The prevalence, severity and chronicity of abuse towards older men: Insights from a multinational European survey.

BACKGROUND: Elder abuse is a growing public health question among policy makers and practitioners in many countries. Research findings usually indicate women as victims, whereas male elder abuse still remains under-detected and under-reported. We aimed to investigate the prevalence, severity and chronicity of abuse (psychological, physical, physical injury, sexual, and financial) against older men, and to scrutinize factors (e.g. demographics) associated with high chronicity of any abuse. METHODS: Randomly selected older men (n = 1908) aged 60-84 years from seven European cities (Ancona, Athens, Granada, Kaunas, Stuttgart, Porto, Stockholm) were interviewed in 2009 via a cross-sectional study concerning abuse exposure during the past 12 months. RESULTS: Findings suggested that prevalence of abuse towards older men varied between 0.3% (sexual) and 20.3% (psychological), with severe acts between 0.2% (sexual) and 8.2% (psychological). On the whole, higher chronicity values were for injury, followed by psychological, financial, physical, and sexual abuse. Being from Sweden, experiencing anxiety and having a spouse/cohabitant/woman as perpetrator were associated with a greater "risk" for high chronicity of any abuse. For men, severity and chronicity of abuse were in some cases relatively high. CONCLUSIONS: Abuse towards older men, in the light of severe and repeated acts occurring, should be a source of concern for family, caring staff, social work practice and policy makers, in order to develop together adequate prevention and treatment strategies.

Financial-patrimonial elder abuse: an integrative review.

OBJECTIVE: to analyze the available evidence in the nursing literature about financial-patrimonial elder abuse. METHOD: integrative review of articles indexed in the databases CINAHL, Scopus, Web of Science, LILACS and MEDLINE, from 2007 to 2017. The combination of controlled and uncontrolled descriptors was used in Portuguese, English and Spanish. RESULTS: 15 studies developed in seven countries were included. In the thematic analysis, three categories emerged: epidemiological data, risk factors and institutions providing services to the elderly. The occurrence of this type of violence concomitantly to the other subtypes was highlighted among the most frequent. FINAL CONSIDERATIONS: the literature points to important epidemiological data, risk factors and characteristics of this type of violence, including within institutions providing services to the elderly, in different countries, essential aspects for structuring and rethinking public policies for protection and appreciation of the elderly.

Hospitalized elder abuse in Iran: a qualitative study.

BACKGROUND: Elder abuse is a serious violation of human rights and a worldwide issue. Upon hospital admission, elderly patients become vulnerable and susceptible to abuse. Understanding the issues perceived as abuse by the elderly patients and their family members allows us to identify, manage, and prevent elder abuse; especially in hospital settings. The present study aimed to identify and describe the abuse of hospitalized elders from the perspective of patients and their family members. METHODS: The present exploratory qualitative study was conducted from October 2017 to September 2018 at six different teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The target population was elderly patients in different wards across various hospitals and their family members. Based on the purposive sampling method, 16 hospitalized elderly patients and 11 family members were recruited and interviewed. The data were analyzed using the inductive content analysis method in accordance with the process described by Elo and Kyngas (J Adv Nurs 62:107-15, 2008). RESULTS: Based on the analysis of the interview data, four main categories were extracted and classified as Micro-level, Meso-level, Exo-level, and Macro-level issues. CONCLUSION: Hospitalized elder abuse is a multi-dimensional phenomenon caused by personal and professional factors as well as issues related to the inadequate physical environment and organizational structure. To prevent the occurrence of elderly abuse, it is recommended to train hospital staff, rearrange the physical environment, reform the organizational structure, and better plan and manage the financial, physical, and human resources.

Elder abuse victimization patterns: latent class analysis using perpetrators and abusive behaviours.

