"Nenhuma Pessoa Idosa Merece Passar por Isso": Compreensão da Violência para Mulheres Gerontes / "Ninguna Persona Adulta Mayor Merece Pasar Por Esto": Comprensión de la Violencia para las Mujeres Adultas Mayores / "No Elderly Person Deserves to Go Through This": Understanding Violence Towards Elderly Women

Resumo Introdução: A violência contra idosos é um fenômeno crescente, ocasionando prejuízos à saúde, com diferentes desfechos e consequências às vítimas. A chance de idosas sofrerem-na no âmbito familiar supera a dos homens, sendo o gênero um fator de risco considerável. Objetivo: Analisar a compreensão da violência contra pessoas idosas segundo mulheres gerontes. Metodologia: Pesquisa descritiva com abordagem qualitativa desenvolvida com 22 idosas de uma comunidade no estado da Paraíba, Brasil, escolhidas por conveniência. Utilizou-se para coleta de dados entrevistas semiestruturadas, processadas pelo software Iramuteq, com posterior Análise de Conteúdo. Resultados: Foram evidenciadas cinco classes: ciclo de violência; rede de apoio ao idoso vítima de violência; Vivência de situações violentas; violência financeira; e simbologia da violência na sociedade, as quais denotam compreensão da violência envolvendo os diferentes tipos. Apoiam-se nos fatores da vivência familiar, cultura e outros, consubstanciando o profissional de saúde como fundamental para o desfecho. O gênero influenciou no que concerne ao olhar lançado sobre a violência física e psicológica, bem como na relevância dada às equipes de saúde para identificação de ocorrências e prevenção de possíveis danos. Conclusão: Os diversos tipos de violência contra a pessoa idosa foram reconhecidos, incluindo fatores individuais, comunitários e sociais no ciclo violento. Além disso, associaram o envelhecimento a maior suscetibilidade para sofrer violência, independente da tipologia. Destaca-se a potencialidade do serviço de saúde na assistência à pessoa idosa vítima de violência, elucidando casos e atuando precocemente para interrupção dos ciclos perpetrados, exigindo a necessidade constante de atualização profissional para lidar com situações detectadas.

Resumen Introducción: La violencia contra las personas adultas mayores es un fenómeno creciente, que causa daños a la salud, con diferentes desenlaces y consecuencias para las víctimas. La posibilidad de que las mujeres adultas mayores la sufran en el ámbito familiar supera la de los hombres, siendo el género un factor de riesgo considerable. Objetivo: Analizar la comprensión de la violencia contra las personas mayores según las mujeres adultas mayores. Metodología: Investigación descriptiva con enfoque cualitativo desarrollada con 22 mujeres adultas mayores de una comunidad en el estado de Paraíba, Brasil, elegidas por conveniencia. Para la recolección de datos, se utilizaron entrevistas semiestructuradas, procesadas por el software Iramuteq, con posterior análisis de contenido. Resultados: Se evidenciaron cinco tipos de violencia: ciclo de la violencia, red de apoyo población adulta mayor víctima de violencia, experimentar situaciones violentas, violencia financiera y simbología de la violencia en la sociedad, que denotan la comprensión de la violencia de diferentes tipos. Estas ideas están respaldadas en los factores de la experiencia familiar, la cultura y otros, donde la persona profesional de la salud se identifica como fundamental para el cuidado y apoyo. El género influyó en la mirada lanzada sobre la violencia física y psicológica, así como en la relevancia dada a los equipos de salud para la identificación de sucesos y la prevención de posibles daños. Conclusión: Se han reconocido los diversos tipos de violencia contra las personas mayores, incluidos los factores individuales, comunitarios y sociales en el ciclo de violencia. Además, asociaron el envejecimiento con una mayor susceptibilidad a sufrir violencia, independientemente de la tipología. Destaca la potencialidad del servicio de salud en la asistencia a la persona mayor víctima de violencia, mediante la identificación de casos y la actuación temprana para la interrupción de los ciclos perpetrados. De manera que, se evidencia la necesidad constante de actualización profesional para hacer frente a situaciones detectadas.

