Elder Abuse

Elder abuse is described as the violation of the human rights of the senior citizens,
which may be a single or repeated act of mistreatment. It may be in the form of physical,
emotional, sexual, material and financial exploitation, and psychological. Moreover, it can be
constituted as deliberate and intentional or unintended, leading to the loss of respect and
dignity among individuals 60 years of age or higher (Dong, 2014). Neglect, medical
insurance fraud, and abandonment have also constituted an abuse of older adults. The
majority of the cases occur among the geriatrics who depend on others for their day to day
activity and can take place anywhere include retirement homes, hospitals, their residents, and
when living with family members. The prevalence rates of mistreatment and molestation are
often underestimated due to underreporting of the violations. However, the evident signs
include unexplained bruising scars and injuries, weight loss for no apparent reason,
depression, and confusion, the individuals appear withdrawn, and are dirty and unkempt
(Falk, Baigis, & Kapac, 2012). Research on the topic and literature review using qualitative
and quantitative methods have been used to shed more light on the magnitude of the abuse
and hence the need to address the problem in communities globally. The research question
indicated in the article is on the extent and severity of elder abuse and how best to use
evidence-based practices to prevent its occurrence.
Literature Appraisal

Aim of the Study
The article titled “Elder abuse: Global situation, risk factors, and prevention
strategies” by Pillemer, Burnes, Riffin, & Lachs (2016) explores the issues involved in
elderly abuse globally. It also delves into how the various agencies involved in matters of the

older adults, including social welfare and healthcare, have equipped themselves to handle the
problem of mistreatment and its implication in society. Additionally, seniors abuse has been
rampant globally and hence the need to address it and execute measure that will act as a
deterrent to the practice (Pillemer, Burnes, Riffin, & Lachs, 2016). Moreover, it aims at
ensuring that policies are formulated and implemented to ascertain that the issues that act as
risk factors are properly handled and dispensed within communities. Moreover, the aim is to
sensitize the healthcare providers, social welfare agencies and other stakeholders such as
policymakers, caregivers and the families taking care of the elderly on how best to ensure that
their needs are met and rights are not violated (Pillemer et al., 2016). There is a need to
understand the extent of the problem and allow for the execution of preclusion strategies in
communities throughout the world.
Addressing the Research Question
The article has addressed the research question on how rampant elderly abuse is
global, the role of the involved agencies such as healthcare, social welfare, legislation in
policy making, and the involvement of the community and general public in the
implementation of prevention strategies. The prevalence rates of mistreatment were from the
analysis of 18 studies conducted in one year (Pillemer et al., 2016). The data involved several
countries to denote the lives in different parts of the world with different sociocultural issues
addressed. As such the study described in the article had explored the various risk factors
associated with older person mistreatment, and what were the implications and levels in
different societies (Wang, Brisbin, Loo, & Straus, 2015). Mass population studies were
utilized in the investigation and review to provide a more representative image of the issue in
society. Different strategies were recommended depending on the risk factors and whether
they are at an individual or victim-perpetrator relationship level factors. Moreover, the
researchers tackled each section that included physical, emotional and psychological,

financial, sexual abuses, and neglect. The risk factors included gender, race, ethnicity, health
status such as mental and physical health, cognitive impairment, abuser and financial
dependence, and substance misuse (Johannesen & LoGiudice, 2013). Consequently, the
research questions raised at the onset of the study were intimately addressed.
Results of the Study
The results of the study from screening using the Conflict Tactic Scale (CTS) outlined
the various prevalence rates of the different forms of abuse (Giraldo-Rodriguez & Rosas-
Carrasco, 2012). They included physical at 0.2-4.9% with Nigeria being an outliner at 14.6%
and an average of 2.8%, sexual screened using revised CTS with a range between 0.04-0.8%
and an outliner of 3.3% while the average was 0.7%. Nigeria recorded the lowest number of
sexual abuse cases. Additionally, the results showed that financial exploitation was rampant
in Nigeria and Israel, while the mean was 4.7% of the cases reported (Pillemer et al., 2016).
However, there was no standardized measure for the investigation of the mistreatment.
Emotional and psychological abuse among the elderly was reported using CTS and had a
mean of 8.8% globally. Nevertheless, it also considered one-time scenarios which did not
provide a clear representation of the abuse.
Neglect was investigated using questionnaires generated by some researchers while
some of the studies utilized the Duke OARS Katz ADL Index. The international mean was
recorded as 3.1% with an outliner being 15.8%.Some investigators also explored an
aggregation of the varying forms of abuses which recorded the highest range and mean which
were 2.2-36.2% and 14.3 respectively. China and Nigeria had the highest percentage of a
combination of the different mistreatments meted against an individual with Canada
recording the lowest (Pillemer et al., 2016). The most effective prevention measures
instituted included shelters, money management programs for the senior adults, use of

