Elder Abuse in the COVID-19 Era

Differential impacts of health systems and sociocultural environment on vulnerable populations during the COVID-19 pandemic: lessons from four Asia-Pacific countries

BACKGROUND

This study aims to evaluate healthcare systems and pandemic responses in relation to marginalized and vulnerable groups, identify populations requiring urgent care, and assess the differential impacts on their health during the pandemic.

METHODS

Data were collected by the Asia-Pacific Observatory on Health Systems and Policies (APO)-National University of Singapore and APO-International Health Policy Program consortium members: Korea, Indonesia, Philippines, and Singapore. Data were collected through a combination of semi-structured interviews, policy document reviews, and analysis of secondary data.

RESULTS

Our findings reveal that the pandemic exacerbated existing health disparities, particularly affecting older adults, women, and children. Additionally, the study identified LGBTI individuals, healthcare workers, slum dwellers, and migrant workers as groups that faced particularly severe challenges during the pandemic. LGBTI individuals encountered heightened discrimination and limited access to health services tailored to their needs. Healthcare workers suffered from immense stress and risk due to prolonged exposure to the virus and critical working conditions. Slum dwellers struggled with healthcare access and social distancing due to high population density and inadequate sanitation. Migrant workers were particularly hard hit by high risks of virus transmission and stringent, often discriminatory, isolation measures that compounded their vulnerability. The study highlights the variation in the extent and nature of vulnerabilities, which were influenced by each country's specific social environment and healthcare infrastructure. It was observed that public health interventions often lacked the specificity required to effectively address the needs of all vulnerable groups, suggesting a gap in policy and implementation.

CONCLUSIONS

The study underscores that vulnerabilities vary greatly depending on the social environment and context of each country, affecting the degree and types of vulnerable groups. It is critical that measures to ensure universal health coverage and equal accessibility to healthcare are specifically designed to address the needs of the most vulnerable. Despite commonalities among groups across different societies, these interventions must be adapted to reflect the unique characteristics of each group within their specific social contexts to effectively mitigate the impact of health disparities.

Disclosure and Reporting of Abuse Against Older Adults: Perspectives of Older Adults with Abuse Histories and Service Providers in Alberta, Canada

This exploratory qualitative study seeks to understand the barriers and facilitators of disclosure and reporting of abuse against older adults by conducting interviews with older adults with lived experience of abuse and service providers working directly with this population in Alberta, Canada. Thematic analysis revealed three key themes: (1) Barriers to disclosure and reporting of abuse; (2) Facilitators to disclosure and reporting; and (3) Key tensions between service providers' and older adults' perceptions of the disclosure and reporting process. Based on these findings, we offer recommendations to increase awareness, promote disclosure, and improve services for older adults experiencing abuse.

The Burden and Quality of Life in Caregivers of Individuals With Stroke During the COVID-19 Pandemic in Turkey: A Cross-Sectional Study

This study investigated the caregiving burden, quality of life and life satisfaction of caregivers of individuals with stroke during the pandemic period. A descriptive a study was performed with a sample of caregivers (n = 80) of inpatient individuals with stroke in Kayseri, Turkey. The Bakas Caregiving Outcomes Scale, Short Form Health Survey-36, and Temporal Satisfaction with Life Scale were used as well as some open-ended questions. Using descriptive analysis and correlations, results showed that caregiving burden of the participants was correlated to quality of life and life satisfaction during the COVID-19 (p < 0.05). Specific types of burden include: stress, isolation, financial issues, disruption of therapy, patient-caregiver relationship, and kinship relations. These findings provide important information about the increased burden of caregivers during the pandemic. This study offers information to design a framework of interventions to reduce the physical, social, and psychological effects on caregivers in similar conditions.

Domestic Violence, Mental Health, and Resilience Among Older Adults in the U.S. During COVID-19

OBJECTIVES

The current study based on the Stress Process Model investigated the impact of experiences of domestic violence on mental health as well as resilience against negative mental health outcomes among older adults in U.S. during COVID-19.

METHOD

Participants included 522 older adults (ages 51-80 and older) living in US at the time of the survey. Path analysis using Mplus was employed. Results:The experience of domestic violence among older adults during the pandemic was positively associated with loneliness and anxiety directly and indirectly. However, resilience acted as a protective factor between the experiences of domestic violence and anxiety. Conclusion: The experience of domestic violence may increase loneliness and anxiety among older adults during challenging times; however, resilience may weaken these negative psychological outcomes both directly and indirectly. Findings and implications are discussed.

Training Senior Companion Volunteers to Identify and Report Adult Abuse, Neglect, and Exploitation

Elder abuse is a national public health challenge that can have dire consequences for the older adults who experience it in any form. The Senior Companion Program presents a unique opportunity to address this public health challenge. An in-person training for Senior Companion volunteers across Ohio on how to recognize and report elder abuse was developed, implemented, and evaluated prior to the COVID-19 pandemic. Evaluation consisted of surveys distributed prior to and at the conclusion of the training. A total of 302 volunteers were trained with a survey response rate of 76%. While there was significant knowledge improvement in one of the five knowledge items (p < .000, all other ps ≥ .065), volunteers' subjective rating of their knowledge on abuse significantly improved (p = .029). Training older adult volunteers working with other community-dwelling adults is likely a valuable strategy to educate and protect against elder abuse.

National cross-sectional survey on psychological impact on French nursing homes of the first lockdown during the COVID-19 pandemic as observed by psychologists, psychomotor, and occupational therapists

Objectives

The main objective was to explore the psychological impact of the French lockdown during the first wave of the COVID-19 pandemic on nursing home residents, their relatives, and healthcare teams, as observed by mental health professionals.

Design

A national online cross-sectional survey was conducted from May 11 to June 9, 2020.

Setting and participants

Respondents were psychologists, psychomotor therapists, and occupational therapists (mental health professionals).

Results

A total of 1,062 participants responded to the survey, encompassing 59.8% psychologists, 29.2% occupational therapists, and 11% psychomotor therapists. All mental health professionals felt fear (76.1%), fatigue and exhaustion (84.5%), and inability to manage the emotional burden (78.4%). In nursing homes with COVID-19 cases, residents felt significantly sadder (83.2%), more anxious (65.0%), experienced more anorexia (53.6%), resurgence of traumatic war memories (40.2%), and were more often disoriented (75.7%). The suffering of relatives did not vary between nursing homes with and without COVID-19 cases. The nursing staff was heavily impacted emotionally and was in need of psychological support particularly when working in nursing homes in a low COVID-19 spread zone with COVID-19 cases (41.8 vs. 34.6%).

