"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.

Risk and protective factors of a wish to die and suicidal ideation in community-dwelling, older, Flemish adults: results of the Belgian ageing studies.

OBJECTIVES: This study aims to increase the understanding of suicidality in older adults by investigating the prevalence, characteristics, risk and protective factors of suicidal phenomena in community-dwelling older adults (60+) in Flanders, specifically of a current wish to die (WTD) and lifetime suicidal ideation and behaviour (LSIB). METHOD: Cross-sectional data from the Belgian Ageing Studies (BAS) is used (N = 3050). The BAS aims to monitor the needs and quality of life of community-dwelling older adults through a standardised survey. Statistical methods used are bivariate analyses and binary logistic regression. RESULTS: Prevalence rates of 4.8% for WTD and 8.2% for LSIB are found. LSIB is the biggest predictor of a current WTD, followed by requiring support on three domains, elder abuse, depression and subjective cognitive complaints, and elder abuse were significant risk factors for both WTD and LSIB. Limited effects of protective factors were found. CONCLUSION: Previous research regarding risk factors to be confirmed in this study, and new insights on the effect of elder abuse, subjective indicators of cognitive complaints and requiring support are added. Further research into protective factors and underlying mechanisms is required.

ERASE: a feasible early warning tool for elder abuse, developed for use in the Dutch emergency department.

BACKGROUND: Elder abuse is a worldwide problem with serious consequences for individuals and society. To effectively deal with elder abuse, a timely identification of signals as well as a systematic approach towards (suspected) elder abuse is necessary. This study aimed to develop and test the acceptability and appropriateness of ERASE (EldeR AbuSE) in the emergency department (ED) setting. ERASE is an early warning tool for elder abuse self-administered by the healthcare professional in patients ≥ 70 years. METHODS: A systematic literature review was previously conducted to identify potential available instruments on elder abuse for use in the ED. Furthermore, a field consultation in Dutch hospitals was performed to identify practice tools and potential questions on the recognition of elder abuse that were available in clinical practice. Based on this input, in three subsequent rounds the ERASE tool was developed. The ERASE tool was tested in a pilot feasibility study in healthcare professionals (n = 28) working in the ED in three Dutch hospitals. A semi-structured online questionnaire was used to determine acceptability and appropriateness of the ERASE tool. RESULTS: The systematic literature review revealed seven screening instruments developed for use in the hospital and/or ED setting. In total n = 32 (44%) hospitals responded to the field search. No suitable and validated instruments for the detection of elder abuse in the ED were identified. The ERASE tool was developed, with a gut feeling awareness question, that encompassed all forms of elder abuse as starting question. Subsequently six signalling questions were developed to collect information on observed signs and symptoms of elder abuse and neglect. The pilot study showed that the ERASE tool raised the recognition of healthcare professionals for elder abuse. The tool was evaluated acceptable and appropriate for use in the ED setting. CONCLUSIONS: ERASE as early warning tool is guided by an initial gut feeling awareness question and six signalling questions. The ERASE tool raised the recognition of healthcare professionals for elder abuse, and was feasible to use in the ED setting. The next step will be to investigate the reliability and validity of the ERASE early warning tool.

The domestic elder abuse in China: Scale development and psychometric properties.

An effective screening tool is essential to elder abuse research. Although several instruments have been developed in China to measure elder abuse, they present several limitations. The instrument development involved three components: (1) generating questionnaire items; (2) questionnaire testing and data collection in older adults; and (3) psychometric evaluation of the Domestic Elder Abuse Scale (DEAS). We collected questionnaire responses from 3725 community-dwelling Chinese older adults. The 26-item DEAS showed good reliability and validity across five dimensions: physical abuse, psychological abuse, financial exploitation, neglect, and abandonment. These five factors accounted for 78.432 % of the total variance, and model fitting results were acceptable. The Cronbach's alpha coefficient of the scale was 0.975, and the test-retest intraclass correlation coefficient (ICC) was 0.934 after 2 weeks. This study developed a five-dimension instrument to measure elder abuse, with good psychometric properties, which can play an essential role in community-based studies in China.

Elder abuse, depression, anxiety, and stress in community-dwelling older adults.