multidisciplinary teams from various agencies and stakeholders, helpline and toll-free
numbers to report abuse and provide counseling services, caregiver intervention measures
that include use of support groups, respite groups and daycare (Pillemer et al., 2016).
Ultimately, they will prevent the occurrence and reoccurrence of elder abuse in societies
Levels of Evidence
The study provided evidence from 18 studies conducted in one year and also utilized a
literature review to identify an describe the various risk factors and forms of elder abuse that
was likely to be experienced. A scoping review using high-quality studies conducted on the
topic and also aided in ensuring that the bias was eliminated. The criterion used included
population-based investigative research and therefore, studies based on convenience, social
service agencies, or clinical investigations as their focus was not broad (Sooryanarayana,
Choo, & Hairi, 2013). Also excluded were data from professionals and caregivers as it would
limit the scope. Consequently, the studies reviewed were conducted at a regional, national, or
individual city level as they captured the prescribed target demographic. Subsequently, there
is the inclusion of studies that provided relevant and pertinent information and data for the
study whose literature was reviewed in the outlined research by Pillemer et al., (2016) on
elder abuse prevalence rates, risk factors, and prevention strategies.
Strengths and Weakness of the Study
The strength of the study is the provision of information gathered and analyses
through a scoping review. The society through the investigation is made aware of the
magnitude of elder abuse and how it impacts society. Moreover, the statistics generated from
the study are sued to influence policies and intervention measures by the social welfare
agency and healthcare providers (Pillemer et al., 2016). Therefore, there is the ability to

formulate and execute relevant policies in communities that are geared at ensuring the
wellbeing of the geriatric demographics. The weaknesses of the research are the inability to
control and standardize some of the data collection methods utilized, such as financial
exploitation. Furthermore, some criterions included single event cases which had little or no
effect on the overall outcome on the elderly abuse form under examination (Winchester &
Salji, 2016). Hence, it poses as a weakness of the study as the results will not be reflective of
a true representation of occurrence in society.

Elder abuse has been defined as a human rights violation,whichis propagated against
the older adults in the community leading to severe consequences on the individuals 65 years
old and above. There is an upsurge in morbidity and mortality rates among the elderly in care
due to abuse. Moreover, it leads to higher institutionalization, hospital admissions, suicides
among senior persons due to indemnification, and other negative societal and familial effects
(Yunus, Hairi, & Choo, 2019). The problem is rampant globally, which has necessitated the
need for the prevention and intervention measures to mitigate the effects of the mistreatment
among the individuals. The risk factors include mental health, financial and functional
dependency, physical health requiring round the clock care, cognitive impairment such as
Alzheimer’s and dementia, which are individually based (Castle, Ferguson-Rome, & Teresi,
2015). Furthermore, there are risk factors which are dependent on the relationship between
the caregiver and the victim and include marital status, resentment and overwhelmed
caregivers, and substance abuse. In addition, there are societal factors propagated against the
elderly that constitute mistreatment and they are sociocultural norms, geographical location,
living arrangements such as overcrowding and negative throughs and perceptions on aging
(Peshevska, Markovik, Sethi, & Serafimovska, 2014). Consequently, the factors lead to the
prevalence of older adult mistreatment in communities and care services.


