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Elder Abuse

Key Messages

  • The definition of elder abuse from World Health Organization (WHO) (2002) is the most commonly used definition. [1-8]
  • Elder abuse is a growing and significant global problem. [1-10]
  • Service providers and health professionals have moral, ethical and regulatory responsibilities to identify, prevent and redress harm and neglect. [1-3] However, they may need to distinguish between situations of family stress rather than abuse in deciding what action to take. [7,8]
  • There is little published literature of elder abuse in a palliative care context.
  • It appears that elder abuse may be perceived differently in between cultures and in between generations [1,2,5,8,11] and these specific issues could arise in an end-of-life context.

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

 

  • References

  • About PubMed Search

  1. The Australian Law Reform Commission (ALRC). Elder Abuse (DP 83) [Internet]. 2016 [cited 2017 May 22].
  2. Kaspiew R, Carson R, Rhoades H. Elder abuse: Understanding issues, frameworks and responses [Internet]. 2016 Feb [cited 2017 May 22].
  3. Aged Care Act 1997 (Cth). 
  4. Baker PR, Francis DP, Hairi NN, Othman S, Choo WY. Interventions for preventing abuse in the elderly. Cochrane Database Syst Rev. 2016 Aug 16;(8):CD010321.
  5. Sooryanarayana R, Choo WY, Hairi NN. A review on the prevalence and measurement of elder abuse in the community. Trauma Violence Abuse. 2013 Oct;14(4):316-25.
  6. Ayalon L, Lev S, Green O, Nevo U. A systematic review and meta-analysis of interventions designed to prevent or stop elder maltreatment. Age Ageing. 2016 Mar;45(2):216-27.
  7. Aged & Community Services Australia (ACSA). Elder Abuse: ACSA Position Statement (718kb pdf). ASCA; 2016 Nov.
  8. Fang B, Yan E. Abuse of Older Persons With Dementia: A Review of the Literature. Trauma Violence Abuse. 2018 Apr;19(2):127-147. doi: 10.1177/1524838016650185. Epub 2016 May 31.
  9. Alt KL, Nguyen AL, Meurer LN. The Effectiveness of Educational Programs to Improve Recognition and Reporting of Elder Abuse and Neglect: A Systematic Review of the Literature. J Elder Abuse Negl. 2011 Jul;23(3):213-33.
  10. Australian Government Attorney-General's Department. Protecting the Rights of Older Australians [Internet]. Canberra: Australian Government [cited 8 Jul 2021].
  11. Yan E, Chan KL, Tiwari A. A systematic review of prevalence and risk factors for elder abuse in Asia. Trauma Violence Abuse. 2015 Apr;16(2):199-219.
  12. Hildebrand C, Taylor M, Bradway C. Elder self-neglect: the failure of coping because of cognitive and functional impairments. J Am Assoc Nurse Pract. 2014 Aug;26(8):452-62.
  13. Council of Attorneys-General. National Plan to Respond to the Abuse of Older  Australians (Elder Abuse) 2019–2023. Canberra: Attorney-General's Department; 2019.
  14. Royal Commission into Aged Care Quality and Safety. Interim Report Volume 1. Canberra: Commonwealth of Australia; 2019 Oct.
  15. Royal Commission into Aged Care Quality and Safety. Interim Report Volume 2. Canberra: Commonwealth of Australia; 2019 Oct.
  16. Dong XQ. Elder Abuse: Systematic Review and Implications for Practice. J Am Geriatr Soc. 2015 Jun;63(6):1214-38.
  17. Killick C, Taylor BJ, Begley E, Carter Anand J, O'Brien M. Older people's conceptualization of abuse: a systematic review. J Elder Abuse Negl. 2015;27(2):100-20. doi: 10.1080/08946566.2014.997374.

Definition

Elder Abuse

Emotional, nutritional, financial, or physical maltreatment, exploitation, or abandonment of the older person generally by family members or by institutional personnel. (MeSH)

Searches

 ("Elder Abuse"[mh] OR elder abuse[tiab])