection between human rights and elder abuse, employing a human rights-based approach. Through a critical examination of a fictional case study on elder abuse, the discussion highlights the vital role of nurses when safeguarding the rights of older individuals in residential care settings. The PANEL framework - encompassing Participation, Accountability, Non-discrimination, Empowerment and Legality - is a comprehensive guide for safeguarding practice and is applied to the example provided. By applying this human rights-based approach, nurses can proactively address elder abuse, ensuring individuals' rights are protected, promoted and supported. Through accountability measures, non-discriminatory practices, empowerment strategies and adherence to legal standards, the authors advocate for a holistic approach to enhance the quality of care and foster a safe environment for older adults.

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.

Psychometric properties of instruments for measuring abuse of older people in community and institutional settings: A systematic review

Background

The examination of psychometric properties in instruments measuring abuse of older people (AOP) is a crucial area of study that has, unfortunately, received relatively little attention. Poor psychometric properties in AOP measurement instruments can significantly contribute to inconsistencies in prevalence estimates, casting a shadow of uncertainty over the magnitude of the problem at national, regional, and global levels.

Objectives

This review rigorously employed the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline on the quality of outcome measures. It was designed to identify and review the instruments used to measure AOP, assess the instruments' measurement properties, and identify the definitions of AOP and abuse subtypes measured by these instruments, ensuring the reliability and validity of the findings.

Search Methods

A comprehensive search was conducted up to May 2023 across various online databases, including AgeLine via EBSCOhost, ASSIA via ProQuest, CINAHL via EBSCOhost, EMBASE, LILACS, ProQuest Dissertation & Theses Global, PsycINFO via EBSCOhost, PubMed, SciELO, Scopus, Sociological Abstract via ProQuest, Chinese National Knowledge Infrastructure (CNKI), Google Scholar and WHO Global Index Medicus. Additionally, relevant studies were identified by thoroughly searching the grey literature from resources such as Campbell Collaboration, OpenAIRE, and GRAFT.

Selection Criteria

All quantitative, qualitative (addressing face and content validity), and mixed-method empirical studies published in peer-reviewed journals or grey literature were included in this review. The included studies were primary studies that (1) evaluated one or more psychometric properties, (2) contained information on instrument development, or (3) examined the content validity of the instruments designed to measure AOP in community or institutional settings. The selected studies describe at least one psychometric property: reliability, validity, and responsiveness. Study participants represent the population of interest, including males and females aged 60 or older in community or institutional settings.

Data Collection and Analysis

Two reviewers evaluated the screening of the selected studies' titles, abstracts, and full texts based on the preset selection criteria. Two reviewers assessed the quality of each study using the COSMIN Risk of Bias checklist and the overall quality of evidence for each psychometric property of the instrument against the updated COSMIN criteria of good measurement properties. Disagreements were resolved through consensus discussion or with assistance from a third reviewer. The overall quality of the measurement instrument was graded using a modified GRADE approach. Data extraction was performed using data extraction forms adapted from the COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments. The extracted data included information on the characteristics of included instruments (name, adaptation, language used, translation and country of origin), characteristics of the tested population, instrument development, psychometric properties listed in the COSMIN criteria, including details on content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, responsiveness, and interoperability. All data were synthesised and summarised qualitatively, and no meta-analysis was performed.

Main Results

We found 15,200 potentially relevant records, of which 382 were screened in full text. A total of 114 studies that met the inclusion criteria were included. Four studies reported on more than one instrument. The primary reasons for excluding studies were their focus on instruments used solely for screening and diagnostic purposes, those conducted in hospital settings, or those without evaluating psychometric properties. Eighty-seven studies reported on 46 original instruments and 29 studies on 22 modified versions of an original instrument. The majority of the studies were conducted in community settings (97 studies) from the perspective of older adults (90 studies) and were conducted in high-income countries (69 studies). Ninety-five studies assessed multiple forms of abuse, ranging from 2 to 13 different subscales; four studies measured overall abuse and neglect among older adults, and 14 studies measured one specific type of abuse. Approximately one-quarter of the included studies reported on the psychometric properties of the most frequently used measurement instruments: HS-EAST (assessed in 11 studies), VASS-12 items (in 9 studies), and CASE (in 9 studies). The instruments with the most evidence available in studies reporting on instrument development and content validity in all domains (relevance, comprehensiveness and comprehensibility) were the DEAQ, OAPAM, *RAAL-31 items, *ICNH (Norwegian) and OAFEM. For other psychometric properties, instruments with the most evidence available in terms of the number of studies were the HS-EAST (11 studies across 5 of 9 psychometric properties), CASE (9 studies across 6 of 9 psychometric properties), VASS-12 items (9 studies across 5 of 9 psychometric properties) and GMS (5 studies across 4 of 9 psychometric properties). Based on the overall rating and quality of evidence, the psychometric properties of the AOP measurement instruments used for prevalence measurement in community and institutional settings were insufficient and of low quality.