Abstract Introduction: Violence against the elderly is a growing phenomenon, causing damage to health, with different outcomes and consequences to the victims. The possibility of elderly women suffering it in the family context surpasses that of men, with gender being a considerable risk factor. Objective: To analyze the understanding of violence against the elderly according to elderly women. Method: Descriptive research with a qualitative approach developed with 22 elderly women from a community in the state of Paraíba, Brazil, chosen for convenience. The data collection was based on semi-structured interviews, processed by the Iramuteq software, with subsequent Content Analysis. Results: Five classes of violence against the elderly were evidenced: cycle of violence; support network for the elderly victims of violence; experience of violent situations; financial violence; and symbolism of violence in society, which denote an understanding of violence involving the different types. They are based on the factors of family experience, culture, and others, placing the health professional as a fundamental element for care and support. Gender influenced the perspective on physical and psychological violence, as well as the relevance given to health teams for the identification of occurrences and the prevention of possible damage. Conclusion: The various types of violence against the elderly have been recognized, including individual, community, and social factors in the violent cycle. In addition, they associated aging with greater susceptibility to suffering violence, regardless of the typology. It highlights the potential of the health service in assisting the elderly victim of violence, elucidating cases, and acting early to interrupt the cycles perpetrated, requiring the constant need for professional updating to deal with detected situations.

Gender Violence During the Three Ages of Life and the Impact of the Covid-19 Pandemic: A Review.

Children, women, and older people suffer different types of violence, which appears to have been exacerbated during the COVID-19 pandemic and the relative lockdown. The aim of this study is to analyze the literature about gender violence and abuse in the different ages of life and during the COVID-19 lockdown. Data were obtained from an electronic literature search using various online sources such as PubMed, Google Scholar, Science Direct and Web of Science. The terms "child abuse" were the most frequently used, followed in frequency by "gender violence," "femicide," and, lastly, "elderly abuse." The first studies considered gender-based violence as a purely physical problem, then, progressively, the analysis focused on the psychological point of view of the issue. There was a greater number of studies in 2020 about violence in comparison with previous years. The social and scientific attention to gender-based violence appeared to be very poor, especially in the case of older people abuse. It is necessary to increase general attention to the topic to correctly identify each form of abuse and to be able to take care of the subjects most at risk.

Social Workers' Perceptions Regarding Legal Intervention for Older Adults without Significant Cognitive Decline Who Are Abused by Their Adult Child.

Social workers aiding older adults facing abuse from their adult child confront an ethical dilemma: whether to honor autonomy or prevent harm. The study explores how social workers perceive legal intervention against the older adult's will. Twenty-one aging-specialized social workers took part in semi-structured interviews using a vignette. The analysis was conducted inductively, guided by content analysis principles. Two main themes emerged, focusing on the disadvantages and benefits of legal intervention. The findings underscore that combining teleological and deontological considerations could form a foundation for developing decision-making tools to aid social workers in navigating this dilemma effectively.

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.

Patient Abuse, Neglect, and Exploitation: Why Physicians Need to Be Trauma-Informed.

Introduction: Many people experience trauma, and its cumulative effects throughout the life span can alter health, development, and well-being. Despite this, few publications focusing on interpersonal trauma include a holistic understanding of the nature and widespread exposure of trauma experiences for patients. We developed an educational resource to teach residents about identifying and intervening with patients who experience trauma across the life span using a trauma-informed care (TIC) perspective. Methods: We created a 4-hour educational session for residents that included didactics, a virtual visit with a domestic violence shelter, a discussion with a person who had experienced trauma, and role-playing. A pretest/posttest retrospective survey assessed resident confidence level in identifying and intervening with patients who may have experienced trauma. We used the Wilcoxon signed rank test to compare pretest and posttest scores and the Kruskal-Wallis test to compare responses by residency type and year. Free-text questions were analyzed for thematic content. Results: During the 2021-2022 academic year, 72 of 90 residents (80%) from four residency programs attended and evaluated the session. More than 90% of respondents reported the session met their educational needs and provided them with new ideas, information, and practical suggestions to use in their clinical endeavors. The results demonstrated significantly increased confidence on most of the metrics measured. Discussion: This session significantly improved residents' confidence in identifying and intervening with patients who have had trauma experiences using a TIC perspective, which may lead them to provide improved patient care to those who have experienced trauma.

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.

Comparative Study on Elder Abuse and Neglect Among Geriatric Population in the Rural and Urban Field Practice Areas of a Medical College.

