Experiences of the Older Adults After Being Abused: A Qualitative Meta-synthesis

Abstract

Elder abuse is a global public health problem with severe social costs. Research on elder abuse has gradually increased; however, less attention has been paid to older adults’ perceptions and experiences of abuse. This review aimed to integrate older adults’ perceptions and experiences of abuse to provide a theoretical basis for developing interventions that meet their authentic needs. Six electronic databases were searched to include qualitative studies examining perceptions and experiences of abuse among adults aged 60 years or older, and 22 studies were included. This study used the Joanna Briggs Institute meta-aggregation approach to integrate the qualitative findings, which identified four themes: (a) changes resulting from elder abuse, (b) causes of abuse, (c) barrier factors and facilitating factors to the disclosure of abusive behavior, and (d) adopting different response strategies. The findings revealed that older adults experience persistent physical and psychological burdens and financial stress following abuse. Multiple factors influence the emergence of abuse and older adults search for help from the outside world, especially social support and perceptions of abuse. Older adults can deal with abuse by accepting the status quo or taking steps to change it. These findings have important implications for helping older adults prevent and cope with abuse experiences.

Keywords

elder abuse domestic violence mental health and violence qualitative research qualitative meta-synthesis

Introduction

The population aged 60 years or older is growing faster than any other age group in the world and is projected to more than double by 2050 and more than triple by 2100 (United Nations (UN), 2017). Elder abuse is becoming a growing social problem with the rapid growth of the world’s older population, regardless of social class, race, or religion (Sommerfeld et al., 2014). According to the World Health Organization (WHO), elder abuse is defined as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, causing harm or distress to an older person,” primarily including physical abuse, emotional or psychological abuse, economic abuse, sexual abuse, and neglect (WHO, 2022). Perpetrators of older adult abuse may be relative and non-relative perpetrators, such as neighbors, friends, coworkers, and health care providers (Wong et al., 2021).

A systematic review of 52 studies in 28 countries found the overall incidence of elder abuse in community settings was 15.7%, with approximately 1 in 6 people over 60 globally experiencing some form of abuse (Yon et al., 2017). With an aging population, the number of abuse victims will continue to increase globally to approximately 320 million by 2050 (WHO, 2022). However, 64.2% of the staff in institutional settings were admitted to elder abuse. Psychological abuse (33.4%) had the highest estimated prevalence among older residents, followed by physical (14.1%), financial (13.8%), neglect (11.6%), and sexual abuse (1.9%) (Yon et al., 2019).

The prevalence of elder abuse varies regionally. For example, prevalence estimates have ranged from 31% in Israel for overall abuse (Cohen et al., 2010) to 86.9% for neglect in the United States (U.S.) (Griffore et al., 2009). In East Asian countries, the overall prevalence of elder abuse is 78.33 per 1,000 individuals annually (Wang et al., 2022). This may be related to population differences, settings, definitions, and research methods. Additionally, the prevalence of maltreatment varies among older adults of different racial groups and genders. For example, black older adults are at increased risk of financial abuse than white individuals (Burnes et al., 2021).

Maltreatment of older adults can seriously damage their physical and mental health, leading to physical injury, premature death, depression, anxiety, feelings of powerlessness, cognitive decline, economic hardship, and other problems (Dong et al., 2013; Lachs et al., 1998). They are also more likely to require hospitalization even when controlling for various health issues (Dong & Simon, 2013). Studies have found that victims of elder abuse are three times more likely to die than non-victims (Lachs et al., 1998). Elder abuse brings substantial economic costs to individuals and the healthcare system. The U.S. Centers for Disease Control and Prevention estimated that elder abuse injuries result in approximately US$5.3 billion in annual health care expenses (CDC, 2016). Victims of elder abuse experience substantially higher health care costs than non-abused older adults (Zhang et al., 2024). Given the importance of this issue, the phenomenon of elder abuse is currently receiving increased attention from public health, social services, health care, and legal and criminal justice professionals (Wang et al., 2022).