Authors' Conclusions

This review aimed to assess the overall rating and quality of evidence for instruments measuring AOP in the community and institutional settings. Our findings revealed various measurement instruments, with ratings and evidence quality predominantly indicating insufficiency and low quality. In summary, the psychometric properties of AOP measurement instruments have not been comprehensively investigated, and existing instruments lack sufficient evidence to support their validity and reliability.

Prevalence of elder abuse in the community and care settings: An umbrella review

OBJECTIVE

Elder abuse, an important human rights issue and public health problem, contributes to increased disability and mortality. In the last decades, several reviews have synthesized primary studies to determine its prevalence. This umbrella review aimed to estimate the worldwide overall prevalence rate of elder abuse in the community and care setting.

METHODS

Following prospective registration at PROSPERO (CRD42021281866) we conducted a search of eight electronic databases to identify systematic reviews from inception until 17 January 2023. The corrected covered area was calculated to estimate the potential overlap of primary studies between reviews. The quality of the selected reviews was assessed using a modified AMSTAR-2 instrument. We extracted data on the prevalence of any type of elder (people aged 60 years old or older) abuse in the community and care setting.

RESULTS

There were 16 systematic reviews retrieved between 2007 and 2022, out of which ten captured prevalence globally, three in Iran, one in Turkey, one in China and one in Brazil. The 16 reviews included 136 primary studies in total between 1988 and 2020. The overlapping of studies between reviews was found to be moderate (5.5%). The quality of reviews was low (2, 12.5%) or critically low (14, 87.5%). The estimated range of global prevalence of overall elder abuse was wide (1.1-78%), while the estimations of specific abuse prevalence ranged from 0-81.8% for neglect, 1.1-78.9% for psychological abuse, 0.7-78.3% for financial abuse, 0.1-67.7% for physical abuse, and 0-59.2% for sexual abuse.

CONCLUSIONS

Although the low quality of the evidence and the heterogeneity of the phenomenon makes it hard to give precise prevalence data, it is without a question that elder abuse is a prevalent problem with a wide dispersion. The focus of attention should shift towards interventions and policymaking to prevent this form of abuse.

Elder Abuse in the Orthopaedic Patient: An Updated Review of Prevalence, Identification, and Screening Tools for Orthopaedic Surgeons

Introduction

Elder abuse is a prevalent, though often overlooked and underreported, cause of musculoskeletal injury in the elderly population. The purpose of this review is to provide an updated overview of the prevalence of elder abuse, its association with musculoskeletal injuries, and the available resources to aid orthopaedic surgeons in early detection and intervention.

Significance

Improved training on this topic is needed throughout the medical education of orthopaedic surgeons to effectively recognize and address elder abuse. Our findings reveal an urgent need for increased awareness, education, and collaboration among healthcare professionals to address this significant public health concern. As the aging population continues to grow, understanding the connection between elder abuse and musculoskeletal injuries is essential for providing comprehensive care to older adults.

Results

This review offers practical recommendations for identifying individuals at risk of elder abuse and outlines strategies for intervention. Indicators of abuse range from obvious signs like dirty clothes, neglect, and unattended injuries from falls, to more subtle cues requiring careful observation and questioning, such as mental health symptoms and family histories of abuse.

Conclusion

By shedding light on this often-overlooked issue, this review advocates for a proactive approach to identifying and addressing elder abuse to safeguard the well-being and quality of life of older individuals.