BACKGROUND: Research on elder abuse has defined it as a multidimensional construct that encompasses a set of different abusive behaviours, victims, perpetrators and settings. The array of possible elder abuse configurations is difficult to capture. This study sought to identify victimization patterns that represent distinct elder abuse configurations based on specific abusive behaviours and on the relationship with the perpetrator; it also sought to determine the association between these latent classes with victims' characteristics. METHOD: Data comes from two elder abuse surveys: a representative sample of community-dwelling adults and a convenience sample of older adults reporting elder abuse to four state and NGOs institutions. Latent Class Analysis (LCA) was used to categorize victimization in the population-based (N = 245) and in the victims' sample (N = 510) using 7 items measuring physical, psychological and financial abuse, and appointed perpetrators. Association tests were conducted to determine differences and similarities of victims' characteristics between the different obtained classes. RESULTS: The LCA procedure identified six different latent classes of victimization experiences in each of the samples, which were statistically and plausibly distinct. In the population-based survey: verbal abuse by others (29%); psychological abuse from children/grandchildren (18%); overlooked by others (18%); stolen by others (15%); verbal Intimate Partner Violence (IPV) (14%) and physical and psychological IPV (6%). In the victims' survey: physical abuse by children/grandchildren (29%); physical IPV (26%); psychological abuse by children/grandchildren (18%); polyvictimization by others (16%); physical abuse by others (6%) and physical and psychological IPV (4%). In the victims survey the 6 groups significantly differ in age, gender, civil status, living arrangements, perceived social support and functional status. CONCLUSIONS: The results support the possibility of the multidimensionality of elder abuse not being accounted by the "classical" abuse typologies. Elder abuse victims seeking help may represent a distinct group from that included in population-based prevalence studies. The appointed perpetrators may be the most meaningful and relevant aspect in distinguishing victimization experiences. Further research is needed to develop tailored interventions to specific elder abuse cases and enhance successful outcomes.

Elder abuse: perception and knowledge of the phenomenon by healthcare workers from two Italian hospitals.

With ageing population the number of elderly vulnerable to abuse is expected to grow. Hospital personnel play a crucial role in identifying mistreatment. The aim of this study was to establish the level of awareness and perception of elder abuse by healthcare workers, and to understand if they are able to recognize and properly report elder abuse, as well as to identify the physical signs of abuse and neglect. A 41-question survey was administered to healthcare professionals, working in the Internal Medicine and Geriatric Wards of two different University Hospitals of Southern Italy, representative of the Italian health public system. The data collection resulted in 98 questionnaires. For the majority, neglect represents a type of abuse, whereas 40% of physicians and 37% of nurses considered this concept false. All the professionals recognized the elder abuse as a violation of the human rights, but 46.94% were not sure about the existence of standard procedures for abuse reporting/treatment. The most of the nurses and the care assistants declared they never had suspected or witnessed abuse, while few physicians stated to have suspected/witnessed abuse 1-3 times in their career. In both the suspected and witnessed cases, the healthcare personnel did not made any action, neither reported them to public authorities nor adult protective service agencies. The level of awareness and perception of elder abuse by healthcare professionals are still poor especially regarding the reporting procedures. There is still strong need for education and specific training programs on elder abuse.

Financial-patrimonial elder abuse: an integrative review / Violencia financiera-patrimonial contra la persona mayor: revisión integrativa / Violência financeiro-patrimonial contra idosos: revisão integrativa

ABSTRACT Objective: to analyze the available evidence in the nursing literature about financial-patrimonial elder abuse. Method: integrative review of articles indexed in the databases CINAHL, Scopus, Web of Science, LILACS and MEDLINE, from 2007 to 2017. The combination of controlled and uncontrolled descriptors was used in Portuguese, English and Spanish. Results: 15 studies developed in seven countries were included. In the thematic analysis, three categories emerged: epidemiological data, risk factors and institutions providing services to the elderly. The occurrence of this type of violence concomitantly to the other subtypes was highlighted among the most frequent. Final considerations: the literature points to important epidemiological data, risk factors and characteristics of this type of violence, including within institutions providing services to the elderly, in different countries, essential aspects for structuring and rethinking public policies for protection and appreciation of the elderly.

RESUMEN Objetivo: analizar las evidencias disponibles en la literatura de enfermería acerca de la violencia financiero-patrimonial contra ancianos. Método: revisión integradora de los artículos indexados en las bases de datos CINAHL, Scopus, Web of Science, LILACS y MEDLINE desde 2007 a 2017. Se utilizó una combinación de descriptores controlados y no controlados, en portugués, Inglés y Español. Resultados: se incluyeron 15 estudios, desarrollados en siete países. En el análisis temático, surgieron tres categorías: datos epidemiológicos, factores de riesgo e instituciones proveedoras de servicios a los ancianos. Se verificó la ocurrencia de este tipo de violencia de forma concomitante a los otros subtipos, que se destacó entre las más frecuentes. Consideraciones finales: la literatura apunta importantes datos epidemiológicos, factores de riesgo y características de ese tipo de violencia, incluso dentro de las instituciones prestadoras de servicio a ancianos, en diferentes países, aspectos esenciales para estructurar y repensar políticas públicas de protección y valorización de la persona anciana.

