Elder Abuse: Systematic Review and Implications for Practice
Elder Abuse: Systematic Review and Implications for Practice
This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem. Evidence suggests that elder abuse is prevalent, predictable, costly, and sometimes fatal. This review will highlight the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences in community populations. The global literature in PubMed, MEDLINE, PsycINFO, BIOSIS, Science Direct, and Cochrane Central was searched. Search terms included elder abuse, elder mistreatment, elder maltreatment, prevalence, incidence, risk factors, protective factors, outcomes, and consequences. Studies that existed only as abstracts, case series, or case reports or recruited individuals younger than 60; qualitative studies; and non-English publications were excluded. Tables and figures were created to highlight the findings: the most-detailed analyses to date of the prevalence of elder abuse according to continent, risk and protective factors, graphic presentation of odds ratios and confidence intervals for major risk factors, consequences, and practical suggestions for health professionals in addressing elder abuse. Elder abuse is common in community-dwelling older adults, especially minority older adults. This review identifies important knowledge gaps, such as a lack of consistency in definitions of elder abuse; insufficient research with regard to screening; and etiological, intervention, and prevention research. Concerted efforts from researchers, community organizations, healthcare and legal professionals, social service providers, and policy-makers should be promoted to address the global problem of elder abuse.
This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem that crosses sociodemographic and socioeconomic strata. Elder abuse, sometimes called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse; neglect (caregiver neglect, self-neglect); and financial exploitation. Physical abuse consists of infliction of physical pain or injury to an older adult and may result in bruises, welts, cuts, wounds, and other injuries. Sexual abuse refers to nonconsensual touching or sexual activities with older adults when they are unable to understand, unwilling to consent, threatened, or physically forced into the act. Psychological abuse includes verbal assault, threat of abuse, harassment, or intimidation, which may result in resignation, hopelessness, fearfulness, anxiety, or withdrawn behaviors. Neglect is failure by a caregiver (caregiver neglect) or oneself (self-neglect) to provide the older adult with necessities of life and may result in being underweight or frail, unclean appearance, or dangerous living conditions. Financial exploitation includes the misuse or withholding of an older adult's resources to their disadvantage or the profit or advantage of another person and may consist of overpayment for goods or services; unexplained changes in power of attorney, wills, or legal documents; missing checks or money; or missing belongings.
Although elder abuse is a newer field of violence research than domestic violence and child abuse, research indicates that elder abuse is a common, fatal, and costly yet understudied condition. An estimated 10% of U.S. older adults have experienced some form of elder abuse, yet only a fraction is reported to Adult Protective Services (APS).
For decades, professionals and the public have viewed elder abuse and broader violence as predominantly social or family problems. Since the first scientific literature citing in the British Medical Journal in 1975, there has been increasing attention from public health, social services, health, legal, and criminal justice professionals. In 2003, the National Research Council brought together national experts to examine the state of science on elder abuse and recommended priority strategies to advance the field. Despite multidisciplinary efforts to screen, treat, and prevent elder abuse, speed of progress has lagged behind the scope and effect of the issue.
In March 2011, the Senate Special Committee on Aging held a hearing: "Justice for All: Ending Elder Abuse, Neglect and Exploitation." Based on a Government Accountability Office report, individuals who had been abused and experts highlighted the lack of research, education, training, and prevention strategies. The Government Accountability Office estimated that, in 2009, national spending by federal agencies was $11.9 million for all activities related to elder abuse ($1.1 million according to the National Institutes of Health), which is much less than the annual funding for violence against women programs ($649 million) and for child abuse programs ($7 billion). On June 14, 2012, the World Elder Abuse Awareness Day commemoration was held at the White House, and President Obama proclaimed the importance of advancing the field of elder abuse. In March 2013, the Centers for Medicare and Medicaid Services held a national symposium to highlight elder abuse as a Physician Quality Reporting System measure (#181) to promote screening of elder abuse in healthcare settings. In April 2013, the Institute of Medicine held a 2-day workshop dedicated to elder abuse prevention, bringing together global experts to advance the field. In October 2013, the U.S. Preventive Services Task Force recommended elder abuse as a research priority area in its report to Congress.
This review highlights the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences. It covers major gaps in research and policy issues for the field of elder abuse and discussed implications for researchers, health professionals, and policy-makers.