Suffering while resigning to an unacceptable violation of dignity

BACKGROUND

The interaction of health personnel with relatives is linked to the quality of care results in nursing homes. However, there is limited knowledge of how relatives perceive being an integral part of the nursing home context. This secondary analysis has its starting point in an ethical concern about relatives' experiences in a previous study.

AIM

To critically discuss relatives' experiences of suffering when their next of kin live in a nursing home in a rural arctic context.

RESEARCH DESIGN, PARTICIPANTS AND CONTEXT

The critical hermeneutic stance is informed by Habermas. The secondary analysis is conducted on original data from five semi-structured focus groups with 18 relatives of residents of two nursing homes in a rural part of Norway. The theoretical framework concerning dignity, well-being, and suffering, as developed by Galvin and Todres, contrasts the analysis.

ETHICAL CONSIDERATIONS

The study followed the principles of the Helsinki Declaration. It was approved by the Norwegian Center for Research Data (NSD) (reg. no. 993360).

FINDINGS

The main theme of this study is: suffering while resigning to an unacceptable violation of dignity. This theme is deepened by two subthemes: (a) suffering while adapting to a relationship of dependence and (b) suffering while accepting the unacceptable.

CONCLUSIONS

Relatives experience suffering as a cross-pressure in their struggle to interact responsibly with health personnel in nursing homes. This may have a negative outcome, where relatives end up adapting to being silent witnesses to missed care and a violation of dignity.

Experiences of Domestic Violence in Adult Patients with Brain Injury: A Select Overview of Screening, Reporting, and Next Steps

This select overview examines the important intersection of adult domestic violence, including intimate partner violence and elder abuse, with brain injury. Despite the high prevalence of domestic violence amongst brain injury patients, there is a notable gap in screening and management training for providers. To provide optimal patient care, brain injury medicine clinicians must screen, recognize, and treat patients who have experienced domestic violence. This select overview highlights barriers to screening, validated screening tools from other medical disciplines, and management considerations for the brain injury clinician. A suggested protocol for domestic violence screening and management, as well as recommended resources for providers and patients, is summarized.

Identification of formation mechanism and key elements of quality geriatric care behavior of nursing assistants in nursing homes: a grounded theory study

Objectives

This study aimed to identify the key elements and develop a formation mechanism model of quality geriatric care behavior for nursing assistants.

Methods

This qualitative research employed the strategy of grounded theory proposed by Strauss and Corbin. Furthermore, the data was collected by participatory observation and semi-structured interviews. A total of 12 nursing managers, 63 nursing assistants, and 36 older people from 9 nursing homes in 6 cities were interviewed, whereas for the observatory survey, participants were recruited from 2 nursing homes.

Results

The comparative and analysis process revealed 5 key elements of quality geriatric care behavior, including holistic care, personalized care, respect, positive interaction, and empowerment. Based on the Capability-Opportunity-Motivation-Behavior (COM-B) model, key elements and the 3 stages of quality geriatric care behavior (negative behavior cognition stage, practice exchange run-in stage, and positive behavior reinforcement stage), the theoretical framework of the formation mechanism was established.

Conclusion

The results indicated that nursing assistants' capabilities, motivation, and organizational and environmental support are vital for quality care behaviors. The theoretical framework established in this study provides theoretical support and practical reference to policymakers, institutional administrators, and healthcare professionals for improving nursing assistant's care behaviors.

Abuse in Canadian long-term care homes: a mixed methods study

OBJECTIVE

To examine reported cases of abuse in long-term care (LTC) homes in the province of Ontario, Canada, to determine the extent and nature of abuse experienced by residents between 2019 and 2022.

DESIGN

A qualitative mixed methods study was conducted using document analysis and descriptive statistics. Three data sources were analysed: LTC legislation, inspection reports from a publicly available provincial government administrative database and articles published by major Canadian newspapers. A data extraction tool was developed that included variables such as the date of inspection, the type of inspection, findings and the section of legislation cited. Descriptive analyses, including counts and percentages, were calculated to identify the number of incidents and the type of abuse reported.

RESULTS

According to legislation, LTC homes are required to protect residents from physical, sexual, emotional, verbal or financial abuse. The review of legislation revealed that inspectors are responsible for ensuring homes comply with this requirement. An analysis of their reports identified that 9% (781) of overall inspections included findings of abuse. Physical abuse was the most common type (37%). Differences between the frequency of abuse across type of ownership, location and size of the home were found. There were 385 LTC homes with at least one reported case of abuse, and 55% of these homes had repeated incidents. The analysis of newspaper articles corroborated the findings of abuse in the inspection reports and provided resident and family perspectives.