BACKGROUND: Elder abuse as an important public health issue is associated in the literature with various physical and psychological symptoms. The aim of the study is to determine the relationship between elder abuse and depression, anxiety, and stress in the elderly living in the community. METHOD: The cross-sectional study was completed with 729 older people. Data were collected through a face-to-face interview and a survey form. The Geriatric Mistreatment Scale (GMS) was used to evaluate elder abuse and the Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress. Multivariate regression analysis was performed to determine the relationship between elder abuse and depression, anxiety, and stress. RESULTS: Of the participants, 20.9% were exposed to at least one type of abuse, 9.2% experienced physical abuse, 18.2% experienced psychological abuse, 4.4% experienced neglect, and 7.0% had financial abuse. The general prevalence of moderate to very severe depression, anxiety, and stress among the elderly was respectively 17.1%, 16%, and 10%. As a result of multivariate analysis it was determined that neglect (t = 6245; ß = 4952) and economic abuse (t = 3865; ß = 3350) had statistically significant effects on depression; psychological abuse (t = 2924; ß = 0,992), economic abuse (t = 3127; ß = 3517) and neglect (t = 5913; ß = 4810) had statistically significant effects on anxiety, while psychological (t = 5023; ß = 1756) and economic abuse (t = 5719; ß = 5238) had statistically significant effects on stress (P < 0.05). CONCLUSION: As a result of the study, it was seen that the prevalence of abuse and depression, anxiety, and stress was high in the elderly. There was also a strong relationship between types of elder abuse and depression, anxiety, and stress. It is recommended that health professionals working with older people to screen them for types of abuse and mental symptoms with the help of appropriate screening tools.

Self-neglect as a significant public health issue: exploring the responsibility of the SPCDN.

Self-neglect is a recognised form of abuse affecting individuals across the lifespan. Gaps are evident within current data to support its prevalence; thus, it is considered to be an under-researched and under-reported phenomenon. Evidence suggests that there are multiple risk factors which contribute to self-neglect and sources recognise it leads to poorer health outcomes. Specialist Community Practitioner District Nurses (SCPDNs) deliver care across a diverse demographic and continuously assess risk for individuals in complex environments leading and managing the care of individuals who self-neglect. It is therefore essential that SCPDNs are equipped with the knowledge and skills required to therapeutically assess the health needs of this patient group and lead on the coordination of care. This article aims to explore the subject of self-neglect as a public health concern and appraise the role and responsibilities of the SCPDN within community nursing practice.

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.

A collaboration between adult protective services and forensic accounting examiners to investigate complex financial exploitation: formative evaluation findings.

Financial exploitation (FE) is one of the most common reports to Adult Protective Services (APS) and the cases are often complex. Consequently, APS caseworkers report FE investigations to be among the most difficult while simultaneously reporting low confidence in productive outcomes for these investigations. This necessitates finding ways to support APS FE investigations. This paper describes the structure, process, and formative findings of a collaboration between forensic accounting examiners and APS workers to investigate complex cases of FE. Among the 77 FE cases completed, forensic examiners reviewed multiple years of financial records which included over 101,000 transactions, totaling over $213,000,000.00 in finances, and identified over $8,000,000 in questionable activity. Scores on the 8-item Client Satisfaction Questionnaire were high indicating high program satisfaction by APS workers, subject matter experts, and forensic examiners. These findings support the feasibility and acceptability of forensic accounting and APS collaborations to investigate complex cases of FE.

Financial decision-making deficits in scam cases: how frequent are they?

Due to the rise in scams perpetrated against older adults, Adult Protective Service workers are more frequently involved in investigating these matters. One significant aspect of scam involvement is the assessment of informed financial decision-making. This study examined 175 consecutive scam cases APS workers investigated using a 10-item financial-decision making tool. Two-thirds of the sample displayed deficits in decision-making. The decision-making tool was effective in differentiating those rated as having deficits from those without deficits. Analysis of each scored item found differences between groups on six of the seven items. A review of the item responses illustrates the types of deficits in understanding and appreciation of the scam and its impact on the older person and their family.

Elder abuse geriatrics: describing an important new medical specialist.