Abstract and Introduction
Abstract
This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem. Evidence suggests that elder abuse is prevalent, predictable, costly, and sometimes fatal. This review will highlight the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences in community populations. The global literature in PubMed, MEDLINE, PsycINFO, BIOSIS, Science Direct, and Cochrane Central was searched. Search terms included elder abuse, elder mistreatment, elder maltreatment, prevalence, incidence, risk factors, protective factors, outcomes, and consequences. Studies that existed only as abstracts, case series, or case reports or recruited individuals younger than 60; qualitative studies; and non-English publications were excluded. Tables and figures were created to highlight the findings: the most-detailed analyses to date of the prevalence of elder abuse according to continent, risk and protective factors, graphic presentation of odds ratios and confidence intervals for major risk factors, consequences, and practical suggestions for health professionals in addressing elder abuse. Elder abuse is common in community-dwelling older adults, especially minority older adults. This review identifies important knowledge gaps, such as a lack of consistency in definitions of elder abuse; insufficient research with regard to screening; and etiological, intervention, and prevention research. Concerted efforts from researchers, community organizations, healthcare and legal professionals, social service providers, and policy-makers should be promoted to address the global problem of elder abuse.
Introduction
This article is based on the lecture for the 2014 American Geriatrics Society Outstanding Scientific Achievement for Clinical Investigation Award. Elder abuse is a global public health and human rights problem that crosses sociodemographic and socioeconomic strata. Elder abuse, sometimes called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse; neglect (caregiver neglect, self-neglect); and financial exploitation. Physical abuse consists of infliction of physical pain or injury to an older adult and may result in bruises, welts, cuts, wounds, and other injuries. Sexual abuse refers to nonconsensual touching or sexual activities with older adults when they are unable to understand, unwilling to consent, threatened, or physically forced into the act. Psychological abuse includes verbal assault, threat of abuse, harassment, or intimidation, which may result in resignation, hopelessness, fearfulness, anxiety, or withdrawn behaviors. Neglect is failure by a caregiver (caregiver neglect) or oneself (self-neglect) to provide the older adult with necessities of life and may result in being underweight or frail, unclean appearance, or dangerous living conditions. Financial exploitation includes the misuse or withholding of an older adult's resources to their disadvantage or the profit or advantage of another person and may consist of overpayment for goods or services; unexplained changes in power of attorney, wills, or legal documents; missing checks or money; or missing belongings.
Although elder abuse is a newer field of violence research than domestic violence and child abuse, research indicates that elder abuse is a common, fatal, and costly yet understudied condition. An estimated 10% of U.S. older adults have experienced some form of elder abuse, yet only a fraction is reported to Adult Protective Services (APS).
For decades, professionals and the public have viewed elder abuse and broader violence as predominantly social or family problems. Since the first scientific literature citing in the British Medical Journal in 1975, there has been increasing attention from public health, social services, health, legal, and criminal justice professionals. In 2003, the National Research Council brought together national experts to examine the state of science on elder abuse and recommended priority strategies to advance the field. Despite multidisciplinary efforts to screen, treat, and prevent elder abuse, speed of progress has lagged behind the scope and effect of the issue.
In March 2011, the Senate Special Committee on Aging held a hearing: "Justice for All: Ending Elder Abuse, Neglect and Exploitation." Based on a Government Accountability Office report, individuals who had been abused and experts highlighted the lack of research, education, training, and prevention strategies. The Government Accountability Office estimated that, in 2009, national spending by federal agencies was $11.9 million for all activities related to elder abuse ($1.1 million according to the National Institutes of Health), which is much less than the annual funding for violence against women programs ($649 million) and for child abuse programs ($7 billion). On June 14, 2012, the World Elder Abuse Awareness Day commemoration was held at the White House, and President Obama proclaimed the importance of advancing the field of elder abuse. In March 2013, the Centers for Medicare and Medicaid Services held a national symposium to highlight elder abuse as a Physician Quality Reporting System measure (#181) to promote screening of elder abuse in healthcare settings. In April 2013, the Institute of Medicine held a 2-day workshop dedicated to elder abuse prevention, bringing together global experts to advance the field. In October 2013, the U.S. Preventive Services Task Force recommended elder abuse as a research priority area in its report to Congress.
This review highlights the global epidemiology of elder abuse in terms of its prevalence, risk factors, and consequences. It covers major gaps in research and policy issues for the field of elder abuse and discussed implications for researchers, health professionals, and policy-makers.
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