Elder Abuse: Hospitalization And Peer-Reviewed Research

Elder abuse is a significant issue that has gained increased attention from the health sector and social welfare organizations in recent years. A 2017 review estimated that 15.7% of people aged 60 and above experienced some form of abuse in the past year. Elder abuse has severe physical and psychological effects on victims, including an increased risk of hospitalization, long-term care placement, and death. The COVID-19 pandemic has also contributed to a rise in elder abuse cases, with a US study suggesting a potential increase of up to 84% in community settings. The complexity of elder abuse, varying definitions, and underreporting pose challenges in addressing this issue effectively. However, early recognition and intervention by healthcare professionals are crucial to mitigating the detrimental impact of elder abuse on individuals, caregivers, and society.

Elder abuse and increased risk of death

Elder abuse is a pressing issue that is often underreported and overlooked. It refers to any single or repeated act, or lack of appropriate action, that causes harm or distress to an older person within a relationship based on trust. This includes physical, sexual, psychological, emotional, and financial abuse, as well as neglect and the loss of dignity and respect. The prevalence of elder abuse is concerning, with a 2017 review estimating that 15.7% of people aged 60 and above experienced some form of abuse in the past year. This issue is not confined to the community; a review of studies on institutional abuse in hospitals, nursing homes, and long-term care facilities found that 64.2% of staff reported perpetrating abuse in the past year.

Elder abuse has severe consequences, including physical injuries, psychological distress, and financial devastation. Furthermore, it significantly increases the risk of hospitalization and placement in long-term care facilities. Most importantly, elder abuse is linked to an increased risk of death. Studies have found that victims of elder abuse are at a heightened risk of mortality, even after accounting for any chronic illnesses they may have. The risk of death is further exacerbated by the delay in recognizing elder abuse, which negatively impacts the patient's quality of life and outcome.

Several factors contribute to the increased risk of death among victims of elder abuse. Firstly, elder abuse can lead to or exacerbate mental health issues such as depression, anxiety, and suicidal ideation. These psychological effects have been well-documented and can have a detrimental impact on an older person's overall health and well-being. Secondly, elder abuse often occurs alongside neglect, which can result in the improper management of chronic illnesses and medical conditions, leading to poorer health outcomes and an increased risk of mortality. Thirdly, the social isolation and loss of support systems that often accompany elder abuse can indirectly increase the risk of death. Social support and living alone are protective factors against elder abuse, so the absence of these supports may exacerbate the negative health outcomes associated with abuse.

Individual-level characteristics also play a role in the increased risk of death among victims of elder abuse. Older adults with functional disabilities, poor physical health, cognitive impairments, mental health issues, and low income are more vulnerable to abuse and may be less resilient in the face of its adverse effects. Additionally, the type of relationship and marital status can influence the risk of abuse and, consequently, the likelihood of experiencing negative health outcomes, including death.

The link between elder abuse and increased risk of death underscores the urgency of addressing this issue. Healthcare professionals, particularly in emergency departments, play a crucial role in identifying and intervening in suspected cases of elder abuse. However, they often face barriers due to insufficient training and a lack of standardized screening tools. To effectively tackle elder abuse and mitigate its deadly consequences, a multifaceted approach is necessary, including raising awareness, developing preventive strategies, and implementing cost-effective interventions.

Elder abuse in institutional settings

Elder abuse is a global public health and human rights issue that is expected to become more common as the population of older adults grows in many countries. Elder abuse is detrimental to an older person's well-being and is linked to a variety of severe health consequences. In institutional care settings, older residents are particularly vulnerable and therefore at a higher risk of being abused.

A review of 52 studies from 28 countries estimated that 15.7% of people aged 60 and older had experienced some form of abuse in the past year. However, data on the prevalence of elder abuse in institutions such as hospitals, nursing homes, and long-term care facilities are scarce. A systematic review of recent studies on elder abuse in institutional settings indicates that 64.2% of staff reported perpetrating some form of abuse in the past year. This includes acts of neglect, psychological, physical, financial/material, and sexual abuse.

Several factors contribute to the risk of becoming a victim or perpetrator of elder abuse in institutional settings. Individual characteristics such as functional dependence, poor physical health, cognitive impairment, poor mental health, and low income increase the vulnerability of older adults to abuse. On the other hand, mental illness, substance abuse, and financial dependency are individual-level factors that increase the likelihood of someone becoming an abuser.

The health and social welfare sectors have taken on the responsibility of raising awareness about elder abuse in some countries. However, globally, there is still a lack of knowledge about elder abuse, especially in developing countries. The World Health Organization (WHO) has identified five priorities for addressing elder abuse as part of the UN Decade of Healthy Ageing (2021-2030). These include combating ageism, generating better data, developing cost-effective solutions, and making a case for investing in prevention and intervention efforts.

Despite the implementation of interventions to reduce elder abuse in both community and institutional settings, the effectiveness of these interventions in improving the knowledge and attitudes of caregivers is still unclear. Nursing staff play a crucial role in detecting and reporting elder abuse. However, they often face barriers due to insufficient knowledge, limited training, and a poorly organized system. Public awareness campaigns and educational programs for healthcare staff are vital to reducing and preventing elder abuse in institutional settings.

Elder abuse during the COVID-19 pandemic

Elder abuse is a widespread issue, with an estimated 1 in 10 older Americans falling victim to it annually before the COVID-19 pandemic. The pandemic has exacerbated the problem, with emerging evidence indicating an increase in the prevalence of elder abuse in both community and institutional settings. A US study suggests that rates in the community may have increased by as much as 84%.

