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Elder abuse results in high rates of morbidity and mortality. It has longstanding physical and psychological effects and is difficult to detect. Due to fear or embarrassment, victims may make attempts to hide it rather than to disclose and professionals are often reluctant to report it as they may worry about worsening a situation. If detected early enough, serious harm can be prevented and lives saved. Screening and screening tools can assist health and social care practitioners to detect abuse. This review of screening tools was undertaken as part of an MSc in clinical research, funded by the National Institute for Health Research; the purpose of this paper is to report on the review and its findings.

This was a systematic review with eligibility inclusion and exclusion criteria decided in advance. Keywords and their synonyms were combined and then used to search health and social care databases. Data items were collected from the included studies. The preferred reporting item for systematic reviews and meta-analysis was followed for the reporting of the results. A narrative synthesis approach was applied to the analysis.

A total of 34 full text studies were downloaded, read and analysed. In all, 11 met the inclusion criteria and were included in the final analysis. Of these, three studies reported sensitivity and specificity, with the remainder reporting validity and reliability testing. In total, 12 tools of varying length and quality were found. The length and characteristics of tools affects the efficacy of their use. The clinical environment will determine choice of screening tool to be used. Screening tools should be used within an overall system of detection and management of abuse.

The synthesis of results was challenging due to the lack of homogeneity between the included studies. The variations in tool characteristics and qualities added to this challenge. A further limitation was the lack of a gold standard tool in elder abuse.

This systematic review highlights a lack of robust evidence in the development and validation of screening tools to detect elder abuse. Though there is an increasing awareness and knowledge about elder abuse, its detection remains problematic and the lack of research in this area is worth emphasising. Specific tools, centred on the clinical setting in which they are used, are recommended.

The purpose of this paper is to identify, describe and compare the studies of the prevalence of abuse and neglect of older adults developed in Portugal.

A retrospective bibliographic search of seven descriptors in English and Portuguese, of academic and professional papers and university institutional repositories was performed.

Of the nine studies selected, seven consisted of grey literature – research developed within the course of academic post‐graduate studies. The studies were conducted on a small scale, more often than not, through a non‐probabilistic convenience sampling method. From the nine studies, two instruments prevailed: the Questions to Elicit Elder Abuse aimed at older adults and the Caregiver Abuse Screen aimed at caregivers. Community‐dwelling older adults self‐reported a higher prevalence of abuse (between 66.7 and 86.7 per cent) than care professionals working with older adults suffering from dementia (between 26.7 and 47.4 per cent). Emotional abuse and neglect were the first and second most prevalent forms of abuse, followed by financial abuse, whereas physical abuse was the least prevalent type of abuse encountered. A poorer perception of health, not making/receiving visits and residing in an urban area were the more consistent variables associated with abuse of older adults.

Overall, this paper provides a first consideration to the prevalence rates of older adult abuse and neglect from research studies in Portugal. The revised design studies and screening methods employed can help researchers improve future study design and move from the description to a more theoretically oriented research. Furthermore, it can help practitioners learn screening methods and discover the findings associated with abuse.

This qualitative study set within Northern Ireland aims to explore professional perspectives on the application of evidence-informed practice to the adult safeguarding threshold screening process.

Data was gathered from seven social workers in one health and social care trust area, who perform the designated adult protection role, through individual semi-structured interviews in one region of Northern Ireland. The interview schedule comprised of a series of questions examining the role of the designated adult protection officer and included three vignettes (Appendix). A thematic analysis was undertaken using NVIVO software.

This paper reports main findings under the themes of: the role of the designated adult protection officer, threshold decision-making, evidence-informed practice and service improvement. One of the main findings was that professionals viewed the current process as too bureaucratic, and there was a desire to engage in more preventive safeguarding in collaboration with service users. There was a need to promote awareness of evidence-informed practice as it applies to the threshold screening process. Furthermore, the study raised the question of the need to consider the application of models or methods of assessment to the threshold screening process.

This in-depth exploration of the role of designated adult protection officers in Northern Ireland provides a valuable insight into the complexity involved in managing adult safeguarding referrals and investigations. This study adds to the existing knowledge base, identifies potential service improvements and highlights the gap in evidence-based practice as it applies to the threshold screening process. Threshold screening of adult safeguarding referrals remains a subjective process and is open to interpretation and differences in professional judgement. The study highlights the need to consider the application of quality improvement methodology to the threshold screening assessment and the need to promote the exchange of safeguarding knowledge.

Elder mistreatment is a widespread medical and social problem that is often under‐recognised by primary care physicians. The primary aim of this study was to estimate the prevalence of elder mistreatment among elderly patients with mental disorders in Bosnia and Herzegovina. One‐hundred‐and‐eighty‐four patients with different mental disorders were asked to complete the EAST questionnaire as part of a comprehensive geriatric assessment. Screening results were evaluated, and patients who had responses associated with ‘mistreatment’ were invited back to the clinics for additional clinical evaluation. Different types of mistreatment were identified in 71% of all patients. This led to a conclusion that screening for elder mistreatment should be a part of the routine health assessment for all older persons and a part of comprehensive geriatric assessment.