Conclusion and implications

Primary prevention must be implemented to limit the psychological consequences in the event of a new crisis and to prevent the risk of psychological decompensation of residents and teams in nursing homes.

Improved outcomes for depressed elder abuse victims with video-delivered psychotherapy during COVID-19

OBJECTIVE

There is a lack of evidence-based scalable therapies for elder abuse victims, with no current remotely delivered tailored psychotherapy. The purpose of this manuscript is to (a) examine the effectiveness of a brief therapy for depression for elder abuse victims, and (b) to compare remote intervention delivery via phone or video to the traditional in-person delivery.

METHOD

PROTECT, Providing Options to Elderly Clients Together, is a brief therapy developed in collaboration with partners at the Department for the Aging (DFTA) of New York City. During the COVID-19 outbreak, PROTECT delivery shifted from in-person to phone or video delivery. Depression severity was tracked using the Patient Health Questionaire-9 (PHQ-9). Reduction in depression severity was evaluated using a linear mixed effects model with non-inferiority test to compare the effectiveness of video vs in-person delivery of PROTECT.

RESULTS

PROTECT reduced depression (average 5.15 PHQ-9 points). Video and phone delivery were non-inferior to in-person delivery. The video group completed therapy more quickly than the in-person group and had a more rapid improvement in depression symptoms.

CONCLUSIONS

PROTECT therapy delivered remotely reduces depression among diverse elder abuse victims. Video delivery of PROTECT could increase reach and scalability to serve more vulnerable older depressed victims.

Challenging experiences of the elderly with heart failure in the COVID-19 pandemic: a phenomenological study in Iran

BACKGROUND

Patients with heart failure (HF), especially the elderly, faced many challenges during the COVID-19 pandemic, which need to be explored. The present study aimed to analyse the challenging experiences facing the elderly with heart failure during the pandemic in Iran. To achieve this aim, a qualitative approach to research was employed.

METHODS

The present qualitative research employed a phenomenological approach to study 12 elderly with heart failure visiting Imam Ali Hospital during the COVID-19 pandemic in Kermanshah, Iran. The data collection occurred between August 5, 2022, and November 21, 2022. The participants were selected through a purposive sampling method and interviewed using a semi-structured interview. MAXQDA10 software was used for data organisation and the Colizzi analytical technique for data analysis. Guba and Lincoln's criteria were also used to evaluate the trustworthiness of the qualitative research.

RESULTS

A total of two categories, 8 subcategories, and 110 primary codes were extracted from the data. The two categories were challenges and coping strategies. The former included the sub-categories of economic issues, fear, anxiety, and fear of death; limited access to health care; quarantine issues; disruption of family life; and medication non-adherence. The subcategories of the latter were faith in God, social support, and self-care behaviors.

CONCLUSIONS

The present study revealed the challenges experienced and the coping strategies employed by elderly patients with heart failure during the pandemic in Iran. A knowledge of these challenges and experiences during the COVID-19 pandemic can raise healthcare workers' awareness of the elderly patients' strategies used to cope with the virus.

Perfil y características de la violencia contra los adultos mayores durante la pandemia de COVID-19

Resumen Objetivo: identificar el perfil sociodemográfico y las características de la violencia interpersonal contra los adultos mayores en el primer año de la pandemia de COVID-19 en una ciudad capital de la región sureste de Brasil. Método: investigación descriptiva, exploratoria con diseño transversal a partir del análisis de las notificaciones de casos sospechosos o confirmados de violencia contra el adulto mayor, ocurridos entre marzo de 2020 y marzo de 2021. Se realizó un análisis estadístico univariado y la prueba exacta de Fisher (p< 0,05). Resultados: hubo 2681 notificaciones en el período. Las principales víctimas fueron personas entre 60 y 64 años, de sexo femenino, blancas y con baja escolaridad. La mayoría de los casos se registró en el hogar. La violencia física y psicológica fueron las más comunes, con uso de fuerza física/golpes y amenaza, respectivamente. El agresor era generalmente del sexo masculino, más joven que la víctima, hijo o pareja. Las agresiones se produjeron más de una vez y fueron motivadas por conflictos generacionales. Hubo baja derivación a organismos de protección de adultos mayores. Conclusión: el perfil sociodemográfico obtenido revela que son víctimas vulnerables, sujetas a múltiples formas de violencia y que la integridad de su salud está en riesgo potencial.

Perfil e características da violência contra a pessoa idosa durante a pandemia COVID-19

Resumo Objetivo: identificar o perfil sociodemográfico e as características da violência interpessoal contra a pessoa idosa no primeiro ano da pandemia COVID-19 em uma capital da região sudeste do Brasil. Método: pesquisa descritiva, exploratória, com delineamento transversal a partir da análise das notificações de casos suspeitos ou confirmados de violência contra a pessoa idosa, ocorridas entre março de 2020 e março de 2021. Foi realizada a análise estatística univariada e teste exato de Fisher (p<0,05). Resultados: houve 2681 notificações no período. As principais vítimas foram pessoas com idade entre 60 e 64 anos, do sexo feminino, brancas e com baixa escolaridade. As ocorrências tiveram maior frequência nos domicílios. As violências físicas e psicológicas foram as mais comuns, com uso de força física/espancamento e ameaça, respectivamente. O agressor era, em sua maioria, do sexo masculino, mais jovem do que a vítima, geralmente filho ou parceiro íntimo. As agressões ocorreram mais de uma vez e foram motivadas por conflitos geracionais. Houve baixo encaminhamento para órgãos de proteção a pessoa idosa. Conclusão: o perfil sociodemográfico encontrado evidencia vítimas vulneráveis, sujeitas a muitas formas de violência e com potenciais riscos à integralidade de sua saúde.

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.

Assessment of Obsessive Thoughts About COVID-19 in 7 Latin American Countries: Structure and Measurement Invariance of the Obsession With COVID-19 Scale

The present study aimed to evaluate the measurement invariance of the Obsession with COVID-19 Scale (OCS) among seven Latin American countries: Bolivia, Brazil, Cuba, El Salvador, Guatemala, Paraguay, and Uruguay. Although the OCS has been used in several countries and languages, there is a need for approaches that better integrate the cross-cultural equivalence of the scale. A total of 3185 people participated in the study. The results indicated the presence of a unidimensional structure and good reliability indices for the OCS in each country. The alignment method indicated that the OCS is an invariant measure of COVID-19 obsession among the populations of seven Latin American countries. The findings based on IRT analysis indicated that all OCS items had adequate discrimination and difficulty parameters. The findings contribute to the understanding of the internal structure of the scale in different countries at the same time, something that has been pending evaluation.

