One Way to Reduce the Prevalence of Elder Abuse and Neglect in Families Is to:

Gerontologist. 2016 Apr; 56(Suppl ii): S194–S205.

Elderberry Abuse: Global Situation, Adventure Factors, and Prevention Strategies

Karl Pillemer

^aneDepartment of Human Development, Cornell University, Ithaca, New York.

David Burnes

²Cistron-Inwentash Kinesthesia of Social Work, Academy of Toronto, Canada.

Catherine Riffin

³Department of Internal Medicine and Elderliness, Yale School of Medicine, New Haven, Connecticut.

Mark South. Lachs

⁴Partition of Geriatrics and Palliative Medicine, Weill Cornell Medical Higher, New York.

Received 2015 Jun eleven; Accepted 2016 Nov 20.

Abstract

Purpose:

Elder mistreatment is now recognized internationally as a pervasive and growing problem, urgently requiring the attending of health care systems, social welfare agencies, policymakers, and the general public. In this article, we provide an overview of global issues in the field of elderberry abuse, with a focus on prevention.

Design and Methods:

This article provides a scoping review of primal bug in the field from an international perspective.

Results:

By drawing primarily on population-based studies, this scoping review provided a more than valid and reliable synthesis of electric current knowledge about prevalence and risk factors than has been bachelor. Despite the lack of scientifically rigorous intervention enquiry on elder abuse, the review also identified 5 promising strategies for prevention.

Implications:

The findings highlight a growing consensus across studies regarding the extent and causes of elderberry mistreatment, every bit well every bit the urgent need for efforts to make elder mistreatment prevention programs more than effective and evidence based.

Key Words: Elder corruption, Epidemiology, Risk cistron models, Prevention

Elder corruption is now recognized internationally as an extensive and serious problem, urgently requiring the attention of health care systems, social welfare agencies, policymakers, and the general public. Reports from the World Health Organisation, United Nations, and other international bodies accept prominently featured elder abuse and highlighted the range of harmful activities subsumed nether this rubric throughout the world (World Health Arrangement, 2011, 2014; OHCHR, 2010; Podnieks, Anetzberger, Wilson, Teaster, & Wangmo, 2010). With a global explosion in the older adult population, elder abuse is expected to go an fifty-fifty more pressing problem, affecting millions of individuals worldwide. Elder corruption is associated with devastating individual consequences and societal costs, meriting attending as a serious public wellness outcome.

In this article, we provide an overview of global problems in the field of elder abuse, with a focus on prevention. This emphasis is appropriate because elderberry abuse is likely the most widespread trouble of older people that is largely preventable (unlike many disease conditions of sometime age). Therefore, a better understanding of causes and prevention of elderberry abuse should be a major international priority. Fortunately, an improving international scientific literature has accompanied this growing business, including prevalence studies in a number of countries and international comparative projects. In add-on, prevention strategies have been increasingly documented in some countries.

Methods of the Review

Scoping reviews are used to provide a wide overview of a bailiwick and to help map commonalities, themes, and gaps in the literature (Armstrong, Hall, Doyle, & Waters, 2011). We conducted a scoping review to gain an overview of the literature on elder abuse prevalence and adventure factors. We restricted the review to loftier-quality elder abuse prevalence studies in lodge to synthesize and advance the near valid and reliable cognition bachelor. To this finish, we only included population-based elder abuse prevalence studies using random or exhaustive sampling and that nerveless data directly from older adults. Nosotros excluded studies based on convenience, clinical, or social service agency samples, besides as studies that collected information from caregivers, professionals, or bureau records to identify cases of elderberry corruption. We focused on regional or national-level studies unless this scale of research was unavailable in a given country (due east.g., in some cases, the only surveys were conducted in an individual urban center). Our scoping review initially drew from existing systematic and comprehensive literature reviews on elder abuse (Cooper, Manela, Katona, & Livingston, 2008; De Donder et al., 2011; Johannesen & LoGiudice, 2013; Sethi et al., 2011; Sooryanarayana, Choo, & Hairi, 2013). These prior reviews covered elder abuse studies until 2011 and identified 12 records satisfying our inclusion/exclusion criteria. To recollect records from 2011 onwards, we conducted title/abstract searches in four major databases (PubMed, MEDLINE, PsycINFO, and Social Work Abstracts) between 2011 and 2014 with the post-obit search terms: [(elder abuse OR elder neglect OR elderberry mistreatment OR elder maltreatment) AND (incidence OR prevalence)]. This database search resulted in 211 records overall, which was reduced to eight studies afterwards omitting duplications and records that did not satisfy inclusion/exclusion criteria. The 20 studies informing our scoping review of elder abuse prevalence and risk factors are described in Supplementary Tabular array. In improver, we consulted international comparative documents regarding the state of elder abuse programing in unlike countries. Special characteristics of the review of prevention programs are described in that section.

