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Age and Ageing 2008 37(2):151-160; doi:10.1093/ageing/afm194
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Copyright © The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society.

Systematic Review

The prevalence of elder abuse and neglect: a systematic review

Claudia Cooper1,, Amber Selwood2 and Gill Livingston1

1 University College London, Camden and Islington Mental Health and Social Care Trust, UK
2 University College London, North East London Mental Health Trust, UK

Address correspondence to: Claudia Cooper. Tel: (+44) 20 7561 4218; Fax: (+44) 20 7561 4236. Email: c.cooper{at}medsch.ucl.ac.uk


   Abstract
Top
 Abstract
Introduction
 Objective
 Methods
 Results
 Discussion
 Conclusions
 Key points
 Conflict of interest
 Funding
 Supplementary data
 References
 
Objective: to perform a systematic review of studies measuring the prevalence of elder abuse or neglect, either reported by older people themselves, or family and professional caregivers or investigated using objective measures.

Methods: we conducted a comprehensive literature search of multiple databases up to October 2006, supplemented by a search of the references of all relevant articles. Validity of studies was graded by two authors independently using a standardised checklist.

Results: forty-nine studies met our inclusion criteria, of which only seven used measures for which reliability and validity had been assessed. In the general population studies, 6% of older people reported significant abuse in the last month and 5.6% of couples reported physical violence in their relationship in the last year. In studies using valid instruments involving vulnerable elders, nearly a quarter reported significant levels of psychological abuse. Five per cent of family caregivers reported physical abuse towards care recipients with dementia in a year, and a third reported any significant abuse. Sixteen per cent of care home staff admitted significant psychological abuse. Rates of abuse recorded using objective measures (5%) or reported to home management or adult protective services (APS) (1–2%) were low.

Conclusion: one in four vulnerable elders are at risk of abuse and only a small proportion of this is currently detected. Elders and family and professional caregivers are willing to report abuse and should be asked about it routinely. Valid, reliable measures and consensus on what constitutes an adequate standard for validity of abuse measures are needed.

Keywords: elders, abuse, prevalence


   Introduction
Top
 Abstract
 Introduction
Objective
 Methods
 Results
 Discussion
 Conclusions
 Key points
 Conflict of interest
 Funding
 Supplementary data
 References
 
Elder abuse is associated with distress and increased mortality in older people [1] and caregiver psychological morbidity [2]. Discovering the prevalence of abuse, perpetrated against vulnerable people by those they rely on, is inherently difficult.

There are a wide range of prevalence figures perhaps because studies employ different populations, measures and definitions of abuse. The Department of Health's guidance [3] defined abuse as ‘a violation of an individual's human and civil rights by another person or persons’. It sub-categorises abuse into physical, psychological, sexual, financial, discriminatory abuse and neglect and specifies that abuse is either an individual or repeated act(s) or omission(s). Numerous instruments measure abuse. They vary in items included and the level and frequency of abusive acts considered to constitute an abuse case. Accurate estimates of elder abuse are vital for service planning in our ageing society.


   Objective
Top
 Abstract
 Introduction
 Objective
Methods
 Results
 Discussion
 Conclusions
 Key points
 Conflict of interest
 Funding
 Supplementary data
 References
 
To produce the first systematic review of the prevalence of elder abuse using standardised criteria of study quality.


   Methods
Top
 Abstract
 Introduction
 Objective
 Methods
Results
 Discussion
 Conclusions
 Key points
 Conflict of interest
 Funding
 Supplementary data
 References
 
Search strategy
We searched databases [Allied and Complementary Medicine (1985–); British Nursing Index (1994–); CINAHL (1982–); EMBASE (1974–); MEDLINE (1950–); PsycINFO (1806–)] up to October 2006. We used the keywords: incidence or prevalence, elder abuse; elder and abuse; potentially harmful behavio(u)r of carer or caregiver; abuse and nursing home and residential home or care home. We searched references of all included papers and review articles.

Inclusion and exclusion criteria
We included primary research reporting the incidence or prevalence of elder abuse. We excluded reports of lifetime abuse (which could, for example, include child abuse); routine service data; dissertations and meeting abstracts.

Data extraction
Two authors evaluated extracted data using the following standardised checklist [4].