The prevalence of elder abuse and risk factors: a cross-sectional study of community older adults

BACKGROUND

The old people population is increasing worldwide. Along with their increasing population, an increase in elder abuse cases is predicted. Elder abuse is a neglected problem, and many cases go unreported. This study was conducted to identify types of elder abuse and examine associated risk factors.

METHODS

This cross-sectional analytical study was conducted on 500 older people in Ardabil (northwestern Iran). Data was collected over three months, from June to September 2020. Data was collected using a demographic information form and the Domestic Elder Abuse questionnaire. The data were analyzed using SPSS software (version 22). Logistic regression was used to identify factors related to elder abuse.

RESULTS

The results showed that out of the 500 participants, 258 (51.6%) were male, and 242 (48.2%) were female. Among the 500 participants, 377 individuals (75/4%) reported experiencing at least one type of abuse in the past year. The highest rate of elder abuse was observed for emotional neglect (47.2%) and psychological abuse (40.8%), while the lowest rate was measured for rejection (15.4%) and physical abuse (12.4%). The results indicated that elder abuse was significantly associated with chronic illness (OR = 0.601, 95% CI: 0.391-0.922) and having 1-4 children (OR = 1.275, 95% CI: 1.137-1.430).

CONCLUSION

Considering the high level of elder abuse and its dangerous effects on the quality of life for older people, it is essential to develop appropriate programs to increase awareness among older people and their families.

Financial Fraud and Deception in Aging

Financial exploitation among older adults is a significant concern with often devastating consequences for individuals and society. Deception plays a critical role in financial exploitation, and detecting deception is challenging, especially for older adults. Susceptibility to deception in older adults is heightened by age-related changes in cognition, such as declines in processing speed and working memory, as well as socioemotional factors, including positive affect and social isolation. Additionally, neurobiological changes with age, such as reduced cortical volume and altered functional connectivity, are associated with declining deception detection and increased risk for financial exploitation among older adults. Furthermore, characteristics of deceptive messages, such as personal relevance and framing, as well as visual cues such as faces, can influence deception detection. Understanding the multifaceted factors that contribute to deception risk in aging is crucial for developing interventions and strategies to protect older adults from financial exploitation. Tailored approaches, including age-specific warnings and harmonizing artificial intelligence as well as human-centered approaches, can help mitigate the risks and protect older adults from fraud.

Geriatric Pharmacotherapy Case Series: The Pharmacist's Role in Preventing Elder Abuse

Elder abuse encompasses many types of abuse, including physical, sexual, emotional, neglect, and financial abuse. Abuse, including neglect and exploitation, is experienced by about 1 in 10 people aged 60 and older who live at home.1 However, this is likely an underestimation. Non-fatal injury reporting is limited to those collected from emergency department visits only, and under-reporting of abuse.1,4,15 It has been reported that only 1 in 24 cases of elder abuse are actually reported to authorities.⁴ Elder abuse is often perpetrated by the family members, caregivers, financial advisors, or other individuals trusted by the older person. Due to the COVID-19 pandemic, there have been stay-at-home orders enacted throughout the country, confining older adults to their homes, potentially increasing their risk. These stay-at-home orders have also decreased social interactions, and social isolation is a known risk factor for elder abuse. During the pandemic, many visits to physicians have been canceled, delayed, or moved to telehealth; however, visits to pharmacies remained essential. Pharmacists are mandated reporters and are able to identify potential misuse of medications and physical and emotional abuse, and neglect. The discussion highlights the continued importance of the role of pharmacists in preventing and reporting elder abuse though discussion of a patient case.

Adult Protective Services Perspectives on Responding to Elder Abuse and Serving Clients During the COVID-19 Pandemic

The initial COVID-19 pandemic and subsequent public health measures dramatically impacted Adult Protective Services (APS), requiring rapid adjustments. Our goal was to describe challenges for APS and strategies developed to respond. We conducted six focus groups and seven interviews during March-April 2021 using a semi-structured topic guide, with 31 participants from APS leadership, supervisors, and caseworkers in New York City, a community hard hit by the initial COVID surge. Data from transcripts were analyzed to identify themes. Participants identified challenges faced by APS (e.g., clients less willing to engage with APS, inability to perform necessary job tasks remotely, and low staffing levels) as well as strategies APS used in response (e.g., increasing collaboration with other community-based programs and service providers, enabling remote court hearings through technology and in-person facilitation, and ensuring staff had access to personal protective equipment). These findings may inform APS planning for future large-scale societal disruptions.

Increasing disclosures of older adult maltreatment: a review of best practices for interviewing older adult eyewitnesses and victims

The current article provides a contemporary review of the best practices for interviewing older adults about crimes they witnessed or experienced. Specifically, we provide a detailed overview of how investigators can use a range of interviewing adaptations and procedures to acquire detailed and accurate maltreatment disclosures from older adults. In addition to discussing well-established investigative interviewing practices (e.g. rapport building, free-recall, cognitive instructions and prompts), this article also summarizes more recent literature on the benefits of multidisciplinary investigations, use of assistive technology and interview accommodations, along with effective practices for working with minority and marginalized older adults. Lastly, several research, professional and policy recommendations are provided for supporting older adults during investigative interviews.

Rural and Urban/Suburban Victim Professionals' Perceptions of Gender-Based Violence, Victim Challenges, and Safety Advice During the COVID-19 Pandemic

This study surveyed a national sample of victim service professionals (N  =  222) and compared rural versus urban/suburban participants' perceptions of a variety of issues, such as the impact of the pandemic on gender-based violence victimization and safety advice for isolated victims. Increased interference with victim employment and the abuser monitoring of online activities were reported by participants across all communities. However, urban/suburban participants rated the magnitude of all victim challenges as greater, while more rural participants noted child abuse as a particular problem in their communities. The results highlight the importance of community context for improving coordinated responses to gender-based violence (n  =  101).

Trends in elder abuse and age discrimination during the COVID-19 pandemic in Hong Kong: Findings from a two-wave representative telephone survey study

OBJECTIVES

Empirical evidence about the heightened risks of elder abuse and age discrimination during the COVID-19 pandemic is scarce. This study aimed to track the changes in rates of both, and investigated their associated factors in the community-dwelling older population in Hong Kong.

METHODS

In this two-wave, cross-sectional telephone survey, we interviewed a population-based sample of individuals (≥55 years), and captured the situation of elder abuse and age discrimination before the COVID-19 outbreak (n = 1209, Wave 1: October-December 2019) and during the pandemic (n = 891, Wave 2: December 2020-January 2021). Participants reported their experiences of different types of abuse and discrimination, financial health, subjective well-being, satisfaction with environment, health and social services, and resilience.