CONCLUSIONS

There are substantial differences between legislation intended to protect LTC residents from abuse and the abuse occurring in LTC homes. Strategies such as establishing a climate of trust, investing in staff and leadership, providing standardised education and training and implementing a quality and safety framework could improve the care and well-being of LTC residents.

Older people's experiences of elder abuse in residential care settings: A scoping review

BACKGROUND

Elder abuse is a global human rights issue, particularly in residential care settings where there is limited understanding of older people's experiences of this phenomenon. This scoping review aims to map and describe the existing literature on this phenomenon.

METHODS

Using Arksey and O'Malley's scoping review methodology, further developed by Levac et al. and the Joanna Briggs Institute, a systematic search of six databases was conducted to identify relevant studies published from inception to January 2023. Studies were included if they focused on older people's experience of abuse within residential care settings. A comprehensive data extraction process was employed to identify key themes from the included studies.

RESULTS

The initial search yielded a total of 3701 articles of which eight met the inclusion criteria. The findings revealed a range of abusive experiences encountered by older people living in residential care settings, including psychological, physical, financial, neglect and sexual abuse. The common attributes of residents vulnerable to abuse were evident throughout each of the studies. Finally, the theme of organizational neglect was apparent through the absence of effective safeguarding measures in the included studies. The findings revealed the insufficient implementation of safeguarding measures increases the risk of abuse among residents.

CONCLUSION

This scoping review highlights the limited research on the experiences of older people who have encountered elder abuse in residential care settings. The findings stress the need for further research exploring the complex interplay of factors contributing to elder abuse within aged care settings. The insights gained from this scoping review can inform the development of comprehensive safeguarding strategies to prevent and address elder abuse in residential care settings, promoting the well-being and safety of older people.

PATIENT OR PUBLIC CONTRIBUTION

This project is a scoping review of the literature; therefore, no patient or public contribution was deemed necessary.

WHAT THIS PAPER CONTRIBUTES TO THE WIDER GLOBAL COMMUNITY

Most research on elder abuse has been conducted in the community rather than in Residential Care Settings where there is a limited understanding of older people's experiences of abuse within the published literature. The scoping review highlights the presence of inadequate safeguarding strategies in Residential Care Settings within the reviewed studies, providing recommendations for developing and improving safeguarding measures in Residential Care Settings to prevent abuse, neglect, and harm in the future.

Australian Frontline Service Response to Elder Abuse During COVID-19: Learnings, Successes, and Preparedness for Disaster

This study examines how service providers in Victoria, Australia, undertook early intervention and response to elder abuse during the COVID-19 pandemic in 2020-2021. This study comprised two phases: (a) interviews with 29 staff members from 23 frontline service organizations about their experience responding to the needs of vulnerable older people during COVID-19; followed by (b) a co-design workshop with 15 service providers to discuss and endorse recommendations to improve sector preparedness for early intervention and responses to elder abuse during disasters. Participants reported that the severity and frequency of elder abuse increased during the pandemic, and that remoteness of services undermined comprehensive risk assessments, especially for older people who were not proficient in English and/or current digital platforms. Service providers endorsed a range of recommendations to improve sector preparedness for responses to elder abuse during disasters, primarily to upskill providers and improve the service system and direct support for individuals.

Prevalence and types of elder abuse in Sub Saharan Africa, systematic review and meta-analysis, 2023

BACKGROUND

Elder abuse is a single or repeated act, or lack of appropriate action, which causes harm to an older person. This systematic review and meta-analysis aimed to assess the prevalence of elder abuse in Sub Saharan Africa.

METHODS

This systematic review and meta-analysis involved a comprehensive search of electronic databases, including PubMed, Scopus, Web of Science, African Journals Online and Google Scholar. Cochrane I2 statistics and Eggers test with funnel plot were done to check heterogeneity and publication bias, respectively.

