Republic of the Philippines

Western Mindanao State University

COLLEGE OF NURSING
GRADUATE PROGRAM
Zamboanga City
Email: rngraduate@wmsu.edu.ph

Neglect Towards Elders in Geriatric Care Settings: A Literature Review

Dr. Rubelle Ho Alavar

 TABLE OF CONTENTS

INTRODUCTION

Background Of The Study…... 1-3

Objectives Of The Study….. 4

Significance Of The Study……………………… 4

Definition Of Terms/Operational Definitions……….. 5-6

METHODOLOGY

Data Collection……………......... 7

Criteria For Including Studies In The Review……… 7

Search Methods For Identification of Studies………………………………………….. 8

Data Analysis……………………… 8

Data Synthesis…………………...... 8-9

REFERENCES……………………………………………………………………………. 10-11

APPENDICES……………………………………………………………………………….. 12

CURRICULUM VITAE…………………………………………………………………….. 13
 CHAPTER I

INTRODUCTION

Background of the Study

Elder neglect is a deeply troubling and alarming issue that requires attention and

action in today’s aging world. It represents a grave violation of the rights, dignity, and well-

being of older individuals in our society, which has significantly contributed to our history.

They deserved respect and dedication, especially at times when they needed it most. Elder

neglect surrounds a range of disturbing and unpleasant situations where older adults are often

among the most vulnerable individuals in a geriatric setting or community (Zegarra

Chiappori, 2022). They do not receive the necessary care, support, and attention for their

physical, emotional, social, psychological, and clinical health. They are struggling to survive

the loneliness they face every day and at the same time enduring the difficulties that await

them.

The primary definition of neglect encompasses institutional caregivers who fail to

provide services that ensure the well-being of residents (Friedman et al., 2019). World Health

Organization (2022, 2022) defines neglect as “ a single or repeated act, or the lack of

appropriate action, occurring within any relationship where there is an expectation of trust

which causes harm or distress to an old person”. Abuse can occur in various forms within an

institutional setting, such as physical, psychological, and financial. Violence against and

abuse and neglect of older persons are pervasive around the world. An increase in violence

against
 older persons have been seen during ongoing crises such as the coronavirus disease

(COVID-19) pandemic, armed conflicts, and climate change. Crises lead to economic

setbacks, which put more strain on support structures worldwide, which in turn may put older

persons at risk of suffering from violent acts (Human Rights Council, n.d.; Kangasniemi et al.,

2022; Zegarra Chiappori, 2022).

It is noteworthy that the majority of instances of neglect observed in institutions are

unlikely to be attributed to substandard care, but rather the dying process or the result of

higher diseases and comorbidities associated with higher levels of depression, thus functional

dependence and burden or work to caregivers constituting a situation that leads to

maltreatment as stated by (Friedman et al., 2019; Ludvigsson et al., 2022; Wolde et al., 2022).

A decline in functioning including cognitive and prevalence of chronic disease tends to

worsen, and it's particularly evident starting at 80 years of age, the consequence can

compromise the ability of older individuals to perform the activities of daily living and

participate in society, as a result increase dependency in the caregivers (Bassett, 2021;

Drommi et al., 2021; Fonseca et al., 2021). Female gender are more susceptible to being the

victims of elder neglect, specifically emotional neglect, their vulnerability comes from

previous experiences in life such as childhood trauma or adulthood trauma, which contributed

to becoming submissive towards the abuser (Ludvigsson et al., 2022).

It is crucial to understand the factors and risk of neglect, and why it’s still increasing

in numbers. Around one in six people 60 years and older experienced some form of abuse in

community settings during the past year, rates of abuse of older people are high in institutions

such as nursing homes and long-term care facilities, with 2-3 staff reporting that they have

committed abuse in the past year as stated by (World Health Organization 2022, 2022).

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 Components of prevention and intervention should be tailored individually to match the needs

and preferences of the older victim (Ludvigsson et al., 2022). Understanding the factor that

influences functional limitations including cognitive and multimorbidity is an important

development of new model care for older adults in the social support system, increasing the

ratio of nurses per older adult will greatly help in reducing the workload of caregivers, high

rate of salaries will give them satisfaction to work accordingly, adequate training should be

provided and workshop on how to manage conflict situations, the relationship between staff

and the individual should be improved, it is also necessary to train caregivers to identify and

manage cases of suspected abuse, and provide adequate support in a situation at risk (Bassett,

2021; Drommi et al., 2021).

Although case of neglect is common and inevitably increasing, it’s still underrated

because of the lack of reporting, older adult are reluctant to report their family and caregiver,

some reason due to physical or mental inability, dependency on the abuser for basic needs,

fear of retaliation, and concern that the report will lead to abuser losing his job (Bassett,

2021). Data on world population Aging indicate that the number of people 65 years and above

will increase from 703 million in 2019 to 1.5 billion in 2050, and the number of people aged

over 80 will increase even more markedly reaching 426 million in 2050, this later group age-

gap is at greater risk of frailty, isolation and impaired personal autonomy factors associated

with a high risk of abuse (World Population, 2019).