The COVID-19 pandemic has introduced or intensified various risk factors for elder abuse. Social isolation, a known risk factor, increased during the pandemic due to stay-at-home orders, making it more challenging for victims to report abuse or seek help. Additionally, the pandemic caused financial strain, with millions of people losing their jobs, and caregivers had to manage multiple responsibilities, including caring for older adults and handling their children's online schooling. These factors collectively contributed to increased stress, a risk factor for abuse.

The improper use of alcohol and drugs is another risk factor that has risen during the pandemic. Caregivers may turn to substances to cope with their increased stress levels, and substance abuse is associated with a higher risk of perpetrating abuse. Furthermore, older adults with dementia are at an elevated risk of experiencing domestic physical and psychological abuse. The pandemic may have further isolated them, making it more difficult to detect and address abuse.

The health and social welfare sectors have crucial roles in addressing elder abuse. However, there is a general lack of knowledge about elder abuse and how to prevent it, especially in developing countries. The World Health Organization (WHO) has identified five priorities for tackling elder abuse as part of the UN Decade of Healthy Ageing (2021-2030). These include combating ageism, generating better data, developing cost-effective solutions, and making a case for investing in addressing this issue.

The pandemic has also impacted the detection and reporting of elder abuse. While the Minnesota Elder Justice Center reported a 25% reduction in calls during the pandemic, experts believe this is more concerning than reassuring. They attribute this decrease to older adults' discomfort in reporting abuse while living in close quarters with their abusers. Telemedicine and telehealth services have been proposed as potential solutions to enhance the safety of older adults and provide avenues for reporting abuse without placing them in unsafe situations.

Elder abuse in nursing homes

Elder abuse is a serious issue that can take many forms, including physical, emotional, sexual, psychological, financial, and neglect. It is estimated that over the past year, 15.7% of people aged 60 and older were subjected to some form of abuse. While data on elder abuse in institutional settings is limited, it is believed that abuse in nursing homes is more common than people may realize.

Nursing home residents can suffer from various types of abuse, including emotional, physical, sexual, and financial abuse, as well as neglect. Emotional abuse can involve threatening, verbally insulting, harassing, socially isolating, or intimidating residents. Physical abuse may include slapping, punching, or shoving, and can result in long-term health issues and even death. Sexual abuse is any unwanted sexual contact, and financial abuse involves the exploitation or withholding of a resident's financial resources. Neglect is the failure of a caregiver to fulfill their obligations to a resident, such as providing essential food, clothing, medicine, or supervision.

According to a survey of nurses and nursing aides in long-term care facilities, 81% had witnessed emotional elder abuse, and 40% had committed at least one act of emotional abuse in a year. The same survey found that 70% of staff had seen coworkers yelling at residents, and 50% had noticed coworkers insulting residents. In a separate survey, 24.3% of family members of nursing home residents reported at least one incident of physical abuse. Additionally, a review of studies on abuse in institutional settings indicated that 64.2% of staff reported perpetrating some form of abuse in the past year.

Several factors increase the risk of elder abuse in nursing homes. Residents with cognitive impairment or dementia are at a higher risk of being abused. Female residents are more likely to be abused than males, and those with a history of trauma or past abuse are also more vulnerable. Residents with functional dependence or disabilities, poor physical or mental health, and low income may also be at a higher risk of abuse. The dependence of residents on staff for safety, protection, and care further increases their vulnerability to abuse.

The consequences of elder abuse in nursing homes can be severe and far-reaching. Victims may experience anxiety, fear, and a loss of trust. Physical injuries can occur, such as bedsores, infections, constant pain, head injuries, and broken bones. Elder abuse has also been linked to an increased risk of hospitalization, long-term facility placement, and death. The psychological effects of abuse, including depression and anxiety, can be long-lasting and detrimental to the well-being of older adults.

The role of healthcare professionals in addressing elder abuse

Elder abuse is a pressing issue, with a 2017 review of 52 studies from 28 countries estimating that 15.7% of people aged 60 and above were subjected to some form of abuse in the past year. The abuse of older people is a single or repeated act or lack of appropriate action within a relationship based on trust that causes harm or distress to an older person. It includes physical, sexual, psychological, and emotional abuse, as well as financial and material abuse, abandonment, neglect, and loss of dignity and respect.

Healthcare professionals play a crucial role in addressing elder abuse, which often goes underrecognized and underreported. The emergency department (ED) is a critical interface where elder abuse can be identified, as older adults are high consumers of ED care. However, healthcare professionals face barriers in detecting and reporting elder abuse due to a lack of knowledge, limited training, and an inadequate system. They may also consider the broader context of the patient, including patient autonomy, confidentiality, quality of life, and future relationships.

To improve the detection and reporting of elder abuse, healthcare professionals should receive more frequent and pragmatic education to strengthen their knowledge. This education should emphasize personal responsibility within an interdisciplinary team. Screening tools have been proposed, but multicenter validation is lacking. Studies on the processes and effects of screening and interventions are necessary to enhance care for this vulnerable population.

In addition to detection and reporting, healthcare professionals can employ indirect and direct questioning to assess potential victims of elder abuse. Indirect questions can help create a safe space by asking about their home environment and finances. If necessary, direct questions can be asked, similar to those used in domestic abuse investigations. Formal assessments of cognition and mood are crucial, especially in cases of dementia or depression, which increase the risk of elder abuse.

The health sector in some countries has played a pivotal role in raising awareness about elder abuse. On World Elder Abuse Awareness Day in 2022, the World Health Organization (WHO) and its partners published a report outlining five priorities for addressing elder abuse during the UN Decade of Healthy Ageing (2021-2030). These priorities include combating ageism, generating better data, developing cost-effective solutions, and making a case for investing in this area.

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