Introduction
Ensuring the conditions for a normal life for older people is the responsibility of various social institutions. This is because the problems that this population faces may relate not only to health but also to other factors, which, nevertheless, are serious barriers to physical and moral well-being. One of these issues is elder abuse, which implies both direct abuse of older people and indirect actions that cause harm and moral discomfort to people in this age group. According to Phillips et al. (2010), “abuse often occurs within the family, in its many complex structures, and also in institutional care” (p. 441). This is why elder abuse should be perceived as a phenomenon that should not exist in modern realities due to the serious consequences for the well-being of many people. This work aims to identify the prerequisites of elder abuse, assess the consequences of the development of such a phenomenon, and highlight the mechanisms that can be used to overcome it.
Statement of the Problem
Elder abuse is a significant issue, which is accompanied by severe problems for the well-being of the relevant population and prevents the maintenance of normal social interaction. Individual drivers, such as rude behavior from family members or within communities, create discomfort for older people and cause the development of psychological trauma and moral imbalance in the target audience.
The topic of elder abuse is an essential theme for research because the analysis of the factors that provoke it can make it possible to highlight relevant ways to combat this phenomenon. From a personal perspective, the problem is of interest as the issue that can be considered in the context of various social concepts and assistance programs, thereby affecting a specific problem and related nuances. On a global scale, elder abuse is important to explore as a social relic that cannot exist in modern conditions of equality and the right of every citizen to respect for personal dignity. For instance, the humiliation of an older adult person by family members should not be allowed for any of the reasons, whether it be a psychological disorder of the former or other factors. Societal barriers, such as denial of access to health care, neglect of the basic needs of the elderly, or other humiliating precedents, are also objective reasons for containing the problem.
To evaluate this topic, different manifestations of elder abuse will be considered to formulate a comprehensive picture of the issue. The causes of the problem will be described to assess the social drivers that stimulate society’s indecent attitude towards older adults. Through the analysis of current programs and projects designed to address the difficulties of the target audience, recommendations will be given to remedy the situation. Through the use of credible academic sources, the findings will be compiled into a literature review, and the main points will be presented to formulate the ideas regarding the topic raised. The problem of elder abuse should not exist in modern society, and corresponding measures should be aimed not only at controlling but also at completely preventing the manifestations of unacceptable attitudes toward older adults.
Literature Review
Identifying the drivers stimulating elder abuse is a fundamental task for a comprehensive assessment of the problem and its prevalence on a global scale. The evaluation of the causes and prerequisites for the issue can help identify the key risk factors that need to be analyzed to successfully combat the social relic in question. The analysis of credible resources is an adequate mechanism to highlight the findings of researchers from different countries regarding the problem raised.
Causes of Elder Abuse
In modern studies, many researchers agree that the lack of emotional support is one of the causes of elder abuse. According to Storey (2020), social isolation caused by poor health and low social contact serves as an incentive to ignore the interests of the target audience. This is manifested in the lack of initiative of a vulnerable elderly person’s family members or poor support from social services responsible for helping the target audience. Patel and Mishra (2018) confirm the existence of this risk factor and draw attention to such a manifestation of social isolation as victimization. This is particularly essential for older people living in rural areas with low economic development, and by using the example of individual Indian settlements, Patel and Mishra (2018) prove the existence of the problem. Despite the fact that in Eastern culture, respect for the elderly is a crucial aspect of social development, cases of victimization based on this feature occur. As a result, without proper support, older people cannot cope with depression or other forms of mental disorders on their own, which aggravates their morale and makes it difficult to maintain normal social ties.
The factor associated with ineffective assistance from the responsible authorities deserves particular attention. As Ostaszkiewicz (2018) states, the problem of the rejection of care is manifested in the unwillingness of medical personnel to create the necessary conditions for comprehensive care for the elderly population. Such behavior on the part of physicians and nurses is a violation not only of ethical standards but also of legislative principles because every citizen has the right to count on competent medical support. However, as the author remarks, older people with care dependence often experience indifference from health services, who understand their impunity due to the lack of mental capacity of some older people (Ostaszkiewicz, 2018). This risk factor directly correlates with the problem of lack of livelihood, which Patel and Mishra (2018) mention as one of the prerequisites for abuse. Lacking sufficient funds, older people cannot count on comprehensive medical care, despite their available benefits, and abuse occurs. Therefore, the rejection of care is a serious driver of the problem, which requires the involvement of responsible authorities to eliminate this form of social neglect and resist inaction from responsible health services.
