The paper titled “A systematic review of psychosocial protective factors against suicide and suicidality among older adults” by Ki and colleagues is a thought-provoking review that emphasizes the importance of improving protective factors for the development of suicide prevention and intervention in older adults, rather than just focusing on risk factors. Since the coronavirus disease 2019 (COVID-19) pandemic, media coverage of mental health and suicide has gained widespread attention. Suicide may become a more pressing issue due to the enormous economic and social toll of the spreading epidemic. Therefore, this systematic review is relevant in preventing suicide among older adults in the “post-pandemic” periods of COVID-19.

In this study, the authors highlight the importance of examining the moderating or mediating role of protective factors in suicide, due to the fact that suicide prevention must take into account a variety of factors simultaneously. More importantly, most studies focused primarily on received support among interpersonal protective factors, neglecting the role of support given to others, which might be more beneficial for older adults’ well-being. The thought that ensues is what role will social support reciprocity play in specific risk factors and suicidal behavior.

Previous literature attempted to gain insight into financial abuse involving people with dementia by analysing court cases, but these studies were limited in sample size or scope. This study collected 214 court rulings directly related to the financial decisions of people with dementia to identify characteristics of the financial abuse victim, perpetrators and the types of assets. The models of bystander intervention and routine activity theory were used as conceptual models to guide analysis regarding the role of bank staff as well as the court's decision in cases of financial abuse. The majority of financial abuse perpetrators were family members (73.8%), as opposed to outsiders (19.2%). Transfer of real estate was the most common legal issue, and land was the most common financial asset involved. Difficult intra-family relationships seem to pose a great risk of financial abuse involving people with dementia since adult children were found to be the most likely perpetrators (52.7%) but also plaintiffs accusing financial abuse (57.6%). In accordance with the bystander intervention model, bank staff were more likely to be suspicious of financial abuse when an outsider was regarded as the perpetrator. In accordance with the routine activity theory model, the court was more likely to acknowledge the case as an invalid financial decision when an outsider was regarded as the perpetrator in financial abuse cases. Since people with dementia suffer from greater losses due to their family members, future policies should establish guidelines for front-line bank staff to identify warning signs to reduce the risk of financial abuse involving people with dementia, not only to prevent fraud by outsiders but also exploitation by family members.

The incidence of elder abuse has led to a growing trend of states taking various methods to regulate the use of electronic monitoring in institutional settings through programs, guidelines, regulations, and laws. This article attempts evaluate how the regulation of electronic monitoring has evolved and may be advanced in the future with the anticipated increase of elder abuse.

Elder abuse is a serious public health concern requiring immediate intervention; however, the under-reporting of elder abuse by victims to formal and informal networks remains a major obstacle. This scoping review aims to identify barriers to help seeking that older adults experiencing abuse confront. The goal is to inform public policies and practices in the Canadian context and identify research gaps in the extant literature. Seven scholarly databases were searched from which 12 articles met the inclusion criteria and were extracted for analysis. The findings from this scoping review revealed three levels at which barriers exist: individual focused, abuser/family focused, and community/culture focused barriers. The results suggest that there are several complex obstacles that older adults face when contemplating disclosure of abuse. Future research into help seeking in the Canadian context should more readily incorporate the voices of elder abuse victim-survivors to develop effective assessment strategies and responsive service provisions.

Elder abuse is prevalent, and victims have high rates of depression and low quality of life. We established an academic–community partnership to test the feasibility, acceptability, and impact of a brief psychotherapy for depression (PROTECT) among elder abuse victims with capacity to make decisions. Elder abuse service providers referred depressed (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) older victims (age ≥ 55 years) for potential pilot study participation. Forty eligible victims who consented were randomized to PROTECT psychotherapy (N = 25) or a Usual Care (N = 15) condition involving a community psychotherapy referral. Follow-up research assessments were conducted at 6 weeks (mid-treatment) and 9 weeks (end of treatment) after study initial assessment. We used mixed-effects regression models to examine treatment effects on depression severity and quality of life over time. Most victims (75%) reported two or more types of abuse. The a priori acceptability benchmark was met at the end of PROTECT therapy. All PROTECT participants initiated therapy; this engagement rate is greater than the a priori 75% standard set for feasibility. We found a significant reduction in depression severity (Montgomery–Åsberg Depression Rating Scale [MADRS]), with PROTECT leading to greater benefits compared to Usual Care. Both study groups had a similar improvement in quality of life. The pilot project results found that PROTECT psychotherapy is feasible, acceptable, and effective in reducing depression. With the support of our partnership, we found that PROTECT could be delivered alongside elder abuse services with victims willing to initiate therapy that leads to meaningful treatment effects.