Definitions

Enquiry and intervention strategies regarding any class of interpersonal abuse depend on a example definition that withstands the criteria of research operationalization, clinical applicability, and policy formulation. A major barrier to improving our understanding elder abuse has been the use of widely varying, and sometimes poorly constructed, definitions of the phenomenon. Fortunately, consensus is at present emerging regarding both the full general definition of elder corruption as well as the major types of mistreatment encompassed past the term.

The U.S. National Academy of Sciences (Wallace & Bonnie, 2003) proposed a widely accepted scientific definition of elder abuse that we employ in this article. Elder corruption is defined every bit: "(a) intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship, or (b) failure by a caregiver to satisfy the elder's basic needs or to protect the elder from damage." This definition includes two major points: that an older person has suffered injury, deprivation, or unnecessary danger, and that another person (or persons) in a relationship of trust was responsible for causing or failing to prevent the harm.

Within the overarching framework of elder abuse, at that place is full general agreement on the telescopic of actions that fall nether this rubric (Council, 2003; Lachs, Williams, O'Brien, Hurst, & Horwitz, 1997; Laumann, Leitsch, & Waite, 2008; Phelan, 2013). Researchers, practitioners, and about legal statutes recognize the following types of abuse: (a) physical abuse, which includes acts carried out with the intention to cause concrete pain or injury; (b) psychological abuse, defined equally acts carried out with the intention of causing emotional pain or injury; (c) sexual attack; (d) material exploitation, involving the misappropriation of the elder'due south money or property; and (eastward) fail, or the failure of a designated caregiver to encounter the needs of a dependent older person.

Although elder abuse generally falls into one or more of these v types, reports have documented all-encompassing cultural variation in the circumstances and context of elderberry abuse. For example, widows in some traditional societies risk having their property seized and existence abandoned by their families. In some regions of Republic of india and Africa, mourning activities expected of widows would elsewhere be considered abusive, such equally beingness forced into matrimony or existence expelled from their homes (Kumari, 2014; McFerson, 2013). Reports have also identified devastating effects of accusations of witchcraft in some cultures, typically directed at older women (Kabole & Kioli, 2013; Krug, Mercy, Dahlberg, & Zwi, 2002; Schnoebelen, 2009). Thus, significant cultural variation exists in these five forms in which elderberry abuse appears.

Prevalence

Data from a number of countries about the extent of elder abuse justify urgent attempts to address the problem. Although some population surveys suffer from unclear or overly wide definitions or questionable methods, evidence is now available from a number of well-conducted, big-scale population surveys of community-dwelling house individuals in a number of countries. Elder abuse research tends to be subdivided into typologies based on customs or institutional living older adult populations (Acierno et al., 2010). In the following review of elder abuse prevalence, we focus on community-based surveys. Elder abuse prevalence in institutional settings is non covered considering of the lack of research in this surface area; no reliable prevalence studies accept been conducted of such mistreatment in nursing homes or other long-term care facilities.

Elderberry abuse prevalence rates for separate and aggregate forms of mistreatment described in this department are based on a synthesis of results from 18 studies in Supplementary Table that reported prevalence rates using a ane-year menstruum. More than specifically, two studies (Brozowski & Hall, 2004, 2010) from Supplementary Table were excluded from prevalence calculations because these ii studies measured prevalence over a dissimilar, five-twelvemonth period. Amidst the remaining 18 studies using a 1-twelvemonth prevalence period, not all studies collected data on every form of elder abuse. Therefore, the synthesized elder corruption subtype prevalence rates were based on the subsets of studies with relevant data.

Physical Abuse

Elderberry physical abuse was the most consistently measured mistreatment type. Screening was commonly based on the Disharmonize Tactic Scale (CTS) or a modified version of the CTS as developed in Pillemer and Finkelhor'south (1988) prevalence study. In near all studies, physical abuse caseness was divers equally ane or more events within a designated prevalence menstruation. Figure 1 shows the distribution of ane-twelvemonth physical abuse prevalence rates across studies, which ranged from 0.ii% to 4.9% (outlier 14.6%) with a mean of 2.8% (95% CI: 1.0%–4.6%). Worldwide, Canada (0.five%) and the United States (ane.4%) reported the lowest prevalence rates of elder concrete abuse, followed by Europe (i.67%). Two studies from Asia reported somewhat college physical abuse rates (Bharat: four.3%, Mainland china: iv.9%), whereas a single report from Nigeria establish by far the highest rate (xiv.half dozen%).

International prevalence rates according to elder abuse type.