Background: Elder abuse is a multidimensional problem of public importance. According to the World Health Organization (WHO), 16% of older people were victims of elder abuse. A study conducted by HelpAge India in 2018 showed that Mangaluru ranks the highest in elder abuse (47%). Given the scarce literature, this study sought to determine the prevalence of elder abuse and its associated sociodemographic factors. Material and Methods: A community-based cross-sectional study was conducted among the senior population in the rural and urban field practice a medical college in Mangaluru for one and a half years. The sample size was 280. Results: Most of the study population was in the age group of fewer than 75 years (75.4%), with 50.4% females, 60% Hindus, 56.4% married, 39.3% illiterate, and 88.9% of them retired. The prevalence of elder abuse was 44.6% (rural = 50.7% and urban = 38.6%). Binary logistic regression showed that elder abuse was statistically significant among the unemployed, extended family members, and staying with children. Conclusions: The study brings to light the sociodemographic factors that play a role in detecting elder abuse. It also shows the importance of awareness of elder mistreatment among older people. These elements must be considered for implementing and enforcing laws and legislation to help curb elder abuse.

ED/hospital program contributions to community multi-disciplinary team meetings: Different models.

Elder mistreatment (EM) is a complex problem, with response and prevention requiring contributions from professionals from many disciplines. Community-based multi-disciplinary teams (MDTs) that conduct meetings to discuss challenging cases and coordinate services are a common strategy to ensure effective collaboration. Though they play an important role in EM identification, intervention, and prevention, hospitals and hospital-based healthcare professionals have been particularly difficult to engage in MDTs. Two hospitals in different communities recently launched Emergency Department (ED)/hospital-based response teams to consult in cases of potential EM, and both participate in MDTs. We explored similarities and differences between the MDTs in these communities including in the role of the ED/hospital-based response team. The comparison demonstrates both core common features as well as large variations. These differences reflect different circumstances in the models on which they were based, on MDT development in these communities, available resources and infrastructure, and the ED/hospital program's role.

Prevalence of elder abuse in the community and care settings: An umbrella review.

OBJECTIVE: Elder abuse, an important human rights issue and public health problem, contributes to increased disability and mortality. In the last decades, several reviews have synthesized primary studies to determine its prevalence. This umbrella review aimed to estimate the worldwide overall prevalence rate of elder abuse in the community and care setting. METHODS: Following prospective registration at PROSPERO (CRD42021281866) we conducted a search of eight electronic databases to identify systematic reviews from inception until 17 January 2023. The corrected covered area was calculated to estimate the potential overlap of primary studies between reviews. The quality of the selected reviews was assessed using a modified AMSTAR-2 instrument. We extracted data on the prevalence of any type of elder (people aged 60 years old or older) abuse in the community and care setting. RESULTS: There were 16 systematic reviews retrieved between 2007 and 2022, out of which ten captured prevalence globally, three in Iran, one in Turkey, one in China and one in Brazil. The 16 reviews included 136 primary studies in total between 1988 and 2020. The overlapping of studies between reviews was found to be moderate (5.5%). The quality of reviews was low (2, 12.5%) or critically low (14, 87.5%). The estimated range of global prevalence of overall elder abuse was wide (1.1-78%), while the estimations of specific abuse prevalence ranged from 0-81.8% for neglect, 1.1-78.9% for psychological abuse, 0.7-78.3% for financial abuse, 0.1-67.7% for physical abuse, and 0-59.2% for sexual abuse. CONCLUSIONS: Although the low quality of the evidence and the heterogeneity of the phenomenon makes it hard to give precise prevalence data, it is without a question that elder abuse is a prevalent problem with a wide dispersion. The focus of attention should shift towards interventions and policymaking to prevent this form of abuse.

Cross-sectional survey of staff and family perspectives on the use of CCTV in Australian residential aged care.

OBJECTIVE: To describe staff and family members' opinions about closed-circuit television (CCTV) in communal and private areas of residential aged care facilities (RACF), and to investigate how this relates to perceptions of care quality. METHODS: A cross-sectional survey was developed to capture perceptions of CCTV's influence on care quality, and acceptable locations for CCTV placement. Data were recorded as ordinal-scale and open responses. Non-parametric tests of association were conducted. RESULTS: The survey was completed by 81 staff and 74 family members. Both staff and family were satisfied with care quality and safety, irrespective of CCTV use. More family members were in favour of CCTV in both public and private areas, compared to staff who favoured public areas. Staff and family assumed there was real-time monitoring, leading to a belief that CCTV monitoring would improve safety and prevent falls and abuse. Concerns were raised that CCTV could be used instead of improving staff-to-resident ratios and interaction. CONCLUSIONS: Overall, participants supported the use of CCTV more in public than in private areas and believed it reveals and prevents poor care. There was no association between CCTV use and satisfaction with care. Closed-circuit television can have positive impacts if all stakeholders are involved in implementation.