With the thought of an older person going through such a horrendous situation in their

late stage of life which they don’t deserve, the researchers were motivated to look deeply into

how to prevent neglect through various interventions, facilitate more awareness, and increase

knowledge regarding the effect of neglect to older adult.

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 Objectives of the Study

This study aims to explore the neglect that elderly individuals face in geriatric settings

by reviewing existing literature. Specifically, it seeks to answer the following questions:

1. What are the identified risk factors contributing to elderly neglect?

2. Determine the underlying causes of neglect in terms of:

i. Physically

ii. Emotionally, and

iii. Psychologically

3. Identify how elderly individuals manage neglect within a geriatric setting

Specific Problems:

1. What are the demographic data of elder individuals in geriatric care settings?

2. What are the effects perceived among older adults after experiencing neglect from the

caregiver?

3. Based on the findings, What policy may be formulated to reduce neglect in geriatric

settings?

Significance of the Study

The importance of this research lies in its potential to enhance the quality of life for older

adults. By deepening our comprehension of the issues at hand, it can guide the development

of strategies aimed at fostering a secure, respectful, and dignified environment for the care of

the elderly. These will be beneficial to the following:

1. Patient: Improve the well-being and quality of life for older adults receiving care in

geriatric settings. Understanding and addressing neglect can directly impact their physical and

emotional health.

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 2. Healthcare Professionals and Caregivers: Healthcare professionals and caregivers who

work with elderly patients can benefit from improved work environments and reduced stress

related to neglect. These improvements may lead to increased job satisfaction and higher

employee retention rates.

3. Family: Family members of loved ones in geriatric care benefit from knowing they

receive quality care and are safe from neglect. This alleviates family concerns and distress.

4. Public Health and Health Care System: Addressing neglect among older adults can

improve health outcomes, reduce the burden on public health and healthcare systems, and

result in cost savings through efficient resource allocation.

5. Government and Regularities Agencies: Government agencies overseeing healthcare

facilities use research to develop or revise regulations, resulting in better enforcement and

safer care environments.

6. Future Researchers: Researchers in the fields of geriatrics, healthcare management, and

social sciences benefit from a deeper understanding of neglect and its implications. This

knowledge can inform future research and academic endeavors.

Definition of Terms/Operational Definitions

 Aging: Natural process of becoming old.

 Cognitive impairment: Perception and understanding of things are slower, forgetful, and

have difficulty retaining information.

 Emotional Neglect: This refers to a lack of emotional support, social interaction, and

companionship that can lead to loneliness and withdrawal from other individuals.

5
  Family Involvement: Involves participation of family or relatives in the care of their

loved one in geriatric care.

 Functioning: Ability to do something normally, without help from others.

 Geriatric Setting – This is a term used for a facility that provides care for elderly

individuals, nursing homes, or long-term care facilities.

 Late Elderly: This is a term that identifies a group of individuals in their late stages of

life, belonging to the age group of adults ages 75 and above.

 Multimorbidity: This is a combination of multiple chronic conditions that is common in

an older adult, a disability that hinders their daily activities.

 Neglect: It’s an act in which one fails to provide the basic support, care, or needs of an

individual, whether it is intentional or not.

 Physical Neglect: It’s a failure to provide physical care to the individual including

personal hygiene, medication, providing nutrition, and assisting in daily activities.

 Psychological Neglect: This is a form of neglectful behavior that can be harmful to the

mental health of elderly individuals, such as verbal abuse, or neglect of their emotional needs.

 Staffing Ratio: Refers to the number of healthcare professionals or caregivers. Shortage

of staffing can contribute to neglect.

 Vulnerable: Refers to older adults who are at risk of harm or neglect due to their

weakness.

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 CHAPTER II

Methodology

Data Collection

We aim to explore the phenomenon of neglect towards elders in geriatric settings. The

following steps were applied in gathering data: (1) a review of 50 published articles globally

from the years 2018 to the present (2)academic databases and resources were searched

including PubMed, Google Scholar, CINAHL, Web of Science articles focusing on neglect

towards elders in geriatric settings (3) screening articles based on inclusion criteria, exclude

irrelevant or duplicate articles (4) extract relevant data from selected articles in detail that can

support the research objectives (5) the utilization of thematic analysis approach to identify

common themes and patterns in the data.

 Criteria for Including Studies in the Review

The criteria for including studies in the review on neglect towards elders in geriatric

settings involve relevant considerations. To start with, the studies must directly address the

topic of neglect in geriatric settings, examining its causes, consequences, and prevention.

Furthermore, the inclusion criteria specify that the studies should have been published

globally from 2018 up to the present, ensuring that the review captures the most recent

research. It is also important to consider the credibility of the sources, so the review should

include articles published in reputable peer-reviewed journals, language limitations, and

exclusion of specific study types such as editorials or case reports. By adhering to these

7
 criteria, the review aims to identify current and reliable evidence that contributes to

understanding neglect in geriatric settings.