RESUMO Objetivo: analisar as evidências disponíveis na literatura de enfermagem acerca da violência financeiro-patrimonial contra idosos. Método: revisão integrativa de artigos indexados nas bases de dados CINAHL, Scopus, Web of Science, LILACS e MEDLINE, no período de 2007 a 2017. Utilizou-se a combinação de descritores controlados e não controlados, nos idiomas português, inglês e espanhol. Resultados: foram incluídos 15 estudos, desenvolvidos em sete países. Na análise temática, emergiram três categorias: dados epidemiológicos, fatores de risco e instituições provedoras de serviços aos idosos. Verificou-se a ocorrência deste tipo de violência de forma concomitante aos outros subtipos, que se destacou entre as mais frequentes. Considerações finais: a literatura aponta importantes dados epidemiológicos, fatores de risco e características desse tipo de violência, inclusive dentro das instituições prestadoras de serviço a idosos, em diferentes países, aspectos essenciais para estruturar e repensar políticas públicas de proteção e valorização da pessoa idosa.

The prevalence of lifetime abuse among older adults in seven European countries.

OBJECTIVES: To investigate the lifetime prevalence rate of abuse among older persons and to scrutinize the associated factors (e.g. demographics). METHODS: This cross-sectional population-based study had 4467 participants, aged 60-84, from seven European cities. Abuse (psychological, physical, sexual, financial and injuries) was measured based on The Revised Conflict Tactics Scale, and the UK survey of abuse/neglect of older people. RESULTS: Over 34 % of participants reported experiencing lifetime psychological, 11.5 % physical, 18.5 % financial and 5 % sexual abuse and 4.3 % reported injuries. Lifetime psychological abuse was associated with country, younger age, education and alcohol consumption; physical abuse with country, age, not living in partnership; injuries with country, female sex, age, education, not living in partnership; financial abuse with country, age, not living in partnership, education, benefiting social/partner income, drinking alcohol; and sexual abuse with country, female sex and financial strain. CONCLUSIONS: High lifetime prevalence rates confirm that elder abuse is a considerable public health problem warranting further longitudinal studies. Country of residence is an independent factor associated with all types of elder abuse which highlights the importance of national interventions alongside international collaborations.

Apoyo social y familiar al adulto mayor del área urbana en Angelópolis, Colombia 2011 / Social and family support to the elderly in urban areas

Objetivo Describir las redes de apoyo social y familiar con que cuenta el adulto mayor del área urbana del Municipio de Angelópolis, Antioquia durante el año 2011. Materiales Se realizó un estudio descriptivo transversal, que determinó a través de la experiencia de la población, el apoyo social recibido por los 239 adultos mayores del área urbana del Municipio de Angelópolis, Antioquia. Los datos se obtuvieron por medio de fuentes primarias y se realizó análisis univariado y bivariado de la información. Resultados Los adultos encuestados fueron en su mayoría mujeres (59,8 %), con edad entre 60-74 años (66,9 %). El estado civil con mayor porcentaje fue casado (47,3 %) aunque en las mujeres el estado civil viuda tuvo mayor proporción (40,6 %). El 69,5 % tenían nivel de educación primaria y un 16,7 % sin ningún nivel educativo; El 60,3 % estaban afiliados al régimen subsidiado. El apoyo recibido por la familia y los amigos fue valorado como satisfactorio, se encontró una relación estadísticamente significativa entre el sexo y la no realización de actividades diferentes a las cotidianas (valor de p=0,004). Conclusiones El estudio mostró que la soledad es un aspecto que lleva a los adultos mayores a sentirse desamparados y vulnerables. A pesar de encontrarse satisfechos por el apoyo de la familia, algunos manifiestan, en especial las mujeres, sentirse maltratados. Los anteriores aspectos junto con la falta de actividad que les ocupe el tiempo deben ser tenidos en cuenta para plantear estrategias de intervención efectiva en redes de apoyo.(AU)

Objective To describe the social and family support networks available to the elderly living in urban areas of the municipality of Angelópolis-Antioquia during the year 2011. Materials A descriptive transversal study was conductedusing the population experience to determine the social support received by the 239 seniors in the urban area of Angelópolis-Antioquia. The data was obtained from primary sources and univariate and bivariate analysis was conducted. Results Mostly women were interviewed (59.8 %) aged between 60 and 74 (66.9 %). The social status that appeared with the highest percentage was "married" (47.3 %) though with the interviewed women the social status with the highest occurrence was "widow" (40.6 %). 69,5 % had an elementary school educational level and 16,7 % had no formal education at all. 60.3 % were registered in the subsidized program. The support from families and friends was qualified as satisfactory. A statistically significant connection was found between gender and undertaking different activities in free time (value of p=0,004). Conclusions the study indicates that loneliness is an aspect that makes the elderly feel unprotected and vulnerable. Despite the general feeling of satisfaction regarding family support, some of them, especially women, expressed feeling mistreated. The data along with the lack of activities for spare time must be taken into account to formulate intervention strategies for effective support networks to improve the situation of this vulnerable population of the municipality.(AU)

Trends in Reporting of Abuse and Neglect to Long Term Care Ombudsmen: Data from the National Ombudsman Reporting System from 2006 to 2013.

