Medical Implications of Elder Abuse and Neglect

This article reviews the prevalence of older adult mistreatment in community and institutional settings, the latest risk factors for mistreatment, theoretical frameworks used to explain mistreatment, and global responses to the problem including interventions and services. Pooled data from 44 studies (2002 to 2015), set the global prevalence of mistreatment at 15.7%, or one in six older adults annually. The estimates of institutional abuse are generally higher than for the community and are widely diverse ranging anywhere between 10% and 54%. The most recent concern is resident-to-resident aggression that is as high as 20.2% monthly. In domestic abuse, older adult functional dependencies are factors associated with greater risk of mistreatment. A life course perspective found that abuse earlier in life was a consistent risk factor for mistreatment later in life. Perpetrator risk factors were poor psychological health, substance misuse and dependency on their victims for psychological support, financial help, and housing. The risk factors for mistreatment in institutional care were high levels of burnout among staff, the frequency of resident related stressors, staff mistreatment by residents, and staff psychological distress. Mistreatment was the least investigated type of violence in national surveys, and the least addressed in national action plans.

This article reviews the prevalence of older adult mistreatment in community and institutional settings, the latest risk factors for mistreatment, theoretical frameworks used to explain mistreatment, and global responses to the problem including interventions and services. Pooled data from 44 studies (2002 to 2015), set the global prevalence of mistreatment at 15.7%, or one in six older adults annually. The estimates of institutional abuse are generally higher than for the community and are widely diverse ranging anywhere between 10% and 54%. The most recent concern is resident-to-resident aggression that is as high as 20.2% monthly. In domestic abuse, older adult functional dependencies are factors associated with greater risk of mistreatment. A life course perspective found that abuse earlier in life was a consistent risk factor for mistreatment later in life. Perpetrator risk factors were poor psychological health, substance misuse and dependency on their victims for psychological support, financial help, and housing. The risk factors for mistreatment in institutional care were high levels of burnout among staff, the frequency of resident related stressors, staff mistreatment by residents, and staff psychological distress. Mistreatment was the least investigated type of violence in national surveys, and the least addressed in national action plans.

Elder abuse is a global problem gaining recognition due to its severe impact on victims and the ageing population. Increased recognition has led to the investigation of perpetrator and victim characteristics that increase the risk of elder abuse. The identification of such risk factors can assist practitioners in preventing abuse, determining the risk of continued elder abuse and, where factors are dynamic, can be targets for risk management. This literature review identifies and describes perpetrator and victim risk factors for elder abuse with the goal of informing professional practice and providing the basis for an empirically derived risk assessment instrument for elder abuse. Electronic searches identified 198 studies that met the eligibility criteria. The studies reviewed provide evidence supporting eight risk factors related to the perpetrator that increase their risk of continued elder abuse and eight victim vulnerability factors that place the victim at heightened risk of elder abuse. Hypotheses raised by researchers to account for the associations are outlined. The practical utility of the risk and vulnerability factors are described. The need for and approach to developing a structured method to assess and manage elder abuse risk based on the empirically supported risk and vulnerability factors is discussed.

Empirically supported dynamic risk factors for elder abuse are identifiable for perpetrators and victims of abuse in the existing research literature. These risk factors can be utilised by professionals to inform their practice and target risk management efforts.