Elder abuse victimization, mental health, and protective factors.

OBJECTIVES: This study investigated the association between elder abuse and depressive symptoms, as well as protective factors against adverse mental health outcomes from elder abuse. METHODS: Participants were drawn from the 5928 graduates of the WLS, Wave 3 study (age range 70-73) who completed both in-person and telephone interviews. From this large group, 975 (16.4%) participants reported having experienced elder abuse and were included in the sample. Path analysis using Mplus was employed. RESULTS: Elder abuse victimization was significantly associated with depressive symptoms, and those who had suffered multiple types of elder abuse experienced more severe mental health outcomes. However, both light physical activity conducted alone and having a friend as a confidant were negatively associated with depressive symptoms among older adults who had experienced elder abuse. CONCLUSION: Given the significant association between elder abuse and negative mental health outcomes among older survivors, screening and prevention programs are recommended. Older adults who have experienced elder abuse may benefit from programs designed to increase physical activity and help older adults build and maintain close relationships with friends and confidants.

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.

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.

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.

On tackling abuse of older people: The forensic challenges in fatal cases investigation.

The World Health Organization recently presented the priorities for tackling abuse of older people in a coordinated and strategic way. However, data on the forensic scenario is still lacking. In this context, the aim of the present work was to provide a comprehensive literature review of this inherently complex phenomenon in the post-mortem setting, in order to better characterize it from a forensic point of view. A comprehensive literature search was performed in three electronic databases following the PRISMA guidelines. Sociodemographic and medical data of victims and perpetrators, post-mortem data, types of abuse and risk factors were extracted from non-aggregated data. Forty-eight papers dealing with abuse in the post-mortem setting were included, with a predominance of case reports and case series. The review showed that neglect was the most common type of abuse and victims are predominantly older women who are abused in a domestic setting by trusted family member. To generate more and better data, expanded research in the forensic field requires standardized methods and the raise of professional awareness about abuse of older people.

Exploring Categories of Family Violence Across the Lifespan: A Scoping Review.

Family violence may be experienced at any stage of the lifespan; however, these experiences are often understood differently based on the age of the victim and who perpetrates the abuse. The significance of age is evident in the three categories of child abuse, domestic and family violence (DFV), and elder abuse. Each of these categories has its own definition which determines who is considered a victim or a perpetrator, and the behaviors counted as violent and abusive. These definitions influence how practitioners view victim-survivors' experiences of violence, and the subsequent available responses. This article reports the findings of a scoping review of international literature published between 2011 and 2021, which explored how family violence is categorized and defined. The review was conducted as part of a larger study exploring how violence against women in intimate and family contexts is conceptualized and experienced, as well as the available responses. Forty-eight articles were included in the final review, and five categories of violence in family and intimate contexts were identified. These were child abuse, DFV, elder abuse, adolescent-to-parent violence, and sibling abuse. Comparison of definitions across categories found similarities in terms of the relationship between victim and perpetrator, behavior, intention, and harm caused to the victim. Review findings suggest that definitions of various forms of family violence do not differ greatly. Further research is needed to determine whether responses to family violence across the lifespan can and should be streamlined.

Research on Abuse in Home Care: A Scoping Review.

Home care is the preferred care option for most people who need support; yet abuse exists in these settings toward both home care workers and clients. There are no existing reviews that assess the scope of current research on abuse in home care, and tangentially related reviews are dated. For these reasons, a scoping review is warranted to map the current state of research on abuse in home care and examine current interventions in this field. Databases selected for searching were Medline and EMBASE on OVID, Scopus, and the following databases in EBSCOhost: Academic Search Complete, AgeLine, and Cumulative Index to Nursing and Allied Health Literature. Records were included if: (a) they were written in English; (b) the participants were home care workers or clients age 18 years or older; (c) they were published in journals; (d) they undertook empirical research; and (e) they were published within the last 10-year period. Following Graham et al. (2006), the 52 included articles are categorized as either knowledge inquiry or as intervention studies. We find three themes among knowledge inquiry studies: (1) prevalence and types of abuse in home care, (2) abuse in the context of living with dementia, and (3) working conditions and abuse. Analysis from the intervention studies suggest that not all organizations have specific policies and practices to prevent abuse, and no existing interventions to protect the well-being of clients were identified. Findings from this review can inform up-to-date practice and policymaking to improve the health and well-being of home care clients and workers.