RESULT

Five studies with 2123 elderly people aged 60 and above were included in this review. The pooled prevalence of elder abuse was (46.73 % (45.08-48.38)) with a substantial level of heterogeneity (I2 =99.7 %; p < 0.001). To overcome the effect of high level heterogeneity subgroup analysis was deployed. Accordingly, the subgroup analysis by publication year revealed that the prevalence of elder abuse was highest among studies conducted after 2018 (64.034 (95 % CI: 12.66, 115.4). Similarly, sub-group analysis by country revealed that the prevalence of elder abuse was highest in Ethiopia (63.2(21.276, 105.124).The subgroup analysis by the sampling technique revealed that elder abuse was highest among studies conducted using systematic random sampling technique (84.57 (95 % CI: 79.22, 89.92). Subgroup analysis by type of abuse revealed that physical abuse was highest (29.27 (-7.854, 66.394)) CONCLUSION: The pooled prevalence of elder abuse was high and, physical abuse was the commonest type of abuse. As a result, there should be awareness creation about the caring of elders to minimize abuse.

Male rape in Brazil: A descriptive analysis from 2010 to 2022

Male rape is a relatively under-discussed topic in scientific literature, despite its significant relevance and prevalence worldwide, including in Brazil. To inform public health and safety policies, this study aimed to analyze cases of male rape using data from SINAN, the Information System for Notifiable Diseases, a division of the Brazilian Ministry of Health, for the years 2010-2022. Our findings reveal a 469 % increase in male rape cases in the country over the study period, with a predominance of cases in the state of São Paulo. Also, a higher prevalence of cases was observed among individuals aged 5-9 years. Furthermore, we identified a correlation between the occurrence of rape and certain factors, including individuals with less than 4 years of formal education if they were over the age of 50, and those who had a history of being sexually abused between the ages of 5 and 14. Additionally, this study reinforces the prevalence of rape cases occurring within domestic environments and perpetrated by individuals closely related to the victims. This study contributes to filling the gap in research on male rape in Brazil, laying the foundation for the development of strategies to prevent and combat rape in the country.

"Just pee in the diaper" - a constructivist grounded theory study of moral distress enabling neglect in nursing homes

BACKGROUND

A growing body of evidence shows that many nursing home residents' basic care needs are neglected, and residents do not receive qualitatively good care. This neglect challenges nursing staff´s professional and personal ideals and standards for care and may contribute to moral distress. The aim of this study was to investigate how nursing staff manage being a part of a neglectful work culture, based on the research question: "How do nursing home staff manage their moral distress related to neglectful care practices?"

METHODS

A qualitative design was chosen, guided by Charmaz´s constructivist grounded theory. The study was based on 10 individual interviews and five focus group discussions (30 participants in total) with nursing home staff working in 17 different nursing homes in Norway.

RESULTS

Nursing staff strive to manage their moral distress related to neglectful care practices in different ways: by favouring efficiency and tolerating neglect they adapt to and accept these care practices. By disengaging emotionally and retreating physically from care they avoid confronting morally distressing situations. These approaches may temporarily mitigate the moral distress of nursing staff, whilst also creating a staff-centred and self-protecting work culture enabling neglect in nursing homes.

CONCLUSIONS

Our findings represent a shift from a resident-centred to a staff-centred work culture, whereby the nursing staff use self-protecting strategies to make their workday manageable and liveable. This strongly indicates a compromise in the quality of care that enables the continuation of neglectful care practices in Norwegian nursing homes. Finding ways of breaking a downward spiralling quality of care are thus a major concern following our findings.

Investigation of Correlation between Communication Skills and Self-Reported Elder Mistreatment in Family Abuse