Sexual Abuse

Although ane study incorporated the Revised CTS (Soares et al., 2010), researchers have generally developed their own set of questions to screen for elder sexual abuse. Studies consistently operationalized sexual corruption caseness as i or more events occurring in a given time menstruation. Across studies, one-yr elder sexual abuse prevalence ranged from 0.04% to 0.eight% (outlier 3.3%), with a mean of 0.vii% (95% CI: 0%–i.five%; come across Effigy ane). Unlike concrete abuse, Nigeria reported the lowest prevalence of sexual abuse (0.04%), followed by the United states of america (0.5%), Mexico (0.eight%), and Europe (1.0%).

Financial Abuse

Standardized tools take been unavailable to screen for elder financial abuse. Therefore, a broad range of measurement approaches were employed across prevalence studies to appraise this mistreatment type. All the same, studies consistently divers elder financial abuse caseness every bit one or more than mistreatment events within a given prevalence flow. Beyond studies, 1-yr prevalence of fiscal corruption ranged from 1.0% to 9.2% (outlier 13.1%; Figure 1) with a mean of 4.7% (95% CI: 2.8%–6.5%). Studies from Nigeria and Israel reported the highest prevalence of financial corruption at 13.1% and 6.4%, respectively. Mexico had the lowest prevalence of financial abuse (2.half-dozen%), whereas hateful rates across Europe (3.8%) and the United States (iv.5%) fell in the centre.

Emotional/Psychological Corruption

The CTS (or a modified version) was the virtually mutual tool used to measure elderberry emotional/psychological abuse, although several studies also developed their ain screening questions. Overall, studies reported a very wide range in 1-year emotional/psychological abuse prevalence rates (0.7%–27.3%), with a mean of viii.eight% (95% CI: 4.iv%–thirteen.1%). However, studies should be subdivided by those that defined emotional/psychological abuse caseness co-ordinate to substantive threshold criteria and those that divers caseness simply every bit one or more events. This definitional/operational distinction appears to account for much of the variation in emotional/psychological abuse prevalence rates, as depicted in Effigy i.

Studies using noun threshold criteria typically divers emotional/psychological abuse caseness as 10 or more than events in the past year, and some studies added a criterion that the mistreatment exist perceived as somewhat or very serious by the older adult. Among studies that used substantive threshold criteria, 1-year emotional/psychological abuse prevalence ranged from 0.seven% to 6.3% (outlier ten.8%), with a hateful of 3.iii% (95% CI: 0.4%–6.3%). Studies that did not use substantive threshold criteria reported 1-yr emotional abuse prevalence ranging from 4.6% to 27.3%, with a hateful of 13.6% (95% CI: 7.0%–20.2%). Defining emotional abuse caseness as ane or more events (without thresholds) is probable oversensitive because it captures ane-time scenarios that ought non to be characterized as elderberry abuse (eastward.k., a single insult between lx-year-former spouses in the terminal yr). Amid studies that used threshold criteria, India reported relatively loftier emotional abuse prevalence (10.eight%), whereas Canada, United states, and Europe had lower mean rates of 1.4%, 1.5%, and two.9%, respectively.

Neglect

The majority of researchers generated their own prepare of questions to screen for elder neglect, although a few studies used standardized tools (Duke OARS, Katz ADL Index). Studies either defined neglect caseness as one or more than events within a given time period or according to noun threshold criteria based on event frequency and elder cocky-perceived seriousness. Studies using substantive thresholds typically defined positive neglect as 10 or more events in the by year, whereas some studies added the criterion that the events exist perceived every bit somewhat or very serious by the elder. Across all studies, 1-year neglect prevalence ranged from 0.2% to v.five% (outlier 15.8%), with a mean of 3.ane% (95% CI: 0.6%–5.5%; see Figure 1). The departure in 1-year fail prevalence between studies that used threshold criteria (hateful = 1.one% [95% CI: 0%–2.3%]) and those that did not (hateful = 5.7% [95% CI: 0.01%–11.3%]) was not pregnant (although this is based on a low sample of studies). However, information technology is worth noting that neglect caseness defined as i or more events is likely oversensitive considering it captures quondam scenarios that near experts would concur should not be characterized as elder abuse (east.g., a child forgetting to clean the older adult'due south house once in the last year). Among studies that incorporated threshold criteria, Canada reported the lowest charge per unit of elder fail (0.4%), followed by Europe (0.v%) and the United States (ane.one%), whereas Republic of india reported the highest neglect prevalence (4.3%).

