Regular Research Articles
Indicators of Elder Abuse: A Crossnational Comparison of Psychiatric Morbidity and Other Determinants in the Ad-HOC Study

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Objective

The objective of this study was to determine crossnationally the prevalence of indicators of elder abuse and their relationship to putative risk factors, particularly depression, dementia, and lack of service provision

Method

Nearly 4,000 people aged 65+ receiving health or social community services in 11 European countries were interviewed using the minimum dataset homecare (MDS-HC) interview, which includes an abuse screen used previously in elder abuse studies and questions about demographic, physical, psychiatric, cognitive, and service factors

Results

One hundred seventy-nine (4.6%) people assessed had at least one indicator of abuse. The proportion screening positive increased with severity of cognitive impairment, presence of depression, delusions, pressure ulcers, actively resisting care, less informal care, expressed conflict with family or friends, or living in Italy or Germany, but not with having a known psychiatric diagnosis

Conclusion

Severity of cognitive impairment, depression, and delusions predicted screening positive for abuse in older adults, but having a known psychiatric diagnosis did not, indicating that screening for psychiatric morbidity might be rational strategies to combat elder abuse. People in Italy and Germany were most likely to screen positive for indicators of abuse, and the authors suggest that this might relate to higher levels of dependency in the participants looked after at home in these countries as a result of cultural and service provision differences.

Section snippets

Setting

The AdHOC (aged in home care) study took place in 11 European countries from 2001–2003. The study coordinator selected an area that they judged to be representative of their whole country. In seven countries (The Netherlands, Czech Republic, and the Nordic countries), this was the capital city. Elsewhere, the areas selected were Kent in the United Kingdom, Amiens in France, Monza in Italy, and Nurenberg and Bayreuth in Germany. Eligibility criteria for health and social services in the

RESULTS

In total, 3,881 people aged 65+ receiving health or social services were assessed, a response rate of 79.7%. Their mean age was 82, and 74.2% were female. Overall levels of psychiatric and cognitive morbidity are shown in Table 1. Table 2 gives the population, numbers assessed, and refusal rates for each country. Three hundred forty-seven (9%) people interviewed had a preexisting psychiatric diagnosis (excluding dementia), with the lowest proportion recorded in Italy. Five hundred seven (13.1%)

Elder Abuse Prevalence

This is the first crossnational study of indicators of elder abuse and the largest reported study of its prevalence and determinants. Approximately 5% of people screened positive for abuse, which is similar to the previous study of elder abuse using the MDS-HC,4 the first time that the same elder abuse assessment tool as a previous large study has been used to allow comparison, and with the overall rate of abuse found in a previous U.K. study.7 Together with the large sample size and robust

CONCLUSIONS

Approximately 5% of older people screened positive for abuse, and clinicians should be aware that it is more likely in people with depression, cognitive impairment, or delusions and ask about it. People with severe cognitive impairment are at greatest risk of physical abuse and people with moderate cognitive impairment of neglect. Improved detection of dementia and other psychologic morbidity would be rational strategies to combat elder abuse.

References (22)

  • House of Commons

    Health Select Committee Second Report, 2004

  • Abuse of Older Persons

    Recognising and Responding to Abuse of Older Persons in a Global Context. New York, United Nations, 2002

  • National Center on Elder Abuse

    National Elder Abuse Incidence Study

    (1998)
  • LR Shugarman et al.

    Identifying older people at risk of abuse during routine screening practices

    J Am Geriatr Soc

    (2003)
  • SL Kivela et al.

    Abuse in old age: epidemiological data from Finland

    J Elder Abuse Neglect

    (1992)
  • SE Kurrle et al.

    Elder abuse: prevalence, intervention and outcomes in patients referred to four aged care assessment teams

    Med J Aust

    (1997)
  • J Ogg et al.

    Elder abuse in Britain

    BMJ

    (1992)
  • CB Dyer et al.

    The high prevalence of depression and dementia in elder abuse or neglect

    J Am Geriatr Soc

    (2000)
  • K Pillimer et al.

    A model of abuse prevention

    J Gerontol

    (1993)
  • GI Carpenter et al.

    Community care in Europe: the Aged in Home Care project (AdHOC)

    Aging Clin Res

    (2004)
  • JN Morris et al.

    Comprehensive clinical assessment in community setting—applicability of the MDS-HC

    J Am Geriatr Soc

    (1997)
  • Cited by (0)

    The AdHOC study was funded by the EC Vth Framework Programme funding contract no. QLK6-2000-00002.

    The AdHOC project was conducted by Fellows of the interRAI collaboration. The authors thank all the participants and interviewers and the European Union Vth Framework Programme for funding this project.

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