A Descriptive Study of the Characteristics of Homicide-Suicide in Forensic Autopsy Cases.

Homicide followed by suicide (HS) is a tragic event with varied characteristics across countries and regions. Compared to Western countries, there are limited studies on HS in Asian countries. Therefore, this study aimed to clarify the characteristics of recent HS cases by examining forensic autopsy records from 2008 to 2020 collected from the Department of Legal Medicine, Chiba University, in Japan. A total of 77 HS cases were identified, involving 77 perpetrators (52 completed suicides, 25 attempted suicides), with 28 perpetrator and 89 victim autopsies. Our findings showed that older adults accounted for nearly half of the victims; victims were mostly females, whereas most perpetrators were male. The most common HS relationship was that between a parent and a child. Autopsy findings showed that the most common cause of death was strangulation, and illegal drugs were detected only in a few cases; however, psychotropic drugs were detected in child victims. No obvious evidence of past child physical abuse by caregivers was found. In contrast, intimate partner violence (IPV) was present, with a history of IPV found in half of HS cases involving adult intimate partner relationships. Notably, gender differences in age and relationship to the victim were identified. Likewise, some perpetrators may have expressed their plans and intentions for HS before the event, which may represent an important sign for HS prevention. However, to accurately reveal the course of HS, nationwide integrated statistics, forensic autopsies, including toxicological analyses of the deceased; and forensic psychiatric perspectives, including psychological autopsy, are required.

The effect of health empowerment on elder abuse in older adults.

BACKGROUND: Understanding elder abuse requires an assessment of variables that may limit older adults' capacities to handle their everyday lives, to live independently, and to defend themselves. This study was conducted to examine the effect of health empowerment on elder abuse in older adults. METHODS: This cross-sectional and correlational study was conducted with 250 elderly individuals who applied to the internal medicine clinics of a university hospital in Elazig, eastern Turkey. Data were collected using the Descriptive Information Form, Elders Health Empowerment Scale (EHES) and the Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST). RESULTS: The average EHES total score of participants was 25.52 ± 6.58. The H-S/EAST total score was 4.22 ± 3.49. Among subscales, the score of "Characteristics of the elder that make him or her vulnerable to abuse" subscale was 1.04 ± 0.83, the score of 'Overt violation of personal rights and direct abuse' subscale was 1.55 ± 1.30, and the score of 'Characteristics of potentially abusive situations' subscale was 1.62 ± 1.94. It was determined that the EHES (ß = -0.163, P < 0.01) variable had a negative and significant effect on H-S/EAST. It was found that a one-unit decrease in the EHES variable increased the level of H-S/EAST 0.849 times. CONCLUSION: It was determined that the level of empowerment of the participants was moderate. Elderly individuals were found to have a moderate risk of elder abuse. It was found that the risk of elder abuse decreased as older individuals became stronger.

Comprehensive Older Adult and Caregiver Help (COACH): A person-centered caregiver intervention prevents elder mistreatment.

BACKGROUND: Elder mistreatment (EM) harms individuals, families, communities, and society as a whole. Yet research on interventions is lagging, and no rigorous studies demonstrating effective prevention have been published. This pilot study examines whether a first-of-its-kind coaching intervention reduced the experience of EM among older adults with chronic health conditions, including dementia. METHODS: We used a double-blind, randomized controlled trial to test a strengths-based person-centered caregiver support intervention, developed from evidence-based approaches used in other types of family violence. Participants (n = 80), family caregivers of older adults who were members of Kaiser Permanente, completed surveys at baseline, post-test, and 3-month follow-up. The primary outcome was caregiver-reported EM; additional proximal outcomes were caregiver burden, quality-of-life, anxiety, and depression. Nonparametric tests (Mann-Whitney U, Fisher's Exact, Wilcoxon Signed Rank, and McNemar's) were used to make comparisons between treatment and control groups and across time points. RESULTS: The treatment group had no EM after intervention completion (assessed at 3-month follow-up), a significantly lower rate than the control group (treatment = 0%, control = 23.1%, p = 0.010). CONCLUSIONS: In this pilot study, we found that the COACH caregiver support intervention successfully reduced EM of persons living with chronic illness, including dementia. Next steps will include: (1) testing the intervention's mechanism in a fully powered RCT and (2) scaling the intervention for testing in a variety of care delivery systems.