Aggregate

Several studies reported an aggregated elderberry abuse prevalence that incorporated all forms of mistreatment. Overall, studies reported an aggregated elder abuse prevalence ranging from 2.2% to 36.two%, with a mean of 14.3% (95% CI: seven.6%–21.one%). Beyond all studies, the highest aggregated prevalence was reported in Cathay (36.2%) and Nigeria (30.0%), followed by Israel (18.four%), Republic of india (fourteen.0%), Europe (10.8%), Mexico (x.3%), United Sates (9.v%), and Canada (4.0%). Later on excluding studies that did not utilize substantive thresholds to screen for emotional abuse, aggregated elderberry corruption prevalence ranged from ii.2% to 14.0%, with a mean of seven.one% (95% CI: ii.9%–11.2%). Among these studies using emotional abuse threshold criteria, Bharat had the highest aggregated elder abuse prevalence (fourteen.0%), followed by the United States (7.6%), Europe (6.03%), and Canada (iv.0%).

It should exist emphasized that prevalence rates reported in existing population-based elder corruption studies probable underestimate the true population prevalence. Older adults tend to underreport personal problems such as interpersonal violence (Wallace & Bonnie, 2003). More important, elder abuse prevalence surveys carried substantial participation bias in that they generally excluded a grouping of older adults that is potentially most vulnerable to the problem: individuals with cognitive harm. A number of smaller studies using convenience clinical/social service samples have been conducted on dementia caregivers, using a fourth dimension frame of mistreatment inside the past year (Cooney, Howard, & Lawlor, 2006; Cooney & Wrigley, 1996; Cooper et al., 2008; Coyne, Reichman, & Berbig, 1993; Paveza et al., 1992; Pillemer & Suitor, 1992; Pot, van Dyck, Jonker, & Deeg, 1996; Wiglesworth et al., 2010). In these studies, physical abuse prevalence ranged from 1.0% to 23.i% with a mean of ten.nine% (95% CI: 4.eight%–16.9%). Elder emotional abuse prevalence ranged from 27.9% to 62.3% with a mean of 39.5% (95% CI: 27.6%–51.5%). Elderberry neglect prevalence ranged from iv.0% to xv.4% with a mean of 11.1% (95% CI: 0%–26.v%). Studies did not report on the prevalence of elder sexual abuse or financial exploitation. Aggregated elderberry abuse prevalence ranged from 27.9% to 52.0% with a mean of 38.4% (95% CI: 25.2%–51.6%). Thus, it appears that elderberry abuse prevalence is much higher among cognitively impaired older adults in the community compared with their cognitively intact counterparts. Also excluded from population-based prevalence studies are individuals in nursing homes; although prevalence estimates practice non exist for institutional care, preliminary evidence suggests that rates may be higher than in the community (Castle, 2012; Goergen, 2001; Pillemer & Moore, 1989; Pot et al., 1996).

These results suggest that the extent of elder abuse is sufficiently large that social service and wellness professionals who serve older adults are probable to meet information technology on a routine basis. For example, using the prevalence rates but described, a clinician seeing 20 older adults a day may encounter a victim of elder abuse daily (Lachs & Pillemer, 2004). Further, as our discussion of risk factors below shows, some subpopulations that are overrepresented in the elder service organization (e.k., dementia patients) have higher adventure of abuse. If prevalence rates remain the same, the accented number of elder abuse incidents will rising in accord with a rapidly growing older adult population. Countries will experience this ascension in elder abuse cases differently depending on differential rates of population growth. Nevertheless, prevention programs in all countries are well-justified to help reduce prevalence and buffer the effect of a global aging population.

Risk Factors

The development of effective prevention programs is predicated on an understanding of gamble factors for mistreatment. In this department, we follow the ecological model (Wallace & Bonnie, 2003) in reporting the main risk factors, focusing on the levels of the individual (victim and perpetrator), relationship, community, and society that are associated with risk of elderberry abuse. We focus on population-based studies (Supplementary Table), selected instance-comparing studies, and systematic reviews to identify take chances factors. Similar to the arroyo used past Sethi and colleagues (2011), run a risk factors were assigned to ane of three categories based on the strength of evidence: (a) potent run a risk factors validated past substantial evidence, (b) potential take chances factors for which the evidence is mixed or limited, and (c) contested hazard factors for which there is lack of clear evidence (Table 1).

Tabular array one.

Gamble Factor Strength of Evidence

Level	Risk factors	Strength of bear witness	Protective actors	Force of prove
Individual (victim)	Functional dependence/ disability	Strong	Social support	Potent
	Poor physical health	Strong
	Cognitive impairment	Strong
	Poor mental health	Strong
	Low income/SES	Strong
	Gender	Potential
	Age	Potential
	Fiscal dependence	Potential
	Race/ethnicity	Potential
Individual (perpetrator)	Mental illness	Strong	Living arrangement	Potent
	Substance abuse	Strong
	Abuser dependency	Strong
Relationship	Victim–perpetrator relationship	Potential
	Marital status	Potential
Customs	Geographic location	Potential
Societal	Negative stereotypes on aging	Contested
	Cultural norms	Contested

Individual-Level Hazard Factors (Victim)

Potent

Functional dependence or disability

Beyond countries, older adult functional dependence or physical disability has consistently been found to be associated with greater risk of elder abuse, including emotional and fiscal abuse in the The states and Mainland china (Acierno et al., 2010; Amstadter et al., 2011; Burnes et al., 2015; Laumann et al., 2008; Peterson et al., 2014; Wu et al., 2012), concrete abuse in the U.s. (Burnes et al., 2015), and aggregate elder abuse in United mexican states and Portugal (Gil et al., 2015; Giraldo-Rodríguez & Rosas-Carrasco, 2013).