This study aims to examine primary care physicians who are in a tenable position to identify signs of abuse in older adults as well as provide an opportunity to safeguard them from abuse. Yet little is known about their clinical decision-making process during a clinic visit to detect abuse of older adults and provide adequate support in the Caribbean.

Fourteen primary care physicians working in a government operated free clinic were interviewed about their clinical decision-making process, in a narrative analysis format on the small island state of Trinidad and Tobago.

Primary care physicians expressed lack of knowledge about the primary health-care clinics’ protocols and procedures regarding abuse of older adults. Lack of attendance to educational in-service programs on recognizing and reporting abuse of older adults. A hands-off approach with non-medical abuse issues. Last there is no uniform assessments among the different types of physicians.

Although these findings are among primary care physicians located in Trinidad and Tobago, the context may be applied to primary care settings in other Caribbean islands. Major focus should be geared towards increasing awareness among the public and health-care professionals.

Sparse research on small island states regarding safeguarding policies for older adults who experience abuse.

Psychological elder abuse (PEA) assessment is described with different thresholds. The purpose of this paper is to examine how the prevalence of PEA and the phenomenon’s characterisation varied using two different thresholds.

Participants from the cross-sectional population-based study, Aging and Violence (n=1,123), answered three questions regarding PEA. The less strict measure considered PEA as a positive response to any of the three evaluated behaviours. The stricter measure comprised the occurrence, for more than ten times, of one or more behaviours. A multinomial regression compared cases from the two measures with non-victims.

Results show different prevalence rates and identified perpetrators. The two most prevalent behaviours (ignoring/refusing to speak and verbal aggression) occurred more frequently (>10 times). Prevalence nearly tripled for “threatening” from the stricter measure (>10 times) to the less strict (one to ten times). More similarities, rather than differences, were found between cases of the two measures. The cohabiting variable differentiated the PEA cases from the two measures; victims reporting abuse >10 times were more likely to be living with a spouse or with a spouse and children.

Development of a valid and reliable measure for PEA that includes different ranges is needed.

The study exemplifies how operational definitions can impact empirical evidence and the need for researchers to analyse the effect of the definitional criteria on their outcomes, since dichotomization between victim and non-victim affects the phenomenon characterisation.

The purpose of this paper is to perform a review of the literature of empirical studies on elder mistreatment (EM) in South Asians, and to discuss key implications for policy, practice and research.

For this review, multiple electronic databases in the international health and social science were searched and supplemented by grey literature and cross-references. Quality of papers was assessed by two authors against the standard checklists.

In total, 16 studies met the inclusion criteria of this review, of which 11 were cross-sectional design, and only six of them used standard instruments to measure EM. The prevalence estimates of overall EM retrieved from general population-based studies ranged from 9.3 per cent in India to 49.1 per cent in Nepal. Age, gender, residential settings, socioeconomic status, health, education, and social structures and processes were key risk factors for EM in South Asian communities. Reporting and action taking were culturally rooted.

While the review is not systematic, there are limitations associated with the paper in covering the diverse range of databases and studies. However, this review provides a valuable synthesis of the empirical papers on the incidence, culturally specific risk factors and reporting trends of EM in South Asians. Additionally, the review presents the papers evaluated for a quality to ensure the validity of empirical data. Finally, the review includes several implications for policy, practice and future research on EM which may ultimately contribute in improving the health and wellbeing of elder South Asians.

The purpose of this paper is to increase understanding of elder abuse in Ethiopia by considering the perspectives of abused elders.

A phenomenological study was conducted to investigate the lived experience of 15 elders (six men, nine women) in Ethiopia who experienced domestic abuse. Data were collected using unstructured interviews and were analyzed using interpretive phenomenological analysis. The results described here focus on Ethiopian elders’ perceptions of factors contributing to abuse.

Themes identified in elders’ statements about the factors contributing to elder abuse included: declining respect for elders, conflicts of interest, poor health, mutual dependency and other economic issues, and loss of support providers. Abject poverty was evident as an underlying influence contributing to abuse. One elder stated, “Life is meaningless without food and without a caregiver. I am ready to welcome death.”

Documentation of elder abuse is needed to bring recognition to abuse as a problem deserving public attention and response.

Given the apparent influence of poverty-related factors on the occurrence of elder abuse among the study's participants, policy initiatives are needed to enhance the economic well-being of older adults in Ethiopia.

Since elder abuse is generally not viewed as a societal problem in Ethiopia, there have been very few studies documenting its existence. Research on elder abuse in Ethiopia and other developing nations can help to bring the issue to the attention of communities and authorities.

The purpose of this paper is to describe and analyse the development and content of the Vulnerable Adults Act 2018 (hereafter “the Act”) in Singapore. It reports the parliamentary processes and deliberations.

A synthesis of publicly available research, policy documents, parliamentary debate, media reports and commentary.

The paper sets the Act’s development and aims in Singapore’s social and legal contexts. It notes the interface with other legislation and the focus of the Act on community and family abuse and neglect.

The paper suggests some areas for research including how the Act is used and its impact and also points to areas where the Act does not apply.

The paper outlines new professional powers and responsibilities and the role of government and community-based organisations.

This paper provides an early account of the genesis and aims of the new legislation, its powers and administration. Also, international comparisons are drawn.