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Towards a best-practice guideline to prevent abuse and neglect of older adults

Hirst S, Penney T, McNeill S, et al.  Best-practice guideline on the prevention of abuse and neglect of older adults  Canadian Journal on Aging. 2016; 35(2): 242-260.

Review question

What are the common approaches to preventing and addressing abuse and neglect of older adults within healthcare settings in Canada?


In Canada, the prevalence of abuse and neglect is estimated to range between 4% and 10% among those 65 and older. Abuse can take various forms, such as financial, physical, emotional, sexual, systemic, spiritual and neglect. The rates of abuse of older adults that are reported may not accurately represent the extent of the incidence.

There are barriers to recognizing and reporting abuse, including a lack of acknowledgment, a lack of professional knowledge, a lack of protocol for abuse identification, and limited services to prevent and manage cases of abuse. There is a lack of research on the topic, which is part of the reason there is no comprehensive guideline for preventing or addressing abuse in the Canadian context.

This systematic review collected evidence to inform the development a best-practice guideline specific to the challenge of preventing and addressing abuse of adults over the age of 65.

How the review was done

A detailed search of a number of electronic databases for studies published from 2000 to 2013 was conducted. Studies that focused on the terms older adult, mistreatment, risk factor, screening, abuse, education, and best practices were included in the review.

A total of 13,064 studies were identified in searches, and 62 were included in the review after assessments for eligibility.

This review was funded by the Government of Canada’s New Horizons for Seniors Program.

What the researchers found

The results of the included studies highlighted the main approaches to identifying and assessing abuse of older adults. These included screenings, routine abuse-related questionnaires, and further training to help professionals identify abuse during an expert assessment.

The studies also noted approaches to responding to cases of abuse of older adults. The evidence proved the effectiveness of multi-pronged, patient-centred, collaborative approaches to responding to older adult abuse. The collected information also revealed that healthcare providers are lacking in training about how to respond to abuse and neglect of the elderly.

Information to inform future strategic planning to manage the rates of older adult abuse was also gathered in this review. Through a lens of patient-centred advocacy, the review highlighted the importance of a rights-focused model for preventing, identifying and responding to abuse in the Canadian context.


In summary, the review identified six strategies to target abuse and neglect of older adults in the future: 1) developing teams to assess abuse/neglect of older adults; 2) improving the working conditions in nursing homes; 3) supporting supervision, tracking and monitoring of abuse in nursing homes; 4) provide funding for programs and services to serve victims of abuse; 5) develop policies and protocols to prevent and respond to abuse; and 6) create support for professionals to manage abuse in their practices. Further research and investigation on abuse and neglect of older adults was recommended.


Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

  • Safeguarding adults
    Know the signs of abuse: frequent arguments with a caregiver, changes in personality, unexplained injuries, bruising, unusual weight loss or unsafe living conditions. Ask doctors, social workers or community nurses for support if you or someone you know might be abused. Contact the police if someone you know is in physical danger.
  • Screening for intimate partner violence and abuse of elderly and vulnerable adults: Consumer fact sheet

    U.S. Preventive Services Task Force (USPSTF)
    Elder abuse can be financial, physical, sexual, psychological harm done to an older adult, or neglect or abandonment. There is not enough evidence to determine if screening all older adults for abuse and neglect can successfully identify elder abuse or help prevent it.
  • Preventing elder abuse

    Centers for Disease Control and Prevention (CDC)
    There are many types of elder abuse. Elder abuse is a serious problem in the USA and can lead to physical injuries, emotional effects, premature death and worsened health problems. Read this resource to learn more about elder abuse and tips to prevent it.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

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