This study uses constructivist grounded theory to explore older women's responses to the unexpected need to provide financial, emotional and residential support to their adult children who were experiencing problems with mental illness, substance abuse and/or absence of employment. Twenty-nine American women (>60) were interviewed:55 per cent were poor and half were women of colour. Using the theoretical model of intergenerational ambivalence, three types of structural ambivalence are discovered: mothers’ reactions to their adult children's behaviour that violate expectations for reciprocity; women's dismayed reactions to their adult children's aggressive behaviours towards themselves as their mothers; and the women's struggle regarding balancing their role as a mother to protect their adult children alongside their wish and identified needs for self-care. All of the conflicts were expressed within the frame of their role of mother. The internalised mandate to be ‘a good mother’ resulted in many experiencing shame, self-blame and guilt, and this self-blame was an obstacle to reaching out for help. This study adds to the growing body of feminist gerontological research and examines the ideological and structural variables that influence the predominance of female unpaid family care-givers in later life. The dilemma for older women with troubled adult children is both personal and political.

Although some studies have revealed practitioner disempowerment in cases of older adult mistreatment, this experience is poorly understood. In addition, dementia and contextual influences further complicate cases; yet,  little is known about the experience of practitioners with this complexity. This critical inquiry, based on Critical social theory, critical consciousness, and professional agency, aimed to address these gaps. Fifty-one practitioners from diverse health care and social service disciplines from rural and urban communities in Northeastern Ontario participated in interviews, journals, and focus groups. Analysis of data revealed the need for empowerment within a perpetual cycle of non-resolution, to refocus on legal clarity and intervention versus the current legal complexity and education focus, and to develop adequate infrastructure to support interprofessional efforts. The infusion of this knowledge into policy, practice, and research has great potential to improve outcomes for older adults with dementia who are mistreated in their homes.

This article investigates the implications of recent research findings that establish that older victims of crime are less likely to obtain procedural justice than other age groups. It explores original empirical data from the United Kingdom that finds evidence of a systemic failure amongst agencies to identify vulnerability in the older population and to put in place appropriate support mechanisms to allow older victims to participate fully in the justice system. The article discusses how the legally defined gateways to additional support, which are currently relied upon by many common law jurisdictions, disadvantage older victims and require reimagining. It argues that international protocols, especially the current European Union Directive on victims’ rights, are valuable guides in this process of re-conceptualisation. To reduce further the inequitable treatment of older victims, the article advocates for jurisdictions to introduce a presumption in favour of special assistance for older people participating in the justice system.

Introduction: This systematic scoping review aims to synthetize the available evidence on the epidemiology, risk factors, clinical characteristics, screening tools, prevention strategies, interventions and knowledge of health care providers regarding elder abuse in the emergency department (ED). Methods: A systematic literature search was performed using three databases (Medline, Embase and Cochrane Library). Grey literature was scrutinized. Studies were considered eligible when they were observational studies or randomized control trials reporting on elder abuse in the prehospital and/or ED setting. Data extraction was performed independently by two researchers and a qualitative approach was used to synthetize the findings. Results: A total of 443 citations were retrieved from which 58 studies published between 1988 and 2018 were finally included. Prevalence of elder abuse following an ED visit varied between 0.01% and 0.03%. Reporting of elder abuse to proper law authorities by ED physicians varied between 2% to 50% of suspected cases. The most common reported type of elder abuse detected was neglect followed by physical abuse. Female gender was the most consistent factor associated with elder abuse. Cognitive impairment, behavioral problems and psychiatric disorder of the patient or the caregiver were also associated with physical abuse and neglect as well as more frequent ED consultations. Several screening tools have been proposed, but ED-based validation is lacking. Literature on prehospital- or ED-initiated prevention and interventions was scarce without any controlled trial. Health care providers were poorly trained to detect and care for older adults who are suspected of being a victim of elder abuse. Conclusion: Elder abuse in the ED is an understudied topic. It remains underrecognized and underreported with ED prevalence rates lower than those in community-dwelling older adults. Health care providers reported lacking appropriate training and knowledge with regards to elder abuse. Dedicated ED studies are required.

Introduction: Elder abuse is infrequently detected in the emergency department (ED) and less than 2% are reported to proper law authorities by ED physicians. This study aims to examine the characteristics of community-dwelling older adults who screened positive for elder abuse during home care assessments and the epidemiology of ED visits by these patients relative to other home care patients. Methods: This study utilized a population-based retrospective cohort study of home care patients in Canada between April 1, 2007 and March 31, 2015. Standardized, comprehensive home care assessments were extracted from the Home Care Reporting System. A positive screen for elder abuse was defined as at least one these criteria: fearful of a caregiver; unusually poor hygiene; unexplained injuries; or neglected, abused, or mistreated. Home care assessments were linked to the National Ambulatory Care Reporting System in the regions and time periods in which population-based estimates could be obtained to identify all ED visits within 6 months of the home care assessment. Results: A total of 30,413 from the 2,401,492 patients (1.3%) screened positive for elder abuse during a home care assessment. They were more likely to be male (40.5% versus 35.3%, p < 0.001), to have a cognitive impairment (82.9% versus 65.3%, p < 0.001), a higher frailty index (0.27 versus 0.22, p < 0.001) and to exhibit more depressive symptoms (depression rating scale 1 or more: 68.7% versus 42.7%, p < 0.001). Patient who screened positive for elder abuse were less likely to be independent in activities of daily living (41.9% versus 52.7%, p < 0.001) and reported having fallen more frequently (44.2% versus 35.5%, p < 0.001). Caregiver expressing distress was associated with elder abuse (35.3% versus 18.3%, p < 0.001) but not a higher number of hours caring for the patient. Victims of elder abuse were more likely to attend the ED for low acuity conditions (Canadian triage and acuity scale (CTAS) 4 or 5). Diagnosis at discharge from ED were similar with the exception of acute intoxication that was more frequent in patients who are victims of abuse. Conclusion: Elder abuse is infrequently detected during home care assessments in community-dwelling older adults. Higher frailty index, cognitive impairment, depressive symptoms were associated with elder abuse during homecare assessments. Patients who are victims of elder abuse are attending EDs more frequently for low acuity conditions but ED diagnosis at discharge, except for acute intoxication, are similar.

