The prevalence of elder abuse and neglect: a systematic review.

Objective: to perform a systematic review of studies measuring the prevalence of elder abuse or neglect, either reported by older people themselves, or family and professional caregivers or investigated using objective measures.

Methods: we conducted a comprehensive literature search of multiple databases up to October 2006, supplemented by a search of the references of all relevant articles. Validity of studies was graded by two authors independently using a standardised checklist.

Results: forty-nine studies met our inclusion criteria, of which only seven used measures for which reliability and validity had been assessed. In the general population studies, 6% of older people reported significant abuse in the last month and 5.6% of couples reported physical violence in their relationship in the last year. In studies using valid instruments involving vulnerable elders, nearly a quarter reported significant levels of psychological abuse. Five per cent of family caregivers reported physical abuse towards care recipients with dementia in a year, and a third reported any significant abuse. Sixteen per cent of care home staff admitted significant psychological abuse. Rates of abuse recorded using objective measures (5%) or reported to home management or adult protective services (APS) (1-2%) were low.

Conclusion: one in four vulnerable elders are at risk of abuse and only a small proportion of this is currently detected. Elders and family and professional caregivers are willing to report abuse and should be asked about it routinely. Valid, reliable measures and consensus on what constitutes an adequate standard for validity of abuse measures are needed.