Elder mistreatment, including elder abuse and neglect, is a difficult diagnosis to make and manage for most providers. To address this, two elder abuse consultation teams were developed for patients in the hospital and emergency department settings. As these teams have developed, the providers involved have obtained specialized training and experience that we believe contributes to a new field of elder abuse geriatrics, a corollary to the well-established field of child abuse pediatrics. Providers working in this field require specialized training and have a specialized scope of practice that includes forensic evaluation, evaluation of cognition and capacity, care coordination and advocacy for victims of abuse, and collaboration with protective services and law enforcement. Here we describe the training, scope of practice, ethical role, and best practices for elder mistreatment medical consultation. We hope this will serve as a starting point for this new and important medical specialty.

Emergency department and hospital-based programs responding to elder mistreatment: developing consensus about an idea whose time has come.

Elder mistreatment is common, serious, and under-recognized, with Emergency Department and hospital clinical encounters offering a potential but currently unrealized opportunity to identify and help older adults experiencing mistreatment. Interdisciplinary emergency department and hospital-based response teams represent a promising care model to address this. This manuscript describes two such teams and introduces a special issue dedicated to this work.

Elder mistreatment experiences, perceptions, and help-seeking behaviors of Asian American older adults.

This study examined the experiences and the perceptions of elder mistreatment (EM), as well as help-seeking knowledge and behaviors, particularly about Adult Protective Services (APS), among community samples of Asian American older adults, including Koreans, Chinese, and others (N = 288). Approximately 27% of the study participants experienced at least one EM incident in the past year. Between 27% and 38% of the participants reported that they were likely to seek help from APS for different types of EM. Significant differences were found across the three Asian groups in their perceptions toward EM and intention to seek help from APS in the event of EM. However, many Asian American older adults in the study did not know about APS prior to participating in the study (75.5%) and other formal sources of help (66.3%). Implications for helping professionals, particularly APS and community-based organizations serving Asian Americans, are discussed.

Determining patterns and types of violence against the elderly in the Kingdom of Saudi Arabia.

Reports indicate an increase in the incidence of violence against the elderly in the Kingdom of Saudi Arabia (KSA). This study aimed to determine the types and risk factors of elder abuse in KSA. A cross-sectional observational study was conducted of abuse among the elderly (65 years and older; n = 128) reported in the National Family Safety Registry (NFSR) between April 2017 and December 2021. Most cases involved women (65.6%) and married individuals (54.7%). Physical abuse was the most common type (44.5%), followed by neglect (34.4%). Men, married individuals, people without family support, and people with physical disabilities were more likely to experience physical abuse. Elderly people, single individuals, women, and those lacking family support showed an increased likelihood of neglect. Preventive strategies should be implemented through awareness raising, capacity building, resource allocation, and the exchange of multidisciplinary good practices across sectors.

Examining ethical issues that arise in providing ED/hospital care for patients experiencing elder mistreatment and approaches to address them.

Clinicians in the emergency department and hospital who treat patients experiencing elder mistreatment (EM) can expect to encounter challenging ethical dilemmas. Collaboration with ethics and EM consultation services offers teams an important opportunity to improve patient-centered outcomes and address value-based concerns when treating these patients. This article describes the role of a hospital clinical ethics consultation service and best practices for collaboration between ethics and EM consultation services. Illuminated via four case studies, the article presents several core ethical frameworks, including allowing patients the dignity of risk, considerations around a harm reduced discharge, involving abusers in surrogate decision making, and providers' experience of moral distress when dealing with patients experiencing EM. Increasing collaboration with ethics and elder mistreatment services can help teams more effectively respond to EM.

Outcomes of elder abuse and neglect in Central Europe: exploring the link between EAN and well-being among non-institutionalized older adults.

Informed by existing gaps in the research of elder abuse and neglect (EAN) outcomes and very limited knowledge from Central-European cultural contexts, this paper analyzes the link between domestic-based EAN and three measures of well-being, namely subjective loneliness, sense of control over one's life, and a broader outlook on life. To do this, we used recently (2022) collected EAN survey fielded among home-dwelling residents of the Czech Republic aged 65 + . The results show that there is a clear relationship between EAN and these selected outcomes. Controlling for several sets of potential modifying or confounding factors further indicates that this relationship is substantial and direct, rather than weak and indirect. Among controls, only variables related to disadvantage (health, income, dependency, history of abuse) partly account for the link between EAN and its outcomes due to their relation to both heightened risk of EAN and lower well-being.

