Elder Abuse Prevalence in Community Settings a Systematic Review and Meta-analysis
Summary
Groundwork
Elder abuse is recognised worldwide equally a serious problem, notwithstanding quantitative syntheses of prevalence studies are rare. We aimed to quantify and sympathize prevalence variation at the global and regional levels.
Methods
For this systematic review and meta-analysis, we searched 14 databases, including PubMed, PsycINFO, CINAHL, EMBASE, and MEDLINE, using a comprehensive search strategy to identify elder abuse prevalence studies in the customs published from inception to June 26, 2015. Studies reporting estimates of past-year abuse prevalence in adults anile 60 years or older were included in the analyses. Subgroup analysis and meta-regression were used to explore heterogeneity, with study quality assessed with the adventure of bias tool. The written report protocol has been registered with PROSPERO, number CRD42015029197.
Findings
Of the 38 544 studies initially identified, 52 were eligible for inclusion. These studies were geographically various (28 countries). The pooled prevalence charge per unit for overall elder corruption was 15·7% (95% CI 12·8–nineteen·3). The pooled prevalence estimate was 11·half-dozen% (viii·1–16·3) for psychological corruption, 6·8% (v·0–ix·2) for financial abuse, iv·ii% (ii·1–8·1) for neglect, ii·half-dozen% (1·6–4·4) for physical abuse, and 0·9% (0·6–1·4) for sexual abuse. Meta-assay of studies that included overall abuse revealed heterogeneity. Pregnant associations were found betwixt overall prevalence estimates and sample size, income classification, and method of data drove, merely non with gender.
Estimation
Although robust prevalence studies are thin in low-income and centre-income countries, elder abuse seems to bear on i in six older adults worldwide, which is roughly 141 1000000 people. Nonetheless, elder abuse is a neglected global public wellness priority, especially compared with other types of violence.
Funding
Social Sciences and Humanities Research Council of Canada and the WHO Department of Ageing and Life Grade.
Introduction
Elder abuse is a serious human being rights violation that requires urgent activity.
It is too a major public health trouble that results in serious health consequences for the victims, including increased risk of morbidity, mortality, institutionalisation, and hospital admission, and has a negative issue on families and lodge at big.
,
,
Despite the severity of its consequences, major gaps remain in estimating the prevalence of elder abuse.
Agreement the magnitude of elder abuse is a crucial beginning step in the public health approach to forbid this blazon of violence.
However, the lack of consensus in defining and measuring elderberry abuse and its major subtypes (psychological, physical, sexual, and financial abuse and neglect) have resulted in broad variations in reported prevalence rates. For example, national estimates of past-yr abuse prevalence rate ranged between ii·6% in the Great britain
and 4% in Canada
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to 18·four% in State of israel
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and 29·iii% in Spain.
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To engagement, only a handful of studies accept synthesised results of elder corruption prevalence studies, and few accept done so quantitatively. Cooper and colleagues'
global approximate is ane in 17, or 6%, in the past calendar month. This judge was based on individual studies selected as best evidence. Dong'south systematic review
ranged from 2·2% to 79·7% and covered five continents, with large geographic variations that might stem from cultural, social, or methodological differences. Given the large number of prevalence studies published over the past decade and the absence of global quantitative estimates of the prevalence of elderberry abuse, we believed it was an opportune time for a full systematic review and quantitative assay of elderberry abuse prevalence.
To address the need for more accurate global and regional estimates of elderberry abuse prevalence, we did a systematic review and meta-analysis of existing elder abuse prevalence studies from around the world. We aimed to sympathize the wide variations in prevalence estimates past investigating the influence of studies' demographic and methodological characteristics.
Methods
Search strategy and option criteria
In this systematic review and meta-analysis, we used a comprehensive 4-pace search strategy to place relevant studies. No language restrictions were placed on the searches or search results. The study conforms to the Preferred Reporting Items for Systematic reviews and Meta-Assay (PRISMA) guidelines. A detailed description of the method has been previously reported and is bachelor upon request.
12
Yon Y, Mikton CR, Gassoumis ZD, Wilber KH. A inquiry protocol to guide the systematic review and meta-analysis of elderberry abuse prevalence studies. Can J Aging (in press).
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The research is part of a larger systematic review; withal, the nowadays study focused on self-reported prevalence studies on elderberry abuse inside community settings. Forthcoming publications will focus on prevalence of abuse in institutional settings as well equally studies using service-based data.
Research in context
Bear witness before this study
We did a thorough search of the scientific literature before initiating this report to detect any existing systematic reviews or prevalence studies; furthermore, we used the systematic review done for this study, as detailed above, to ensure that no studies had been missed. Although no meta-analyses existed before this study, 1 systematic review emerged in the scientific literature later the initiation of this study that found a global aggregate elderberry corruption prevalence charge per unit of fourteen·3% (95% CI 7·six–21·1).