Recently, some systematic reviews of elder abuse have been published (Marzbani et al., 2023; Wang et al., 2022; Wei & Balser, 2024; Wong et al., 2022; Zhang et al., 2022); they primarily focused on quantitative studies. Many of these studies have focused on obtaining prevalence estimates for different countries and identifying the risk factors (Marzbani et al., 2023). Regarding risk factors, quantitative systematic reviews have discovered that poor health, increasing age, black persons, living alone, and lack of social support are associated with an increased risk of abuse (Burnes et al., 2021; Marzbani et al., 2023; Wong et al., 2022). In terms of the consequences of elder abuse, studies have revealed that elder abuse increases hospitalization rates and the risk of metabolic syndrome (Dong & Simon, 2013, 2015). However, quantitative systematic evaluations have lacked attention to how older adults cope with abuse and the factors that influence older adults’ disclosure of abuse experiences, particularly facilitating factors (Fraga Dominguez et al., 2021; Wei & Balser, 2024). In contrast, qualitative research can provide a better and more contextualized understanding of the phenomenon by revealing new information and nuances about the experience of victimization based directly on survivors’ accounts (Lindhorst & Tajima, 2008). For example, in some qualitative studies (Cadmus et al., 2015; Giebel et al., 2023; Ludvigsson et al., 2022; Mysyuk et al., 2016; Simmons et al., 2022) on elder abuse, older adults describe how they cope with the status quo and the factors that facilitated their disclosure of their experiences of abuse, which are critical for addressing elder abuse. In summary, researchers can better address elder abuse by focusing on positive coping styles and facilitators involved in qualitative research.

Some studies have also indicated that older adults’ perspectives and experiences should be fully considered when developing elder abuse prevention and intervention programs (Fraga Dominguez et al., 2021; Van Royen et al., 2020). While there has been an increase in qualitative research on older adults’ post-abuse experiences, the types of elder abuse focused on and the cultural contexts may differ between studies (Band-Winterstein & Avieli, 2022; Cadmus et al., 2015; Dow et al., 2020; Giebel et al., 2023; Wamara et al., 2021). There has been no synthesis of qualitative evidence specifically synthesizing older adults’ experiences of abuse, resulting in a lack of a richer and more complete understanding of the phenomenon. Consequently, this study systematically evaluated and integrated qualitative studies on older adults’ experiences after abuse under different cultural backgrounds to improve the resonance of this field and provide a basis for the subsequent development of targeted intervention measures.

Methods

Study Design

Qualitative synthesis followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (Page et al., 2021). This study used the Joanna Briggs Institute (JBI) qualitative research quality evaluation criteria for evidence-based healthcare centers to evaluate the quality of the included literature (Lockwood et al., 2020). A meta-aggregation approach was used to synthesize qualitative evidence (Lockwood et al., 2020) and registered with PROSPERO (registration number CRD42023401178). This research approach was chosen because meta-aggregation is the preferred JBI approach for developing action recommendations (Lockwood et al., 2020).

Inclusion and Exclusion Criteria

The inclusion criteria were as follows: (a) participant types: the participants were ≥60 years old (UN defines older persons as those aged 60 years or over) (UN, 2020); (b) phenomenon of interest: reported experiences and perspectives of older adults after suffering abuse; types of elder abuse include physical abuse, emotional or psychological abuse, economic abuse, sexual abuse, and neglect (by a perpetrator), excluding self-neglect; (c) context: this review considered any setting where elder abuse occurs; (d) study types: this review considered studies that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, and action research. Mixed-method studies were included when a qualitative component was present. The exclusion criteria were as follows: (a) articles that were not in English, (b) full-text or incomplete data could not be obtained, and (c) repeated publication or identical literature.

Literature Search

A computer search was conducted using PubMed, Web of Science, the Cochrane Library, CINAHL (EBSCO), Embase, and PsycINFO (EBSCO). The search period was from the establishment of the database to November 15, 2023. The search strategy was developed after identifying relevant search terms by searching for keywords contained in the titles and abstracts of the papers and index terms used to describe related articles. Specific search strategies were developed based on the requirements of each database. A research librarian reviewed the search strategies to ensure accuracy. The reference lists of all included studies were also searched for additional studies. Three search terms were combined: (a) aged, (b) elder abuse, and (c) qualitative research. Some of the key search terms were as follows: (geriatric OR aged OR senior OR old* OR aging OR aged) AND (elder abuse OR domestic violence OR neglect* OR ill-treat* OR maltreat* OR mistreat* OR exploit* OR fraud* OR assault* OR bully* OR aggress* OR extort* OR fraud OR rape OR theft) AND (Qualitative Research OR Qualitative OR grounded theory OR theme* OR content analysis OR narrative OR mixed method* OR discourse analysis OR focus group* OR interview* OR experience* OR view* OR attitude*). Keywords and MeSH subject terms were used. Table 1 details the complete search strategies for all databases.

Table 1.

Summary of Search Strategies and Databases.