Based on the aforementioned factor, the concomitant factors of the failure to provide adequate assistance to older adults can be identified. Mattoo et al. (2019) cite the situational theory as a concept explaining the rejection of care in terms of an overburdened care environment. According to this theory, caregivers are unable to pay due attention to older patients due to the complexity of working with them and tedious procedures. From a practical perspective, such situations are possible, but the violence that Mattoo et al. (2019) mention as a manifestation of caregivers’ neglect is an unacceptable interaction form. Other concepts may also be involved as those interpreting the premises of the problem. According to Mattoo et al. (2019), the exchange theory and the political-economic theory explain the issue from the perspectives of the tedium of long-term care and the marginalization of the elderly in society, respectively. Each of these concepts offers appropriate reasons for the existence of the issue under consideration. However, although the aforementioned arguments are reasonable, the fact of the problem’s existence cannot be denied, and despite the risk factors, combating the issue is a significant social task.
The theoretical background of the problem makes it possible to identify the relevant mechanisms of elder abuse. In their analysis, Ludvigsson et al. (2022) provide a socio-ecological model as a framework that describes the risk factors of the issue at different levels, such as “individual, relationship, community, or societal level” (p. 2). At each of them, distinctive stimuli and drivers may emerge, for instance, neglect by social services or abuse demonstrated by family members. The researchers draw attention to cultural structures as significant determinants of relevant behavioral phenomena and note that, although some countries promote their own prevention strategies, like Sweden, the situation is similar in the world (Ludvigsson et al., 2022). This is due to the fact that the problem of elder abuse is not the result of only one prerequisite, for example, low social development, but of various reasons. Ernst and Maschi (2018) draw attention to life course trauma as a phenomenon that, if not addressed, directly correlates with abuse and entails difficulties in the target audience’s social adaptation. Therefore, regardless of theoretical interpretations and cultural backgrounds, it is crucial to consider the risk factors in the aggregate.
When considering the reasons for elder abuse, one can note that the common prerequisites are observed against individual risk factors, such as low social development or overworked caregivers. To combat the presuppositions of the issue, it is essential to promote cumulative action at different levels, which Ludvigsson et al. (2022) mention, including in the family environment and other social communities. Ignoring the problem is fraught with accompanying issues, which are critical to investigate to obtain a comprehensive picture of the situation and determine the measures to create conditions for the implementation of the necessary steps.
The consequences of elder abuse are critical to study because, without reliable information about the outcomes of the problem, neither researchers nor policymakers will be able to identify adequate optimization steps and solutions. In the academic field, numerous theories are involved in analyzing the premises of the problem (Mattoo et al., 2019). Nevertheless, in terms of the significance of the analysis, it is important to evaluate the results of the issue no less closely. The more attention is drawn to this topic, the higher the chances that the target audience will be able to count on equal treatment in individual social environments and receive comprehensive support. Therefore, the analysis of the consequences of elder abuse plays an essential role in the study of the topic.
Consequences of Elder Abuse
The consequences of elder abuse have been extensively researched in academic literature and described by different authors from distinctive perspectives. For instance, according to Podnieks and Thomas (2017), it is common to distinguish between physical, emotional, social, and individual outcomes, each of which manifests itself through its respective consequences. Yunus et al. (2019) supplement this classification by citing health outcomes as a separate category, thereby describing the consequences from a purely medical perspective. Regardless of the type of problem, vulnerable citizens experience symptoms that prevent them from normal socialization and directly affect their well-being. Depression, increased mortality, and other outcomes of abuse are the most common conditions, although in some cases, other problems manifest themselves, such as the development of chronic diseases (Yunus et al., 2019). These results suggest that along with the background, the consequences of elder abuse for the target audience can be different and manifest themselves distinctively. Moreover, experiencing the relevant symptoms allows for correlating specific causes with outcomes and providing an evidence base to justify the value of the necessary interventions. As a result, each of the risk factors requires individual interventions to prevent hazardous outcomes.