Added value of this report
Our report is the first of its kind to use meta-analysis to quantify prevalence estimates derived from a comprehensive search strategy that included additional search for studies that are non normally plant in bookish sources.
Implications of all the bachelor bear witness
The famine of elder abuse prevalence studies from low-income and middle-income countries and from southeast Asia and Africa, despite our comprehensive search strategy, suggests a need for farther research to meliorate sympathise elder corruption in these areas of the world. Even so, high rates of abuse globally suggest that increased attention to the issue of elderberry abuse is warranted, including investment in development and assessment of elder abuse interventions to help reduce the spread and effect of elder corruption.
First, we searched the post-obit 14 academic databases from inception to June 26, 2015: PubMed, PsycINFO, CINAHL, EMBASE, MEDLINE, Sociological Abstracts, ERIC, AgeLine, Social Piece of work Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, ProQuest Criminal Justice, ASSIA, Dissertations & Theses Full Text, and Dissertations & Theses Global. A search strategy was developed for each database with a combination of free text and controlled vocabulary (ie, MeSH terms). Additional search terms were included in consultation with an data specialist (librarian) who has extensive experience in systematic reviews. Some of the search terms include: "older adults", "frail elderly", "anile", "elderly", "seniors", "elder abuse", "elderberry neglect", "elder mistreatment", "elder maltreatment", "domestic violence", "intimate partner violence", "abuse", "violence", "aggression", "crimes", "harmful behaviour", "anger", "rape", "hostility", "conflict", "verbal abuse", "physical corruption", "sexual abuse", "emotional abuse", "prevalence", "incidence", "morbidity", and "epidemiology". See appendix for the total search strategy.
2nd, reference lists of publications retrieved in the first pace were screened for relevant studies. Third, we searched additional spider web-based platforms including specialised journals, Google searches for grayness literature, and WHO Global Health Library for scientific literature published in developing countries. Finally, later on all the screening and reviewing of studies had been completed, we consulted 26 experts in the field by email, representing each of the six WHO regions (ie, African, Americas, South-Due east Asia, Europen, Eastern Mediterranean, and Western Pacific) to provide farther review to place any studies that were missing upward to Dec 18, 2015.
Articles were independently screened in two stages: screening of titles and abstracts followed by the retrieval and screening of full-text manufactures by 2 reviewers using the eligibility criteria described below. If several publications reported on a single study, the publication that provided the almost data was selected for further synthesis. Inter-rater reliability was analysed using the Statistical Package for Social Sciences (SPPS Statistics 21). This analysis showed high levels of understanding between the reviews (κ 0·86–0·96). Disagreements were resolved through give-and-take, or with the help of a third reviewer.
Inclusion criteria were community-based samples that provided estimates of abuse prevalence at a national or subnational level (eg, states or provinces, counties, districts, and large cities [except in the United states of america, where states are the smallest unit of measurement, due to a large number of prevalence studies]) and inclusion of participants that were aged 60 years and older, in line with the Un definition of older people.
Nosotros excluded studies that were reviews, conference proceedings, or used qualitative methods simply; studies that focused exclusively on self-fail or homicide; and studies that concentrated only on institutional abuse or on specific subpopulations.
Information extraction and quality assessment
Data were extracted past two reviewers (YY, CRM): YY extracted data from the publications and CRM cross-checked for accuracy. Three main categories of data were extracted: characteristics of the samples, methodological characteristics of each study, and prevalence estimates of elder abuse and its subtypes. The data extraction tables were pilot tested and refined before extraction. The report quality was assessed as part of the data extraction strategy past two reviewers with the standardised Risk of Bias Tool (panel i)
designed to assess population-based prevalence studies. To assess the gamble of bias, reviewers rated each of the ten items into dichotomous ratings: depression risk and high risk. An overall score was calculated by adding all the items rated as low risk. Thus, higher scores indicated lower hazard of bias and stronger method quality.
