Violence against older adults in long-term care institutions is poorly addressed by public policies

Poltronieri B, Souza E, Ribeiro A. Analysis of the theme of violence in policies of long-term care for the elderly Ciencia & Saude Coletivas. 2019; 24: 2859-2870.

Review question

•      How the theme of violence is addressed in current studies of public policies for older adults in long-term care institutions?

Background

•      The high rate of chronic illnesses such as diabetes, hypertension, and dementia among elderly populations is widely known. These conditions frequently affect the ability of older adults to perform basic activities like eating, dressing, walking, preparing meals, and managing finances, among others.

•      These functional disabilities result in the formation of a dependent relationship between older adults and their relatives or workers in long-term care facilities in charge of their care.

•      Unfortunately, such dependent relationships can give rise to violence or neglect.

•      This systematic review aims to examine how the theme of violence is addressed in current studies of public policies for older adults in long-term care institutions.

How the review was done

•      Review authors conducted a search in four research databases for eligible studies. Major synthesis reports were also reviewed to identify relevant citations.

•      Search terms included public policy, old age homes, nursing homes, long-term care, and elderly. An alternate set of key words were used in a Spanish-language search.

•      Studies were eligible for inclusion if they were written in Portuguese, English, or Spanish, were published between 2010 and 2016, and addressed the topic of violence in the context of public policies related to older adults in long-term care.

•      In total, 102 studies were retrieved from the initial search, of which 77 were included in this review.

•      No conflicts of interest were declared.

What the researchers found

•      Included studies in this review spanned a number of countries, including the United States (30), Brazil (12), Japan (8), Australia (6), France (5), China (3), Canada (3), Taiwan (2), Singapore (1), Portugal (1), North Korea (1), Hong Kong (1), and England (1).

•      Among the included studies, only eight directly addressed the theme of violence. Discussion on issues such as prejudice, caregiver burden, and qualification of professionals working in long-term care facilities, however, also shed light on factors related to violent behaviours in long-term care settings.

•      One study in the United States estimated that 84% of cases of elder abuse are not reported to protective agencies. The same study pointed out that although each state has specific legislation to prevent elder abuse, there is no federal law regarding elder abuse. This gives rise to inconsistencies in the definition and management of abuse across the country.

•      Another study estimated that 36% of workers at long-term care facilities in the United States carry out physical abuse and 81% practice psychological abuse against elderly residents.

•      Three of the most frequent types of neglect in nursing homes were identified as medical conduct-related neglect, neglect of professional caregivers, and neglect of hygiene and care for the physical environment.

•      Many studies stress that adopting interventions to reduce violence in the care of the elderly must be context-specific, as perspectives on the care of older adults differs significantly across cultures.

Conclusion

•      Review authors found that there tended to be an insufficiency or absence of long-term care public policies in countries where the care of elderly people is predominantly provided by family members. In such contexts, family members often take on caregiving tasks informally without proper preparation and support, resulting in poor outcomes for both the caregiver and care recipient.

•      Unfortunately, in countries that did have guidelines and recommendations for long-term care, it was found that most facilities had poor compliance with established policies for care provision.