More research needed to prevent elder abuse

Maltreatment and abuse have important effects on the health, quality of life and even the lifespan of elderly people, but there is very little evidence on ways to stop it, according to a new research review.

Elder maltreatment can include physical injury, emotional abuse like screaming or threatening, illegal use of financial resources, sexual abuse, intentional or unintentional neglect, as well as using physical or chemical restraints.

There's some evidence for the benefits of interventions to help long-term carers find ways to handle older patients without physically restraining them, researchers say, but many other questions remain unanswered by the studies available.

"Prevalence rates vary by country and assessment method, with some surveys claiming that as many as 1 in 4 older adults is exposed to some type of maltreatment," said lead author Liat Ayalon of the Louis and Gabi Weisfeld School of Social Work at Bar Ilan University in Ramat Gan, Israel. "No doubt there are a lot of efforts to increase public attention in this field, but in reality, we know little about the potential effects of these efforts."

Bruises, disorganized appearance or isolation may indicate elder abuse, Ayalon told Reuters Health by email, but many of these signs resemble general pathology in older adults that are unrelated to maltreatment.

"The secrecy around abuse, because it tends to occur within the family is another challenge," Ayalon said.

The researchers searched through a few thousand studies addressing elder maltreatment, but only found 24 that met scientific standards and were published in English between 2000 and 2014.

Two of these studies were designed to help professionals detect or stop elder maltreatment, three were aimed at intervening with the older adults who experience maltreatment, and 19 were targeted at caregivers who maltreat older adults. In the last category, only one specifically dealt with family caregivers, while most addressed paid caregivers.

Interventions that targeted use of restraints did appear to help caregivers to use physical restraints less, the researchers report in Age and Ageing.

But most of the studies on physical restraint did not assess the quality of the intervention, and did not describe exactly which type of caregivers they were targeting, the authors note.

The analysis in found no conclusive evidence for or against the benefit of interventions targeting the abused elderly to help prevent maltreatment. Just one study provided evidence for interventions targeting unpaid caregivers who maltreat.

Elder care in Japan is most often left to family members, even after the establishment of a public long-term care insurance system across the nation, said Miharu Nakanishi of the Tokyo Metropolitan Institute of Medical Science, who was not part of the new review.

"This may sometimes lead to social isolation of family members who care for the elderly person," Nakanishi said.

Abuse from family caregivers is technically domestic violence, so may require different interventions than those used for professional caregivers, Nakanishi told Reuters Health by email.

Caregiver burnout, high levels of interdependence, financial dependence and alcohol abuse among caregivers are all risks for abuse, Ayalon said.

"Cognitive impairment in older adults is another vulnerability factor that puts older adults at risk for abuse, so are behavioral problems associated with dementia," Ayalon said.

"Many times, maltreatment is not a result of a volitional act, but rather represents the inability of the caregiver to deal with the task of caring appropriately," Ayalon said.

Physical restraint may be a necessity in some settings, especially to prevent falls, but it tends to be over-used, Ayalon said. "As can be seen by current research, it is one of the only acts we can actually reduce and prevent at the present time - hence, this is one place where we, as professionals, can intervene and improve the care provided to older adults."