Panel 1
Risk of Bias Tool: criteria for assessment of quality
External validity (maximum score=4)
- 1
Was the study's target population a close representation of the national population (subnational or urban center) in relation to relevant variables such as historic period, sex, occupation? (Aye: low hazard=ane point; no: high risk=0 points)
- 2
Was the sampling frame a true or shut representation of the target population? (Yes: depression risk=ane bespeak; no: high risk=0 points)
- 3
Was some form of random option used to select the sample, or was a census undertaken? (Yes: low risk=ane point; no: high hazard=0 points)
- 4
Was the likelihood of non-response bias minimal? (Yes: low risk=1 signal; no: loftier run a risk=0 points)
Internal validity (maximum score=6)
- 1
Were data nerveless directly from the subjects (as opposed to a proxy)? (Yeah: depression risk=one betoken; no: loftier risk=0 points)
- two
Was an acceptable case definition used in the study? (Yes: low risk=one point; no: high risk=0 points)
- 3
Was the written report instrument that measured the parameter of interest shown to have reliability and validity (if necessary)? (Yeah: low risk=1 signal; no: loftier hazard=0 points)
- four
Was the same mode of data collection used for all subjects? (Yes: depression risk=1 point; no: high risk=0 points)
- five
Was the length of the shortest prevalence period for the parameter of involvement appropriate? (Yes: low risk=1 signal; no: high risk=0 points)
- 6
Were the numerator(s) and denominator(s) for the parameter of involvement advisable? (Yep: low take chances=one point; no: high risk=0 points)
Data assay
Meta-analysis was done to synthesise the prevalence judge for elderberry abuse and its subtypes. The decision to do a meta-analysis was fabricated a posteriori to ensure that sufficient studies with similar characteristics (eg, same prevalence menstruum population) were available for meta-analysis. Prevalence rates were calculated from raw proportions or percentages reported in the selected studies. The investigators were contacted for those studies in which raw data were missing or unclear. All analyses were done using Comprehensive Meta-Analysis software (CMA version 3.ix).
Variances of raw proportions or percentages were pooled based on a random-effects model.
We calculated the pooled estimates and the 95% CIs in studies and considered not-overlapping CIs as an indication of statistically pregnant differences. To determine the extent of variation betwixt the studies, we did heterogeneity tests with Higgins' I 2 statistic to measure out the proportion of the observed variance that reflects true effect sizes.
We followed Duval and Tweedie'south Trim and Fill method to visually inspect the funnel plots and appraise both the degree of publication bias and its effect on the study findings.
,
We used their method of removing extreme outliers (ie, modest studies) from the funnel plot and re-computing the effect size to right for publication bias.
Subgroup analyses were done to investigate the sources of heterogeneity, using bivariate comparisons and meta-regression. These analyses tested individual associations between the pooled estimates and several covariates: WHO regions (recoded every bit Americas, Asia, Europe, and others); income classification of each country (according to the World Bank classification, recoded into loftier vs middle-income and depression-income countries); method of data collection (face-to-face vs all others); sampling procedure (random vs convenience sampling); research quality (recorded equally good vs off-white-to-poor); and sample size (coded every bit high, medium, and depression tertiles, using the 33rd and 67th percentile scores). Significant and relevant covariates were entered into a multivariate meta-regression model. This study is registered with PROSPERO, number CRD42015029197.
Part of the funding source
The Social Sciences and Humanities Research Quango of Canada (SSHRC) funded the corresponding writer'south time spent on this projection and the WHO Section of Ageing and Life Grade funded boosted data extraction efforts. Neither the SSHRC nor the WHO Department of Ageing and Life Form had whatsoever role in study design, data collection, data analysis, data interpretation, or writing of the report. The respective author had full access to all the information in the written report and had final responsibility for the determination to submit for publication.
Results
Of the 38 544 studies, 415 potentially relevant total-text manufactures were independently reviewed. From these, we identified 234 studies that provided data on abuse prevalence. Amidst these, seven studies examined elder corruption prevalence in people with dementia, xiv provided prevalence information for whatever corruption that had occurred since the victims became older adults (ie, aged sixty or 65 years and older), ten focused on subpopulations (eg, older women and ethnic minorities), 32 were incidence-based and service-based, 84 did non study the prevalence period or provided prevalence periods ranging from the by month to the past 5 years, and 35 were duplicates in that they used the aforementioned datasets as other studies (figure 1). To avoid bias in data synthesis, we grouped studies with the aforementioned prevalence menses for meta-analysis. After excluding ineligible studies, 52 studies provided past-year prevalence information for corruption and were thus included in the meta-assay. Panel 2 summarises the key outcome measures based on the definitions provided past WHO
and the U.s. Centers for Illness Control and Prevention.
Panel 2
Fundamental characteristics of participants and event measures of interest
Type of violence and definition
- •
Overall abuse (44 studies, 59 203 participants): "a single, or repeated act, or lack of appropriate action, occurring within whatever relationship where there is an expectation of trust which causes harm or distress to an older person".