RESULTS

Abuse was reported by 20.2% of the sample before the outbreak and 17.8% during the pandemic; while discrimination was reported by 24.6% and 29.8% at the two time points, respectively. A drop in physical abuse was observed, but it was accompanied by a rise in discrimination in the form of harassment or refusal of services. Findings of logistic regression analysis show that abuse during the pandemic was associated with younger age, poorer subjective well-being, and lower resilience; while discrimination was associated with female gender, being married, and poorer subjective well-being.

CONCLUSIONS

Elder abuse and discrimination were prevalent across time points. The pandemic has highlighted the marginalization of older persons in our communities. There is an urgent need for development of effective interventions to end abuse and discrimination.

Education program promoting report of elder abuse by nursing students: a pilot study

BACKGROUND

Elder abuse is an important public health concern that requires urgent attention. One main barrier to active responses to elder abuse in clinical settings is a low level of relevant knowledge among nurses. This study aims to develop an educational program to promote an intent to report elder abuse among nursing students and assess its effectiveness, with a focus on the rights of older adults.

METHODS

A mixed method design was used with the Analyze, Design, Develop, Implement, and Evaluate model. Twenty-five nursing students from Chungbuk Province participated in the study. Attitude toward older adults and knowledge of, awareness of, attitude towards, and intent to report elder abuse were assessed quantitatively and analyzed using paired t-test. The feasibility of the program and feedback were collected qualitatively through group interviews and analyzed using content analysis.

RESULTS

After the education program, attitude toward older adults (Cohen's d = 1.08), knowledge of (Cohen's d = 2.15), awareness of (Cohen's d = 1.56), attitude towards (Cohen's d = 1.85), and intent to report elder abuse (Cohen's d = 2.78) increased, confirming the positive effects of this program. Overall, all participants were satisfied with the contents and method of the program.

CONCLUSIONS

The method of program delivery should be improved and tailored strategies to boost program engagement among nursing students should be explored to implement and disseminate the program.

Changes in prescription drug abuse during the COVID-19 pandemic evidenced in the Catalan pharmacies

Introduction

The impact of a pandemic on the mental health of the population is to be expected due to risk factors such as social isolation. Prescription drug abuse and misuse could be an indicator of the impact of the COVID-19 pandemic on mental health. Community pharmacists play an important role in addressing prescription drug abuse by detecting signs and behaviors that give a clearer indication that a drug abuse problem exists.

Methods

A prospective observational study to observe prescription drug abuse was conducted from March 2020 to December 2021 to compare with data obtained in the previous 2 years, through the Medicine Abuse Observatory, the epidemiological surveillance system set up in Catalonia. Information was obtained through a validated questionnaire attached on a web-based system and data collection software. A total of 75 community pharmacies were enrolled in the program.

Results

The number of notifications during the pandemic period (11.8/100.000 inhabitants) does not indicate a significant change compared with those from pre-pandemic period, when it was 12.5/100.000 inhabitants. However, the number of notifications during the first wave when lockdown was in place stood at 6.1/100,000 inhabitants, significantly lower than in both the pre-pandemic and the whole of the pandemic periods. Regarding the patient's profile, it was observed that the proportion of younger patients (<25 and 25-35) rose in contrast to older ones (45-65 and >65). The use of benzodiazepines and fentanyl increased.

Conclusions

This study has made it possible to observe the impact of the pandemic caused by COVID-19 on the behavior of patients in terms of use of prescription drugs through analysis of the trends of abuse or misuse and by comparing them with the pre-pandemic period. Overall, the increased detection of benzodiazepines has pointed out stress and anxiety generated by the pandemic.

Profile and characteristics of violence against older adults during the COVID-19 pandemic

OBJECTIVE

to identify the sociodemographic profile and the characteristics of interpersonal violence against older adults during the first year of the COVID-19 pandemic in a capital city from the Brazilian Southeast region.

METHOD

a descriptive and exploratory research study with a cross-sectional design based on the notifications of suspected or confirmed cases of violence against older adults between March 2020 and March 2021. A univariate statistical analysis and Fisher's exact test (p<0.05) were performed.

RESULTS

a total of 2,681 notifications were recorded during the period. The main victims were individuals aged between 60 and 64 years old, female, white-skinned and with low schooling levels. The instances of violence were more frequent in the victims' homes. Physical and psychological violence predominated, through physical force/beatings and threats, respectively. Most of the aggressors were male, younger than the victims and generally their children or intimate partners. The aggressions were perpetrated more than once and were driven by generational conflicts. There was low referral to entities for the protection of older adults.

CONCLUSION

the sociodemographic profile found evidences vulnerable victims, subjected to many types of violence, and at a potential risk against their overall health.

Tale of two countries: attitudes towards older persons in Italy and Israel during the COVID-19 pandemic as seen through the looking-glass of the media

The COVID-19 pandemic has exposed the many challenges and difficulties of healthcare systems caring for older frail people. This public health crisis has indeed jeopardised the concept of the welfare state, in particular the right of older people to uncompromised healthcare. Together with the clinical challenges facing the geriatric patient and the organisational difficulties of the healthcare systems, sociocultural factors may have also played a substantial role in the strategies that countries have applied in coping with the pandemic. In this opinion article, we report attitudes towards the older populations of two countries, Italy and Israel, during the COVID-19 pandemic as viewed through the looking-glass of the media.

Forensic Characteristics of Physical Elder Abuse and Current Status and Issues of Collaboration between Forensic Medicine Departments and Related Institutions in Japan

This study sought to clarify the characteristics and trends of physical elder abuse and the status of collaboration between forensic medicine departments and related institutions in Japan. Questionnaires were sent to 82 forensic medicine departments and 2857 institutions randomly selected from hospitals, municipalities and public community general support centers. The survey period was February to June 2021, including an extension period for collection. Responses from 675 facilities were analyzed. The most common finding in cases of physical elder abuse at forensic medicine departments was subcutaneous hemorrhage on the head (85.7%), with mixed old and new injuries most commonly observed in the lower limbs (70%). There were few cases in which there was collaboration between forensic medicine departments and other institutions. Among the issues identified, there is a need to provide related institutions with information obtained in forensic medicine departments. A new collaboration system is needed to achieve this.