  1. Was the target population defined by clear inclusion and exclusion criteria?
  2. Was probability sampling used to identify potential respondents (or the whole population approached)?
  3. Did characteristics of respondents match the target population, i.e. was the response rate ≥80% or appropriate analysis included comparing responders and non-responders?
  4. Were data collection methods standardised?
  5. Was the abuse measure valid?
  6. Was the abuse measure reliable?
  7. Were features of sampling design accounted for in the analysis, through appropriate weighting of the data, or the whole population approached?

Disagreements were resolved by consensus between three authors. We calculated the 95% confidence intervals (CI) for the prevalence or incidence of total elder abuse where authors did not.


   Results
Top
 Abstract
 Introduction
 Objective
 Methods
 Results
Discussion
 Conclusions
 Key points
 Conflict of interest
 Funding
 Supplementary data
 References
 
About 322 abstracts were identified electronically, and 31 further titles from references of included studies. We retrieved 80 of these papers which appeared to meet the inclusion criteria. Forty-nine studies met the inclusion criteria, 13 were not on elder abuse prevalence or incidence studies, 13 were not of original research, 3 were meeting abstracts, 1 reported lifetime abuse and 1 repeated data. We discuss below studies using valid and reliable abuse measures (n = 7) or studies with clearly defined target populations, probability sampling and standardised data collection methods. Tables 1–4 list all other studies.


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  		Table 1. Studies asking general population samples of older people about abuse

 


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  		Table 2. Studies asking other populations of older people about abuse

 


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  		Table 3. Rates of abusive behaviours reported by family carers

 


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  		Table 4. Studies using third party measures of abuse

 
General older population surveys
Prevalences of overall abuse ranged between 3.2 and 27.5% in general population studies [Table 1 and Appendix 1, (see the supplementary data on the journal website http://www.ageing.oxfordjournals.org)].


General population studies using validated and reliable instruments
Oh et al. [5] recruited people aged ≥65 in Seoul, and reported content validity and subscale internal reliability ({alpha} = 0.7–0.92) of a new instrument. Abuse caseness was defined as ≥1 abusive act occurring ≥2–3 times per month. About 1.9% reported physical abuse, 4.1% financial abuse, 3.6% verbal abuse, 2.4% neglect and 4.2% psychological abuse. Harris [6] reanalysed data from an epidemiologically representative US survey about violence in private homes. They included older couples and used the physical aggression subscale of the Conflict Tactics Scale (CTS), for which internal consistency and construct validity have been reported in a different (student) population [7].


Studies using reliable instruments
Chokkanathan [8] investigated elder abuse in an Indian probability survey. They systematically excluded people who scored <4 on the Elderly Cognitive Assessment Questionnaire (indicating probable dementia), so the sample differed from the target total population. Their abuse scale, which included items from the CTS and additional questions, was translated to Tamil and again translated back to ensure accuracy. They reported internal reliability for their scale ({alpha} = 0.94) and subscales ({alpha} = 0.75–0.98), but no measure of validity was included. The study used the Pillemer criteria which defined abuse caseness as verbal or neglectful acts occurring ≥10 times a year, and physical or financially abusive acts occurring at least once a year. About 10.8% of participants reported verbal, 5% financial, 4.3% physical abuse and 4.3% neglect.


Studies using instruments without reported psychometric properties
In a 1992 British National survey [9], people aged 60+ were asked whether a close family member or relative had recently frightened them by shouting, insulting or speaking roughly (verbal abuse); pushed, slapped, shoved or been physically rough with them in any other way (physical abuse); or taken money or property from them without their consent (financial abuse). About 1.7% reported any physical abuse, while 1.5% reported financial abuse and 5.6% verbal abuse that had occurred ‘recently’.

Pillemer and Finkelhor [10] conducted a random sample survey among people aged 65+. They over-sampled those living with younger people, whom the literature indicated were at greater risk of abuse, and weighted analyses accordingly. If the older person was not capable of being interviewed, they interviewed the primary carer. They modified the CTS to measure physical and psychological abuse, but did not report psychometric properties for their adapted instrument. They also used a section of the OARS (Duke Older American Resources and Services) instrument to measure neglect, but we found no evidence that this is a valid measure of neglect. They developed ‘the Pillemer criteria’ wherein abuse caseness was defined as verbal (1.1%) and neglect (0.4%) acts occurring ≥10 times, or any physical abuse (2.0%) in a year.

