Elder abuse and life-course victimization in hospitalized older adults in Sweden: prevalence and associations with mental ill-health

Do Higher Levels of Lifetime Victimization Predict an Earlier Onset of First IADL Limitation in Later Life?

BACKGROUND AND OBJECTIVES

This study examines the relationship between lifetime victimization and health in later life and asks whether the level of lifetime victimization is associated with an earlier onset of an IADL limitation.

RESEARCH DESIGN AND METHODS

Using data from the Health and Retirement Study (N = 11,143), we construct 3 levels of lifetime victimization (none, monovictimization, and polyvictimization). We use Weibull accelerated failure time models to examine the relationship between the level of lifetime victimization and the onset of an IADL limitation.

RESULTS

Monovictimization and polyvictimization were associated respectively with a 9% and 18% earlier time to onset of an IADL limitation compared with individuals who did not experience victimization. Additionally, polyvictimization respondents had an earlier onset of an IADL limitation compared toQ monovictimization respondents.

DISCUSSION AND IMPLICATIONS

Lifetime victimization is a life course antecedent to IADL limitations in later life, especially among individuals who have experienced multiple types of victimization. Future research should examine resources that slow health declines among people who have experienced victimization.

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.

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.

Lifetime Revictimization: Evidence From the Wisconsin Longitudinal Study

Despite the documented increasing prevalence of elder abuse victimization and its devastating health effects, a life-course view of the victimization experiences of older adults has rarely been adopted in the elder abuse literature. The current study investigated lifetime links between victimization experiences by examining the indirect effect of adverse childhood experiences (ACE) on elder abuse victimization via intimate partner violence (IPV) victimization in middle adulthood, and whether this indirect association would differ by gender. Using data from the Wisconsin Longitudinal Study, we analyzed the previous and current victimization experiences of a total of 5,391 older adults in their early 70s and estimated mediational and moderated mediation models. The key results indicated that a higher ACE score was associated with exposure to IPV victimization in middle adulthood, which was in turn associated with exposure to elder abuse victimization. This indirect association was stronger for women than for men. Regarding specific types of childhood victimization, parental physical abuse, sexual abuse, and witnessing domestic violence significantly predicted elder abuse victimization via IPV victimization. Our results support the phenomenon of lifetime victimization, whereby an individual experiences reoccurring forms of victimization across the life course from childhood to late adulthood. Findings highlight the compelling need for the assessment of cumulative victimization experiences and their impact on elder abuse victims. A life-course-based, trauma-informed approach would greatly enhance prevention and intervention services for elder abuse.

Interpersonal Violence Against Indigenous Sámi and Non-Sámi Populations in Arctic Sweden and the Mediating Effect of Historical Losses and Discrimination

The prevalence of interpersonal violence has been reported at higher levels among Indigenous than non-Indigenous populations worldwide, but has not been thoroughly investigated among the Sámi population in Sweden. The aims of this study were to investigate: (1) the prevalence of emotional, physical, and sexual violence and violence by intimate partners, family members, acquaintances, and strangers among participants identifying as Sámi or Swedish, (2) whether reporting experiences of historical losses and discrimination mediated the anticipated association between identifying as Sámi and reporting experiences of violence, and (3) whether background characteristics were associated with reporting experiences of violence. Cross-sectional questionnaire data collected in 2021 for the "Health and Living conditions in Sápmi" study were used. All adults in an arctic region in Sweden were invited to participate (response rate: 41%). Respondents self-identifying as Sámi (n = 375; 24.7%) or Swedish (n = 1,144; 75.3%) were included in this study. Sámi respondents of both sexes more often reported violence by an acquaintance or stranger. Likewise, more Sámi than Swedish women reported family violence (16.4% vs. 9.2%), but there was no difference concerning intimate partner violence (13.3% vs. 15.4%). Mediation analyses revealed strong positive indirect effects of historical losses and discrimination on the different types of violence. Being female was the strongest predictor of reporting intimate partner violence, and younger age was associated with violence by all perpetrators except family members. In conclusion, interpersonal violence was more often reported by Sámi respondents, but the association was explained in full by experiences of historical losses and discrimination. The results underline the importance of a life-course and even intergenerational and historical perspectives when investigating interpersonal violence.

Lifetime Abuse Victimization and Prospective Health Outcomes in Older Adults

Objectives: The current study examined the associations between lifetime abuse victimization and prospective health outcomes in late adulthood. Methods: Data from 4907 older adults (mean age = 80) from the Wisconsin Longitudinal Study were analyzed. Multivariate analyses examined the associations of lifetime abuse victimization with depression, physical health status, and memory. Results: Greater exposure to lifetime abuse was associated with a significantly higher risk of depression (OR = 1.13, CI: [1.08, 1.19], p < .001) and a greater number of limitations in physical functioning (b = .08, SE = .02, p < .001), but not with memory performance (b = .01, SE = .14, p > .05). Discussion: Our results support the interrelations of interpersonal violence across the life course and the lasting health effects of exposure to lifetime abuse. Findings highlight the need for a life course-based, trauma-informed approach in prevention and intervention programs for older adults.

Is lifetime abuse forgivable in old age?

Old age is characterized by reflection and a retrospective examination of the multiple meanings of various life experiences, including lifelong abuse. Forgiveness is found to have a salutary effect, especially for older adults. To understand the place and role of forgiveness in the reflective process during aging, we performed a secondary analysis of in-depth, semi-structured interviews (N = 78) with older women survivors of abuse. Inductive thematic analysis was based on concepts developed deductively from the literature review. The findings include three main themes: (1) The dimensions of forgiving: The victim as subject; (2) Being forgiven: Between lost forgiveness and hope; and (3) Self-forgiveness and the aging self. Despite the known salutary effect of forgiveness, we must consider that this is not a universally desirable process. We included the dimension of forgiveness in the study of abuse throughout the older person's life course and identified further complexities in addition to the "forgiveness"/"unforgiveness."