Elder abuse is prevalent in older adults across five continents, especially minority older adults. Because different research methodologies are used in the literature, a variety of risk factors have been found to be associated with elder abuse. Among the risk factors, cognitive and physical impairment and psychosocial distress seem to be consistently associated with elder abuse. Elder abuse may lead to deleterious health outcomes and increase healthcare use.
There are various limitations in the field of elder abuse that add to the challenges of synthesizing data in this systematic review. One particular limitation is that no consistent elder abuse instrument has been used to measure elder abuse, making it difficult to compare the prevalence and understand the risk factors between studies. Despite using the same instrument, the cutoff for definite elder abuse varies greatly across studies. Many studies have used an “any positive item” approach, whereas others have more systematically considered the heterogeneity of the definitions and have been stricter in the categorization of elder abuse cases. In addition, some studies have used an extensive version of the screening instrument, whereas others chose a shorter version that may contain only one question. Recently, to address the question of inconsistencies in elder abuse instruments, operational definitions of different strictness have been used to examine elder abuse in the same population cohort, and the prevalence of elder abuse and its subtypes varied greatly in the same population through using different measurements.[33] The present study provided important empirical evidence of the effect of different instruments on the prevalence, but future studies should expand efforts to develop a more-consistent instrument and cutoff score. Another limitation is that most of the existing studies do not provide reliability and validity information for the instrument. Lack of consistency and precision in the assessment of elder abuse may prevent clear understanding of the accurate prevalence and risk and protective factors and impede the development of prevention and intervention programs.
In addition, the number and quality of studies varied greatly according to region and cultural group. The majority of studies of elder abuse were conducted in North America, Europe, and Asia, with only two studies identified in Africa. Almost all studies in North America were conducted in the United States. A lack of representative studies in certain regions, including Africa, Canada, Australia, and South America, has impeded the comparison and understanding of prevalence of elder abuse across continents, and the number of studies in U.S. minority populations such as Asian American and Hispanic older adults is not enough to perform a rigorous analysis of the differences in elder abuse between cultural groups.
In terms of the analysis of risk factors of elder abuse, existing studies have primarily focused on victim characteristics, but perpetrator characteristics such as caregiver burden, mental health, substance abuse, and premorbid relationship may also affect the occurrence of elder abuse. Moreover, the majority of studies of risk factors of elder abuse have used a cross-sectional design, which further hampers the ability to determine the causal relationship between vulnerability risk factors and elder abuse.
Elder abuse is prevalent in older adults across five continents, especially minority older adults. Because different research methodologies are used in the literature, a variety of risk factors have been found to be associated with elder abuse. Among the risk factors, cognitive and physical impairment and psychosocial distress seem to be consistently associated with elder abuse. Elder abuse may lead to deleterious health outcomes and increase healthcare use.There are various limitations in the field of elder abuse that add to the challenges of synthesizing data in this systematic review. One particular limitation is that no consistent elder abuse instrument has been used to measure elder abuse, making it difficult to compare the prevalence and understand the risk factors between studies. Despite using the same instrument, the cutoff for definite elder abuse varies greatly across studies. Many studies have used an “any positive item” approach, whereas others have more systematically considered the heterogeneity of the definitions and have been stricter in the categorization of elder abuse cases. In addition, some studies have used an extensive version of the screening instrument, whereas others chose a shorter version that may contain only one question. Recently, to address the question of inconsistencies in elder abuse instruments, operational definitions of different strictness have been used to examine elder abuse in the same population cohort, and the prevalence of elder abuse and its subtypes varied greatly in the same population through using different measurements.[33] The present study provided important empirical evidence of the effect of different instruments on the prevalence, but future studies should expand efforts to develop a more-consistent instrument and cutoff score. Another limitation is that most of the existing studies do not provide reliability and validity information for the instrument. Lack of consistency and precision in the assessment of elder abuse may prevent clear understanding of the accurate prevalence and risk and protective factors and impede the development of prevention and intervention programs.In addition, the number and quality of studies varied greatly according to region and cultural group. The majority of studies of elder abuse were conducted in North America, Europe, and Asia, with only two studies identified in Africa. Almost all studies in North America were conducted in the United States. A lack of representative studies in certain regions, including Africa, Canada, Australia, and South America, has impeded the comparison and understanding of prevalence of elder abuse across continents, and the number of studies in U.S. minority populations such as Asian American and Hispanic older adults is not enough to perform a rigorous analysis of the differences in elder abuse between cultural groups.In terms of the analysis of risk factors of elder abuse, existing studies have primarily focused on victim characteristics, but perpetrator characteristics such as caregiver burden, mental health, substance abuse, and premorbid relationship may also affect the occurrence of elder abuse. Moreover, the majority of studies of risk factors of elder abuse have used a cross-sectional design, which further hampers the ability to determine the causal relationship between vulnerability risk factors and elder abuse.
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