The psychological health consequences of elder abuse and neglect in sheltered homes

Background Psychological health effects of elder abuse and neglect in sheltered homes are unknown. Objectives:The objective of the present study was to determine if several types of elder abuse were related to an increased likelihood of negative psychological health. Methods Data were derived from the elder mistreatment in sheltered homes project, a cross-sectional study conducted in 2018 that included 446 older adults living in 43 sheltered homes.A face-to-face interview was carried out to complete structured questionnaires for participants to assess the psychological health effects of different subtypes of elder abuse. Results All subtypes of elder abuse were significantly associated with increased prevalence rates of depressive symptoms and sleep problems. Similarly, all subtypes except physical abuse were associated with higher rates of anxiety symptoms. In multivariate regression analysis, Older adults who reported physical mistreatment were three times more likely to experience suicidal ideation(OR=3.28, 95% CI=1.14 to 9.44), while no other subtypes were significantly associated with suicidal ideation.Older adults who report at least one type of abuse were eight times more likely to have depressive symptoms (OR=7.99, 95% CI=4.43 to 14.41), twice as likely to screen positive for anxiety symptoms(OR=2.05, 95% CI=1.20 to 3.49), three times more likely to have sleep problems (OR=3.20, 95% (CI=1.78 to 5.75). All subtypes of abuse were significantly associated with the presence of depressive symptoms, sleep problems, and anxiety symptoms except physical mistreatment. Conclusion Abuse is common among older adults living in sheltered homes and is associated with negative impacts on psychological health.

Investigating Elder Abuse and Neglect in Diverse Refugee Communities in Greensboro, NC

Elder abuse and neglect (EAN) comprises multiple dimensions, is experienced by about 10% of older adults in the U.S in diverse communities, and is severely detrimental to older adults’ (OA) health and wellbeing. However, documentation of EAN among refugee OA is greatly lacking as are services for these communities. Refugee OA are overall underserved members of marginalized communities. This paper reports on a community-engaged study to collect information and raise awareness of EAN among OA in 2 North Carolina refugee communities - Nepali-speaking Bhutanese and Congolese. Research partners included University researchers and community refugee-serving organizations. Surveys and focus group interviews were conducted. 17 Nepali-speaking Bhutanese and 13 Congolese filled out survey questions, including the Elder Abuse Suspicion Index. They participated in focus group discussions (FGDs), separately for men and women of each community. Survey results indicated EAN more among Congolese than Nepali-speaking Bhutanese. FGD results showed both communities prefer to depend on family members, and experience difficulties with language, transportation, and economic insecurity. No EAN was reported in the FGDs. In line with principles of community-engaged approaches, a capacity-building event to increase awareness of EAN was held, attended by 25 persons from the two communities. This study adds documentation on an under-researched area and marginalized communities. Action recommendations include disseminating culturally appropriate EAN information, strengthening English language and job skills and transportation options, encouraging cooperation across state, nonprofit, educational, and service organizations to address needs of older refugee adults.

Elder abuse and neglect in nursing homes as a reciprocal process: the view from the perspective of care workers

Purpose Reciprocal abuse inside care practices remain under-studied due to their invisibility and further research is required. The purpose of this paper is to explore different levels of conflicts inside organisations. Design/methodology/approach The paper is based on a self-administered questionnaire filled out by care workers (n = 150), in 16 Portuguese care homes. Findings Results indicated that, overall, 54.7% of care workers had observed abuse, in their daily practice, in the preceding 12 months: 48.7% psychological; 36.0% neglectful care practices; 14.0% physical and 3.3% financial abuse. The figures decreased significantly as regards abuse committed themselves, with 16.7% of those admitting to having committed at least one of these behaviours. The highest figures were also recorded for psychological abuse (13.3%) and neglect (6.7%). However, there is a statistically significant relationship between abuse committed by care workers and abuse committed by residents. Overall, 52.0% of care workers reported having been the target of at least one such behaviour by residents. Research limitations/implications This paper has its limitations as the sample consisted of only 16 nursing homes (12 not-for-profit and 4 for-profit nursing homes). The fact that only 4 of the 16 LTC homes were for-profit is a potential limitation both in general and in particular because research has shown that lower quality of care and elder abuse and neglect are more common in for-profit nursing homes at least in Portugal. The results were also based on self-reported measures. Practical implications A reactive behaviour, the risk of retaliation, after a complaint, the difficulty in dealing with dementia and the residents' aggressive behaviour, an absence of a training and support policy in an environment where difficult working conditions prevail, are factors enhancing a reciprocal process of abuse. The analysis followed by a discussion of potential implications to prevent institutional elder abuse and neglect, based on communication and social recognition, including better working conditions and training, and a cooperative work environment. Social implications Conflict is much more than reducing an interpersonal relationship problem between residents and staff (care workers, professional staff, managers) and extending to the whole organisation. Therefore, there are still uncertainties on how organisations, staff and residents interact between themselves, and affect care practises. Originality/value Reciprocal abuse in nursing homes is an important area of research and this paper enabled a discussion of potential implications concerning the quality of care, which required the identification of levels of conflict, in an organisational system, including interactions, the context where care is provided, difficult working conditions, lack of training and levels of support. All these factors are important when considering elder abuse and neglect and this calls for special attention by policymakers and researchers.

189Mobilizing for change through UM PEACE (Prevent Elder Abuse and negleCt initiativE) Program

Focus of Presentation Elder abuse and neglect (EAN) includes psychological, physical, sexual abuse, neglect, and financial exploitation. Malaysia – projected to become an aged nation by 2030 – is not spared. PEACE focuses on protecting elder rights, empowering the community to be actively engaged in elderly issues, and refining the Malaysian law to address existing gaps. Findings Our cohort study revealed that the overall lifetime prevalence of EAN (abuse episodes ever experienced from the age 60) was 8.1% with 4.8%, 3.4%, 1.2%, 0.3% and 1.1% for financial abuse, psychological abuse, physical abuse, sexual abuse and neglect respectively. Perpetrators tend to be family members (adult children) and abuse usually occurs at home. Premature mortality are shown higher among victims. From the legal perspective, the only existing act addressing family violence is the Domestic Violence Act (DVA 1994) and Penal Code. The DVA is neither adequate nor specific to EAN and dynamics of elder abuse. Our findings were presented to the relevant stakeholders including the Deputy Prime Minister of Malaysia. Using four main approaches - making findings understandable to policymakers, increasing opportunities for interaction, addressing barriers and ensuring research is relevant allows better communication between researchers and policy makers and ensuring evidence are translated to policy. PEACE are working on drafting the new Elder Act which will be ready by 2021. Conclusions/Implications The PEACE program is an example of how a complex health problem should be addressed. Better communication strategies and multiple interactions between policy makers and PEACE researchers is key to our impactful research. Key messages Dissemination approaches should be timely and consistent with culture to translate research evidence to policy. Protecting the well-being and dignity of our elders is not only a question of conscience or morality, but also a matter of upholding human rights and justice.