Iowa family physician's reporting of elder abuse: 20-year follow-up.

The purpose of this project was to assess changes over 20 years, between family physicians perceived magnitude of elder mistreatment, physician knowledge of state laws, barriers to reporting suspected cases, and what is done in practice. Questionnaires were mailed to 1,080 physician members of the Iowa Academy of Family Physicians. Thirty-six percent of physicians returned the questionnaire. These respondents had a mean age of 51 years, were licensed for 19 years, and 51% were male. Twenty-nine percent of physicians ask their patients direct questions about elder abuse in 2022 compared to 14% in 2002. Identifying an elder abuse case was associated with asking direct questions about abuse and the belief that prompt action would be taken. Knowledge of elder abuse legislation was associated with reporting of all abuse cases, along with thinking there were clear definitions of abuse and that reporting benefits patients.

Elder abuse experienced by older Mexican women with disabilities: a current and retrospective view on domestic violence.

The objectives of this study were: 1) to estimate the prevalence of child abuse (CA), intimate partner violence (IPV), and elder abuse (EA) in a representative sample of older Mexican women by status, type, and cause of disability; and 2) to examine the associations of EA with CA, IPV, and disability status. We conducted a secondary data analysis of 21,718 women aged 60 years and older. Older women with disabilities had higher prevalences of CA, IPV, and EA than those with some difficulties or without disabilities. In older women whose disability was acquired at birth or due to aggression, this prevalence was especially high. Older women with disabilities and a history of CA and IPV were twice as likely to suffer EA. Policymakers and government leaders should incorporate the matter of violence against women with disabilities into their public agendas. This should be done while considering the women's various disabilities and causes of disability.

From a humble identity to an identity of respect: lifetime abuse among Arab Israeli older women.

This study addresses the retrospective experiences of older Arab Israeli women after a lifetime of living in the shadow of intimate partner violence. Qualitative research was conducted, using in-depth, semi-structured interviews of 15 Arab Israeli older women. Underlying this study is a feminist perspective and a life course perspective. Two main themes emerged: (1) socially endorsed violence against Arab Israeli women. This took several forms: men's dominant position and women's dependence, sources of violence used against women before and after marriage, and the social education of women to accept their fate. (2) The construction of a multifaceted survival identity throughout Arab Israeli women's life and old age. This identity has a variety of dimensions, including: a submissive victim identity, a rehabilitative identity of respect in old age, and a form of split identity that combines both the rehabilitative social identity and the marginal identity still experienced within the home.

Strategies for dissemination of ED/hospital elder mistreatment response team model.

Interdisciplinary Emergency Department/hospital-based teams represent a promising care model to improve identification of and intervention for elder mistreatment. Two institutions, Weill Cornell Medicine/NewYork-Presbyterian Hospital and the University of Colorado Anschutz Medical Campus have launched such programs and are exploring multiple strategies for effective dissemination. These strategies include: (1) program evaluation research, (2) framing as a new model of geriatric care, (3) understanding the existing incentives of health systems, EDs, and hospitals to align with them, (4) connecting to ongoing ED/hospital initiatives, (5) identifying and collaborating with communities with strong elder mistreatment response that want to integrate the ED/hospital, (6) developing and making easily accessible high-quality, comprehensive protocols and training materials, (7) offering technical assistance and support, (8) communications outreach to raise awareness, and (9) using an existing framework to inform implementation in new hospitals and health systems.

Older mothers and their difficult adult children: a life course exploration.

Adult child to parent violence is a growing international social problem that needs to be better understood to develop clinical interventions. An exploratory study on the antecedents of early life adversity on adult child to parent violence/elder mistreatment was carried out using secondary analysis. Directed content analysis was used based on life course theory with a data set of older mothers all > 57 years old (J. R. Smith 2021, 2022). Measurement of instances of child abuse, domestic violence, and birth trauma among abused older mothers was conducted. All the older women had reported being negatively affected by their adult children's problems and 56% reported being physically attacked. A case example is presented to illustrate how repeated incidents of abuse or neglect in early life might explain an older woman's inability to take actions for her own safety.