We utilized the National Ombudsman Reporting System (NORS) to describe national trends in reporting of abuse and neglect in nursing facilities to long term care ombudsmen (LTCO) from 2006 to 2013. We investigated complaints made against facility staff or residents with the following codes: physical abuse, verbal/mental abuse, sexual abuse, financial exploitation, gross neglect, and resident to resident physical or sexual abuse. Nationally, LTCO received an annual average of 11,749 abuse and neglect-related complaints in nursing homes from 2006 to 2013. These complaints trended down significantly, from 7.5 to 5.6 reports per 1000 beds (P < 0.0001). Physical abuse by a non-resident was the most frequently reported, representing an average of 28% of total abuse/neglect complaints. Improved understanding of the reasons for declines in reporting, increased training on other types of abuse and neglect, and expansion of the NORS database to allow for more comprehensive analysis are needed.

Prevalencia y factores asociados a sospecha de malos tratos en la unidad geriátrica del área de urgencias del hospital / Prevalence and factors associated with suspected mistreatment in a geriatric unit in a hospital emergency area

Objetivo. Conocer la prevalencia de sospecha de maltrato e identificar los factores asociados en las personas mayores sin déficit cognitivo, que son atendidas por la unidad geriátrica ubicada en el servicio de urgencias del hospital. Métodos. Estudio descriptivo y transversal de una población de 65 años o más, valorada por la Unidad Funcional Interdisciplinaria Sociosanitaria (UFISS) geriátrica del servicio de urgencias del hospital Arnau de Vilanova de Lleida. El total de participantes fue de 127. La sospecha de maltrato se midió con el cuestionario de la American Medical Association (AMA) y la Canadian Task Force (CTF). Las variables estudiadas fueron las características sociodemográficas y la dependencia funcional. Resultados. La prevalencia de sospecha de maltrato fue del 29,1% (IC del 95%: 0,21-0,37). Los subtipos más frecuentes fueron por abandono y psicológico, y menos frecuente por negligencia. Los factores asociados fueron el sexo femenino, profesión previa no remunerada, ser viudo, y vivir solo. Conclusiones. Tres de cada 10 personas mayores fueron identificadas como posibles víctimas de maltrato. Debido al relativo aislamiento de muchos adultos mayores que son maltratados, una visita inesperada al servicio de urgencias puede ser la única oportunidad para su detección. Las unidades geriátricas ubicadas en esta área deberían incluir en la valoración integral, la sospecha de malos tratos a dicha población. Para ello, es necesario poder contar con un instrumento con un alto índice de sensibilidad y especificidad para la detección de los malos tratos en las personas mayores(AU)

Objective. To know the prevalence of mistreatment and to identify the associated factors among elderly people without cognitive impairment, seen in the geriatric unit, located in the hospital emergency area. Methods. Cross-sectional study of a population of 65 years or older assessed by the geriatric Interdisciplinary Social Welfare Functional Unit (ISSFU) of the emergency area in the Arnau de Vilanova hospital of Lleida. We excluded participants with cognitive impairment. The total number of participants was 127. The suspicion of mistreatment was measured using the Questionnaire of the American Medical Association (AMA) and the Canadian Task Force (CTF). The variables studied were social demographic characteristics and functional dependency. Results. Prevalence of suspicion of mistreatment was 29.1% (95% CI: 0.21-0.37). The most frequent subtypes were neglect and psychological, and less frequent was negligence. Associated factors were being female, being in unpaid work, being a widow and living alone. Conclusions. Three out of ten elderly people were identified as possible victims of abuse. Due to the relative isolation of many of the elderly who were abused, an unexpected visit to the emergency area may be the only opportunity for detection. Geriatric units located in this area should include the suspicion of mistreatment of this population in their comprehensive assessment. For this, it is necessary to have tool with a high degree of sensitivity and specificity for detection of abuse in the elderly(AU)

Safety and security of older persons in Tehran, Iran: a sociological appraisal of elder abuse.

The article explores and evaluates the quality of life, safety, and security of elderly people in Tehran City in Iran. In that, different dimensions of material and social well-being, and abuse of people of the age 65 and above, are assessed. Besides the human rights, the dignity, and the gradual decline of the elderly's social security are reflected. The research also aims to study the elder age-groups in order to find out how these people gradually lose their physical and mental reliance, and as a result, how their dependence on others and various services enhances. The method of research mainly being empirical, it is preceded by theoretical and literature review. Five hundred elderly people were randomly selected for the study. Findings suggest that the aging pyramid shrinks and narrows at the age of 65 or even before in the present study. Research reached the conclusion that the young elderly with new needs and expectations are highly different from those of their pervious generations.