Overall abuse might consist of whatsoever combination of abuse subtypes defined past the U.s. Centers for Disease Control and Prevention,
below:
- •
Physical abuse (46 studies, 64 946 participants): when an older person is injured as a consequence of hitting, boot, pushing, slapping, burning, or other prove of strength
- •
Sexual corruption (xv studies, 43 332 participants): involves forcing an older person to take part in a sexual human action when the elder does not or cannot consent
- •
Psychological or emotional abuse (44 studies, sixty 192 participants): behaviours that harm an older person's cocky-worth or wellbeing. Examples include name calling, scaring, embarrassing, destroying property, or not letting the elder run across friends and family unit
- •
Fiscal abuse (40 studies, 45 915 participants): illegally misusing an older person's money, property, or avails
- •
Neglect (28 studies, 39 515 participants): failure to meet an older person'due south basic needs. These needs include food, housing, article of clothing, and medical care
The 52 studies selected for meta-analysis were geographically various and included 28 countries, with five studies from the WHO region of the western Pacific, five from the southeast Asia region, 15 from the region of the Americas, 25 from the European region, and two from the eastern Mediterranean region. Studies as well came from countries across the Globe Bank income classification: five studies from lower-center-income countries, xiii from upper-eye-income countries, and 34 from high-income countries. Moreover, twoscore studies were based on random samples and the remaining 12 were convenience samples. Most studies (38) used face-to-face interviews to collect data, eight studies used self-administered questionnaires, and half dozen used telephone interviews. The quality of each study was assessed. A maximum quality score of 10 was achieved in xvi of the 52 studies; 35 studies were scored as skilful quality and 17 studies were scored every bit fair-to-poor (tabular array 1).
Table 1 Characteristics of prevalence studies included in meta-analysis for overall elder abuse
| Country | WHO region | Age (years) | Events | Total sample size | Event rate | Income classification | Method of information collection | Sampling procedure | Enquiry quality | |
|---|---|---|---|---|---|---|---|---|---|---|
| Podnieks, 1992 | Canada | Region of the Americas | ≥sixty | eighty | 2008 | four·0% | High income | Phone interview | Random sampling | Expert |
| Pitsiou-Darrough and Spinellis, 1995 | Hellenic republic | European region | ≥60 | 83 | 506 | 16·iv% | Loftier income | Face-to-face interview | Random sampling | Adept |
| Comijs et al, 1998 | Netherlands | European region | ≥65 | 101 | 1797 | v·half-dozen% | High income | Face-to-face interview | Random sampling | Practiced |
| Yan and Chang, 2001 | Hong Kong, Cathay | Western Pacific region | ≥threescore | 76 | 355 | 21·four% | High income | Self-administered | Convenience sampling | Fair-to-poor |
| Kim and Sung, 2001 | Republic of korea | Western Pacific region | ≥threescore | 31 | 144 | 21·v% | High income | Telephone interview | Random sampling | Good |
| Chokkanathan and Lee, 2005 | India | Southeast Asia region | ≥65 | 56 | 400 | 14·0% | Lower centre income | Contiguous interview | Random sampling | Good |
| Keskinoglu et al, 2007 | Turkey | European region | ≥65 | Due north/A | N/A | North/A | Upper middle income | Face-to-face interview | Random sampling | Good |
| Ogioni et al, 2007 | Italian republic | European region | ≥65 | 462 | 4630 | 10·0% | High income | Face-to-face up interview | Convenience sampling | Fair-to-poor |
| Gomez Ricardez et al, 2007 | Mexico | Region of the Americas | ≥sixty | 87 | 1078 | eight·1% | Upper centre income | Self-administered | Random sampling | Fair-to-poor |
| Yaffe et al, 2007 | Canada | Region of the Americas | ≥65 | 113 | 858 | thirteen·ii% | High income | Contiguous interview | Convenience sampling | Off-white-to-poor |
| Marmolejo, 2008 | Espana | European region | ≥65 | 19 | 2401 | 0·8% | High income | Face up-to-face interview | Random sampling | Off-white-to-poor |
| Lowenstein et al, 2009 | State of israel | European region | ≥65 | 191 | 1045 | 18·three% | High income | Face up-to-confront interview | Random sampling | Good |
| Ajduković et al, 2009 | Croatia | European region | ≥65 | 188 | 303 | 62·0% | Loftier income | Face-to-face interview | Convenience sampling | Fair-to-poor |
| Biggs et al, 2009 | UK | European region | ≥66 | 55 | 2111 | two·6% | Loftier income | Contiguous interview | Random sampling | Good |
| Garre-Olmo et al, 2009 | Spain | European region | ≥75 | 197 | 672 | 29·3% | High income | Contiguous interview | Random sampling | Good |