Introduction  In today's world, old age has become an important global phenomenon following the increase in life expectancy and the decrease in birth rates. Communication skills are an important requirement in old age. Changing role of the family and existing tensions, mental pressures, and modern life undermine the social position of the elderly and lead to abuse of the elderly by family members. The goal of the present study is to determine the relationship between communication skills and family self-reported domestic abuse among older adult in Iran. Materials and Methods  For this cross-sectional-analytical study, 153 elderly adult people admitted in hospitals of the Guilan province were randomly selected. The research instruments were the following questionnaires: demographic characteristics, abbreviated mental test (AMT), the Persian version of Domestic Elder Abuse Questionnaire, family mistreatment of the elderly (Heravy), and Queendom Communication Skill Test-Revise (QCSTR). The data were analyzed by SPSS software (version 22) using descriptive (frequency distribution tables, mean, and standard deviation [SD]) and analytical statistics (Mann-Whitney, Kruskal-Wallis, and Spearman's correlation tests) considering the significance level of 0.05. Results  A majority of the elderly were men (51%), were in the age group of 60 to 69 years (72.5%) and married (75.5%), did not hold high school diploma (88.8%), had four to five children (41.2%) with low income (75.9%), and suffered from chronic diseases (68.6%). The mean score of communication skills was 129.09 ± 12.60. The mean score of domestic elder abuse was 2.89 ± 3.97. Communication skills have a significant relationship with age and marital status, but not with sex, education level, income, and chronic disease. There is an inverse correlation between communication skills and domestic elder_abuse ( p  < 0.001, r  = -0.468). Conclusion  Communication skills are one of the influential factors of domestic violence. Therefore, to prevent or reduce the amount of violence, it is recommended that family members increase the communication skills of the elderly.

Experiences for Geriatric Care from Nursing Students' Knowledge: A Qualitative Approach

(1) Background: Studies have shown that clinical experience has an impact on how students perceive geriatric care. The vulnerability of older people particularly allows students to reflect on and evaluate their learning. In this context, communication between tutors and students is important to guiding a contextualized view of the complexity of clinical situations. The principal objective was to explore the feelings, perceptions, and experiences of nursing students in geriatric care units during their practices. (2) Methods: This is a qualitative study using content analysis where the data collected were analyzed deductively. An intentional sample of 81 nursing degree students enrolled in the subject of clinical practices. During these sessions, a dynamic discussion forum was incorporated. (3) Results: There were 6 forums with a total of 591 participants, with an average of 98.5 per forum. Four categories emerged: humanization, geriatric nurse, aging, and learning. (4) Conclusions: A change of management oriented to the person-centered model would improve the quality in the residences and as well as in the expectations of the students towards geriatric nursing. Changing perspectives could be a way to confront and become aware of the fallacies of care that have been evidenced. This study was not registered.

On tackling abuse of older people: The forensic challenges in fatal cases investigation

The World Health Organization recently presented the priorities for tackling abuse of older people in a coordinated and strategic way. However, data on the forensic scenario is still lacking. In this context, the aim of the present work was to provide a comprehensive literature review of this inherently complex phenomenon in the post-mortem setting, in order to better characterize it from a forensic point of view. A comprehensive literature search was performed in three electronic databases following the PRISMA guidelines. Sociodemographic and medical data of victims and perpetrators, post-mortem data, types of abuse and risk factors were extracted from non-aggregated data. Forty-eight papers dealing with abuse in the post-mortem setting were included, with a predominance of case reports and case series. The review showed that neglect was the most common type of abuse and victims are predominantly older women who are abused in a domestic setting by trusted family member. To generate more and better data, expanded research in the forensic field requires standardized methods and the raise of professional awareness about abuse of older people.

Risk Factors for Post-Discharge Adverse Outcomes Following Hospitalization Among Older Adults Diagnosed With Elder Mistreatment

Using 100% Medicare data files, this study explored whether primary elder mistreatment (EM) diagnosis, EM type, and facility type were associated with 3-year mortality and 1-year unplanned hospital readmission among older patients diagnosed with EM with hospital discharge from 10/01/2015 through 12/31/2018 (n = 11,023). We also examined outcome differences between older patients diagnosed with EM and matched non-EM patient controls. Neglect by others was the most common EM diagnosis. Three-year mortality was 56.7% and one-year readmission rate was 53.8%. Compared to matched non-EM patient controls, older EM patients were at an increased risk of mortality and readmission. Among patients diagnosed with EM, patients with a secondary (vs. primary) diagnosis and those discharged from a skilled nursing facility (vs. acute hospital) were at an increased risk for both mortality and readmission. Compared to other EM types, patients diagnosed with neglect by others had a greater risk for mortality following discharge.

Healthcare costs for legally adjudicated elder mistreatment victims in comparison to non-mistreated older adults

BACKGROUND

Elder mistreatment (EM) is associated with adverse health outcomes and healthcare utilization patterns that differ from other older adults. However, the association of EM with healthcare costs has not been examined. Our goal was to compare healthcare costs between legally adjudicated EM victims and controls.