Poor physical health

Poor health has also been consistently associated with elder abuse across countries (Chokkanathan & Lee, 2005; Giraldo-Rodríguez & Rosas-Carrasco, 2013; Lowenstein, Eisikovits, Ring-Winterstein, & Enosh, 2009; Naughton et al., 2010; Pillemer & Finkelhor, 1988), including fiscal abuse in the United states of america, United Kingdom, and Canada (Laumann et al., 2008; O'Keeffe et al., 2007; Podnieks, 1993); physical, sexual, and emotional abuse in State of israel (Lowenstein et al., 2009); and neglect in the United States, Canada, and Israel (Acierno et al., 2010; Amstadter et al., 2011; Burnes et al., 2015; Lowenstein et al., 2009; Pillemer & Finkelhor, 1988; Podnieks, 1993).

Cognitive impairment/dementia

Although most population-based studies of elder abuse excluded individuals with cognitive harm, other research has found relatively high rates of mistreatment committed by dementia caregivers (equally outlined above) or identified cognitive impairment as a stiff risk factor (Lachs et al., 1997; Sethi et al., 2011).

Poor mental wellness

Studies across countries have found a relationship between poor mental/emotional health of the victim and elderberry abuse, including overall mistreatment in Mexico (Giraldo-Rodríguez & Rosas-Carrasco, 2013) and Republic of ireland (Naughton et al., 2010). Depression or depressive symptoms have been associated specifically with emotional and physical abuse in the United Kingdom (O'Keeffe et al., 2007), China (Wu et al., 2012), and Canada (Podnieks, 1993).

Depression income/SES

Low income has predicted aggregated elder abuse in United mexican states (Giraldo-Rodríguez & Rosas-Carrasco, 2013), Ireland (Naughton et al., 2010), and Bharat (Chokkanathan & Lee, 2005); financial (Peterson et al., 2014), emotional and physical abuse (Burnes et al., 2015), and neglect (Acierno et al., 2010) in the United States; and physical and sexual abuse in Canada (Brozowski & Hall, 2004, 2010).

Potential

Gender

International studies, including reports from Portugal (Gil et al., 2015), India (Chokkanathan & Lee, 2005), Ireland (Naughton et al., 2010), Israel (Lowenstein et al., 2009), and Mexico (Giraldo-Rodríguez & Rosas-Carrasco, 2013), betoken that women are more likely than men to experience elder abuse; specifically, emotional (Laumann et al., 2008) and financial abuse (Lowenstein et al., 2009). However, a recent report conducted in Seoul, Korea (Oh, Kim, Martins, & Kim, 2006) constitute that men were more probable to experience emotional and financial corruption.

Age

In the United states of america, younger historic period has been consistently associated with greater risk of elder abuse, including emotional, physical, financial corruption, and fail (Acierno et al., 2010; Burnes et al., 2015; Laumann et al., 2008). Nevertheless, studies from Mexico and Europe report that older individuals are at heightened hazard (Gil et al., 2015; Giraldo-Rodríguez & Rosas-Carrasco, 2013; Naughton et al., 2010).

Financial dependence

Evidence from studies conducted in Europe, Asia, and Africa suggest that financial dependence is linked to elder abuse and neglect (Lachs & Pillemer, 2004; Olofsson, Lindqvist, & Danielsson, 2012; Pot et al., 1996).

Race/ethnicity

Findings related to race/ethnicity come from the The states and Canada and suggest that specific racial/ethnic groups have divergent adventure trends in relation to unlike types of elder corruption. Compared with Caucasians, African American older adults may be at increased take a chance of financial corruption and psychological abuse (Beach, Schulz, Castle, & Rosen, 2010; Laumann et al., 2008) and aboriginal older adults have demonstrated higher risk of physical and sexual corruption (Brozowski & Hall, 2010), whereas Hispanic older adults have shown lower risk of emotional abuse, financial abuse, and fail (Burnes et al., 2015; Laumann et al., 2008).