Prevalence Rates
Furthermore, the abuse may be a single or continuous, repeat, and ongoing event
which may be unintended or intention from the caregiver to the geriatric. The mistreatment
can take different forms or types that include physical abuse, emotional and psychological,
sexual abuses, financial and material exploitation, and neglect. The overall prevalence that
included all the types above averaged at 15.7% of the population studies subjected to meta
nalysis (Yon, Mikton, Gassoumis, & Wilber, 2017). Moreover, it was noted to be higher in
incidence at the community level as compared to institutional living such as retirement and
assisted living homes. The majority of the cases were reported by the staff of the facilities
(Pillemer et al., 2016). Psychological abuse had a prevalence rate of 11.6% averaged from the
global studies assessed with 33.4% of the cases reported by the senior individuals or their
representations and 32.5% having been reported byemployees in the homes.
Additionally, the financial exploitation prevalence rate was reported at an average of
6.8%,with 13.8 % of the cases being identified by the geriatrics or their caregivers. Neglect
accounted for 4.2%, while sexual abuse was 0.9%form the analyzed international studies
selected for metanalysis. Elderly homes have a high percentage of abuse cases reported, and
they may arise from the use of retains, provision of insufficient care, and deprivation of
dignity and respect by not changing their clothes and cleaning their rooms after they have
spilled themselves (Yan, Chan, & Tawari, 2015). Due to the high rates reported, there is the
need to devise prevention strategies and intervention measure to reduce the incidence of
Predisposing Factors
The predisposing factors that lead to elder abuse include caregiver stresses and
frustrations, addictions and addictive behaviors, a dependency which may be in the form of

physical or financial, family feuds and conflicts, and emotional and psychological problems
which lead to depression and isolation. Moreover, they can be classified as a combination of
individual societal, familial, cultural, and caregiver factors (Roberto, 2017).Their interaction
may predispose geriatrics to be susceptible to abuse. As such, there is a need for the
implementation of measures that will aid in the mitigation of the factors to reduce the risk of
occurrence. Stringent policies should be formulated and executed to protect older adults in
Elder Abuse and Recognition in Primary Healthcare
Health professionals in primary healthcare recognize elder abuse through the physical
and mental examination of the patients. Clinically they might present with unexplained
scratches scars and bruises; they may also be fearful, withdrawn, and isolated. Depression can
also be detected from the older patients presented for physical examination and treatment
(Murphy, Waa, Jaffer, Sauter, & Chan, 2013). Nurses and other healthcare providers play an
integral role in ensuring that elderly patients are examined for physical, sexual, psychological
abuse, and neglect. Moreover, they are also required to report suspicious cases for
investigations to take place (Schmeidel, Daly, Rosenbaum, Schumuch, & Jogerst, 2012).
Majority of the injuries seen on the patients are on the torso and the face. However, they may
also develop pressure sores due to insufficient care if bedridden or wheelchair-bound. The
wrists may also have ligature marks due to use of restraints. Mental health assessment was
also considered as depression could be caused by mistreatment (Murphy et al., 2013).
Moreover, it is imperative that healthcare personnel are sensitized on the recognition of the
various ways that abuse may manifest to ensure that intervention measures are implemented.
Role of Nurses and Midwives

The role of nurses and midwives is the implementation of prevention and intervention
measures against elder abuse. They are instrumental in conducting physical examinations
which reveal the extent and severity of the mistreatment. Moreover, they offer protective
services to the victims of molestation and hence act as a shield (Dawson, Nkowane, &
Whelan, 2015). They are also involved in the provision of educative programs to create
awareness in communities on the detrimental effects of the mistreatment in society.
Sensitization of the healthcare workers increases vigilance, detection, and reporting of any
form of exploitation identified. Furthermore, they are involved in the formulation of policies
which address the issues faced by geriatrics in the community and hence are used to prevent
the occurrence and safeguard their rights. They also offer linkages between multidisciplinary
teams the healthcare and caregivers who are charged with the responsibility of looking after
the older adults on a day to day basis (Saint-Pierre, Herskovic, & Sepulvelda, 2018). They
offer training and act as a support system for the family members and provide the required
tools to effect execution of prevention measures using evidence-based practices from
research and studies conducted globally.

Research Question



Research Question

Research Question What are the evidence-based practices that are implemented in practice to prevent elder abuse in communities?