The National Programme for Health Care of the Elderly: A Review of its Achievements and Challenges in India

Aging care is critical. Projections for 2020 indicate that India’s older population will comprise 6.57% of the overall population. The best-known newly developed technologies must be provided to the older population. Non-governmental organizations and private institutions are increasingly providing more door-to-door guidance and help. This study evaluated the impact of the National Programme for Health Care of the Elderly (NPHCE) in India and analyzed its achievements and challenges. The program’s key strategies include providing preventive and promotional care and sickness management, empowering geriatric services, and guaranteeing optimal rehabilitation. The NPHCE is an excellent project for caring for a rapidly aging population. This study described the existing programs and schemes related to older people in India, with a focus on the NPHCE and an analysis of the program’s achievements and challenges.

The association between elder abuse and refrainment from daily activities during the COVID-19 pandemic among older adults in Japan: A cross-sectional study from the Japan Gerontological Evaluation Study

Objectives

Elder abuse is a public health issue that is thought to have increased during the COVID-19 pandemic due to lockdowns and behavioral restrictions. This study examines the association between elder abuse and refrainment from daily activities during the pandemic.

Methods

We used data from a self-administered mail survey conducted by the Japan Gerontological Evaluation Study (JAGES) from November 2020 to February 2021 in 11 municipalities. Our participants included 18,263 older adults (age ≥65 years) who were independent in their daily lives. Logistic regression analysis was conducted to evaluate the association between elder abuse and refrainment from 10 daily activities, and the total number of refrained behaviors.

Results

Experiences of abuse were reported by 288 participants (1.6%). The risk of elder abuse was 1.37 times (95% confidence interval, 1.04–1.81) higher among those who refrained from shopping for food and daily necessities and 1.60 times (1.20–2.13) higher among those who refrained from interaction with neighbors, than those who did not. Also, a dose-response relationship was observed where the risk of abuse increased with the number of restrictions.

Conclusion

The risk of elder abuse increased as the number of refrained behaviors increased which suggests that refrainment from multiple behaviors may significantly increase the risk of elder abuse, compared with refrainment from a single behavior. To avoid increasing the risk of abuse in likely future pandemics, it is necessary to maintain social connections without face-to-face contact, or with adequate infection control measures.

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The risk of elder abuse was higher among those who refrained from shopping for food and daily necessities and from interaction with neighbors.

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The risk of abuse increased as the number of refrained behaviors increased.

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Our results illustrate that refraining from multiple behaviors may be significantly associated with an increased risk of abuse over that of refraining from a single behavior.

Elder abuse in the COVID-19 era based on calls to the National Center on Elder Abuse resource line

BACKGROUND

The COVID-19 pandemic has exacerbated circumstances that place older adults at higher risk for abuse, neglect, and exploitation. Identifying characteristics of elder abuse during COVID-19 is critically important. This study characterized and compared elder abuse patterns across two time periods, a one-year period during the pandemic, and a corresponding one-year period prior to the start of the pandemic.

METHODS

Contacts (including social media contacts, and email; all referred to as "calls" for expediency) made to the National Center on Elder Abuse (NCEA) resource line were examined for differences in types of reported elder abuse and characteristics of alleged perpetrators prior to the pandemic (Time 1; March 16, 2018 to March 15, 2019) and during the pandemic (Time 2; March 16, 2020 to March 15, 2021). Calls were examined for whether or not abuse was reported, the types of reported elder abuse, including financial, physical, sexual, emotional, and neglect, and characteristics of callers, victims, and alleged perpetrators. Chi-square tests of independence compared frequencies of elder abuse characteristics between time periods.

RESULTS

In Time 1, 1401 calls were received, of which 795 calls (56.7%) described abuse. In Time 2, 1009 calls were received, of which 550 calls (54.5%) described abuse. The difference between time periods in frequency of abuse to non-abuse calls was not significant ([Formula: see text]). Time periods also did not significantly differ with regard to caller, victim, and perpetrator characteristics. Greater rates of physical abuse ([Formula: see text] and emotional abuse ([Formula: see text] were reported during Time 2 after adjustment for multiple comparisons. An increased frequency of multiple forms of abuse was also found in Time 2 compared to Time 1 ([Formula: see text].

CONCLUSIONS

Findings suggest differences in specific elder abuse subtypes and frequency of co-occurrence between subtypes between time periods, pointing to a potential increase in the severity of elder abuse during COVID-19.

Abuse and risk factors among community-dwelling elderly in South Korea during COVID-19

Elder abuse is a serious social problem in South Korea. This study aimed to estimate the prevalence and identify risk factors of elder abuse during the coronavirus disease 2019 (COVID-19) pandemic. By using the 2020 Living Profiles of Older People Survey in Seoul Metropolitan City and considering sociodemographic, health-related, social support, and isolation factors as independent variables, a logistic regression model was established. Among 3,106 samples, the overall rate of elder abuse was 8.5%, with emotional abuse being the most frequent. Social isolation (OR = 1.47, p = .018) and recognition of abuse (OR = 0.90, p = .003) were associated with having experienced abuse. Seniors with a greater number of diseases, higher levels of dependency, depressive symptoms, and/or cognitive impairments were more likely to suffer abuse, as were those who smoked or drank alcohol. To prevent elder abuse by social isolation during and after COVID-19, more active health promotion programs and healthy aging policies should be implemented.

Early Stages of COVID-19 Pandemic Had No Discernable Impact on Risk of Elder Abuse and Neglect Among Dementia Family Caregivers: A Daily Diary Study

There is widespread concern that elder abuse and neglect (EAN) incidents increased during the onset of the COVID-19 pandemic due in part to increases in risk factors. Initial reports relying on administrative systems such as adult protective services records produced mixed results regarding whether or not there was a change in EAN incidents. Using data from an ongoing longitudinal study on EAN in dementia family caregiving that started before the pandemic, we assessed the hypothesis that the pandemic is related to a change in probability of EAN and EAN protective factors. Family caregivers to persons with dementia completed two waves of 21 daily diaries, 6-months apart, assessing their daily use of EAN behaviors. The first group (n = 32) completed their first wave before the pandemic and their second wave during the pandemic. The second group (n = 32) completed both waves during the pandemic. For this cohort, the generalized linear mixed logistic model results showed inconsistent associations between the onset of COVID-19 and the probability of a caregiver engaging in elder abuse or neglect behaviors. In terms of protective factors, the use of formal services was not significantly impacted by COVID-19; however, the likelihood of receiving informal support from family and friends increased significantly during the pandemic period. Dementia family caregivers were not likely impacted negatively by initial pandemic restrictions, such as shelter-in-place orders, as anticipated. These findings contribute to our understanding of how distal, disruptive processes may influence more proximal caregiver stresses and the likelihood of EAN.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10896-022-00392-8.