A physician's perspective: elder abuse and neglect over 25 years.

Twenty-five years of involvement with elder abuse and neglect has yielded mixed results. The contribution by physicians to elder abuse, in contrast with child abuse, has been very limited. Physicians, despite being in an advantaged position to intervene, lag behind other professionals in reporting. Potential remedies include identification of abuse as a syndrome to allow for reimbursement, increased education and research funding, and a greater advocacy role by physician organizations.

Future directions for social policy and elder abuse: through the looking glass of generational characteristics.

The future directions for social policy and elder abuse are forecast using the characteristics of three contiguous generations: Baby Boomers, Gen Xers, and Nexters. The results suggest greater potential victimization for the Boomers than previous generations, particularly neglect and exploitation. Gen Xers may experience more self-neglect. Social policy will continue to emphasize the criminalization of elder abuse, reflecting Boomer self-righteousness and severity. Elder abuse victimization will have a medical hue, given the Boomer obsession with health and wellness. Although Gen Xers are less cynical than Boomers, they will be more concerned about their immediate lives and pass the elder abuse policy torch to the Nexters, who will elevate it in deference to the Boomers and in quest for a higher moral order.

Research assessment of elder neglect and its risk factors in a hospital setting.

BACKGROUND: The aims of this experiment were to assess the rate of neglect in hospitalized patients and to identify risk factors for neglect. METHODS: During 2004-2006, patients aged 70 years and older hospitalized in internal departments were screened for signs of neglect. Principal caregivers were interviewed too. RESULTS: Signs of neglect were identified in 14.1% of the patients. Neglected patients differed from the non-neglected in level of education and had poorer economic status and more frailty, lower albumin level, higher incontinence problem and higher subjective caregiving burden reported by their caregivers. Mean risk scores, based on patients' and caregivers' risk indicators, were higher in the neglect group. CONCLUSION: Health, functional and psychosocial factors correlated to the presence of neglect. These factors should be used as warning signs to draw attention to professional help.

Una forma de esclavitud en pleno siglo XXI: el síndrome de la abuela esclava / No disponible

El Síndrome de la Abuela Esclava es un cuadro clínico con una alta prevalencia entre las mujeres que superan los 50 años y compatibilizan el rol de abuela y madre de sus nietos. Se trata de un síndrome grave, que afecta a amas de casa responsables en ejercicio activo, inducido por factores extrínsecos (estrés familiar, enfermedades intercurrentes) e intrínsecos (sentido excesivo del orden, la dignidad y el pudor). Entre las manifestaciones típicas destacan las físicas (hipertensión arterial, descontrol metabólico,...) como las psíquicas (autoinculpación, tristeza, desánimo,...). La implantación de medidas estructurales y educativas podría paliar la aparición y posterior desarrollo de este síndrome (AU)

The slave grandmother syndrome is clinically relevant and of high prevalence in women above 50 years of age (responsible housewives on active service) who share the grandmother and mother role with their grand children. The factors associated with this serious syndrome are extrinsic (family stress, illness) and intrinsic (obsessive order, worthy and shame). Typical signs of this syndrome are of great variability and mainly physical (hypertension, metabolic disorders…) as well as psychic (self-guilty feeling, sadness, discouragement…). This study proposes the importance of an adequate management by means of organisational and educational measurements that may prevent the appearance and development of this syndrome (AU)

Violência contra o ancião / Violence against the elder

A violência esta hoje disseminada na sociedade brasileira, sob variados ângulos, implicando em assimetria de poder. A violência contra a pessoa idosa é uma violação dos direitos consagrados não só no Estatuto do Idoso, mas na legislação civil e penal. Essas violações referem-se tanto à integridade física quanto à psicológica, produzindo exclusão, sofrimento, incerteza e segregação. É obrigação da sociedade e do Estado assegurar à pessoa idosa proteção à vida e à saúde, propiciando-lhe o respeito, a liberdade e a dignidade.

Today the violence is spread in the Brazilian society, under varied angles, implying in power asymmetry. The violence against the elderly is a breaking of the rights consecrated in the Statute of the Aged and in the civil and criminal legislation. This violence braks the physical and the psychological integrity, producing exclusion, suffering, uncertainty and segregation. It is society and State obrigation to assure to the elderly protection to the life and the health, propitiating respect, freedom and dignity.