Population Intervention Comparison Outcome

Briefly describe each
element of your PICO

The population described
in the PICO framework
are the elderly aged 65
years and above (Dong,
2014). They are
considered the older adults
in the community and are
vulnerable to abuse from
caregivers, family
members and

The intervention measures
executed and described are
aimed at preventing the
occurrence and
reoccurrence of the
various forms of abuse
(Daly & Butcher, 2018).
They include the use of
respite care, help with
meal preparation, support

The comparison done
involves the assessment of
the non-detailed
intervention measures
among the caregivers and
what risk they pose in the
care and management of
the need of the geriatrics
in the community (Dong,
2014). They include a

The expected outcome is
increased awareness on
how to prevent and
ultimately reduce the
prevalence and incidence
rates of the different forms
of mistreatment faced by
the elderly population in
the community (Roberto,
Brossole, McPherson,


unscrupulous doctors and
insurance officials

groups for caregivers,
training, and provision of
information to prevent the
occurrence, daycare
services for families with
older persons living with
them, emergency facilities
to accommodate them in
case of abuse, and
management of their

simple verbal
communication of the
intervention measures, use
of pamphlets to
disseminate information
and minimized hospital or
home visits by relevant

Pulsifer, & Brown, 2013).
Consequently, there is
reduced morbidity and
mortality, reduced
admissions to hospitals
due to related injuries,
depression, and mental
conditions. It also
minimizes the likelihood
of mistreatment from the

Links to evidence
Roberto, Brossole,
McPherson, Pulsifer,
&Brown, 2013
Daly & Butcher, 2018

 Evidence-based practice is used to implement the best course of action in the prevention and management
of elder abuse (Roberto, Brossole, McPherson, Pulsifer, & Brown, 2013). Moreover, they are used to equip
the nurses and caregivers and also augment the nursing theories that are relevant to their execution in the
 The purpose is to create awareness on the prevalence and how rampant intentional and deliberate or
unintentional violence and mistreatment meted against the elderly affects their health, mortality, and rate


Dong, 2014
Johannesen & LoGiudice,

of hospitalization (Daly & Butcher, 2018). Moreover, it improves their outcome and wellbeing.
 Furthermore, evidence-based practices utilized have been summarized and analysis of literature through
scope research on how to prevent mistreatment of geriatrics in the community. The focus has been in the
different forms and the aggregate of the varying abuse types. As such, their implementation will ensure
the safety of older adults in society.
 The studies also outline the various available instrument for the assessment of presence, magnitude, and
severity of the abuse and also delves into the potential prevention measures that would best suit individual
abuse situations.

Rationale  The rationale of the research question is based on the high prevalence rate of elder abuse, whichrequires

the implementation of intervention measures in society.
 It also aims at the improvement of public health policies which will, in turn, affect the management and
strategies required for the prevention of abuse and how best to rehabilitate the victims through mitigation
measures (Dong, 2014).
 It also leads to a combination of population-based studies which are based on large geographical location,
which include cities and countries.
 Moreover, it requires a long-term study preferably one year to allow for data collection, implementation of


mitigation factors and measures, and the evaluation of outcomes to assess their effectiveness (Johannesen
& LoGiudice, 2013).
 The desired outcomes are used as a measure of the effectiveness of the practices implemented for the
prevention of abuse on the elderly in society.




Elderly abuse is rampant in most societies globally and takes many forms, which
include physical, emotional, psychological, and negligence. The risk factors may either be
individual based or stem from the relationship between the caregiver and the family member
and the victim. The varying forms may be intended or unintended and can be a single event
or repeat. The most rampant among older persons with cognitive impairment is the
forgetfulness and accusation that their valuables have been stolen. Moreover, there are cases
treated as felonies by the authorities such as sexual abuse and financial exploitation.
Ultimately, it provides data which is utilized to denote the prevalence rates as majority of the
mistreatment cased are not reported, andhence, mitigation measures are not implemented. As
such, there is a need to ensure that the public is sensitized through the implementation of
public policies that are geared at the provision of education and information on the risk
factors and available remedies as intervention measures. Therefore, there is a need for the
execution of evidence-based practices which are from research on elderly abuse. Various
sectors and agencies are required to cooperate and form multidisciplinary teams which are
effective in their mitigation of the mistreatment meted against the geriatrics in the
community. The agencies include social welfare, law enforcement, healthcare, policymakers,
and caregivers to chart the best course of action to prevent the occurrence of abuse through
guidelines provided by research as evidence-based practices.



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Daly, J. M., & Butcher, H. K. (2018). Evidence-based practice guideline: Elder abuse
prevention. Journal of Gerontological Nursing, 44(7), 21-30. doi:10.3928/00989134-
Dawson, A. J., Nkowane, A. M., & Whelan, A. (2015). Approaches to improving the
contribution of the nursing and midwifery workforce to increasing universal access to
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