[Abuse and neglect alerts in vulnerable adults: the evolution during the COVID-19 outbreak in France]

AIM

The COVID-19 outbreak is likely to affect both the occurrence and the reporting of abuse or neglect in vulnerable adults in a variety of ways. This study aims to explore such effects based on the alerts reported to the national system dedicated to these situations by the Ministry of Solidarity and Health in France.

METHOD

The main characteristics of the situations of abuse or neglect (age and gender of the victims, main type of abuse or neglect, persons considered as responsible, place of occurrence) reported to the national system from March to December 2020, since the beginning of the COVID-19 outbreak, have been compared to those observed during the same months from 2017 to 2019.

RESULTS

In 2019-20, abuses or neglects in nursing homes decreased (-111 or -8%), during 3-months, while those reported in domestic situations increased slightly (+50 or +1%), despite a short decline at the beginning of the epidemic. The situations reported during the epidemic as compared to those of the three previous years affected more often women, and less often involved persons other than families or professionals. Violations of rights, and psychological abuses have been more frequent, financial abuses and neglects have been less frequent since the beginning of the outbreak.

What "Family Affair?" Domestic Violence Awareness in China

Introduction

Domestic violence is toxic to society. With approximately one in three women on average falling victim to domestic violence, systematic solutions are needed. To further complicate the issue, mounting research shows that COVID-19 has further exacerbated domestic violence across the world. Situations could be even more pronounced in countries like China, where though domestic violence is prevalent, there is a dearth of research, such as intervention studies, to address the issue. This study investigates key barriers to domestic violence research development in China, with a close focus on salient cultural influences.

Methods

A review of the literature on domestic violence in China in PubMed, PsycINFO, and Scopus was conducted to answer the research question. The search was focused on three themes, domestic violence, China, research, and cultural influences.

Results

The study findings show that categorizing domestic violence as a "family affair" is a key barrier to domestic violence research development in China-an incremental hindrance that prevents the public and policymakers from understanding the full scale and scope of domestic violence in China. In addition to abusers, witnesses, and victims, even law enforcement in China often dismisses domestic violence crimes as "family affairs" that resides outside the reach and realm of the law. The results indicated that mistreating domestic violence crimes as "family affairs" is a vital manifestation of the deep-rooted cultural influences in China, ranging from traditional Confucian beliefs in social harmony to the assumed social norms of not interfering with other people's businesses.

Conclusion

Domestic violence corrupts public health and social stability. Our study found that dismissing domestic violence cases as "family affairs" is an incremental reason why China's domestic violence research is scarce and awareness is low. In light of the government's voiced support for women's rights, we call for the Chinese government to develop effective interventions to timely and effectively address the domestic violence epidemic in China.

Older Women’s Loneliness and Depression Decreased by a Reminiscence Program in Times of COVID-19

The confinement caused by the current COVID-19 pandemic protects physical health, but in turn, has a long-lasting and far-reaching negative psychosocial impact; anxiety, stress, fear and depressive symptoms. All of these have a particular impact on vulnerable older people, putting them at serious risk of loneliness. Women report feeling lonelier than men, affecting women to a greater extent. The present study aims to analyze the efficacy of an integrative reminiscence intervention in older women living in nursing homes to reduce the effects of loneliness and depression after COVID-19. 34 older women living in nursing homes are included into study and were divided into intervention group (N = 14) and control group (N = 20). Results showed a significant reduction in perception of loneliness, depression and better positive affects, after the intervention. The pandemic has not yet finished and the most affected group has been the people living in nursing homes. These results show the need for evidence of interventions that can help the recovery of these people who have been so affected. The effects of loneliness during confinement and its psychological effects can be mitigated through such programs.

Reducing Inequities During the COVID-19 Pandemic: A Rapid Review and Synthesis of Public Health Recommendations

Objectives: Efforts to contain the COVID-19 pandemic should take into account worsening health inequities. While many public health experts have commented on inequities, no analysis has yet synthesized recommendations into a guideline for practitioners. The objective of this rapid review was to identify the areas of greatest concern and synthesize recommendations. Methods: We conducted a rapid systematic review (PROSPERO: CRD42020178131). We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials databases from December 1, 2019 to April 27, 2020. We included English language peer-reviewed commentaries, editorials, and opinion pieces that addressed the social determinants of health in the context of COVID-19. Results: 338 articles met our criteria. Authors represented 81 countries. Income, housing, mental health, age and occupation were the most discussed social determinants of health. We categorized recommendations into primordial, primary, secondary and tertiary prevention that spoke to the social determinants of COVID-19 and equity. Conclusion: These recommendations can assist efforts to contain COVID-19 and reduce health inequities during the pandemic. Using these recommendations, public health practitioners could support a more equitable pandemic response. Systematic Review Registration: PROSPERO, CRD42020178131.

Elder Mistreatment Victims during the COVID-19 Pandemic: Administrative Data from San Francisco Adult Protective Services

This study examined elder mistreatment victims' experiences at the beginning of the COVID-19 pandemic, focusing on their COVID-19 awareness and unmet needs. San Francisco Adult Protective Services (APS) caseworkers conducted phone interviews with clients or collaterals (client's family, trusted other, or service provider) to inquire about clients' awareness of COVID-19 and unmet needs. Nine-hundred-and-thirty-four (71%) of 1,313 APS' past clients or their collaterals were interviewed, with 741 (79%) responding positively to COVID-19-awareness questions, and 697 (75%) having no unmet needs. Binary logistic regression with Firth adjusted maximum likelihood estimation method revealed that older persons (p < .05), self-neglectors (p < .05), and victims of neglect (p < .05) were less aware of COVID-19. Unmet needs varied by mistreatment type. Victims of isolation were more likely to have medical needs (p < .05), while victims of emotional abuse were more likely to report loneliness (p < .001). Case notes reflected clients who were well-prepared for the pandemic, versus those who required additional assistance to follow preventative measures of the COVID-19 pandemic to stay home. Although the majority of San Francisco APS' past clients experienced no unmet needs at the beginning of the COVID-19 pandemic, the prolonged length and intensity of the pandemic could have exacerbated this vulnerable group's situation. Collaboration between service providers is key in assisting victims experiencing unmet needs to live safely in a public health crisis, especially underserved victims of specific ethnic backgrounds.

Invisible and at-risk: older adults during the COVID-19 pandemic

During the COVID-19 pandemic the risks to older adults of systemic abuse and neglect have become amplified, alongside increasing abuse and neglect in the community. Novel risks have also evolved involving cybercrime and the use of remote technologies in health and social care related to the pandemic. This commentary brings together lessons to be learned from these developments and initial ideas for actions to mitigate future risks.