Database	Search Strategy	Total Number of Items
PubMed	((“Geriatrics”[Mesh]) OR “Aged”[Mesh]) OR ((Aging[Title/Abstract] OR aged[Title/Abstract] OR senior[Title/Abstract] OR old[Title/Abstract]) AND (wom?n[Title/Abstract] OR m?n[Title/Abstract] OR lady[Title/Abstract] OR ladies[Title/Abstract] OR adult[Title/Abstract] OR citizen[Title/Abstract] OR resident[Title/Abstract] OR residents[Title/Abstract] OR population[Title/Abstract] OR people[Title/Abstract] OR person[Title/Abstract]))) AND (((“Domestic Violence”[Mesh]) OR “Elder Abuse”[Mesh]) OR ((mental[Title/Abstract] OR physical[Title/Abstract] OR verbal[Title/Abstract] OR emotional[Title/Abstract] OR financial[Title/Abstract] OR sexual[Title/Abstract] OR psychological[Title/Abstract] OR material[Title/Abstract] OR elder[Title/Abstract]) AND (harm[Title/Abstract] OR abus[Title/Abstract])) OR (neglect[Title/Abstract] OR “ill treat”[Title/Abstract] OR maltreat[Title/Abstract] OR mistreat[Title/Abstract] OR exploit[Title/Abstract] OR fraud[Title/Abstract] OR assault[Title/Abstract] OR crim[Title/Abstract] OR violen[Title/Abstract] OR bully[Title/Abstract] OR intimidat[Title/Abstract] OR aggress[Title/Abstract] OR coerc[Title/Abstract] OR extort[Title/Abstract] OR stigmati[Title/Abstract] OR ostraci[Title/Abstract] OR fraud[Title/Abstract] OR homicid[Title/Abstract] OR “sex offenc”[Title/Abstract] OR rape[Title/Abstract] OR theft[Title/Abstract])) AND (“Qualitative Research”[Mesh] OR Qualitative Research[Title] OR Qualitative[Title] OR phenomen[Title] OR grounded theory[Title] OR theme[Title] OR ethnograph[Title] OR content analysis[Title] OR narrative[Title] OR mixed method[Title] OR discourse analysis[Title] OR focus group[Title] OR interview[Title] OR experience[Title] OR perception[Title] OR view[Title] OR opinion[Title] OR attitude[Title] OR perspective[Title] OR observation*[Title])	6,768
Embase	(“aged”/exp OR “geriatrics”/exp OR geriatric:ab,ti OR elder:ab,ti OR “old age”:ab,ti OR “old aged”:ab,ti OR pensioner:ab,ti OR (((aging OR aged OR senior OR old) NEAR/2 (wom?n OR m?n OR lady OR ladies OR adult* OR citizen* OR resident OR residents OR population1 OR people OR person)):ab,ti)) AND ((((mental OR physical OR verbal OR emotional OR financial OR sexual OR psychological OR material OR elder) NEAR/2 (harm OR abus)):ab,ti) OR neglect:ab,ti OR “ill treat”:ab,ti OR “ill treatment”:ab,ti OR “ill treated”:ab,ti OR “ill treating”:ab,ti OR maltreat:ab,ti OR mistreat:ab,ti OR exploit:ab,ti OR fraud:ab,ti OR assault:ab,ti OR crime:ab,ti OR violen:ab,ti OR bully:ab,ti OR intimidat:ab,ti OR aggressi:ab,ti OR coerc:ab,ti OR extort:ab,ti OR stigmati:ab,ti OR ostraci:ab,ti OR “fraud”/de OR “homicide”/de OR “sexual crime”/de OR “rape”/de OR “theft”/de OR “violence”/de OR “domestic violence”/de OR “elder abuse”/de) AND (“qualitative research”/exp OR “qualitative research”:ti OR “qualitative”:ti OR “phenomen”:ti OR “grounded theory”:ti OR “theme”:ti OR “ethnograph”:ti OR “content analysis”:ti OR “narrative”:ti OR “mixed method”:ti OR “discourse analysis”:ti OR “focus group”:ti OR “interview”:ti OR “experience”:ti OR “perception”:ti OR “view”:ti OR “opinion”:ti OR “attitude”:ti OR “perspective”:ti OR “observation*”:ti)	7,111
Web of Science	(AB=((Geriatric* or old-age* or pensioner))) OR AB=(((Aging OR aged OR senior OR old) NEAR/2 (wom?n OR m?n OR lady OR ladies OR adult* OR citizen* OR resident OR residents OR population* OR people OR person))) AND (AB=(((mental* OR physical OR verbal OR emotional OR financial OR sexual OR psychological OR material OR elder) NEAR/2 (harm or abus* or violence)))) OR AB=((neglect* OR ill-treat* OR maltreat* OR mistreat* OR exploit* OR fraud* OR assault* OR crime* OR violen* OR bully* OR intimidat* OR aggressi* OR coerc* OR extort* OR stigmati* or ostraci)) AND AB=(Qualitative Research OR Qualitative OR phenomen OR grounded theory OR theme* OR ethnograph* OR content analysis OR narrative OR mixed method* OR discourse analysis OR focus group* OR interview* OR experience* OR perception* OR view* OR opinion* OR attitude* OR perspective* OR observation*)	8,376
CINAHL (EBSCO)	(AB (Geriatric* or Elder* or old-age or pensioner) or ((Aging or aged or senior or old) N2 (wom#n or m#n or lady or ladies or adult* or citizen* or resident or residents or population* or people or person)) or MH “Geriatrics”) AND (AB ((mental* or physical or verbal or emotional or financial or sexual or psychological or material or elder) N2 (harm or abus)) or (neglect or ill-treat* or maltreat* or mistreat* or exploit* or fraud* or assault* or crime* or violen* or bully* or intimidat* or aggressi* or coerc* or extort* or stigmati* or ostraci) or (Fraud or homicid* or “sex offen” or rape or theft or Violence or MH “Domestic violence” or MH “Elder abuse”)) AND (AB (MH “Qualitative Studies”) or (Qualitative Research OR Qualitative OR phenomen OR grounded theory OR theme* OR ethnograph* OR content analysis OR narrative OR mixed method* OR discourse analysis OR focus group* OR interview* OR experience* OR perception* OR view* OR opinion* OR attitude* OR perspective* OR observation*))	3,231
PsycINFO (EBSCO)	(AB (Geriatric* or Elder* or old-age or pensioner) or ((Aging or aged or senior or old) N2 (wom#n or m#n or lady or ladies or adult* or citizen* or resident or residents or population* or people or person)) or (“Retirement home” or “retirement care home”) or DE “Geriatrics”) AND (AB ((mental* or physical or verbal or emotional or financial or sexual or psychological or material or elder) N2 (harm or abus)) or (neglect or ill-treat* or maltreat* or mistreat* or exploit* or fraud* or assault* or crime* or violen* or bully* or intimidat* or aggressi* or coerc* or extort* or stigmati* or ostraci) or (Fraud or homicid* or “sex offen” or rape or theft or DE “Violence” or DE “Domestic violence” or DE “Elder abuse”)) AND (TI Qualitative Research OR Qualitative OR phenomen OR grounded theory OR theme* OR ethnograph* OR content analysis OR narrative OR mixed method* OR discourse analysis OR focus group* OR interview* OR experience* OR perception* OR view* OR opinion* OR attitude* OR perspective* OR observation*)	2,093
Cochrane Library	“Elder Abuse”[Mesh]	27