A Canadian telephone study of a random sample [11] used items from the CTS, their own questions and the OARS (to measure neglect). They reported a prevalence of 1.4% of verbal abuse and 0.4% of neglect occurring ≥10 times, and 0.5% of any physical abuse over a year. About 2.5% of participants reported financial abuse since the age of 65. Wetzels et al. [12] also modified the CTS and added their own questions; they asked a random sample of people aged 60+ in Germany about physical and verbal abuse perpetrated by another household member over the past 4 years. For neglect, they asked whether the person had been refused food or medical assistance or forced to take sedatives. About 3.4% had experienced any physical abuse, 1.3% financial abuse, and 2.7% neglect in the last 4 years, and 0.8% ≥10 verbally abusive acts over any 1 year of that time; the computed 1-year prevalence rate for any abuse or neglect was 3.1%.

The 1-year prevalences reported among people aged 65+ in Amsterdam [13] were about 3.2% for verbal abuse and 0.2% for neglect occurring ≥10 times, 1.2% for physical and 1.4% for financial abuse. About 6.7% of participants in Finland had experienced abuse or neglect after their retirement age [14]. Those living in long-term care settings with moderate or severe dementia were excluded, so the sample was unrepresentative of the target population.

Summary of best evidence:

  • Almost 6.3% of older people reported significant abuse in the last month [5] and 5.6% of the couples reported that their relationship had been physically violent in the last year [6].

Asking dependent older people about abuse
Three studies in this category [15–17] employed abuse measures with established reliability and validity. Wang [15] used the Psychological Elder Abuse Scale, reporting satisfactory content validity, inter-rater and test–retest reliability. They defined caseness as endorsing ≥10/32 items, and reported psychological abuse in 22.6% (16.7–28.5) of people interviewed. Beach [16] interviewed disabled older people and their carers using an instrument adapted from the CTS. Internal reliability was adequate ({alpha} = 0.69). Concurrent validity was tested by comparing care recipient and carer reports. There was 71% agreement (r = 0.30) (Beach, personal communication). Our group has previously reported convergent and discriminant validity of this measure [19]. Items were scored on a 5-item Likert scale, with caseness defined as a score of ≥2 (sometimes occurs) for any item. About 25.7% (20.5–31.0) of care recipients reported any abuse, 1% reported physical abuse and the remainder psychological abuse. Fulmer [17] recruited older people attending emergency departments. An expert team used the Elder Abuse Assessment Instrument to diagnose neglect in 18% (12.1–23.9) of participants (Table 2).

Two studies using measures with untested psychometric properties recruited participants from home-care service lists. In Canada, Pittaway and Westhues [20] found that 14% of older people had experienced ≥10 episodes of verbal abuse in the last year; 6% had experienced financial abuse; 14% neglect and 4% physical or sexual abuse since the age of 55. Buri [21] recruited participants from the Medicaid Waver program (which has dependency and financial need criteria): wherein 2% reported physical abuse, 18% financial abuse, 7% neglect, 1% psychological and 21% (18.5–23.5) any abuse.

Summary of best evidence:

  • A quarter of the dependent older people reported significant levels of psychological abuse and 1% reported physical abuse. A fifth of the older people presenting to an emergency department were experiencing neglect. Studies using unvalidated scales have reported rates of 6% and 18% for financial abuse.

Clinical populations of older people
Two studies screened people from Spanish primary care for physical, sexual, psychological abuse or neglect, and found rates of 53% (46–60) [22] and 11.9% (7.6–16.2), respectively [23]. Neither study used a valid or reliable measure or recruited samples matching the target population (Table 2).

Reports of abuse by family carers
Family carers have been asked about physical, verbal, psychological abuse and neglect. Only Paveza et al. [24] used a valid and reliable abuse measure. They found that 5% (1.9–8.1) of carers reported physical abuse in the year since diagnosis on the severe violence subscale of the CTS. In studies with well-defined target populations, 11–20% of family carers reported physical abuse and 37–55% reported any abuse meeting the Pillemer criteria (Table 3). Pot [25] reported that abuse scores were not correlated with the Eysenk personality Questionnaire lie scale as an indicator of validity.