| Acierno et al, 2010 | USA | Region of the Americas | ≥threescore | 659 | 5777 | xi·4% | High income | Telephone interview | Random sampling | Good |
| Apratto Júnior, 2010 | Brazil | Region of the Americas | ≥60 | Due north/A | N/A | N/A | Upper middle income | Face-to-confront interview | Convenience sampling | Fair-to-poor |
| Chompunud et al, 2010 | Thailand | Southeast Asia region | ≥60 | 34 | 233 | fourteen·6% | Upper middle income | Face-to-face interview | Convenience sampling | Good |
| Görgen et al, 2010 | Germany | European region | ≥60 | 773 | 3023 | 25·6% | High income | Face up-to-face interview | Random sampling | Proficient |
| Su, Hao, Xiong, et al, 2011 | China | Western Pacific region | ≥60 | 281 | 975 | 28·8% | Upper middle income | Face-to-face interview | Convenience sampling | Fair-to-poor |
| Amstadter et al, 2011 | USA | Region of the Americas | ≥lx | North/A | N/A | N/A | High income | Telephone interview | Random sampling | Good |
| Perez-Rojo et al, 2011 | Spain | Region of the Americas | ≥lx | 11 | 1207 | 0·ix% | High income | Face up-to-face interview | Random sampling | Proficient |
| Abdel Rahman and El Gaafary, 2012 | Arab republic of egypt | Eastern Mediterranean region | ≥60 | 483 | 1106 | 43·7% | Lower middle income | Face-to-face interview | Convenience sampling | Skillful |
| Cevirme et al, 2012 | Turkey | European region | ≥60 | 129 | 452 | 28·5% | Upper middle income | Face up-to-face interview | Convenience sampling | Fair-to-poor |
| Ergin et al, 2012 | Turkey | European region | ≥65 | 107 | 756 | xiv·2% | Upper middle income | Contiguous interview | Random sampling | Skilful |
| Olofsson et al, 2012 | Sweden | European region | 65–85 | N/A | N/A | N/A | Loftier income | Cocky-administered | Random sampling | Fair-to-poor |
| Wu et al, 2012 | China | Western Pacific region | ≥60 | 724 | 2000 | 36·two% | Loftier income | Face-to-face interview | Random sampling | Adept |
| Yan and Chan, 2012 | Hong Kong | Western Pacific region | ≥sixty | N/A | N/A | N/A | Loftier income | Face-to-face interview | Random sampling | Expert |
| Naughton et al, 2012 | Ireland | European region | ≥65 | 44 | 2021 | ii·2% | High income | Contiguous interview | Random sampling | Skilful |
| HelpAge India, 2012 | India | Southeast Asia region | ≥60 | 1552 | 6748 | 23·0% | Lower heart income | Contiguous interview | Random sampling | Off-white-to-poor |
| Afifi et al, 2012 | United states | Region of the Americas | ≥65 | N/A | N/A | Due north/A | Loftier income | Face-to-face interview | Random sampling | Adept |
| Giraldo-Rodriguez and Rosas-Carrasco, 2013 | Mexico | Region of the Americas | ≥60 | 63 | 613 | 10·3% | Upper middle income | Face-to-face interview | Random sampling | Good |
| Perez-Rojo et al, 2013 | Kingdom of spain | European region | ≥60 | 41 | 340 | 12·1% | High income | Cocky-administered | Convenience sampling | Fair-to-poor |
| Alizadeh-Khoei et al, 2014 | Iran | Eastern Mediterranean Region | ≥sixty | 44 | 300 | 14·7% | Upper centre income | Face-to-face interview | Random sampling | Proficient |
| Chokkanathan, 2014 | Bharat | Southeast Asia region | ≥61 | 187 | 897 | 20·8% | Lower heart income | Contiguous interview | Random sampling | Expert |
| Cannell et al, 2014 | USA | Region of the Americas | ≥60 | N/A | N/A | N/A | High income | Telephone interview | Random sampling | Good |
| Peterson et al, 2014 | United states | Region of the Americas | ≥threescore | N/A | N/A | Due north/A | High income | Telephone interview | Random sampling | Skillful |
| Préville et al, 2014 | Canada | Region of the Americas | ≥65 | 282 | 1765 | 16·0% | Loftier income | Face-to-face interview | Convenience sampling | Off-white-to-poor |
| Martins et al, 2014 | Portugal | European region | ≥65 | 32 | 135 | 23·7% | High income | Self-administered | Convenience sampling | Off-white-to-poor |
| Peshevska et al, 2014 | Macedonia | European region | ≥65 | 307 | 960 | 32·0% | Upper heart income | Face up-to-face interview | Random sampling | Good |
| Fraga et al, 2014—Federal republic of germany | Germany | European region | ≥60 | 197 | 648 | 30·four% | High income | Self-administered | Random sampling | Good |
| Fraga et al, 2014—Hellenic republic | Greece | European region | ≥lx | 100 | 643 | 15·6% | Loftier income | Face-to-face interview | Random sampling | Good |
| Fraga et al, 2014—Italy | Italy | European region | ≥60 | 80 | 628 | 12·7% | Loftier income | Face-to-face up interview | Random sampling | Skillful |
| Fraga et al, 2014—Lithuania | Lithuania | European region | ≥threescore | 165 | 630 | 26·2% | High income | Face-to-face interview | Random sampling | Skilful |