Note: “*” is a truncation symbol that can be used to replace multiple characters.

Literature Screening

Literature screening, data extraction, and cross-checking were performed independently by two researchers (MJC and XYG) who had received evidence-based training. Any disagreements were resolved by discussion with a third reviewer (JG). Duplicate literature was excluded after importing all database records from the search into EndNote X9 (Thomson ResearchSoft, Stanford, Connecticut). Titles and abstracts were reviewed to screen for potential studies that met the inclusion criteria. The full texts of the potential studies were evaluated to identify the final eligible studies.

Quality Assessment

Two reviewers (JLG and XMX) evaluated the quality of the included literature using the JBI qualitative research quality evaluation criteria for evidence-based healthcare centers (Lockwood et al., 2020). The evaluation included 10 items. The first five items assessed the consistency of the research methodology with the stated philosophical perspective, research question or objectives, data collection methods, data representation and analysis, and result interpretation. The last five assessed locating the researcher culturally or theoretically, the researcher’s influence on the research, participant representation and voices, ethical approval by an appropriate body, and the relationship between conclusions and analysis or interpretation. Each item was evaluated by “yes,” “no,” “unclear,” and “not applicable.” The scores were calculated based on the number of yes responses. Papers with less than six “yes” were excluded to ensure quality (Boehm et al., 2021). The reviewers were blinded to each other’s assessments, which can only be compared once both reviewers completed the initial appraisal of an article. If the evaluation results were inconsistent and no consensus was reached after discussion, a third reviewer’s (CMH) opinion was added to judge whether to include the literature.

Data Extraction and Synthesis

Two independent reviewers (YL and JLG) extracted qualitative data using a recognized framework (Lockwood et al., 2020). The data extraction content included author, year, country, study design, data collection methods, participants, sample size, phenomena of interest, study sites, and primary results. The JBI meta-aggregation approach was used to extract and synthesize data (Lockwood et al., 2020). All findings or themes were presented as in the original studies without reinterpretation. Two reviewers (YL and WTJ) re-read each included study to ensure maximum familiarity with the data. Subsequently, a three-step process was adopted to synthesize qualitative findings (Lockwood et al., 2020). First, the results of the included studies were extracted line-by-line according to their meaning. Second, the abstracted findings were grouped into developed and synthesized categories based on their similarities in meaning. Third, synthesized findings were created for at least two overall synthesized categories. These synthesized findings and categories form the basis of meta-aggregation and are illustrated using quotes from individual studies.