Individual-Level Take a chance Factors (Perpetrator)

Knowledge about elderberry abuse perpetrator take a chance factors remains a major gap. To appointment, population-based elderberry abuse studies have nerveless information from older adults, equally opposed to trusted others. Without generating a random sample of individuals who are in a trusting relationship with an older adult, it is hard to define actual factors that place these trusted others at take a chance of perpetrating elder abuse. Information near perpetrators available from existing population-based elder abuse studies is too restricted by methodological specifications that are often put in identify to protect older adult respondents (due east.g., closed-ended questions over the phone). Despite these limitations, several studies depict perpetrator characteristics and we are able to construct a preliminary profile of elder abusers.

Strong

Mental disease

Poor psychological wellness (Cooney et al., 2006; Vandeweerd, Paveza, & Fulmer, 2006) including depression and anxiety (Pot et al., 1996; Wiglesworth et al., 2010) are mutual among elder abuse perpetrators (Sethi et al., 2011). In the United States, studies show that caregiver depression is predictive of physical (Coyne et al., 1993; Paveza et al., 1992) and verbal abuse (Vandeweerd et al., 2006) and, further, that abusers are more than likely to feel psychiatric hospitalization than nonabusers (Pillemer & Finkelhor, 1988).

Substance misuse

Drug or substance misuse is also common amongst elder corruption perpetrators (Anetzberger, Korbin, & Austin, 1994; Homer & Gilleard, 1990; von Heydrich, Schiamberg, & Chee, 2012; Wolf & Pillemer, 1989). Booze and drug problems have been linked with verbal and financial corruption in Canada (Podnieks, 1993) and financial corruption in Ireland (Naughton et al., 2010) and the Great britain (O'Keeffe et al., 2007).

Abuser dependency

Studies accept also shown that abusers are likely to be dependent on their victims for emotional support, financial help, housing, and/or other assistance (Anetzberger, 1987; Greenberg, McKibben, & Raymond, 1990; Iborra, 2008; Pillemer, 1986, 2004; Sethi et al., 2011; Wolf, Strugnell, & Godkin, 1982).

Victim–Perpetrator Human relationship-Level Risk Factors

Potential

Relationship type

Perpetrator relationship type appears to vary co-ordinate to mistreatment blazon and culture. In the The states, State of israel, and Europe, the about common perpetrator of elder emotional and physical abuse is a spouse/partner (Amstadter et al., 2011; Burnes et al., 2015; Laumann et al., 2008; Lowenstein et al., 2009; O'Keeffe et al., 2007; Pillemer & Finkelhor, 1988; Soares et al., 2010), whereas the most common perpetrators of these mistreatment types in Asian countries are children and children-in-law (Chokkanathan & Lee, 2005; Oh et al., 2006).

Marital status

Some studies from the United States, Canada, and Europe indicate that existence married is associated with aggregated elderberry abuse (Pillemer & Finkelhor, 1988), emotional and concrete abuse (Podnieks, 1993; Soares et al., 2010). However, other studies from the United States, Europe, Mexico, and China have institute that being unmarried, separated/divorced, or widowed is associated with college odds of aggregated elder corruption (Giraldo-Rodríguez & Rosas-Carrasco, 2013; Naughton et al., 2010; O'Keeffe et al., 2007) and each of the individual mistreatment types (Burnes et al., 2015; Laumann et al., 2008; O'Keeffe et al., 2007; Podnieks, 1993; Wu et al., 2012).

Community-Level Gamble Factors

In addition to characteristics of the victim, perpetrator, and victim–perpetrator relationship, community contexts may also place sure individuals at greater risk for abuse.

Potential

Geographic location

Studies conducted in Canada (Brozowski & Hall, 2004, 2010) and Southwestern Nigeria (Cadmus & Owoaje, 2012) reported that individuals living in urban areas were at greater risk for elder abuse. Residing in a specific country may also be a risk factor for abuse. For example, a prevalence study of seven European countries found that residing in Greece was associated with increased risk of sexual abuse, whereas residing in Portugal was associated with increased risk of financial abuse (Soares et al., 2010).

Societal-Level Risk Factors

Speculation has also been made nearly societal-level factors that may place individuals at higher risk of elder corruption. Although data are lacking, two factors are oftentimes cited in the literature.

Contested

Negative views on aging (ageism)

Some authors have suggested that negative attitudes and stereotypes nigh older people may contribute to societal acceptance of elder corruption (Nelson, 2005; Sethi et al., 2011). Older individuals may be perceived as fragile, dependent (Bytheway, 1994), or burdensome, making it more permissible for younger generations to mistreat them (Penhale, Parker, & Kingston, 2000).

Social and cultural norms

Although empirical evidence remains limited, scholars speculate that the normalization of violence may farther perpetuate trigger-happy behavior toward older people (Browne, 1989; Penhale, Parker, & Kingston, 2000).

Protective Factors

There is limited empirical evidence regarding factors that may protect individuals from elder abuse or promote resilience after mistreatment. Nonetheless, a trunk of research suggests that two factors may confer protection from elder abuse.