 Search Methods for Identification of Studies

The research study about neglect towards elders in geriatric settings was gathered

from databases and different search engines such as PubMed, Web of Science, and CINAHL

using specific keywords. Google Scholar is also useful for broader searches. It’s important to

document search methods for transparency.

Data Analysis

In this research, we will employ content analysis as our chosen method to investigate

and ascertain the motivations of individuals by carefully examining the contents of pertinent

articles about elder neglect. Following the application of PRISMA for data screening, the

collected data will be consolidated and subsequently employed to summarize, structure,

present in tabular form, and analyze the gathered information.

Data Synthesis

After the consensus meeting our initial systematic review that met the inclusion

criteria was included. The condition of geriatric elder individuals that was include those older

adults who are susceptible to neglect, older individuals who have multimorbidity, with

cognitive impairment, a female who has a history of abuse in childhood or adulthood, and

vulnerable aging individuals. The exclusion of those adult individuals who are bedridden and

8
 have comorbidity and those older individuals who have enough support system from family

and relatives.

The analysis employed is qualitative content analysis based on the Graneheim and f7

approach, involving steps such as preliminary readings, utilizing text coding, abstraction, and

discussion. 50 literature reviews were coded individually, followed by collaborative

discussion among the group members. The NVivo 12 software was used for data

management.

The collected data will be consolidated and subsequently employed for Summarizing

the information gathered from the selected articles. Structuring the data in an organized

manner. Presenting data in tabular form for clarity. Analyzing the gathered to identify

common themes and patterns related to elder neglect in geriatric settings.

This data synthesis provides a comprehensive overview of the research methodology,

criteria for study inclusion, search methods, and data analysis approach applied in the study

exploring neglect towards elders in geriatric settings.

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 References

Altintop, I., & Tatli, M. (2019). Physical abuse of the elderly: a 4‐year

retrospective evaluation in the emergency department. Psychogeriatrics,

19(1), 10–15. https://doi org.libproxy.lib.csusb.edu/10.1111/psyg.12355

Anthropology and Humanism 2022-12 | Journal article

https://doi.org/10.1111/anhu.12385

Bassett, Erica (2021) "Abuse and Neglect against Elderly Adults in Nursing Homes in the United

States," Ballard Brief: Vol. 2021: Iss. 2, Article 10. Available at:

https://scholarsarchive.byu.edu/ballardbrief/vol2021/iss2/10

Department of Health Care Services. (2019). Medi-Cal Managed Care and

Mental Health Office of the Ombudsman.

https://www.dhcs.ca.gov/services/MH/Pages/MH-Ombudsman.aspx

Dionísio AS, Gomes JF, Veríssimo MTM (2020) Elder Abuse: Characterization of a Population

Hospitalized in CHUC. J Geriatr Med Gerontol 6:100. doi.org/10.23937/2469-

5858/1510100

Drommi, M., Ponte, A., Ventura, F. et al. Elder abuse in Europe’s “most elderly” city: an update

of the phenomenon based on the cases reported to the Penal Court of Genoa from 2015 to

2019 and literature review. Aging Clin Exp Res33, 2865–2871 (2021).

https://doi.org/10.1007/s40520-021-01790-6

Fonseca, C., de Pinho, L.G., Lopes, M.J. et al. The Elderly Nursing Core Set and the cognition of

Portuguese Older Adults: a cross-sectional Study. BMC Nurs 20, 108 (2021).

https://doi.org/10.1186/s12912-021-00623-1

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Lee Friedman, Susan Avila, Daniel Friedman, Wendy Meltzer; Association between Type of

Residence and Clinical Signs of Neglect in Older Adults. Gerontology 16 January 2019;

65 (1): 30–39. https://doi.org/10.1159/000492029

Ludwigsen, M., Wiklund, N., Swahnberg, K. et al. Experiences of elder abuse: a qualitative

study among victims in Sweden. BMC Geriatr 22, 256 (2022).

https://doi.org/10.1186/s12877-022-02933-8

National Council on Aging. (2019). Get the facts on elder abuse.

https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-fats/

Tackling abuse of older people: five priorities for the United Nations Decade of Healthy Ageing

(2021–2030). Geneva: World Health Organization; 2022. Licensed: CC BY-NC-SA 3.0

IGO.

Wolde A, Wolancho W, Belay Y, Alemu A, Asefa A, Gebremedhin T. A Community-Based

Exploratory Cross-Sectional Study of Elder Abuse Perpetration or Victimization Among

Elders in Ethiopia, 2022. Clin Interv Aging. 2022;17:957969

https://doi.org/10.2147/CIA.S360548

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APPENDICES

Appendix A: PRISMA 2016 flow diagram

Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Four-Phase
Flow Diagram
cat
tifi
en
Id

io
Studies through database searching
(n = )

Duplicates removed
(n =)
eni

ng
Sc

re

Titles/abstracts screened
(n =)

Excluded, irrelevant to the

objectives of the review
(n = )
Eli

ity
bil
gi

Full-text assessed for

eligibility
(n = )
Excluded, did not meet the
inclusion criteria
(n =)
clu

de
In

Studies included
(n =)

12
CURRICULUM VITAE

13