Global abuse of older people: A mega‐map of systematic reviews on prevalence, consequences, risk and protective factors and interventions

Background Globally, around one in six people 60 years and older experience some form of abuse in community settings annually and the rate in institutions in higher still. Abuse of older people can result in serious consequences, including, for instance, premature mortality, physical injuries, and mental health problems. Yet the issue has not received the attention it deserves, partly due to the perception that there is a lack of evidence on all aspects of the problem. The United Nations Decade of Healthy Ageing has identified generating more and better evidence as a top priority for tackling abuse of older people. Objectives To produce a mega‐map – which identifies, maps and provides a visual interactive display, based on systematic reviews in community and institutional settings – of all aspects of abuse of older people, including prevalence, consequences, risk and protective factors, and interventions to prevent, detect, and respond. Search methods We searched 23 electronic databases; grey literature was searched using repositories, relevant organizational websites, dissertation and theses databases, and academic search engines such as Google Scholar; and one journal was hand searched. Selection criteria Detailed selection criteria were applied related to aspects of abuse of older people (prevalence, consequences, risk and protective factors, and interventions), population addressed (people 60 and over in community and institutional settings), and study design (systematic reviews of quantitative and qualitative studies and evidence and gap maps). Data collection and analysis A data extraction form (including definitions) and screening tool were developed and pilot tested for screening studies. Two researchers independently conducted the screening, data extraction, and coding processes. Discrepancies were resolved through consultation with a third-party arbitrator. EPPI-Reviewer was used to facilitate data extraction and coding.Main results We identified 111 systematic reviews, but no evidence and gap maps. About 50 systematic reviews addressed prevalence, risk factors, and interventions, 30 reviews addressed consequences, and 19 protective factors. The largest proportion focused on physical abuse, while a roughly equal proportion focused on psychological, sexual, and financial abuse and neglect. Few reviews addressed systemic/organizational abuse and poly-victimization. The number of reviews published began to increase sharply around 2010. Half the reviews were judged to be of medium or high quality. Only a minority used meta-analytical techniques to synthesize their findings. Most of the primary studies included in the review were from the WHO Region of the Americas and, to a somewhat lesser extent, the European Region. Fewer primary studies from the other WHO regions were included and almost none from the African Region. Most of the primary studies included were from high-income countries, few from upper middle and lower-middle countries and very few from low-income countries. The report also provides a detailed analysis of reviews on the different aspects of abuse of older people and of the 1652 primary studies included in the 111 reviews.Authors' conclusionsAn increasing number of systematic reviews addressing all aspects of abuse of older people are being published. Still, there are fewer than in other related fields, confirming the perception that there is a dearth of evidence on this issue. The mega-map identifies some notable gaps: reviews on consequences and risk and protective factors; reviews addressing systemic/organizational abuse and poly-victimization; meta-analyses on all aspects of abuse of older people; and reviews on all aspects of abuse of older people occurring online. The reviews included few primary studies addressing interventions and consequences than prevalence and risk and protective factors. There was also a paucity of primary studies and systematic reviews on all aspect of abuse of older people from the South-East Asian Region, the Eastern Mediterranean region, and, particularly, the African Region and from upper and lower middle and low-income countries.