JG led the meta-aggregation, with input from all authors. All authors reached a consensus on the categories and synthesized the findings. Two reviewers (YL and WTJ) independently assessed the consistency between the findings and supporting data and provided a plausibility score (unequivocal, credible, and unsupported) for each finding. “Unequivocal” relates to evidence beyond a reasonable doubt, including factual, directly reported/observed, and cannot be challenged. “Credible” indicates a lack of clear correlation between them, but it can be inferred from the data. “Not supported” indicates that the data do not support the findings. According to the JBI methodology, only unequivocal and credible findings were included in the meta-aggregation, and any unsupported findings were excluded from the synthesis (there were no unsupported findings in this study) (Lockwood et al., 2020).

Results

Study Inclusion

A preliminary search yielded 27,606 studies. After importing, duplicate literature was excluded from all database records from the search in EndNote X9. After removing duplicate studies, we obtained 16,271 pieces of literature. After reading the titles and abstracts, 14,731 papers were excluded because they did not fit the study population, type, and topic. Finally, 22 eligible papers were obtained after reading the full text to enter the quality assessment stage. Figure 1 illustrates the literature screening process.

Figure 1.

Flow chart of literature screening.

Characteristics of the Included Studies

The included studies were published between 2010 and 2023 and conducted in Iran (n = 3), China (n = 2), Sweden (n = 2), Portugal (n = 2), Brazil (n = 2), the U.S. (n = 1), Ghana (n = 1), Ireland (n = 1), Uganda (n = 1), Holland (n = 1), New Zealand (n = 1), the United Kingdom (n = 1), Israel (n = 1), Nigeria (n = 1), Australia (n = 1), and Colombia (n = 1). These studies included 768 older adults. All the 22 included studies were qualitative, without mixed-methods studies meeting the inclusion criteria. The study sites included home (n = 8), community (n = 3), and organization (n = 9). Three studies did not mention the study sites (Dow et al., 2020; Giebel et al., 2023; Maryam et al., 2022), while one study mentioned two study sites (Smith, 2015), making a total of 20 study sites. Table 2 presents the essential characteristics of the included literature.

Table 2.

Characteristics of the Included Studies (N = 22).