Recent approaches in the care of older people have led to a greater emphasis on good practices to prevent elder abuse. The instruments assessing good practices are very limited, and those focused on elder abuse have rarely considered subtle forms, especially in institutional settings. The aim of this study was to develop and assess the content validity of a good practices scale for professionals working in nursing homes. An extensive literature review of the tools assessing professionals’ good–bad practices towards older people was conducted. A preliminary scale based on Kayser-Jones’ (1990) [Old, Alone and Neglected: Care of the Aged in Scotland and the United States. Berkeley, CA: University of California Press] types of abuse was developed, including four subscales: Personalization, Humanization, Absence of Infantilization, and Absence of Victimization. Content validity was analyzed through a panel of eight experts. Rovinelli and Hambleton’s index of item-objective congruence was used to analyze the items’ inclusiveness in the assigned subscale to establish their representativeness. Items’ relevance and clarity were analyzed using the paired comparison method. The final version of the scale included 56 items, with appropriate levels of item objective-congruence, relevance, and clarity. This instrument will allow professionals to detect and develop awareness and intervention programs that aim to promote good practices in nursing homes.

The objectives of this study were to replicate the analyses conducted by the creators of the Indicators of Abuse (IOA) Screen with a Spanish sample group and compare the results, to present new validity evidences, to analyze which items were more relevant in the detection of situations of risk of abuse, and to establish a cut-off point to interpret the obtained scores. The IOA was used by 46 professionals from social services teams who assessed the situation of 231 elderly individuals and their main caregivers. The obtained results advocated towards unidimensionality of the scale. It showed a high level of internal consistency (α = .94). The Confidence Interval of 99% for the alpha coefficient was between .92 and .95. The ordinal alpha coefficient reached the value of .98. The total score of the scale showed adequate temporal stability (r = .91; p ≤ .001; N = 163). Statistically significant differences (t-test) in the mean scores of most of the items were found between cases of adequate treatment and cases of risk of abuse. The scale classified correctly 93% of all cases. The best balance between sensitivity and specificity was found at the cut-off point given by score 16 (Sensitivity = 0.94, Specificity = 0.85). The results appear to confirm the validity evidence of the instrument when used with a Spanish population. However, it is necessary to conduct further research and confirm the results with wider, more representative sample groups.

Domestic Homicide Reviews (DHRs) are conducted when an individual aged 16 or over appears to have died from violence, abuse or neglect by a person to whom they are related or with whom they are in an intimate relationship or who is a member of the same household. DHRs aim to identify lessons to be learned, to improve service responses to domestic abuse and to contribute to prevention of domestic abuse/homicide. We submitted Freedom of Information requests to English Local Authorities to identify DHRs where victim, perpetrator or both were aged over 60. Collected Reports and/or Executive Summaries were thematically analysed. Analysis identified four key themes in the context of the key relationship and caring: major mental illness of the perpetrator; drug and/or alcohol abuse; financial issues; and a history of domestic abuse in key or family relationships. We analysed 14 adult family homicides, 16 intimate partner homicides and five homicide–suicides. Age per se did not emerge as a significant factor in our analysis. Terminology needs to be standardised, and training/education regarding risk assessment needs to be improved in relation to age, myths around ageing/dementia and stresses of caring. Management of mental illness is a key factor. A central repository of DHR Reports accessible for research and subject to regular review would contribute to maximising learning and improving practice.

India is home to one out of every 10 senior citizens of the world. According to the 2011 Census, 8.6% of people are aged above 60 years. A number of cases of elder abuse have been reported in the mass media as these people are easy victims of violence and criminal activities. Society comes to know about only those problems which are reported. Innumerable cases of disrespect and neglect are not given any consideration. The situation becomes even worse when perpetrators are very near relatives and in some cases blood relatives also. To overcome the problem a law, the “Maintenance and Welfare of Parents and Senior Citizens Act”, was passed in 2007. Based on primary data, the present paper will attempt to study the problems of the elderly with focus on gender, their abuse and victimization. The paper concludes that the majority of elders, especially those with little or no source of income, reside with their families and face abuse and victimization. Those who have a regular source of income face less abuse. To maintain confidentiality of family matters, elderly persons often do not report such crimes and undergo trauma.