Potent

Social Embeddedness/Social Support

Studies conducted in the United States (Acierno et al., 2010; Amstadter et al., 2011; Schafer & Koltai, 2015; von Heydrich et al., 2012), Canada (Podnieks, 1993), Europe (Chokkanathan & Lee, 2005; Garre-Olmo et al., 2009; Melchiorre et al., 2013; Naughton et al., 2010; Soares et al., 2010), India (Chokkanathan & Lee, 2005), and Israel (Lowenstein et al., 2009) accept constitute that higher levels of social support and greater embeddedness in a social network lower the chance of elder abuse.

Living Arrangement

Studies from the Us and Europe have shown that a shared living environment is a major adventure cistron for aggregated elder abuse and, more specifically, physical and financial abuse (Naughton et al., 2010; Peterson et al., 2014; Pillemer & Finkelhor, 1988).

Prevention

The most pressing demand in the field of elderberry abuse is for interventions that have the potential to preclude mistreatment. Selecting and evaluating prevention options poses a considerable claiming, all the same, because reliable evaluation data do not exist on any of the options (Ploeg, Fear, Hutchison, MacMillan, & Bolan, 2009; Sethi et al., 2011; Stolee, Hiller, Etkin, & McLeod, 2012). Indeed, it is unfortunate that the greatest gap in noesis virtually elderberry corruption lies in the surface area of prevention, given the pressing nature of the problem. Merely approximately 10 intervention studies have been conducted with even minimally acceptable methods, and the results of most of these efforts accept been negative or equivocal (Ploeg et al., 2009). No international comparative studies of prevention programs have been conducted. Further, no information exists on the toll-effectiveness of programs; indeed, there are virtually no descriptive information of any kind of the costs incurred by any elderberry abuse interventions.

Despite the lack of effectiveness data from rigorous controlled designs, the seriousness and scope of the problem of elderberry abuse require countries and communities to take action to prevent it. We have, therefore, identified five interventions as "promising" based on the evidence from multiple case studies or plan descriptions that report beneficial effects of the program. Nosotros practice so with the caveat that programme initiators must keep with caution, given the absence of randomized, controlled intervention studies in elder abuse. Nonetheless, nosotros believe that guidance from the descriptive literature can be useful in identifying programs that merit further testing.

Caregiver Interventions

Caregiver interventions were among the start models used to prevent elder abuse. These interventions provide services to salvage the brunt of caregiving, such as housekeeping and meal grooming, respite care, educational activity, support groups, and day care and are promoted every bit abuse-prevention strategies. There is suggestive bear witness that these interventions, when directed specifically to abusive caregivers, may help preclude revictimization (Nahmiash & Reis, 2001; Reay & Browne, 2002). Further, there is some indication that the potential for the onset of abuse may be reduced by caregiver back up interventions (Livingston et al., 2013; Sethi et al., 2011). Caregiver interventions therefore are a promising approach to prevention.

Money Direction Programs

Extensive case study reports propose that individuals vulnerable to financial exploitation tin can exist helped through money management programs (Nerenberg, 2003; Sacks et al., 2012). Such programs feature daily money management assistance, including assistance with paying bills, making banking company deposits, negotiating with creditors, and paying home intendance personnel. These programs are targeted to groups at high risk for financial exploitation and in particular individuals with some degree of cognitive impairment and who are socially isolated. This intervention is also promising, as the preventive potential is high and with well-trained and accredited money managers, the risks of agin outcomes are low.

Helplines

The most widely used intervention across countries is phone "helplines," which allow individuals to seek advice and assistance regarding elder abuse. In that location is considerable instance report evidence suggesting that helplines facilitate early on intervention that can prevent or forbid mistreatment. Such helplines are typically staffed by trained volunteers or professionals. Because many elders feel shame about the abusive state of affairs, helplines have the reward of assuasive callers to remain bearding if they choose. In some countries, existing helplines have been expanded to support elderberry abuse victims. In other countries, hotlines have been established specifically for elder abuse victims, such as the "Helpline for Driveling Older People" in Milan, Italy, which counsels abuse victims (Van Bavel, Janssens, Schakenraad, & Thurlings, 2010). The most extensive helpline arrangement is a national network of helpline centers created by ALMA France that provides both immediate counseling and longer-term follow-upwards (Sethi et al., 2011). Helplines should exist considered a promising intervention, given the positive case reports and lack of evidence of any adverse outcomes.