In addition to the aforementioned classification that includes the main consequences of elder abuse, some researchers provide additional criteria that are regarded as the outcomes of the problem. Brijoux et al. (2021) argue that along with physical, emotional, and some other manifestations, financial and sexual results may take place. In the first case, older people’s finances are exploited when the accumulated funds are spent by third parties (Brijoux et al., 2021). In the second case, sexual abuse occurs, which, although a rare precedent, still occurs (Brijoux et al., 2021). However, as Podnieks and Thomas (2017) state, health consequences are the most serious and dangerous outcomes of elder abuse due to older people’s vulnerable mental and physical condition. This argument is logical since, in adulthood, people often develop chronic diseases or other dangerous diagnoses, which, if abused, are exacerbated and cause new health issues. Without adequate help, these citizens cannot cope with such problems on their own, and their condition worsens, thereby leading to sad results. Therefore, despite numerous social risk factors, health consequences are the most serious outcomes to take into account and address.
When taking into account the global nature of the problem, it is essential to single out the results of elder abuse for individual regions that experience the greatest negative consequences. In her research, Kotzé (2018) assesses the prevalence of elder abuse in South Africa and notes that, due to cultural characteristics, the level of the problem in the state is high. One of the main reasons is the backwardness of the legal framework that defines responsibility for relevant violations, which is reflected in the high percentage of older adults experiencing abuse (Kotzé, 2018). The cultural context determines the resistance to any changes and the unwillingness of policymakers to meet international standards for ensuring the protection of the target population. In more economically and culturally developed countries, the situation is less serious. For instance, according to Farid (2017), the average elder abuse rate in the world varies within 10%, while in such countries as the US, the UK, Canada, and some others, this figure does not exceed 6% (p 126). Therefore, one can speak of the need to promote cultural and ethical values in society to combat elder abuse successfully.
Along with unique manifestations, the analysis of relevant academic sources reveals the most typical consequences of elder abuse. According to Santos et al. (2017), emotional exhaustion, namely depression, is the most prevalent symptom in older adults who have experienced abuse. In addition, depending on the type of problem, such issues as poor relationships with loved ones, low social activities, and deterioration in individual cognitive properties can occur. As Santos et al. (2017) note, self-reported emotional distress is observed in almost all respondents involved in the study on the results of abuse. At the same time, Brijoux et al. (2021) draw attention to a weak research base regarding the responsibility that abusers themselves bear. Due to the particular attention to the problems of the target audience, their difficulties and problems are evaluated, which is natural in the context of this topic. However, to obtain a comprehensive picture of the consequences for all involved participants in abuse incidents, it is crucial to evaluate the outcomes for perpetrators too. This vital practice can help create the necessary precedent base and define the methods of dealing with elder abuse as a widespread social phenomenon.
The analysis of the consequences of elder abuse shows that many negative outcomes are the result of entrenched forms of inappropriate attitudes toward older adults. Phillips et al. (2010) mention gender discrimination and segregation as the manifestations of the problem. Vulnerable people who are under pressure from relatives or members of their communities cannot resist the pressure, and additional methods of influencing their moral and physical condition appear. In such an environment, victims of abuse do not have an opportunity to count on adequate resistance, and the scope of the issue is expanded, entailing additional difficulties. In this regard, the search for adequate methods to counter elder abuse is not a desirable but a mandatory task aimed at eliminating any manifestations of violence against vulnerable older adults. Regardless of cultural, gender, or other characteristics, the target audience has the right to count on assistance from both communities and the authorities. Legislative initiatives in the form of policies and regulations can be regarded as one of the mechanisms for such activities. At the same time, without social support, such solutions are unlikely to address the problem under consideration to the fullest.
Ways to Overcome Elder Abuse
Addressing elder abuse can take place in a variety of ways, and different mechanisms to deal with this phenomenon can be put in place depending on which parties and resources are involved. The modern academic base offers a wide range of insights into which tools can be useful. In their study, Hosseinkhani et al. (2017) note that qualitative analytical tools, namely large-scale surveys among the target audience, can improve the situation. The authors argue that the identification of high-risk individuals is possible only through personal interaction with them (Hosseinkhani et al., 2017). As an intervention, planning should be carried out based on the assessment of the mechanisms for improving living standards. The cultural environment, in this case, does not play a significant role; the researchers analyze the difficulties of older people in Iranian families, where Muslim laws are considered a priority (Hosseinkhani et al., 2017). However, even in such an environment, cases of elder abuse are not uncommon, indicating the prevalence of the problem. Adequate planning is a practice based on the evaluation of the specific causes and outcomes of abuse, on the basis of which optimal steps are proposed.