Study	Country	Study Design and (Data Collection Methods)	Age (Years)	Sample (Male/Female)	Study Sites	Study Objective	Main Results (Themes)
Awuviry-Newton et al. (2020)	Ghana	Phenomenology (semi-structured interviews)	65–120	12 (5/7)	Community	Feelings and thoughts of neglect experienced by older adults	Four themes: neglect as a function of a natural cause; neglect attributed to the self; neglect resulting from the failure of government institutions; neglect attributed to the breakdown of the extended family system.
Band-Winterstein and Avieli (2022)	Israel	Phenomenology (semi-structured interviews)	62–83	19 (0/19)	Organization	Lived experiences of older women who have been sexually abused	Three themes: sexual violence shaping lifelong intimate partner violence (IPV); the occurrence of sexual violence in old age in the context of lifelong IPV; cumulative insights and reflections on being a survivor of lifelong IPV and sexual violence.
Cadmus et al. (2015)	Nigeria	Grounded theory (focus group interviews)	60–92	64	Organization	Older adults’ views on elder abuse	Five themes: roles in the community and problems faced; types of abuse; factors responsible for elder abuse; consequences resulting from abuse; suggested solutions.
Dow et al. (2020)	Australia	Qualitative research (semi-structured interviews)	62–89	28 (9/19)	Not mentioned	Older adults’ experiences of abuse and barriers to reporting abuse	Four themes: fear of negative consequences for the abuser, including homelessness; fear of negative consequences to themselves; belief that the abuse was not the abuser’s fault; stigma, shame, and embarrassment.
Giebel et al. (2023)	Colombia	Qualitative research (semi-structured interviews)	62–96	26 (14/12)	Not mentioned	The effect of stressful life events on older adults	Four themes: living in violent and dangerous communities; disturbing gender violence and gender roles; lack of mental health awareness; coping mechanisms.
Heravi-Karimooi et al. (2011)	Iran	Phenomenology (semi-structured interviews)	75–89	14 (5/9)	Home	The lonely experience of older adults who have been abused	Three themes: feeling of pain and suffering; feeling of being an outsider; feeling of deprivation.
Khosravi et al. (2019)	Iran	Qualitative descriptive study (semi-structured interviews and focus group interviews)	≥60	55 (17/38)	Home	The meaning of elder abuse and sociocultural factors	Two themes: structural changes in family interactions; changes in sociocultural values.
Liu and Hu (2021)	China	Narrative research (semi-structured interviews)	73–86	59 (53/6)	Home	Views and experiences of abuse among older adults in rural China	Four themes: disrespect; dependency and the down-valued self; disconnection and rejection; social comparisons in the construction of abuse.
Ludvigsson et al. (2022)	Sweden	Qualitative research (unstructured interview)	65–85	24 (9/15)	Organization	The experience of elder abuse	Four themes: vulnerability in old age; experiences from earlier in life; perceptions of abuse; consequences and suffering from the abuse.
Maryam et al. (2022)	Iran	Qualitative descriptive study (semi-structured interviews)	61–92	20 (14/6)	Not mentioned	Older adults’ perceptions and experiences of abuse	Three themes: broken toughness; hidden abuse; exploitation.
McGarry et al. (2010)	UK	Qualitative research (open-ended interview)	60–84	16 (0/16)	Home	Older women’s experiences of domestic violence and its impact on their health and lives	Three themes: the effect of domestic abuse on the lives and health of older women; the effect of domestic abuse on the lives and health of older women; service provision for older women.
Mysyuk et al. (2016)	Holland	Grounded theory (semi-structured interviews and focus group interviews)	63–90	17 (6/11)	Home	Older adults’ experiences and perspectives on abuse	Three themes: causes of abuse; effects of elder abuse; coping strategies.
Park (2014)	New Zealand	Qualitative research (unstructured interview)	71–88	10	Community	The impact of abuse on the physical and mental health of the older adults	Two themes: physical effects of abuse; psychological effects.
Pereira et al. (2020)	Brazil	Qualitative descriptive study (open-ended interview)	63–81	25 (7/18)	Home	Signs of elder abuse	Four themes: evidence of violence against the elderly; domestic violence; neighborhood conflicts; urban violence.
Ribeiro et al. (2023)	Brazil	Qualitative descriptive study (semi-structured interviews)	60–85	8 (4/4)	Organization	The experience of institutionalization of older adults from the perspective of the victims in a Brazilian social shelter	Three themes: personal, relational, and social bonds: broken or weakened; denial of the violence suffered; from imposed protection to compassionate care.
Santos et al. (2019)	Portugal	Qualitative research (open-ended interview)	≥60	22 (6/16)	Organization	Older adults’ experiences of abuse	Four themes: abuse grown old; abuse after entering later life; vulnerability to abuse; responses to abuse.
Simmons et al. (2022)	Sweden	Qualitative research (unstructured interview)	≥65	30 (10/20)	Organization	How older adults deal with experiences of abuse	Five themes: self-reliant coping; restoring dignity in relation to others; needing formal and informal help; inner resistance to disclosure; external barriers and facilitators for disclosure.
Smith (2015)	U.S.	Grounded theory (unstructured interview)	>62	15 (0/15)	Home or organization	Older women’s perceptions of abuse and adult children	Four themes: types of adult children’s problems; defying mothers’ expectations; taking or not taking action; self-blame and shame.
Taylor et al. (2014)	Ireland	Grounded theory (focus group interviews)	65–89	58 (8/50)	Community	Older adults’ understanding of abuse and their views on getting help	Four themes: the emotional underpinning of most or all abuse; the vulnerability of the older person; the intention of the perpetrator; concepts of family duties and relationships.
von Humboldt et al. (2022)	Portugal	Phenomenology (semi-structured interviews)	65–91	173 (62/111)	Home	Older adults’ views on bullying	Seven themes: compromised learning capacity; loss of sense of agency and decision-making; asexuality; less attractive appearance; less social skills; gender discrimination; less financial resources.
Wamara et al. (2021)	Uganda	Qualitative descriptive study (semi-structured interviews)	60–89	33 (14/19)	Organization	Older adults’ experiences and perspectives on abuse	Five themes: economic abuse; harassment and violence; disrespect; neglect and abandonment; discrimination.
Yan (2015)	China	Grounded theory (open-ended interview)	61–81	40 (14/26)	Organization	Elder abuse and help-seeking behavior in older adults	Seven themes: definitions of abuse; denial of one’s own experience; patterns of abuse; patterns of help-seeking behaviors; perceived barriers to help seeking; actual barriers to help seeking; recommendations to elder abuse victims.

Note: “Home” means in the older adults’ own homes; “Community” means the community in which the older adults currently reside; “Organization” includes primary health care centers, senior or elder abuse service centers, long-stay institutions for the elderly, university hospitals, social clubs, active retirement groups, and others.

Quality Assessment

This review assessed the methodological quality of 22 studies. Only a few studies (n = 7) described the researcher’s cultural and theoretical orientation. Furthermore, 19 studies did not explain the researcher’s influence on the research or researcher. Only two studies did not provide ethical approval. Supplemental material Appendix A depicts the methodology quality evaluation results.

