DOI: 10.25549/usctheses-c40-362476
title: Systematic review and meta-analysis of elder abuse prevalence studies

description: Elder abuse is an important public health and human rights issue. Yet its true extent is not well understood. To address this, a global systematic review and meta-analysis of elder abuse prevalence studies occurring in the community that were published from inception to June, 2015 was conducted. Studies that reported estimates of past-year abuse among adults aged ≥60 years were included in the analyses. This dissertation examined two broad research objectives to: (1) investigate the prevalence estimates of elder abuse and its sub-types as well as (2) examine how the characteristics of the studies and its methodology were associated with prevalence estimates among older adults and older women. ❧ Chapter 1 provided contexts to the importance of addressing elder abuse by describing the consequences of abuse as well as the need for urgent action in elder abuse prevention. A description of existing national and international policies and targets including the UN Sustainable Development Goals on violence prevention were discussed. This introduction chapter provided background information on the current state of elder abuse prevalence research. In particular, it synthesized the major studies that have been conducted to assess national prevalence estimates and outlined the gaps in the literature. Next, the chapter described the systematic review process to address the gaps of elder abuse prevalence, its methodology and concluded with a description on the aims of this dissertation. ❧ Chapter 2 provided a detail outline of the research protocol that described the methodological approach for conducting the systematic review and meta-analysis. In particular, the protocol described the search strategies and eligibility criteria to identify and select studies as well as how the data from the selected studies were extracted for the analysis. The protocol also described the analytical approach to calculate pooled prevalence estimates and discussed the use of meta-regression to assess how studies’ characteristics influence the prevalence estimates. The protocol conformed to the Preferred Reporting Items for Systematic reviews and Meta-Analysis—or PRISMA—guidelines and has been registered with the PROSPERO International Prospective Register of systematic reviews. ❧ Chapter 3 examined the heterogeneity of 52 selected studies and provided the results of sub-group analysis and meta-regression. These studies were geographically diverse indicating an overall elder abuse prevalence of 15.7%. This rate was equivalent to about 141 million older adults in the world. The pooled prevalence estimate for psychological abuse was 11.6%; for financial abuse, 6.8%; for neglect, 4.2%; for physical abuse, 2.6%; and for sexual abuse, 0.9%. Meta-regression indicated that sample size, income classification, and method of data collection were significantly associated with overall abuse prevalence rates. ❧ Chapter 4 examined the prevalence of elder abuse specifically among older women. The chapter attempted to disentangle the wide variations in prevalence estimates by conducting a meta-regression of studies’ demographic and methodological characteristics. A total of 50 studies were included in the meta-analysis. The combined prevalence for overall elder abuse in the past year for older women was 14.1%. This estimate was equivalent to 69 million older women worldwide. Pooled prevalence for psychological abuse was 11.8%, neglect was 4.1%, financial abuse was 3.8%, sexual abuse was 2.2%, and physical abuse was 1.9%. Significant associations were found between prevalence estimates and the following covariates: WHO-defined regions, countries’ income classification and sample size. ❧ The final chapter summarized the major findings of this doctoral dissertation. The findings of this study strengthen the case for global action to expand efforts for preventing and supporting victims of abuse. Specifically, the chapter advocated the important role of the health sector in preventing, raising awareness and providing evidence-based guidance for healthcare practitioners to respond to elder abuse. Moreover, the chapter provides recommendation to integrate aging into existing services as well as to recognize the specific needs of older women and men. Finally, the chapter concludes with future research directions in addressing research gaps, including more prevalence studies in low- and middle-income countries, assessing evidence-based prevention programs of elder abuse, as well as examining older men as victims of elder abuse.