When assessing the types of assistance to the target population, one can note that in scholarly sources, different methods of dealing with elder abuse are provided. Daly and Butcher (2018) do a great deal of analysis of the problem and state that as potentially effective interventions, legislative initiatives, education, caregivers’ work, social support, financial assistance, and work with abusers can be promoted. The authors offer justifications for each type of activity, and depending on various criteria, such as the sustainability of the resource base, the type of abuse, or other factors, the best course of action can be built. Hosseinkhani et al. (2017) suggest fewer interventions and the aforementioned aspects regarding legislators’ involvement or educational methods are mentioned superficially and not as individual assistance programs. In reviewing the proposed options for helping vulnerable populations, one can note that, depending on specific practices, distinctive outcomes can be achieved. Based on this classification, legislative initiatives and social support may be characterized as the most effective steps to involve a large number of stakeholders and build interaction with older adults based not on recommendations but on practical solutions designed to provide real assistance.
Of particular note are findings related to addressing elder abuse in individual communities characterized by unique cultural or other characteristics. In their work, Guruge et al. (2019) develop a specific protocol to identify elder abuse among older immigrants. They propose to create an appropriate knowledge base to enable risk planning and strengthen social assistance strategies (Guruge et al., 2019). This practice is potentially valid because the living conditions of people with a distinctive cultural mentality in a foreign country may be poor, and such a protocol can be a valuable intervention guideline. Similar work is suggested by Warren and Blundell (2019) because the authors also focus on individual communities by paying attention to older residents in rural areas and remote regions. They insist on the need to develop relevant legislative initiatives specifically for such areas (Warren & Blundell, 2019). Their remoteness from large population centers is a risk factor due to the inability of the target audience to count on timely assistance. Both these types of intervention are justified as narrow assistance practices aimed at addressing the concerns of vulnerable older people in difficult living conditions.
Targeted activities to address the problem under consideration should concern not only older adults themselves but also those who are involved in direct interaction with them. In their article, Fearing et al. (2017) insist on the need to develop customized programs for both target audiences and caregivers. The researchers propose specific interventions for healthcare professionals and social workers based on developing and implementing appropriate educational programs to enhance professional training (Fearing et al., 2017). Among these programs, they mention guidelines for caregivers working with elderly patients with dementia, protocols for organizing the activities of multidisciplinary teams, and several other initiatives (Fearing et al., 2017). Such targeted educational activities are essential to ensure the safety of older adults and avoid the risk of elder abuse both in specialized facilities and at home. With appropriate guidelines and courses of action, caregivers can conduct their work in accordance with ethical, legal, and other conventions without violating any norms and principles. As a result, such targeted work has value as an additional mechanism to prevent elder abuse through the comprehensive training of social service and healthcare professionals to interact with older adults.
In light of the prevalence of elder abuse worldwide, appropriate policy interventions based on the development and implementation of the necessary legislative initiatives are discussed in academic literature. The study by Mikton et al. (2022) assesses the importance of promoting “global policy windows” as a mechanism to deal with the issue worldwide (p. e535). As modern measures are taken for this purpose, the authors cite some steps to highlight the problem in the masses, one of which is the activities of the 2030 Sustainable Development Goals program (Mikton et al., 2022). Another step that also contributes to increasing the knowledge of the world population about the problem of elder abuse is the organization of World Elder Abuse Awareness Day. This date is dedicated to discussing the methods of combating the issue and the results achieved to this day (Mikton et al., 2022). Legislative initiatives in the context of the COVID-19 pandemic have also contributed to raising awareness of older people’s needs, which, as Mikton et al. (2022) argue, is also a positive consequence of political interventions. Therefore, from a legislative perspective, real steps are taken to eliminate the problem in question.
At the national level, relevant legislative initiatives are also promoted, and specific results of this practice are presented in corresponding academic sources. Bobitt et al. (2018) analyze the effectiveness of the Elder Community Act, a document ratified by the US government in 2009. The authors state that this act was designed to address the interests and needs of the target population, focusing on ensuring senior citizens’ safety (Bobitt et al., 2018). As activities in this direction developed, additional legislative solutions began to emerge, and as a result, the National Voluntary Consensus Guidelines were presented, which according to Bobitt et al. (2018), was an important step. Blundell and Warren (2019) evaluate the existing regulatory frameworks in Australian law and review a list of documents aimed at addressing the issue at hand. The authors focus on the difficulties that older people in remote and rural areas face and, according to their assessment, of all the documents analyzed, only a third mention the target population (Blundell & Warren, 2019). This suggests that paying more attention to local communities at the national and international levels is essential.