Meta-Aggregation

Sixty-nine findings were aggregated into 10 categories and classified into four synthesized findings. Figure 2 summarizes study findings, categories, and synthesized findings on older adults’ perceptions of abuse experiences.

Figure 2.

Meta-synthesis findings of the older adults’ perceptions of abuse experiences.

Main Findings of the Meta-synthesis

Meta-synthesis included 22 reports and yielded four main themes: (a) changes resulting from elder abuse, (b) the causes of abuse, (c) barrier factors and facilitating factors to the disclosure of abusive behavior, and (d) adopting different response strategies. The following is an analysis report on each theme. Supplemental material Appendix B describes the detailed synthesis process and levels of credibility.

Synthesized Finding 1: Changes Resulting from Elder Abuse

The first theme integrated from the included studies was changes caused by elder abuse. For example, abuse can lead to negative psychological experiences and long-term physical burdens and can put older adults under economic pressure.

Category 1: Negative Psychological Experience

The older adults felt disrespected (Liu & Hu, 2021); neglected (Awuviry-Newton et al., 2020); rejected (Santos et al., 2019); dispossession of autonomy (Maryam et al., 2022); sense of boundaries violated (Smith, 2015); difficulties with decision-making, disappointment (Liu & Hu, 2021); anxiety (McGarry et al., 2010); fear (Santos et al., 2019); devaluation of self (Liu & Hu, 2021); and despair (Mysyuk et al., 2016). Simultaneously, the older adults felt helpless and worried about having to live dependent on their children (Liu & Hu, 2021), guilty of burdening them, and overly worried about losing their will to live: “No one takes care of themselves before they die, so I considered suicide” (Liu & Hu, 2021, p. 213). Eventually, older adults lose trust in others, and the pain persists: “Because I sense this. . . I try to get rid of it when it comes, but it isn’t so easy, sometimes it just comes and yes, it’s just there” (Ludvigsson et al., 2022, p. 8).

Category 2: Long-term Physical Burdens

Older adults’ physical burdens may originate from their partners, such as being bossed around (Maryam et al., 2022) and sexually abused in daily life: “He pushed the door and entered and raped me. I was in pain the following day” (Wamara et al., 2021, p. 298). It can originate from children, such as being forced to care for their grandchildren (Wamara et al., 2021). Additionally, it can originate from grandchildren, and the noisy living environment seriously affects sleep: “All nights, I hear the sound of laughter or talking over the phone to a friend or listening to music” (Maryam et al., 2022, p. 251). After abuse, seniors experience physical discomfort, such as persistent stomach pain, urinary incontinence, sleep problems, and loss of appetite (McGarry et al., 2010). Abusers even physically attack the older adults, posing a life-threatening threat to them (Yan, 2015), and the violence is long-standing: “My whole life was like this” (Santos et al., 2019, p. 60).

Category 3: Under Economic Pressure

Children and their close family members often perpetrate financial abuse. The scarcity of resources facilitates it, the greed of family members and the desire to get rich quickly, with the older person being forced to share their property (Maryam et al., 2022) and even tricked into signing false documents (Wamara et al., 2021): “They expect me to sell the house they live in and meet their financial needs” (Maryam et al., 2022, p. 252). The criminal behavior of their children and telephone fraud suffered by the older adults put them under tremendous financial stress (Wamara et al., 2021). After suffering financial abuse, seniors are more careful with their possessions: “I became very tight with money” (Mysyuk et al., 2016, p. 3 in Supplemental material data). Older adults have difficulty finding suitable employment or living solely on government subsidies due to the COVID-19 pandemic and other causes, leading to financial strain (Cadmus et al., 2015; Giebel et al., 2023): “Sometimes I worry about how I’m going to be able to afford things. That’s why I was happier when the government was sending me that money, but that’s stopped now” (Giebel et al., 2023, p. 3).

Synthesized Finding 2: The Causes of Abuse

The causes of elder abuse are external factors, such as social and caregiver factors. There are also factors within older adults themselves, such as increased dependence on others due to aging or illness, as well as limited social networks, thus increasing their risk of abuse.