Emergency Shelter

The provision of emergency shelter is a authentication of intervention for dilapidated women, providing a safe oasis to both escape abuse and to plan for the adjacent stage of life (Moracco & Cole, 2009). Shelters, withal, are underutilized by older women, who are often unaware of them (Straka & Montminy, 2006). Additionally, battered women's shelters typically are not designed to accommodate older women with physical wellness issues or dementia, and they do not offer services to abused men. Therefore, specialized shelter programs for elder abuse victims have been developed. These programs offer temporary relocation for victims, providing non just a safe environs but also a medically advisable one. As such, they may prevent permanent relocation to a nursing dwelling house, providing security while allowing a program for safety at home to be put in identify. Descriptive studies of shelter programs suggest positive results (Heck & Gillespie, 2013; Reingold, 2006), indicating that this is a promising program option.

Multidisciplinary Teams

In all countries, effective elder abuse prevention requires the coordination of available services. The responses required for elder mistreatment cut across many systems, including criminal justice, health care, mental wellness intendance, victim services, ceremonious legal services, adult protective services, financial services, long-term care, and proxy decision making. Example study and quasi-experimental evidence bear witness that multidisciplinary teams (MDTs) are likely to be an effective response to coordinating care and reducing fragmentation, leveraging resource, increasing professional knowledge, and improving outcomes (Blowers et al., 2012; Navarro, Gassoumis, & Wilber, 2013; Rizzo, Burnes, & Chalfy, 2015; Teaster, Nerenberg, & Stansbury, 2003; Ulrey & Brandl, 2012). These teams can also drive collaboration betwixt the elderberry justice field and other allied fields involved with older adults (Nerenberg, 2002). As one of the field's most promising practices, MDTs should exist implemented and tested internationally. Withal, information technology should exist noted that MDTs are at present more than appropriate in higher-income nations, given that services must showtime be bachelor in lodge to be coordinated. In lower-income countries, a higher priority is likely to be establishment of basic elder abuse services, with later attention to coordination.

In summary, given both a scarcity of resource in many countries and the lack of a solid show base of operations, efforts to create comprehensive prevention approaches to elderberry corruption are nevertheless in their infancy. Substantial differences be among nations; there are conspicuously much more expansive elder abuse service systems in high-income countries (Krug et al., 2002). Although there is a paucity of evaluation information, there is consensus in the field internationally regarding the need to aggrandize the range of services for elder mistreatment. However, in that location are several prevention options that are supported by preliminary evidence of their effectiveness and no reports of adverse outcomes. Programs with the greatest promise based on clinical, quasi-experimental, or single case study evidence are: (a) MDT approaches (particularly in countries where the service system is sufficiently developed to crave coordination); (b) helplines for potential victims; (c) fiscal management for elders at risk of financial exploitation; (d) caregiver back up interventions; and (e) emergency shelter for victims.

Although the literature on elderberry abuse interventions is not sufficiently developed to offer extensive guidance to countries and localities, this review suggests an important office for practitioners in promoting prevention and treatment approaches. It is vitally necessary that practitioners follow developments in the field, making them able to adopt prove-based approaches as they are tested and disseminated. Practitioners can besides play a critically of import role as collaborators in practical research projects, providing locations for intervention studies and access to participants. Farther, a primal role for service providers engaged in the issue of elder abuse is to serve every bit advocates for service development in their regions and in their countries. In areas where such concerted advocacy has occurred, improvements in elder abuse intervention have often followed (World Health Organisation, 2014).

Determination

Elder abuse is a growing international trouble with different manifestations in different countries and cultures. Substantial variation in legal and legislative approaches to the trouble also exists between different countries. Similarly, resources bachelor to prevent and intervene in elder corruption, and the degree to which they are coordinated, vary considerably throughout the world. Promising prevention and intervention strategies are being developed primarily in higher-income countries (eastward.g., MDTs) that may have applicability to other societies, just these should be tested in the context of available resources and the local manifestations of elder abuse. In some countries, awareness campaigns may get-go take precedent over intervention and prevention efforts given limited public understanding of the problem. Irrespective of the local strategies employed, cases of elder corruption will merely increase given the aging of the population worldwide, making it a public health problem of global importance.

The most urgent demand at present is for a widely expanded inquiry base of operations that uses high-quality methods. In that location is a paucity of information about the nature and extent of elder abuse in depression-income countries, and most studies take taken place in high-income nations. Culturally specific forms of elder abuse and cultural attitudes toward prevention and treatment (including potential barriers) remain virtually unexplored. Further, the applicability of transferring service models from high-income to low-income countries requires serious study, as resource-intensive options such as adult protective services may not be viable in nations where the crumbling services sector is underdeveloped. Although multicountry studies accept taken identify in Europe, they should be expanded to low-income countries every bit well. Improved scientific cognition well-nigh elder abuse is the key to developing effective prevention and handling strategies and should be promoted worldwide.

Funding

This research was supported past funding from the National Institute on Crumbling through an Edward R. Roybal Centre grant (1P30AG022845;) and by grant AG014299-06A2.

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