| Fraga et al, 2014—Portugal | Portugal | European region | ≥60 | 181 | 656 | 27·6% | High income | Contiguous interview | Random sampling | Practiced |
| Fraga et al, 2014—Spain | Spain | European region | ≥60 | 92 | 636 | xiv·v% | Loftier income | Contiguous interview | Random sampling | Good |
| Fraga et al, 2014—Sweden | Sweden | European region | ≥60 | 193 | 626 | 30·viii% | Loftier income | Cocky-administered | Random sampling | Good |
| Sooryanarayana et al, 2015 | Malaysia | Southeast Asia region | ≥60 | 28 | 291 | nine·6% | Upper middle income | Face-to-face interview | Convenience sampling | Fair-to-poor |
| Gil et al, 2015 | Portugal | European region | ≥60 | 138 | 1123 | 12·iii% | High income | Contiguous interview | Random sampling | Good |
| Silva-Fhon et al, 2015 | Republic of peru | Region of the Americas | ≥65 | 294 | 369 | 79·7% | Lower centre income | Confront-to-face interview | Random sampling | Fair-to-poor |
| Cano et al, 2015 | Colombia | Region of the Americas | ≥60 | 192 | 4248 | four·5% | Upper middle income | Confront-to-face interview | Random sampling | Fair-to-poor |
| Giraldo-Rodriguez et al, 2015 | Mexico | Region of the Americas | ≥60 | 350 | 1089 | 32·1% | Upper eye income | Self-administered | Random sampling | Good |
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Prevalence rates for overall elder abuse were reported in 44 studies that included of 59 203 individuals. Overall elder corruption consisted of any combination of corruption subtypes as reported in the studies. The combined prevalence for overall abuse in the past yr was 15·seven% (95% CI 12·8–xix·three; figure 2). Visual inspection of the funnel plot showed no evidence of publication bias (data not shown). The set of studies was heterogeneous for overall corruption (Q[43]=4532·02, p<0·0001), suggesting differences in the effect sizes exist inside this set of studies. Higgins' I two showed that 99% of the variance comes from a source other than sampling error. The sources of the variation were investigated with bivariate analyses. Sample size was significantly associated with elder abuse prevalence (ie, high, medium, and depression; Q[2]=eighteen·96, p<0·0001). Two further covariates had p values beneath 0·x: income nomenclature (ie, high-income and centre-income or low-income; Q[1]=3·66, p=0·0558) and method of data collection (ie, random sampling and convenience sampling; Q[1]=3·10, p=0·0784).
Sample size, income classification, and method of data collection were entered into the meta-regression, which yielded a meaning model (F[4]=3·34, p=0·0191) that explained 26% of the variance. We institute that when compared with studies with high sample size, studies with medium and depression sample sizes had significantly college prevalence estimates (7·ii% vs 18·2%; T[36]=2·seventy, p=0·0101) and 18·1% (T[36]=2·51, p=0·0164). Studies using random sampling and those washed in high-income countries had lower prevalence estimates in the meta-regression model, although differences for these variables were not independently statistically significant.
Of the 44 studies that reported overall abuse, 32 provided gender breakdown, with women representing xix 756 of 34 886 individuals. There was no gender departure in prevalence estimates (Q[one]=iii·07, p=0·0799). Boosted analyses were washed to examine bivariate gender differences within several subgroups, revealing no significant differences. The global and WHO regional prevalence estimates for abuse in women and men are shown in figure 3.
Pooled prevalence estimates were determined for each of the abuse subtypes, with trim and make full adjustments done to account for missing studies because of publication bias. After adjustment, the prevalence approximate was 11·6% (95% CI 8·1–xvi·3) for psychological abuse, 6·eight% (v·0–ix·2) for financial abuse, four·2% (2·1–viii·1) for neglect, ii·vi% (one·6–four·4) for physical abuse, and 0·nine% (0·half-dozen–ane·4) for sexual abuse (table two).
Table 2 Prevalence of abuse and its subtypes
| Number of studies | Number of countries | Total sample | Pooled prevalence estimates | 95% CI | |
|---|---|---|---|---|---|
| Overall elder abuse | 44 | 26 | 59 203 | 15·7% | 12·viii–19·three |
| Concrete | 46 | 25 | 64 946 | two·6% | 1·6–4·4 |
| Sexual * Pooled estimates presented here were adjusted for publication bias. | xv | 12 | 43 332 | 0·ix% | 0·6–1·4 |
| Psychological | 44 | 25 | 60 192 | eleven·6% | 8·one–16·iii |
| Fiscal * Pooled estimates presented here were adapted for publication bias. | 52 | 24 | 45 915 | 6·8% | 5·0–9·2 |
| Neglect * Pooled estimates presented here were adjusted for publication bias. | thirty | twenty | 39 515 | iv·two% | ii·i–8·1 |
* Pooled estimates presented here were adjusted for publication bias.
