The aging population is growing, by the year 2050 the number of elderly reach to 17% of the world's population (1.6 billion). Increase in life span also requires an increase in health promotion too. The increase in aging population presents several health challenges that we have to think for them. One of the most important challenges in the care of the elderly is the occurrence of elder abuse.

The World Health Organization (WHO) defines abuse as “a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. It is not possible to determine the exact prevalence and compare the results of elder abuse however; studies have reported the prevalence of elder abuse, approximately 5 to 52 percent.

According studies some variables such as, individual characteristics, different biological, cultural, social, environmental and economic conditions, are the risk factors of elder abuse. According the assess of literature review, few countries have addressed this challenge. In the future, we are faced with a prevalent issue that is not properly reported, has not the same prevented strategies, and are more dependent to the different culture. In this mini review, all aspect of this issue will be paid.

Keywords: elder, aging, abuse, violence

The aging population is growing.The age of 60+ years is refer to the elderly people, within the elderly person, the age of 80+ and 100+ are also classified as oldest old, and centenarian too. Due to the decline of fertility, the number of working age person also declinesand leads to growth of elderly population, and also rising to dependency relations. World Health Organization called this phenomenon as, ‘demographic burden’. It seems that all countries will face thisdemographic transition.¹

The number of elderly people is increasing unprecedentedly. An Aging World reported that, in 2015, the number of elderly were about 5% of the world's total population (617 million) but by the year 2050 it will reach to 17% of the world's population (1.6 billion).

Certainly, this rapid growth in the aged population will require different care needs. Increase in life span also requires an increase in health promotion too. The increase in aging population presents several health challenges that we have to think for them. In the future, the provision of dwelling, development of old-age nursing homes, a deeper attention to the aging process, more attention to chronic illnesses and malignant diseases, health and socioeconomic challenges and all those things that come along with age, should be given special attention.²

With the increasing number of elderly people, in the future, we will need more public and private care organizations, as well as more informed care givers.To meet the multiple care needs of the elderly, caregivers, include of family members or nursing staff will face a number of challenges. One of the most important challenges in the care of the elderly is the occurrence of elder abuse.

The World Health Organization (WHO) defines abuse as “a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person”. Elder abuse defines as intentional actions that cause harm or create a risk of harm to an elder by a caregiver such as nurses or elder family members, or failure by a caregiver to provide elder’s needs or to protect him/her from harm.¹ Elder abuse is a term in National Library of Medicine (NLM) too and defines, as emotional, nutritional, or physical mistreatment of the elder people by family members or by institutional staff.²

There are some types of elder abuse, such as abandonment, emotional abuse, financial exploitation, neglect, physical abuse and sexual abuse.^3,4 WHO also introduce five types of elder abuse in form of intention or unintentional violation such as physical abuse, caregiver neglect, financial exploitation, psychological abuse, and the last one is sexual abuse. In another study, elder abuse divided in eight subscales such of negligence, psychological, physical, financial abuse, deprivation of authorities, ostracizing, financial and emotional negligence.⁵

Prevalence of elder abuse

It is not possible to determine the exact prevalence and compare the results of elder abusestudies for a variety of reasons (6). First, elder abuse has different subtypes in different studies, secondly how to answer the questionnaire depends on the culture of elderly, and it is full of subjectivity and related to an elderly mental interpretation.On the other hand, the period of violence against the elderly has been asked at different time periods, for example, in six months, and during one year ago, which makes it impossible to compare the results. Because of more limitations elder abuse is still a hidden problem,⁴ however, studies have reported the prevalence of elder abuse, approximately 5 to 52 percent, the exact amount of elder abuse prevalence seems to be more than the studies suggest. In one study, among 14 elder abuse events, only one case is reported⁵ few cases are reported or referred to social services agencies.⁷

There is a feeling that the elder people always need caregiver’s help, when responding to a questionnaire, they will not be able to express the facts, so the correct prevalence of elder abuse is often underestimated.