Technology-based interventions for nursing home residents: a systematic review protocol

INTRODUCTION

A growing number of technology-based interventions are used to support the health and quality of life of nursing home residents. The onset of COVID-19 and recommended social distancing policies that followed led to an increased interest in technology-based solutions to provide healthcare and promote health. Yet, there are no comprehensive resources on technology-based healthcare solutions that describe their efficacy for nursing home residents. This systematic review will identify technology-based interventions designed for nursing home residents and describe the characteristics and effects of these interventions concerning the distinctive traits of nursing home residents and nursing facilities. Additionally, this paper will present practical insights into the varying intervention approaches that can assist in the delivery of broad digital health solutions for nursing home residents amid and beyond the impact of COVID-19.

METHODS AND ANALYSIS

Databases including the PubMed, PsycINFO, CINAHL and Scopus will be used to identify articles related to technology-based interventions for nursing home residents published between 1 January 2010 to 30 September 2021. Titles, abstracts and full-text papers will be reviewed against the eligibility criteria. The Cochrane Collaboration evaluation framework will be adopted to examine the risk of bias of the included study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures will be followed for the reporting process and implications for existing interventions and research evaluated by a multidisciplinary research team.

ETHICS AND DISSEMINATION

As the study is a protocol for a systematic review, ethical approval is not required. The study findings will be disseminated via peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

CRD 42020191880.

Why is COVID-19 more deadly to nursing home residents?

COVID-19 is deadly to older adults, with research showing that being older and having underlying chronic diseases are significant risk factors for COVID-19 related deaths. However, though similarities exist between both nursing home residents and older community-dwelling people, nursing home residents are substantially more vulnerable to COVID-19. A closer review of both demographic groups provides clarity concerning the difference within the context of COVID-19. Therefore, to address the research gap, drawing insights from Maslow's hierarchy of needs model, this article aims to examine similarities and differences in COVID-19 risk factors experienced by nursing home residents and community-dwelling older people.

High Prevalence of Elder Abuse During the COVID-19 Pandemic: Risk and Resilience Factors

OBJECTIVE

Before the COVID-19 pandemic, elder abuse affected one in 10 American older adults annually. It has been assumed that the pandemic has brought with it a surge in elder abuse due to individuals ordered to stay at home combined with increased interpersonal stressors. However, empirical evidence is lacking. This study aims to estimate the prevalence of, and risk and resilience factors of elder abuse during the pandemic.

METHODS

The survey was conducted via two online platforms during April 23 and May 5, 2020, when all states had stay-at-home orders. The final cohort consisted of a sociodemographically diverse sample of 897 older persons in the United States. The prevalence of elder abuse was evaluated by a validated measure previously used in a population-based study of elder abuse. Pandemic-related factors were examined at the community, relational, and individual contexts. We conducted multivariate logistic regression analyses to examine determinants of elder abuse.

RESULTS

One in five older persons in the study sample (n = 191; 21.3%) reported elder abuse, an increase of 83.6% from prevalence estimates before the pandemic. In the final models, sense of community emerged as a persistent protective factor for elder abuse (odds ratio [OR]: 0.89, 95% confidence interval [CI]: 0.85-0.93). At the relational level, physical distancing was associated with reduced risk of elder abuse (OR: 0.94, 95% CI: 0.90-0.98). At the individual level, financial strain was associated with increased risk of abuse (OR: 1.08, 95% CI: 1.02-1.14).

CONCLUSION

Health care professionals and policy makers must be prepared to address the increase in elder abuse associated with the evolving pandemic.

Coronavirus Disease 2019

In this article, the authors review manifestations of COVID-19 in older adults, normal physiologic changes and frequent comorbidities of aging that increase pathogenicity, factors contributing to overwhelming viral spread among seniors, negative effects on health and well-being resulting from measures to control the virus, and health-system improvements necessary to protect and care for this vulnerable population.

High Rate of Elder Abuse in the Time of COVID-19-A Cross Sectional Study of Geriatric and Neurology Clinic Patients

The ongoing COVID-19 pandemic is believed to have caused a sharp increase in the incidence of elder abuse (EA), including as a result of isolation, social distance combined with increased interpersonal stressors. Thus, the aim of this study is to determine the impact of the COVID-19 pandemic on the elder abuse rates and the characteristics of risk factors. A total of 347 patients hospitalized in the Department of Neurology and Department of Geriatrics at University Hospital No. 1 in Bydgoszcz were selected as subjects for the analysis. The tools used in the study are: Authors-Designed Questionnaire, the Vulnerability to Abuse Screening Scale, the Geriatric Depression Scale and the Activities of Daily Living Scale. Descriptive statistics, chi-squared tests, Spearman's rank correlation test, and logistic regression analyses were used. In the studied population, nearly 45% of the elderly were victims of violence. This represents an increase of more than 6 percent compared to the pre-pandemic. The most common type of EA was psychological abuse (72.3%). In the final models, the risk factors include, among others, low income (OR = 3.60, 95% CI = 1.93-6.72), chronic diseases (OR = 2.06, 95% CI = 1.28-3.31), poor relationship with the family (OR = 3.26, 95% CI = 1.96-5.43), and moderate and severe depression (OR = 18.29, 95% CI = 10.24-32.69; OR = 18.49, 95% CI = 3.91-87.30, respectively). Moreover, moderate functional impairment 5.52 times more often and severe functional impairment 21.07 times more likely to predispose to EA. People who suffered from COVID-19 are 1.59 times more likely to be victims of EA (95% CI = 1.03-2.46). In this study, we saw significant increases in EA rates during the COVID-19 pandemic.

A spatial interpretation of Australia's COVID-vulnerability

The school of social vulnerability in disaster sciences offers an alternative perspective on the current COVID-19 (coronavirus) pandemic crisis. Social vulnerability in general can be understood as a risk of exposure to hazard impacts, where vulnerability is embedded in the normal functioning of the society. The COVID-19 pandemic has exposed systemic (political and health care systems), demographic (aging, race) and,based on the results of our approach, spatial (spatial isolation and connectivity) yvulnerabilities as well. In this paper, we develop a risk prediction model based on two composite indicators of social vulnerability. These indicators reflect the two main contrasting risks associated with COVID-19, demographic vulnerability and, as consequences of the lockdowns, economic vulnerability. We conceptualise social vulnerability in the context of the extremely uneven spatial population distribution in Australia. Our approach helps extend understanding about the role of spatiality in the current pandemic disaster.

