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Elder abuse and neglect are important social problems in Canada
and have been reviewed elsewhere (1,2). Since the reports of “granny
battering” by Baker and Burston in 1975, research has become
increasingly systematic in attempting to clarify the nature, extent,
and causes of the problem (3,4).
Five broad types of abuse and neglect have been described: physical
abuse, psychological abuse or chronic verbal aggression, material
abuse or financial exploitation, neglect (intentional or unintentional),
and violation of rights. Several references define these terms in
detail (1,2,5–10).
Several community-based studies have estimated the prevalence of
elder abuse. In Canada, in a telephone interview random sample of
2000 individuals over age 65 years living in private houses, Podnieks
and others reported a 4% prevalence of abuse or neglect, with 2.5%
financial abuse, 1.4% chronic verbal aggression, 0.5% physical violence,
and 0.4% neglect (9). In the US, Gioglio and Blakemore reported
a 1% prevalence in a random sample of 342 community-dwelling individuals
over age 65 years, with financial abuse being the most frequent
form (over 50% of abuse) (11). Pillemer and Finkelhor reported a
3.2% prevalence in a telephone interview random sample of 2020 community-living
elderly, with 2% physical abuse, 1.1% verbal aggression, and 0.4%
neglect (8) . Lachs and others linked an established research cohort
of 2812 community-dwelling older adults in New Haven with protective
service records (12) and reported a 9-year prevalence of protective
service referral for elder abuse of 1.6% (13). In Denmark, Finland,
and Sweden, Hydle reported a 1% to 8% prevalence of abuse by close
relatives (14). In the Netherlands, Comijs and others (15) reported
a 1-year abuse prevalence of 5.6% in a random sample of 1797 elderly
persons living independently in Amsterdam, with 3.2% verbal aggression,
1.4% financial abuse, 1.2% physical aggression, and 0.2% neglect
(15). In Germany, Hirsch and Brendebach (16) reported a 5-year abuse
prevalence of 10% in a postal questionnaire sample of elderly living
in Bonn, most often psychological and financial abuse (16).
In summary, elder abuse has been reported in 1% to 10% of community
samples, with financial abuse in 0.5% to 2.5%, chronic verbal aggression
in 1% to 3.2%, physical aggression in 0.5% to 2%, and neglect in
0.2% to 0.4%. We caution, however, that ascertainment methods and
prevalence periods vary widely.
Reported correlates of and risk factors for elder abuse are complex
and vary with study objectives, types of abuse, samples, and methods.
Ecological studies suggest that communities with high rates of
elder abuse referral tend to show lower socioeconomic status (17),
more children in poverty, higher population density, higher child-abuse
reporting rates (18), more community training of area health professionals,
and higher agency-service rating scores (17). Studies of health
care professionals show increased reporting with increased knowledge
and education about abuse (19).
Data on caregivers and abusers suggest an association of elder
abuse with caregiver stress (20), defensiveness and irritability
(21), abuser psychopathology (20), and history of prior abuse over
many years (22). Studies also associate physical abuse and chronic
verbal aggression with spouses rather than with more distant contacts
(9,23), and associate financial abuse with distant relatives and
nonrelatives (9). Likewise, studies associate physical and emotional
abuse with caregiver substance abuse (24) and physical abuse with
caregiver alcohol abuse (22). In addition, another study related
caregiver substance abuse to care receiver substance abuse (24).
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Studies in dementia report an association of physical abuse with
higher caregiver burden scores (25), depression scores (25,26),
general health symptom scores (27), and longer duration of caregiving
(25). Studies associate verbal abuse with caregiver social isolation
of physical abuse and with verbal abuse (27).
Situational correlates of abuse include family emotional problems
(28), strained family relationships, poor premorbid relationship
between dependent and caregiver (27,22) and, in studies of dementia,
the situation of living with nonspouse family (26).
Data on dependents suggest associations of abuse with greater functional
disability (25,20), greater cognitive impairment (20), and various
personality traits (29). In the New Haven study linking a research
cohort with protective service records, risk factors for protective
service referral were age and race (12,13), poverty, greater functional
disability, cognitive impairment (particularly new impairment) (13),
and poor social network (12). The authors, however, suggested that
the influence of race and poverty were likely overestimated because
the study used the case-finding method through the social welfare
system (13). Several studies reported a relation of abuse or violence
by the caregiver to abuse or violence by the care receiver (25,22,23).
With the exception of 1 particularly relevant study of a geriatric
psychiatry service, we will not review case reports, case series,
or studies of clinical populations (30–32). Compton and others
recently reported a small sample of subjects with dementia who were
referred to a geriatric psychiatry service in Northern Ireland (33).
Of the 49 patients, the caregivers of 38 agreed to provide information.
Of these, Compton and others found 14 cases of abuse (37%), including
13 cases of verbal abuse (34%), 4 cases of physical abuse (10.5%),
and none of neglect. Reported risk factors included a poor premorbid
relationship between the patient and the caregiver, verbal or physical
abuse by the patient, behaviour problems in the patient, and anxiety
and the perception of not receiving help in the caregiver.
The paucity of data worldwide on elder abuse in geriatric psychiatry
services led us to undertake the present study to determine the
prevalence and correlates of elder abuse and neglect in a Canadian
geriatric psychiatry service.
We performed a retrospective cross-sectional study of a clinical
sample of all new patients seen in 1 calendar year at the Montreal
General Hospital (MGH), Division of Geriatric Psychiatry (DGP).
We estimated the prevalence of emotional, financial, and physical
abuse, as well as neglect. Potential correlates of abuse and neglect
were compared in abused and nonabused subjects using bivariate methods
and multivariate logistic regression.
The MGH, DGP comprised 4 services. Of these, the MGH Geriatric
Psychiatry Clinic (GPC) provided outpatient geriatric psychiatry
consultation and follow-up to patients referred by health professionals,
families, and patients themselves. The Geriatric Psychiatry Liaison
to the MGH Geriatric Assessment and Rehabilitation Unit (GARU) provided
service to a multidisciplinary inpatient unit that the MGH Division
of Geriatric Medicine operated. The Geriatric Psychiatry Liaison
to the MGH Geriatric Medicine Community Consultation Team (CCT)
provided service to a multidisciplinary outpatient community outreach
team. The Geriatric Psychiatry Liaison to the Centre Local de Services
Communautaires (CLSC) Montréal Metropolitain provided service
to the community health centre.
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