In an unexpected findings regarding elder abuse in an urban area in Iran, it was calculated higher than 80%, among 500 elderly, 400(80%) had experienced at least one type of elder abuse in the last year. Financial abuse had the most prevalence (45.6%) and psychological abuse had reported (45%) respectively.^5,8

Associated factors

According studies some variables such as, age, sex, education, unemployment, insurance situation, chronic disease and disabilities, level of depression⁵ different biological, cultural, social, environmental and economic conditions⁹ poor physical health, cognitive impairment, poor mental health, substance abuse, abuser dependency, victim–perpetrator relationship, marital status, low income, community geographic location and societal negative image on aging^10,11 are the risk factors of elder abuse.

Unfortunately, the prevalence of elder abuse is expected to grow based on progressive increase in the aging of the population in the future and may be remain as hidden problem due to unreported issue.^9,10

During this short review the available literature in the last 10 years (2008-2017) regarding elderly abuse was assessed. For this purpose, articles published in the last 10 years in the international literature regarding the elder abuse were selected. The search was conducted on using the two citation databases such as Scopus and Web of Science (WOS).

The keywords used for the query were: "elderly abuse”, "elder abuse”, "elderly neglect” and "elderly mistreatment” by combined with Boolean operators “OR”.⁹ The query was limited to the title, abstract or keywords. The results showed that there are 985 documents were published in WOS and there are 1658 documents were published in SCOPUS, respectively. In this review only articles were selected, however there are 979 articles in WOS and 1600 articles in SCOPUS were considered. The distribution of these articles were Shawn in Figure 1.

Figure 1 Distribution of published articles related elder abuse in two databases, SCOPUS and WOS.

The number of published articles in SCOPUS are more than in WOS in the field of elder abuse. The first ten journals that are most published the articles related elder abuse with their number of articles during 10 years ago were classified in Table 1.

Table 2, show that the first five countries those have contribute to publish academic articles regarding elder abuse in two selected databases, as we can see United States and United Kingdom are two leading countries with the most published articles in this area.

Dongx and Lachs MS are the leading researchers that have the most published articles in two selected databases. The most articles were published with affiliation of Rush Univ and School of Social Work in two selected databases. The detail of distributions were shown in Table 2.

We are faced with a challenge that is not properly reported, its prevalence is increasing, its complications and consequences are devastating and fatal, and we do not have the unit standard tool that we evaluate in all societies. And most importantly, the world's population is aging, and preventive studies and violence management are also scarce, what can we do with this elderly care problem in the future?

None.

The authors declare no conflict of interest.

1. Health situation and trend assessment. Regional Health Observatory (RHO).
2. Daly JM, Merchant ML, Jogerst GJ. Elder abuse research: a systematic review. J Elder Abuse Negl. 2011;23(4):348–365.
3. Acierno R, Hernandez MA, Amstadter AB, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the united states: the national elder mistreatment study. Am J Public Health. 2010;100(2):292–297.
4. Jackson SL. A systematic review of financial exploitation measures in prevalence studies. J Appl Gerontol. 2018;37(9):1150–1188.
5. Khalili Z, Taghadosi M, Gilasi H, et al. The prevalence of elder abuse and associated factors among the elderly in Kashan city, Iran. Journal of Basic Research in Medical Sciences. 2016;3(2):26–34.
6. Dong X. Associations between the differential definitions of elder mistreatment and suicidal ideation outcomes in US. chinese older adults: do the definitions matter?. J Gerontol A Biol Sci Med Sci. 2017;72(suppl_1):S82–89.
7. Baker PR, Francis DP, Hairi NN, et al. Interventions for preventing abuse in the elderly. Cochrane Database Syst Rev. 2016(8):CD010321.
8. Molaei M, Etemad K, Taheri TP. Prevalence of elder abuse in iran: a systematic review and meta analysis. Iranian Journal of Ageing. 2017;12(2):242–253.
9. Corbi G, Grattagliano I, Ivshina E, et al. Elderly abuse: risk factors and nursing role. Intern Emerg Med. 2015;10(3):297–303.
10. Pillemer K, Burnes D, Riffin C, et al. Elder abuse: global situation, risk factors, and prevention strategies. Gerontologist. 2016;56 (2):S194–205.
11. Dong X. Do the definitions of elder mistreatment subtypes matter? Findings from the PINE Study. J Gerontol A Biol Sci Med Sci. 2014;69(2):S68–75.