Attention to educational practices designed to raise awareness among caregivers and older adults about dealing with abuse is also an essential aspect of the research field. In their study, Adib et al. (2019) consider such preventive solutions as special training programs in which both target citizens and their family members can be involved to achieve better productivity. For policymakers, such programs can become a background for evaluating the effectiveness of ongoing social work and the basis for developing new approaches to solving the issue under consideration. According to Adib et al. (2019), elder abuse is a problem that makes it difficult for older people to seek help due to limited opportunities for social interaction. As a result, training programs are critical initiatives to educate target citizens about what resources they can use to overcome the issue and count on support. Caregivers can also be involved in such projects, which is an important practice designed to expand the knowledge of medical and social workers. Therefore, educational solutions can be considered successful if different stakeholders understand the significance of the problem and the necessary steps to eliminate it timely.
As an additional practice to prevent elder abuse, some researchers mention financial assistance to the target population. As Rosen et al. (2019) state, this way of dealing with the problem under consideration is based on cash assistance to older people so that they can use more opportunities to find the necessary social services. In addition, through financial assistance, the authorities also organize the operation of specific programs that function to implement official projects to help older adults (Daly & Butcher, 2018; Rosen et al., 2019). When assessing the effectiveness of such activities, one can note that in the case of stable funding, targeted citizens can count on continuous support from responsible services. Financial difficulties in families often lead to elder abuse, and, as Rosen et al. (2019) remark, relevant assistance from the state can minimize the risks of mistreatment of older people. Therefore, along with educational initiatives, the distribution of budgetary funds is a potentially effective task to realize in the context of programs to help the target population.
Based on the assessment of existing ways to combat elder abuse, the key activities related to this work concern social, legislative, and financial initiatives. Involving as many stakeholders as possible increases the relevance and success of the proposed initiatives, thereby enhancing the chances of overcoming the problem. Based on the aforementioned prerequisites for the development of elder abuse, social and legislative solutions are the most important. Appropriate control by the responsible authorities is mandatory to minimize cases of unacceptable treatment of older people. Future research may concern the mechanisms to promote programs aimed at addressing the problems of the target population living in remote and rural areas. This topic is researched mainly at the national rather than global level, which is a limitation. Evaluating the results of specific regulations from the perspective of comparing the outcomes before and after their implementation is also a promising research area due to an opportunity to test the effectiveness of relevant solutions.
Conclusion
The conducted literature review has made it possible to identify the causes of elder abuse as a common social problem, assess its consequences, and present ways to overcome it through various methods. Based on the analysis of the findings, one can note that the issue of elder abuse is relevant and requires the involvement of a wide range of stakeholders to introduce effective solutions. The target population often cannot cope with the problem on their own due to low social contacts, lack of funds, poor knowledge, or violence from their family members. The consequences of the problem are serious and affect not only older adults themselves but also other parties, including medical communities and other social institutions. The most convenient and effective methods of dealing with elder abuse have been identified based on the assessment of credible academic sources. These include targeted training and educational programs, legislative initiatives, and social projects designed to draw attention to the issue and support vulnerable people in different regions. Timely measures and comprehensive interventions are crucial factors in the fight against elder abuse as a dangerous phenomenon that has a global character.
References
Adib, M., Esmaeili, M., Zakerimoghadam, M., & Nayeri, N. D. (2019). Barriers to help-seeking for elder abuse: A qualitative study of older adults. Geriatric Nursing, 40(6), 565-571. Web.
Blundell, B., & Warren, A. (2019). Reviewing the extent of rural and remote considerations in elder abuse policy: A scoping review. Australian Journal of Rural Health, 27(4), 351-357. Web.
Bobitt, J., Carter, J., & Kuhne, J. (2018). Advancing national policy on elder abuse. Public Policy & Aging Report, 28(3), 85-89. Web.