Surveys of professional carers
Wang [18] conducted the only survey asking professional carers about abuse that used a valid and reliable measure. The Caregiver Psychological Elder Abuse Scale has satisfactory content validity, test–retest reliability and internal consistency. A random sample of 114 nurses and care attendants working in Taiwanese long-term care facilities for ≥6 months were interviewed. About 16.1% had witnessed significant abuse, and 99% some abuse. The authors described a well-defined target population, used probability sampling, a valid and reliable instrument and standardised data collection methods (validity score = 5).

Pillemer and Moore [26] approached intermediate care and nursing homes in New Hampshire with ≥15 beds and 54% participated. They found no significant differences between participating and non-participating homes in terms of ownership status (profit or not for profit) and size. They adapted the CTS by adding questions, but did not report psychometric properties for the scale. About 85% (n = 577) of randomly selected nurses and nursing aids participated. Almost 36% reported observing and 10% reported committing physical abuse in the last year, most frequently with excessive use of restraints. Most staff (81%) had observed and 40% had committed ≥1 psychologically abusive acts over this time period. The target population for this study was well-defined; the authors used probability sampling, standardised data collection methods and although the response rate was <80%, participating and non-participating homes’ characteristics were comparable (validity score = 4).

Jogerst et al. [27] asked Iowan Medicare-certified nursing homes about physical, financial, neglect or sexual abuse reported to them in the last year, in a postal questionnaire study. The response rate was 87% (355 homes). Over a year, for every 1,000 residents, 20.7 incidents were reported to the staff, and 18.4 to state authorities of which 29% were substantiated. The authors recruited >80% of a well-defined target population, but did not use a standard measure of abuse (validity score = 3).

Saveman [28] interviewed nursing staff working with older people living at home, in sheltered housing, or group dwelling or nursing homes in urban Sweden. All nursing aides and nurses within the well-defined target population were approached; the response rate was 78%. The authors developed an instrument to measure abuse but did not report psychometric properties (validity score = 3). Eleven per cent of professionals interviewed knew of abuse in the last year (physical, psychological, financial, sexual abuse or neglect), and 2% admitted to abuse. Staff working in nursing homes were more likely to have witnessed abuse. Finally, Goergen [29] found that 79% of 80 nursing home staff from a convenience sample of German nursing homes had witnessed ≥1 physical, verbal or neglect incident in the last year in a study fulfilling none of the validity criteria we used (score = 0).

Summary of best evidence:

  • About 16% of long-term care staff reported committing significant psychological abuse in the only study using a valid and reliable measure.
  • About 10% of staff admitted physical abuse and 40% any psychologically abusive act in the last year in a study with a well-defined representative population and standardised data collection methods.
  • Over 80% of nursing home staff have observed abuse occurring, but rates of abuse actually reported to home management were low (2%).

Studies using third party measures of abuse
Two studies [30, 31] used the Minimum Dataset Home Care (MDS-HC) abuse screen, which includes indicators of severe neglect, physical abuse, demonstrating fear of a carer and physical restraint. Reliability, but not validity, of the MDS-HC is reported [32]. In the first study, case managers completed the MDS-HC for people seeking home and community-based services in Michigan from two programs with functional eligibility criteria, one of which was only accessible by people below a maximum income level [31]. Cooper et al. [30] also reported results from MDS-HC assessments by trained interviewers who were research assistants or home-care personnel for people receiving health or social services in 11 European countries; in some areas community services were provided to people living in residential homes, although most participants lived in private homes.

Fulmer et al. [33] reported the prevalence of abuse among people attending day health care programs in New York. The authors devised a list of physical indicators of abuse, e.g. unexplained bruises and frequent injuries, and whether the person appeared apprehensive. They reported internal consistency for the scale ({alpha} = 0.60).

The other studies used reports of abuse from agencies or staff reports of abuse, rather than a standardised measure of abuse (Table 4).

Summary of best evidence:

  • About 5% of the people referred to care services screened positive for elder abuse in two studies using a reliable instrument [30, 31]. In a day care sample, 3.6% screened positive for physical abuse.
  • Less than 1% of older people were reported to the Adult Protective Services (APS) or were identified by sentinels in the US national incidence survey.