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Discussion
Using meta-analytical methods, we pooled the prevalence estimates of elder abuse reported in 52 publications published between 2002 and 2015. The global prevalence of elder abuse was 15·7%, or about one in half dozen older adults. Given the gauge 2022 population estimates of 901 million people anile 60 years and older,
this charge per unit amounts to 141 million victims of elderberry abuse annually. Prevalence estimates for abuse subtypes were highest for psychological abuse, followed by financial abuse, neglect, physical corruption, and sexual corruption. There was pregnant heterogeneity in the studies; 26% of the variance could be explained by sample size, income nomenclature, and method of information collection. Nosotros constitute that studies with smaller sample sizes have higher prevalence estimates.
Few systematic reviews on the global prevalence of elder corruption exist, and none have used meta-analysis to synthesise global prevalence estimates. For the first fourth dimension, this study provides methodologically rigorous global and regional estimates of elder abuse. Nearly 1 in six older adults experienced corruption in the past year. This estimate is similar to the judge from a recent systematic review by Pillemer and colleagues,
which constitute a global amass of 14·3% (95% CI seven·6–21·1). This figure was calculated based on 18 well conducted and large-calibration population studies from 20 countries: 17 from high-income countries, two from upper-center-income countries, and 1 from a lower-middle-income land. Our guess of fifteen·seven% was calculated based on 44 studies that came from a broad range of research quality and sample sizes. The convergence between these two global estimates, from two independently conducted systematic reviews, lends them credibility.
The present study also reveals considerable regional variations. Dong did a modest systematic review of prevalence studies and grouped estimates by continents,
including Asia with a range from fourteen% in India
to 36·2% in China,
30
- Wu L
- Chen H
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- et al.
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Europe with a range from ii·2% in Ireland
to 61·1% in Croatia,
and the Americas with a range from 10% in the USA
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to 79·seven% in Republic of peru.
Like Dong,
our findings provided insights into geographical differences in prevalence estimates, with Asia at twenty·2%, Europe at xv·4%, and the Americas at 11·7%.
There are few analyses of how studies' characteristics influence abuse prevalence, and none in the area of elderberry abuse. Meta-belittling inquiry on childhood sexual corruption suggested that studies using random sampling, compared with convenience sampling, as well equally those with larger sample sizes, rather than smaller ones, were more likely to produce lower prevalence estimates.
,
The present study's meta-regression found that these two variables and income classification explained 26% of the variance in elder abuse prevalence. Big sample sizes, random sampling, and loftier-income countries were associated with lower prevalence estimates, although merely sample size differences were independently statistically significant. As such, the methodological characteristics of this sample had effects in similar directions to those seen in published work on childhood sexual corruption.
Despite several additional analyses, our research found no significant difference in prevalence between older women and older men. Few studies have examined gender differences in elder abuse; those that did constitute mixed results, with some identifying disparate rates across genders.
Yet in studies of intimate partner violence, gender symmetry is reported, supported by both systematic review
and meta-analysis.
Although much research on abuse has used gender roles and masculinity as a predictor for violent behaviour, emerging testify has shown a weak association between gender roles and abuse.
This bear witness is farther supported by similar rates of intimate partner violence emerging amid same-sexual activity and heterosexual couples.
However, most of this scientific literature comes from high-income countries and if more studies from depression-income and centre-income countries were available, the finding of gender symmetry might not agree. All the same, our findings contribute to this growing evidence for gender symmetry in abuse victimisation.
At that place are many strengths in this systematic review and meta-analysis. Our report is the first of its kind to apply meta-analysis to quantify prevalence estimates derived from a comprehensive search strategy that included boosted searches for studies that are non unremarkably plant in academic sources. We also communicated with 26 experts to identify relevant articles. This report is besides the first to include not-English language linguistic communication articles in a systematic review. We accept extracted data from 47 non-English articles; the ten included in the assay were written in Castilian, Portuguese, Chinese, German, and Persian. Our study is the only written report on elder abuse to explore the sources of heterogeneity. The broad confidence intervals found in our study likewise equally Pillemer and colleagues' study
show the importance of farther research in this surface area to identify further sources of this big variance.