Brijoux, T., Neise, M., & Zank, S. (2021). Elder abuse in the oldest old: Prevalence, risk factors and consequences. Zeitschrift für Gerontologie und Geriatrie, 54(2), 132-137. Web.
Daly, J. M., & Butcher, H. K. (2018). Evidence-based practice guideline: Elder abuse prevention. Journal of Gerontological Nursing, 44(7), 21-30. Web.
Ernst, J. S., & Maschi, T. (2018). Trauma-informed care and elder abuse: A synergistic alliance. Journal of Elder Abuse & Neglect, 30(5), 354-367. Web.
Farid, S. (2017). Elder abuse and neglect in Bangladesh: Understanding issues, associated factors and consequences. Family Medicine & Primary Care Review, (2), 123-127. Web.
Fearing, G., Sheppard, C. L., McDonald, L., Beaulieu, M., & Hitzig, S. L. (2017). A systematic review on community-based interventions for elder abuse and neglect. Journal of Elder Abuse & Neglect, 29(2-3), 102-133. Web.
Guruge, S., Sidani, S., Matsuoka, A., Man, G., & Pirner, D. (2019). Developing a comprehensive understanding of elder abuse prevention in immigrant communities: A comparative mixed methods study protocol. BMJ Open, 9(1), e022736. Web.
Hosseinkhani, Z., Moradi, Z., & Khodamoradi, F. (2017). Elder abuse: Screening in Iranian families. Medical Journal of the Islamic Republic of Iran, 31, 126. Web.
Kotzé, C. (2018). Elder abuse – The current state of research in South Africa. Frontiers in Public Health, 6, 1-5.
Ludvigsson, M., Wiklund, N., Swahnberg, K., & Simmons, J. (2022). Experiences of elder abuse: A qualitative study among victims in Sweden. BMC Geriatrics, 22(1), 1-12.
Mattoo, K. A., Garg, R., & Dhingra, S. (2019). Classifying elder abuse – A review. Gerontology and Geriatric Research, 2(1), 118.
Mikton, C., Campo-Tena, L., Yon, Y., Beaulieu, M., & Shawar, Y. R. (2022). Factors shaping the global political priority of addressing elder abuse: A qualitative policy analysis. The Lancet Healthy Longevity, 3(8), e531-e539. Web.
Ostaszkiewicz, J. (2018). A conceptual model of the risk of elder abuse posed by incontinence and care dependence. International Journal of Older People Nursing, 13(2), e12182. Web.
Patel, A. B., & Mishra, A. J. (2018). An empirical study of elder abuse in the state of Uttar Pradesh of India. Quality in Ageing and Older Adults, 19(2), 106-116. Web.
Podnieks, E., & Thomas, C. (2017). The consequences of elder abuse. In X. Dong (Ed.), Elder abuse (pp. 109-123). Springer.
Phillips, D. R., Chan, A. C. M., & Cheng, S.-T. (2010). Ageing in a global context: The Asia-Pacific region. In D. Dannefer & C. Phillipson (Eds.), The SAGE handbook of social gerontology (pp. 430-446). SAGE Publications.
Rosen, T., Elman, A., Dion, S., Delgado, D., Demetres, M., Breckman, R., Lees, K., Dash, K., Lang, D., Bonner, A., Burnett, J., Dyer, C. B., Snyder, R., Berman, A., Fulmer, T., Lachs, M. S., & National Collaboratory to Address Elder Mistreatment Project Team. (2019). Review of programs to combat elder mistreatment: Focus on hospitals and level of resources needed. Journal of the American Geriatrics Society, 67(6), 1286-1294.
Santos, A. J., Nunes, B., Kislaya, I., Gil, A. P., & Ribeiro, O. (2017). Exploring the correlates to depression in elder abuse victims: Abusive experience or individual characteristics? Journal of Interpersonal Violence, 36(1-2), NP115-NP134.
Storey, J. E. (2020). Risk factors for elder abuse and neglect: A review of the literature. Aggression and Violent Behavior, 50, 101339. Web.
Warren, A., & Blundell, B. (2019). Addressing elder abuse in rural and remote communities: Social policy, prevention and responses. Journal of Elder Abuse & Neglect, 31(4-5), 424-436. Web.
Yunus, R. M., Hairi, N. N., & Choo, W. Y. (2019). Consequences of elder abuse and neglect: A systematic review of observational studies. Trauma, Violence, & Abuse, 20(2), 197-213.