   Discussion
Top
 Abstract
 Introduction
 Objective
 Methods
 Results
 Discussion
Conclusions
 Key points
 Conflict of interest
 Funding
 Supplementary data
 References
 
The range of prevalence of abuse reported by general population studies was wide (3.2–27.5%), possibly reflecting true variation in abuse rates across cultures as well as the differences in defining and measuring abuse. Over 6% of the older general population reported abuse in the last month. In addition, 5% of older couples reported that their relationship had been physically violent in the last year, using measures with known psychometric properties. These rates are probably an underestimate, as some people may be reluctant to report abuse.

Nearly a quarter of older people dependent on carers reported significant psychological abuse, and a fifth reported neglect. Over a third of family carers report perpetrating significant abuse. These studies indicate that vulnerable old people are at high risk of abuse and that they and their family carers are frequently willing to report it. The act of abuse does not imply intent, and in many cases the carers may not have viewed their own actions in this light. Abusive acts reported may reflect lifelong verbally or physically abusive relationships, or onset of abuse in response to carer stress or challenging care recipient behaviours. Studies using observed abuse measures in vulnerable older people report much lower rates (5%), suggesting that they are probably only detecting the most serious abuse, and this is supported by a study that compared objective and family carer reports of abuse in older people [19]. This probably reflects the isolated and secretive nature of the abusive act. Our results suggest that routinely asking vulnerable older people and their family carers about abuse will often lead to its detection, and is more sensitive than using observer measures. Nonetheless these may have a role for detecting serious abuse in non-verbal patients or in those too afraid to report it.

One in six professional carers report committing psychological abuse and one in ten physical abuse. Over 80% of care home staff had observed abuse, suggesting that care home staff might have been denying any abusive acts. We speculate that most care staff are able to cope without abusing as unlike family carers they have a limited number of hours for caring. There may be a small but worrying proportion of professional carers who sadistically misuse their power over vulnerable individuals in their care, and this might also explain the high number of staff who have observed abuse. Very few cases of abuse were reported to home staff [27] or the APS [34]. We suggest that greater efforts to address institutional abuse through improved detection strategies such as whistle-blowing schemes are urgently needed.

Limitations
Measures for which validity and reliability had not been demonstrated may have had adequate properties that have not yet been tested. We accepted all types of validity including content validity. Even so, only seven studies met our criteria for a valid measure. We suggest that consensus on methods of validation for abuse and neglect scales as well as validation studies are needed. Carers were not asked about financial abuse, and may be less willing to report this type of abuse. Some studies sampled all people in narrowly defined populations and thus had samples representative of these target populations, while others recruited general population cohorts that were fairly representative but did not meet the stringent criteria of an 80% response rate. There are currently no measures of financial abuse or neglect with established psychometric properties and we have therefore not been able to report robust estimates for this.


   Conclusions
Top
 Abstract
 Introduction
 Objective
 Methods
 Results
 Discussion
 Conclusions
Key points
 Conflict of interest
 Funding
 Supplementary data
 References
 
More than 6% of the older general population, a quarter of vulnerable adults and a third of family carers report being involved in significant abuse, but only a small proportion of this is currently known to protective services. One in six professional carers reported committing abusive acts but over four-fifths observed it. Vulnerable elders and family and to a lesser extent professional carers are willing to report abuse and should be asked about it routinely. Valid, reliable measures as well as consensus on what constitutes an adequate standard for validity of abuse measures are needed.


   Key points
Top
 Abstract
 Introduction
 Objective
 Methods
 Results
 Discussion
 Conclusions
 Key points
Conflict of interest
 Funding
 Supplementary data
 References
 

  • More than 6% of the older general population, a quarter of vulnerable adults and a third of family carers report being involved in significant abuse.
  • Valid, reliable measures as well as consensus on what constitutes an adequate standard for validity of abuse measures are needed.
  • Only a small proportion of elder abuse is currently known to protective services. We suggest that routinely asking older people and their carers about abuse, and detection strategies in care homes including whistle-blowing could help improve reporting.


   Conflict of interest
Top
 Abstract
 Introduction
 Objective
 Methods
 Results
 Discussion
 Conclusions
 Key points
 Conflict of interest
Funding
 Supplementary data
 References
 
Two authors are also the authors of one of the reviewed papers. None of the authors have a financial conflict of interest.


   Funding
Top
 Abstract
 Introduction
 Objective
 Methods
 Results
 Discussion
 Conclusions
 Key points
 Conflict of interest
 Funding
Supplementary data
 References
 
Camden and Islington Mental Health and Social Care Trust funded article collection.