Our model (which included country income classification, whether the study used a random or convenience sample, and the size of the sample) left 74% of the variance unaccounted for. Factors that might explain this big proportion of variance, specially betwixt WHO regional estimates, might include country-specific or culture-specific social norms that govern family dynamics and expectations and methodological characteristics that we were unable to include. These methodological factors might include varying definitions of elder corruption besides equally the use of standardised or non-standardised instruments to assess and measure out abuse.
Despite the strengths of our report, there are several limitations that can be addressed with futurity research. Although our comprehensive search strategy has identified many relevant studies, the majority of the studies included in the meta-assay were from high-income countries. Prevalence studies are sparse or absent for many regions of the world, specially in southeast Asia and Africa, which seem to have higher rates of corruption than adult countries.
,
,
More prevalence studies in low-income and middle-income countries are needed, peculiarly within these regions. These prevalence studies should employ like methods to allow for comparisons across countries.
Although many attempts have been fabricated to contact the authors of selected studies, crucial data on definitions and measurements were even so missing. This information is important for further methodological analyses that could examine how dissimilar definitions, measurements, and study periods affect prevalence estimates. For instance, although our findings are consequent with existing studies showing higher prevalence for psychological and financial corruption compared with other subtypes, at that place are challenges in defining and measuring psychological and financial abuse. Moreover, although our systematic review identified 234 studies on prevalence, the meta-assay simply focused on abuse occurring in the past twelvemonth. Information technology is possible that death of a victim can affect past-year prevalence; future research could compare and examine abuse estimates by using different study periods (eg, past month or lifetime), focusing on national or subnational studies, or examining prevalence variations inside each WHO region. Additional research could explore the issue of country-specific or culture-specific social norms on prevalence estimates by including additional normative variables (eg, filial piety and beingness of elder caregiving policies). The nowadays report, focusing on older adults in general, found lower prevalence estimates than did studies that examined abuse in people in other age groups with disabilities.
,
Future research might as well benefit from examining elderberry abuse prevalence in older adults with concrete and cognitive disabilities, particularly given the widespread cerebral declines often seen in the oldest elders. Enquiry in these areas would provide the basis to developing effective strategies to prevent and respond to abuse.
Elder abuse, despite affecting almost one in six (more than 140 million) older people, has not achieved the aforementioned public health priority as other forms of violence. None of the 169 targets of the UN's recently adopted 17 Sustainable Evolution Goals explicitly addresses violence against older people. By dissimilarity, target 5.2 aims to eliminate all forms of violence against women and target sixteen.two aims to end violence against children.
If the proportion of elderberry abuse victims remains abiding, the number of victims will increase rapidly due to population ageing,
growing to 330 meg victims by 2050. The findings of this study strengthen the case for global action to expand efforts for preventing and supporting victims of corruption. Considering the serious wellness consequences, the wellness sector has an important role to foreclose, enhance sensation of, and provide bear witness-based guidance for health-care practitioners to respond to elder abuse, particularly on psychological and financial corruption, which are more than prevalent. Notwithstanding, few prove-based interventions exist at present.
65
- Ayalon L
- Lev S
- Light-green O
- Nevo U
A systematic review and meta-analysis of interventions designed to prevent or finish elderberry maltreatment.
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,
,
Investment in developing and assessing elder abuse interventions must exist a public health priority to help to reduce the effect of elder corruption worldwide.
Contributors
YY, CRM, ZDG, and KHW designed the report. All authors oversaw its implementation. YY and CRM coordinated and did all review activities, including searches, written report choice (including inclusion and exclusion of abstracts), information extraction, and quality assessment. YY, CRM, ZDG, and KHW planned the analyses and YY did the meta-analyses and meta-regressions. YY wrote the initial typhoon and YY, CRM, ZDG, and KHW contributed writing to subsequent versions of the manuscript. All authors reviewed the study findings and read and canonical the last version before submission.
Declaration of interests
Nosotros declare no competing interests.
Acknowledgments
This written report was funded in part past the Social Sciences and Humanities Inquiry Quango of Canada and the WHO Department of Ageing and Life Course. There were no other external funding sources. We thank the members of the International Network for the Prevention of Elder Abuse, its affiliated organisations, and the Oxford Found of Population Ageing, as well every bit the University of Oxford and WHO interns for their aid in screening and extracting information from not-English manufactures.
Supplementary Material
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DOI: https://doi.org/10.1016/S2214-109X(17)30006-2
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- Protecting the global longevity dividend
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1 of the unheralded developments in global health is the welcome increase in the number of older people (ie, anile 60 or 65 years and older) in low-income and middle-income countries. In parallel with the gains from this longevity dividend, ageing presents particular challenges to health services. These challenges arise from increasing interindividual variability and complexity of presentation of health conditions for which specialist geriatric services can provide constructive responses.1
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