Background
There is no universally accepted definition of elder abuse. A commonly cited definition of elder abuse is that developed by World Health Organization (WHO) (p.2, 2002): 'a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person'. [1-6,8] The phenomenon is often categorised as physical, sexual, psychological and emotional, financial and material abuse, abandonment and neglect. [1-6,8] The Australian Law Reform Commission also includes chemical abuse which describes unnecessary sedation of older people. [1] Resident-to-resident abuse is an emerging type of elder abuse. [4,8] Self-neglect is a well-known geriatric syndrome and is not always regarded as elder abuse. [12]
Evidence Summary
Elder abuse is a complex issue. The abuse is often committed by someone with whom the older person has a relationship of trust such as a partner, family member, friend, carer or professional person. Abuse can occur in several settings, including the older person's home. [2,10,13]
Risk factors for older people are cognitive impairment or disability, isolation from a social network and community support, and intensive or exclusive interaction with a primary carer. [4,6,8,11,13] Neglect is a major theme in the interim findings of the Royal Commission into Aged Care Quality and Safety. [14,15]
Older people living with dementia have higher risks of abuse due to their impaired cognitive status, reliance on carers and social isolation. [8] The reported prevalence of abuse of older people living with dementia is extremely varied partly due to how people define abuse and this will include cultural attitudes, expectations, and sensitivities. [8]
Lack of resources and training, burnout and stress in the work environment may also contribute to elder abuse by members of the aged care workforce. [9] Important cultural factors relating to abuse and neglect of older people are emerging [2,5,8,11,16] and are important in the context of aged care in Australia. These cultural factors include expectations of duty to care or to be cared for by a family member, and the understanding of sufficient respect and attention that an older people should receive. [8]
Service providers – individuals and organisations – have a moral, ethical, and regulatory responsibility to recognise, prevent and redress neglect and harm of older people. The requirements for reporting are evolving and people need to be aware of the legislative requirements for action and the protective and supportive resources which are available. [1-3] However, service providers may need to distinguish between situations of family stress rather than abuse in deciding what action to take. [7,8] Indirect intervention by way of mediation and support services could be beneficial in some cases but should take into account the best interest of the older person. [8] Different interventions have been studied [9] but their effect is unclear and recommendations are difficult to make as the studies are generally scarce, of low quality, diverse in their intent and design, and on a small scale.
Quality Statement
The included systematic reviews are of variable quality and include research of variable methodological design and rigour. Research into elder abuse is growing but is hampered by a lack of agreement on definitions and measurement. Only one study focussed on the older people’s understanding of elder abuse. [17]
Page updated 08 July 2021