   Supplementary data
Top
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 Introduction
 Objective
 Methods
 Results
 Discussion
 Conclusions
 Key points
 Conflict of interest
 Funding
 Supplementary data
References
 
Supplementary data for this article is available online at http://ageing.oxfordjournals.org.


   Acknowledgements
 
Thanks to Stephanie Habermann, Monica Manela, and Peijing Su for helping us translate the papers, to Camden and Islington Mental Health and Social Care Trust, and to Scott Beach for providing additional information about his study.


   References
Top
 Abstract
 Introduction
 Objective
 Methods
 Results
 Discussion
 Conclusions
 Key points
 Conflict of interest
 Funding
 Supplementary data
 References
 

    (Due to the large number of references, only 40 are listed below and are represented by boldtype throughout the text. The full list can be found in the supplementary data online, on the journal website http://www.ageing.oxfordjournals.org as Appendix 2.)
  1. Lachs MS, Williams CS, O'Brien S, et al. The mortality of elder mistreatment. J Am Med Assoc (1998) 280:428–32.[Abstract/Free Full Text]
  2. Compton SA, Flanagan P, Gregg W. Elder abuse in people with dementia in Northern Ireland: prevalence and predictors in cases referred to a psychiatry of old age service. Int J Geriatr Psychiatry (1997) 12:632–5.[CrossRef][Web of Science][Medline]
  3. Department of Health. ’No Secrets’ Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. (2000).
  4. Boyle MH. Guidelines for evaluating prevalence studies. Evid Based Ment Health (1998) 1:37–9.[Free Full Text]
  5. Oh J, Kim HS, Martins D, et al. A study of elder abuse in Korea. Int J Nurs Stud (2006) 43:203–14.[CrossRef][Web of Science][Medline]
  6. Harris S. For better or worse:spouse abuse grown old. J Elder Abuse Negl (1996) 8:1–33.[Medline]
  7. Straus MA, Hamby SL, BoneyMcCoy S, et al. The revised Conflict Tactics Scales (CTS2) - Development and preliminary psychometric data. J Fam Issues (1996) 17:283–316.[CrossRef]
  8. Chokkanathan S, Lee AEY. Elder mistreatment in Urban India A community based study. J Elder Abuse Negl (2005) 17:45–61.[Medline]
  9. Ogg J, Bennett G. Elder abuse in Britain. Br Med J (1992) 305:998–9.[Free Full Text]
  10. Pillemer K, Finkelhor D. The prevalence of elder abuse–A random sample survey. Gerontologist (1988) 28:51–7.[Web of Science][Medline]
  11. Podkieks E. National survey on abuse of the elderly in Canada. J Elder Abuse Negl (1992) 4:5–58.
  12. Wetzels P, Greve W. Older people as victims of family violence. Results of a German victimization survey. Z Gerontol Geriatr (1996) 29:191–200.[Web of Science][Medline]
  13. Comijs HC, Pot AM, Smit JH, et al. Elder abuse in the community: Prevalence and consequences. J Am Geriatr Soc (1998) 46:885–8.[Web of Science][Medline]
  14. Kivela SL, Kongas-Saviaro P, Kesti E, et al. Abuse in old age: epidemiological data from Finland. J Elder Abuse Negl (1992) 4:1–18.[Medline]
  15. Wang JJ. Psychological abuse behavior exhibited by caregivers in the care of the elderly and correlated factors in long-term care facilities in Taiwan. J Nurs Res (2005) 13:271–80.[Medline]
  16. Beach SR, Schulz R, Williamson GM, et al. Risk factors for potentially harmful informal caregiver behavior. J Am Geriatr Soc (2005) 53:255–61.[CrossRef][Web of Science][Medline]
  17. Fulmer T, Paveza G, VandeWeerd C, et al. Dyadic vulnerability/risk profiling for elder neglect. Gerontologist (2005) 45:498.
  18. Wang JJ. Psychological abuse and its characteristic correlates among elderly Taiwanese. Arch Gerontol Geriatr (2006) 42:307–18.[CrossRef][Web of Science][Medline]
  19. Cooper C, Manela M, Katona C, et al. Screening for elder abuse in dementia in the LASER-AD study: prevalence, correlates and validation of instruments. Int J Geriatr Psychiatry (2007) In press.