Formal and informal social participation and elder mistreatment in a national sample of older adults

BACKGROUND/OBJECTIVES

Older adults' susceptibility to mistreatment may be affected by their participation in social activities, but little is known about relationships between social participation and elder mistreatment.

DESIGN

Cross-sectional analysis.

SETTING/PARTICIPANTS

National probability sample of older community-dwelling U.S. adults interviewed in 2015-2016, including 1268 women and 973 men (mean age 75 years and 76 years, respectively; 82% non-Hispanic white).

MEASUREMENTS

Frequency of participation in formal activities (organized meetings, religious services, and volunteering) and informal social activities (visiting friends and family) was assessed by questionnaire. Elder mistreatment included emotional (four items), physical (two items), and financial mistreatment (two items) since age 60. Multivariable logistic regression examined associations between each type of social participation and elder mistreatment among men and women, adjusting for age, race/ethnicity, education, and comorbidity.

RESULTS

Forty percent of women and 22% of men reported at least one form of mistreatment (emotional, physical, or financial). Women reporting at least monthly engagement in formal social activities were more likely to report emotional mistreatment (adjusted odds ratio (AOR) 1.59, 95% confidence interval (CI) 1.09-2.33). Among men, monthly organized meeting attendance was associated with increased odds of emotional mistreatment (AOR 1.34, 95% CI 1.01-1.93). Weekly informal socializing was inversely associated with emotional mistreatment (AOR 0.59, 95% CI 0.44-0.78) and financial mistreatment (AOR 0.59, 95% CI 0.42-0.85) among women.

CONCLUSION

In this national cohort, older adults who were frequently engaged in formal social activities reported similar or higher levels of mistreatment than those with less frequent organized social participation. Older women with regular informal contact with family or friends were less likely to report some kinds of mistreatment. Strategies for detecting and mitigating elder mistreatment should consider differences in patterns of formal and informal social participation and their potential contribution to mistreatment risk.

A review on the COVID-19-related psychological impact on older adults: vulnerable or not?

BACKGROUND

COVID-19 is a novel event of the twenty-first century. Therefore, contemporary research is required to determine the current pandemic's psychological impact on older populations. Soon after the COVID-19 outbreak, several narrative reviews and guidelines were released to support older adult's psychological wellbeing. However, a lack of data from original studies was reported until May 2020.

AIM

To identify studies published from May 2020 until January 2021 that quantitatively assessed the mental health impact of COVID-19 on older adults using validated psychometric tools.

METHOD

A comprehensive literature search of original research articles was conducted using specific terms. The screening procedure was conducted stepwise.

RESULTS

Among the 18 included studies, cross-sectional online surveys indicated that older adults were less psychologically distressed than younger ones. A longitudinal study revealed that COVID-19 did not have a major impact on loneliness and satisfaction with life. On the contrary, studies comparing pre- with peri-pandemic data revealed that older adults experienced more severe depressive/anxiety/stress symptoms and loneliness during the pandemic. Several studies reported though only subclinical symptoms, as well as low loneliness levels during the pandemic.

CONCLUSIONS

Research studies suggested that older age may buffer against the COVID-19-related impact on mental health. Despite evidence against generalised perceptions of vulnerability, older adults' ability to adapt to adversity may be uneven, depending on cultural, social, economic and other individual factors. Taken together, the impact, moreover the long-term impact of COVID-19, is expected to vary across countries and older subpopulations, and remains to be evaluated by prospective, longitudinal studies.

Deviations in criminal filings of child abuse and neglect during COVID-19 from forecasted models: An analysis of the state of Oklahoma, USA

BACKGROUND

The COVID-19 pandemic has contributed to risk factors for child abuse and neglect and disrupted conventional abuse surveillance.

OBJECTIVE

The goal of this study was to assess how counts of criminal charges have been affected by COVID-19 social distancing measures and related policy changes.

PARTICIPANTS AND SETTING

This study used publicly available court filings pertaining to child abuse and neglect from Jan 1, 2010 to June 30, 2020.

METHODS

Autoregressive integrated moving average (ARIMA) algorithms were constructed with case data from January 2010 to January 2020 to forecast trends in criminal charges for February to June 2020. These forecasted values were then compared to actual charges filed for this time period.

RESULTS

Criminal cases filed between February and June 2020, had an overall 25.7 percent lower average than forecasted. All individual months had progressively lower cases than forecasted with the exception of March. June had the largest deviation from forecasted with 60.1 percent fewer cases than predicted.

CONCLUSIONS

Although risk factors for child abuse have increased due to COVID-19, these findings demonstrate a declining trend in child abuse charges. Rather than a decreasing incidence of child abuse and neglect, it is more likely that less cases are being reported. The results warrant immediate action and further investigation in order to address the dangers this pandemic poses for children in abusive situations.

The geriatric emergency literature 2020: COVID and beyond

Older adults are a rapidly growing patient population with unique characteristics and health considerations. Over the past few years, emergency physicians have started to recognize the complexities and importance of Geriatric Emergency Medicine. Several noteworthy elements of their healthcare were brought to the forefront of emergency medicine because this especially vulnerable patient population was disproportionately affected by the pandemic. Clinical topics such as delirium, telehealth, end-of-life care, and elder abuse came into focus; select relevant articles are reviewed. We also highlight equally notable literature which address clinically challenging topics, such as hip fractures and syncope. Finally, articles about improving the experience of and decreasing recidivism in geriatric emergency department patients are reviewed. In short, this review article summarizes geriatric emergency medicine literature that can help you improve your practice while caring for older adults.

Transforming Aging Services: Area Agencies on Aging and the COVID-19 Response

For over four decades, Area Agencies on Aging (AAAs) have served as focal points to help older adults remain in their homes and communities. AAAs partner with other organizations to administer services authorized under the Older Americans Act (OAA). AAAs represent loosely coupled systems; they are responsive to guidelines established by the OAA while maintaining flexibility to leverage limited resources, establish partnerships, and create innovative programs to meet community needs. As stay-at-home orders and concern for safety have kept many older adults homebound during the COVID-19 pandemic, an important question is how the Aging Network, including the over 600 AAAs, has responded to these rapidly changing needs. Although time and more systematic assessments are required, available information suggests that the loosely coupled network of AAAs has been a key, adaptable resource. This article begins with a description of the Aging Network and its history before turning to how the community-specific, collaborative, and evolving nature of AAAs places them at a unique position to respond to the challenges that arise with COVID-19. It concludes with how AAAs can continue to adapt to meet the needs of older adults and the people who care for them.