Institutional Abuse of Older Adults: What We Know, What We Need to Know

Abstract

Although Canadian policies support "aging in place," there still will be a number of older adults who will require institutional care in the future. Most research on elder abuse, however, has focused on domestic abuse and has paid less attention to institutional abuse. The purpose of this article is to comprehensively review current research to identify gaps in knowledge and methodological issues in the study of institutional abuse. Overall, 49 studies in English and 20 studies in French were reviewed, and 11 key-informant interviews were conducted with methodological experts. Methodological challenges are addressed in light of the review and interviews.

Institutional betrayal.

“…Raja, 2005;Carr et al, 2010;McDonald et al, 2012). This research has begun to uncover at least two important patterns.…”

Physical abuse against elderly persons in institutional settings

“…Difficulties in estimating prevalence and incidence of institutional elder abuse is referred in various studies, 6,14,15 with underreport being the justification found for this fact. 1,2,16 Possible explanations for underreport have been proposed, such as elderly feeling of shame and fear of retaliation after disclosing the abuse to the authorities, 6,14,17,18 lack of elderly knowledge on how to do it 6 or their inability to communicate, due to mental disability or other, 6,18 this corresponding to 47.2% of our sample. Another explanation would be fear of reprisal and criminal consequences experienced by nursing homes' staff when admitting an abusive behaviour or denunciating one perpetrated by their co-workers.…”

“…Another explanation would be fear of reprisal and criminal consequences experienced by nursing homes' staff when admitting an abusive behaviour or denunciating one perpetrated by their co-workers. 6 At this level, it might be pertinent to ensure the existence of policies that guarantee staff's and elder's protection in case of report. Lack of available information to the population and specific training for professionals, resulting in uncertainty on defining criteria, low index of suspicion and/or divergent tolerance levels regarding what constitutes elder abuse, might also explain the difficulty in recognising and reporting possible abusive situations.…”

“…5 Following this is the arising of the "oldest old", people older than 85 years old, more susceptible to chronic and disabling diseases, cognitive impairment and even more dependent with greater needs of long-term care. 2,6,7 As a result, the families of these elders require institutional care more often, which can lead to an overload of the professional caregivers, increasing their risk of burnout and, subsequently, placing the elders at higher risk of abuse. 2,6,8e10 In the WHO European Region, it is estimated that physical abuse against people aged 60 years and older affects at least 4 million every year, a prevalence of 2.7% 1 which is expected to increase, as this population continues to grow, accentuating the stress on family and professional caregivers.…”

“…1 Despite the well-studied familial abuse, institutional abuse still lacks proper analysis of its risk factors, with low detection and reporting rates. 2,6,7,11,12 Therefore, and in anticipation to the expected increased prevalence following the rapid ageing of the population, it is urgent to analyse and understand this emerging issue so that social policies and regulation may be developed, in an effort to protect the elderly, as well as to make improvements in professionals' training. 13 The general objective of this study is to provide a better knowledge about physical abuse against elderly persons in institutional settings, in order to contribute to a timely detection, correct forensic diagnosis and prevention of these cases.…”