  20. Pittaway E, Westhues A. The prevalence of elder abuse and neglect of older adults who accessed health and social services in London, Ontario, Canada. J Elder Abuse Negl (1993) 5:77–93.[Medline]
  21. Buri H, Daly JM, Hartz AJ, et al. Factors associated with self-reported elder mistreatment in Iowa's frailest elders. Res Aging (2006) 28:562–81.[Abstract/Free Full Text]
  22. Risco RC, Paniagua V, Jimenez M, et al. Prevalence and risk factors of suspicion abuse in elder population. Med Clin (2005) 125:51–5.
  23. Ruiz SA, Altet TJ, Porta MN, et al. Domestic violence: prevalence of suspected ill treatment of the elderly. Aten Primaria (2001) 27:331–4.[Medline]
  24. Paveza GJ, Cohen D, Eisdorfer C, et al. Severe family violence and Alzheimers-disease–prevalence and risk-factors. Gerontologist (1992) 32:493–7.[Abstract]
  25. Pot AM, Dyck R, Jonker C, et al. Verbal and physical aggression against demented elderly by informal caregivers in the Netherlands. Soc Psychiatry Psychiatr Epidemiol (1996) V31:156–62.[CrossRef][Web of Science][Medline]
  26. Pillemer K, Moore DW. Abuse of patients in nursing-homes—Findings from A survey of staff. Gerontologist (1989) 29:314–20.[Web of Science][Medline]
  27. Jogerst GJ, Daly JM, Dawson JD, et al. Iowa nursing home characteristics associated with reported abuse. J Am Med Dir Assoc (2006) 7:203–7.[CrossRef][Web of Science][Medline]
  28. Saveman BI, Astrom S, Bucht G, et al. Elder abuse in residential settings in Sweden. J Elder Abuse Negl (1999) 10:43–60.[Web of Science]
  29. Goergen T. Stress, conflict, elder abuse and neglect in German nursing homes: A pilot study among professional caregivers. J Elder Abuse Negl (2001) 13:1–26.
  30. Cooper C, Katona C, Finne-Soveri H, et al. Indicators of elder abuse: A cross-national comparison of psychiatric morbidity and other determinants in the Ad-HOC study. Am J Geriatr Psychiatry (2006) 14:489–97.[CrossRef][Web of Science][Medline]
  31. Shugarman LR, Fries BE, Wolf RS, et al. Identifying older people at risk of abuse during routine screening practices. J Am Geriatr Soc (2003) 51:24–31.[CrossRef][Web of Science][Medline]
  32. Morris JN, Fries BE, Steel K, et al. Comprehensive clinical assessment in community setting: Applicability of the MDS-HC. J Am Geriatr Soc (1997) 45:1017–24.[Web of Science][Medline]
  33. Fulmer T, Ramirez M, Fairchild S, et al. Prevalence of elder mistreatment as reported by social workers in a probability sample of adult day health care clients. J Elder Abuse Negl (1999) 11:25–36.[Web of Science]
  34. The National Center on Elder Abuse. The National Elder abuse incidence study. (1998) Report No.: Final.
  35. Tornstam L. Abuse of the elderly in Denmark and Sweden: results from a population study. J Elder Abuse Negl (1989) 1:35–44.
  36. Hirseh RD, Brendebach C. Violence against the aged within the family: results of studies by the "Bonner HsM (treating vs. mistreating Study. J Gerontol Geriatr (1999) 32:449–55.[CrossRef]
  37. Yan E, Tang CSK. Prevalence and psychological impact of Chinese elder abuse. J Interpers Violence (2001) 16:1158–74.[Abstract/Free Full Text]
  38. Yan EC, Tang CS. Elder abuse by caregivers: A study of prevalence and risk factors in Hong Kong Chinese families. J Fam Violence (2004) 19:269–77.[CrossRef][Web of Science]
  39. Ockleford E, Barnes-Holmes Y, Morichelli R, et al. Mistreatment of older women in three European countries - Estimated prevalence and service responses. Violence Against Women (2003) 9:1453–64.[Abstract]
Received 14 March 2007; accepted in revised form 24 September 2007.


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C. Cooper, A. Selwood, M. Blanchard, Z. Walker, R. Blizard, and G. Livingston
Abuse of people with dementia by family carers: representative cross sectional survey
BMJ, January 22, 2009; 338(jan22_2): b155 - b155.
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