METHODS

We used Medicare insurance claims to examine healthcare costs of EM victims in the 2 years surrounding initial mistreatment identification in comparison to matched controls. We adjusted costs using the Centers for Medicare and Medicaid Services Hierarchical Condition Categories (CMS-HCC) risk score.

RESULTS

We examined healthcare costs in 114 individuals who experienced EM and 410 matched controls. Total Medicare Parts A and B healthcare costs were similar between cases and controls in the 12 months prior to initial EM detection ($11,673 vs. $11,402, p = 0.92), but cases had significantly higher total healthcare costs during the 12 months after initial mistreatment identification ($15,927 vs. $10,805, p = 0.04). Adjusting for CMS-HCC scores, cases had, in the 12 months after initial EM identification, $5084 of additional total healthcare costs (95% confidence interval [$92, $10,077], p = 0.046) and $5817 of additional acute/subacute/post-acute costs (95% confidence interval [$1271, $10,362], p = 0.012) compared with controls. The significantly higher total costs and acute/sub-acute/post-acute costs among EM victims in the post-year were concentrated in the 120 days after EM detection.

CONCLUSIONS

Older adults experiencing EM had substantially higher total costs during the 12 months after mistreatment identification, driven by an increase in acute/sub-acute/post-acute costs and focused on the period immediately after initial EM detection.

Managing reports of trouble: designated officials' responses to reports of mistreatments initiated by service users and relatives

Mandatory reporting of elder abuse aims to detect and prevent mistreatment and improve services. Service users and their relatives can raise concerns, but only staff can file mandatory reports. This article examines how the concerns of service users and relatives were managed by designated officials in reports of mistreatments in care for older adults in Sweden. We lean on sociological theories of "interpersonal trouble" and organizational "disputes domains." The thematic analysis is based on 28 incident reports initiated by service users or their relatives. The analysis shows that the reports were managed in one of three ways: asymmetrically, by 1) dismissing or 2) supporting the complainant's position, or symmetrically, by 3) treating complainants' accounts as credible but minimizing their seriousness. There were differences between reports initiated by service users and relatives. Dismissing concerns about abuse, mainly those made by relatives, risks support for service users failing.

Safeguarding adults at risk of abuse

Safeguarding adults at risk of abuse presents complex ethical challenges. By knowing what counts as adult abuse, recognising the signs of adult abuse and appropriately addressing suspected adult abuse, nurses contribute to protecting patients' safety, well-being, autonomy and dignity. This article discusses categories and indicators of adult abuse, relevant legislation and standards, the principles of adult safeguarding and the key elements of a nursing assessment of suspected adult abuse. The author highlights that nurses need to approach safeguarding concerns sensitively and strike a balance between acting to safeguard the person and preserving their right to autonomy. There is a need for ongoing education and training to enhance nurses' understanding of safeguarding practices, legislation, policies and standards.

Elder abuse: a conceptual analysis

OBJECTIVE

to analyze the concept of elder abuse and identify its respective antecedents, attributes and consequents.

METHODS

this is a conceptual analysis according to Walker and Avant's proposition. The search for the concept was mediated by an integrative review in the LILACS, PubMed, CINAHL, Web of Science and BDENF databases.

RESULTS

as antecedents, female, family member, low social support and low income or socioeconomic conditions stand out. Attributes were threats and/or intimidation, intentional use of physical force, using resources without authorization, unwanted sexual activity, offering low insufficient amount of nutrients for older adults and not meeting older adults' affective/emotional needs. Consequents were psychological disorders, dependence on aggressors, environment of insecurity and damage/loss of human rights or human dignity.

FINAL CONSIDERATIONS

the phenomenon under discussion is broad and multifaceted, suggesting expansion of studies related to the theme in order to explore it in detail.

Forgotten and without Protections: Older Adults in Prison Settings

The number of older adults incarcerated in prisons is growing significantly, and there is a great need for legal authority, processes, and resources to mitigate individual and social burdens of elder neglect and abuse within these settings. Older adults in prison may be particularly vulnerable to abuse, neglect, or exploitation. They are dependent on the carceral system for basic resources, are at risk for retaliatory actions for reporting mistreatment, and bear disproportionately high health burdens. This essay first considers standards and resources for mitigating elder mistreatment in the community and residential-care settings in contrast to the available resources in prisons. Arguing that a conceptual model of elder abuse tailored to the prison population is needed, the essay proposes a research agenda through which such a model could be developed. The model could then be used in the creation of policy for detecting and mitigating elder mistreatment of incarcerated people. The essay concludes with a call to action to address the rift in legal protections and processes that leave older adults in prison at increased risk of abuse and neglect without a clear pathway for recourse.

Status and influencing factors of elder neglect by geriatric nursing assistants in Chinese nursing homes: a cross-sectional survey

Background

In nursing homes, elder neglect has come to the forefront. Currently, few studies have examined the impact of personal and organizational factors of geriatric nursing assistants on elder neglect. From the perspective of geriatric nursing assistants, this study aims to explore the current situation and influencing factors of elder neglect in Chinese nursing homes.

Methods

A convenience sampling method was used to recruit 412 geriatric nursing assistants from 50 nursing homes in China. Participants were surveyed using a demographic questionnaire, the Elder Neglect Scale for Geriatric Nursing Assistants, the General Self-Efficacy Scale (GSES), and the Proactive Personality Scale (PPS). Spearman correlation analysis and multiple linear regression were used to analyze the factors influencing elder neglect.

Results

Geriatric nursing assistants scored a median of 74 out of 85 on the Elder Neglect Scale. Multiple linear regression analyses showed that the main personal factors influencing geriatric nursing assistants' elder neglect were general self-efficacy (β = 0.312), proactive personality (β = 0.180), and advanced qualification (β = 0.084), while the main organizational factors included monthly salary ≤ 1,900 RMB (β = -0.256), no regular training after induction (β = -0.253), and the number of days off per month (3-4 days off β = 0.192, ≥ 5 days off β = 0.101).

Conclusion

Although geriatric nursing assistants are at low levels of elder neglect, it remains a cause for concern. Among the personal factors, geriatric nursing assistants who possessed proactive personalities, high self-efficacy and advanced qualifications, exhibited low levels of elder neglect. Among the organizational factors, those who possessed a high number of days off per month portrayed low levels of elder neglect. Conversely, those who received low monthly salaries and no regular training after induction portrayed high levels of elder neglect. To reduce the risk of elder neglect, nursing homes should give due consideration to candidates' self-efficacy and proactive personality traits when recruiting, and focus on fostering these personality traits in their employees during their work. In addition, strengthening regular training for geriatric nursing assistants, optimizing the salary structure, and arranging rest days in a reasonable manner are also necessary measures.

Insights into caregivers' perspectives on abuse of older persons: a qualitative exploratory study in southwest Nigeria

OBJECTIVE

Elder abuse perpetration by caregivers is well documented, particularly from the perspectives of older persons who are victims of abuse. However, few studies in Nigeria have examined the caregivers' viewpoints. This study explored the perception about the perpetration of elder abuse perpetration among adults aged 18-59 in Nigeria.

DESIGN

Using a qualitative descriptive approach, this study generated data through four in-depth interviews (IDIs) and eight focus group discussions (FGDs). All IDIs and FGDs were audiorecorded, transcribed coded and analysed thematically with Atlas ti.

SETTING

Rural and urban communities in Oyo State, southwest Nigeria.

PARTICIPANTS

73 purposively selected adults who had provided care for or lived near an older person in southwestern Nigeria.

RESULTS

Types of elder abuse identified were verbal (grumbling, insulting, snapping and shouting at older persons), physical (shoving and beating an older person) and neglect (refusing to render assistance, cook or carry out chores for an older person). Participants believed relatives of older persons were unlikely to perpetrate abuse compared with neighbours and paid caregivers. They, however, felt that people whose parents had maltreated them during childhood could perpetrate abuse especially neglect of their older parents. Identified possible provocation for abuse included an unkempt physical appearance, poor attitude or offensive behaviour in the older person. Participants further opined that lack of communal unity or mutual respect, loss of moral ideals and religious values and erosion of cultural values could also provide an environment where elder abuse can thrive.

CONCLUSION

Interventions for community-level prevention of elder abuse can leverage on the identified moral and religious values, relationship and cultural factors for successful deployment.