Category 4: Social Factors

Older adults’ causes of abuse are related to social factors, including lack of social attention and intervention (Awuviry-Newton et al., 2020; Heravi-Karimooi et al., 2011); weakening of neighborhoods (Khosravi et al., 2019); changes in family power structures, the fact that older adults are no longer key decision-makers in family matters (Khosravi et al., 2019); the absence of traditional cultural values and morals in modern society (Cadmus et al., 2015; Khosravi et al., 2019); negative labeling of older adults (Band-Winterstein & Avieli, 2022; Mysyuk et al., 2016); and paying too much attention on individualism and efficiency can lead to a lack of patience with older adults (Liu & Hu, 2021; Taylor et al., 2014; von Humboldt et al., 2022). One older adult said, “They are considered and treated as worthless people” (Khosravi et al., 2019, p. 7). “Some countries have supportive systems for elderly people. We are deprived of any services for elderly people suffering abuse or special centers to help us with our problems. At least, we need to talk to a person about our situations” (Heravi-Karimooi et al., 2011, p. 143).

Category 5: Caregiver Factors

Perpetrators’ unfortunate childhood experiences (Taylor et al., 2014); children’s failure to educate their children (Khosravi et al., 2019); and children’s distance from the older adults (Taylor et al., 2014) can all contribute to abuse: “Shadows of childhood still motivate behavior, if you have a strict parent who was strict on you when you were a child, you’ll harbor still the basic resentment into your adulthood and come the situation that now roles are reversed, I’m the boss now, that can motivate unconsciously unknown to themselves it can motivate their behavior to their parent” (Taylor et al., 2014, p. 233).

Violence escalated when the children left home independently: “Nobody has got my back now, I have no one to lean on” (Band-Winterstein & Avieli, 2022, p. 10). Abusers may use abuse to control the older adults and take control of power (Mysyuk et al., 2016). Older adults believe that a lack of safe family relationships increases the risk of becoming victims of elder abuse (Ribeiro et al., 2023).

Category 6: Older Adults’ Factors

Due to normal aging or illness, the older adult needs the care of others while having infrequent contact with the outside world and limited social networks, making them more vulnerable to abuse: “I am dependent on care. . . that does not put you in a strong and advantageous position, you are much more vulnerable and can easily become a victim. . .” (Mysyuk et al., 2016, p. 3). Living alone in old age (Santos et al., 2019) and reduced attractiveness in appearance and economic capacity are factors within the older adults themselves that may increase the risk of abuse (von Humboldt et al., 2022).

Synthesized Finding 3: Barrier Factors and Facilitating Factors to the Disclosure of Abusive Behavior

This result explains the complex reasons why older adults are reluctant to report abuse. This result also explains the circumstances under which older adults are more likely to report experiences of abuse.

Category 7: Barrier Factors

Regarding the older adults themselves, the barriers to disclosure of abuse are many factors involved. First, the traditional concept of the older adult focuses on family harmony: “Traditional Chinese women like us, we would always want a family to stick together. So, I didn’t go anywhere and tried to tolerate as much as I could” (Yan, 2015, p. 14). Second, older adults are ashamed of their experiences of abuse (Yan, 2015) and attribute abuse to their failure to educate their children (Smith, 2015). Third, older adults are embarrassed about accepting charitable behavior (Dow et al., 2020). Fourth, the lack of mental health awareness and insufficient knowledge of elder abuse among older adults means that they do not seek psychosocial support even when distressed by their life experiences (Giebel et al., 2023; Ribeiro et al., 2023). Besides, the older adults may fear that disclosing abuse will affect someone they care about (Dow et al., 2020) or result in fear of retaliation (Simmons et al., 2022). The older adults may also depend financially on abusers (Santos et al., 2019). When analyzing the external factors perceived by the older adults, we found that the barriers to disclosing abuse include other people preventing them from disclosing abuse (Dow et al., 2020), lack of legal support for the older adult, protective services (Yan, 2015), agencies (McGarry et al., 2010), and access to services. Lack of knowledge about elder abuse among professionals also leads to a lack of confidence among older adults: “I did talk to a social worker, there was this social worker from XXX. She said she couldn’t offer me any help on such things” (Yan, 2015, p. 17). These factors prevent the older adults from seeking help from the outside world.

Category 8: Facilitating Factors

The facilitators of the disclosure of abuse also include many factors. Older adults’ increased health problems due to aging can facilitate their disclosure of abusive behaviors (Santos et al., 2019). Societal concern for the older adults (Yan, 2015) and trusting relationships with others (Simmons et al., 2022) can also facilitate the disclosure of abuse by the older adults. Older adults find it easier to disclose abuse using a written questionnaire (Simmons et al., 2022). Sometimes, older adults voluntarily disclose the abuse out of concern for their abusers to stop their misbehavior: “People told me I shouldn’t spoil my son. It’s bad for him” (Yan, 2015, p. 13). Older adults’ disclosure of abuse can also sometimes be triggered by life circumstances, such as the parent’s death or exposure to abuse on television (Simmons et al., 2022). As the abuse escalates, older adults begin to fear for their safety (Yan, 2015). The relentlessness of the abuse prompts them to find the courage to seek help: “There is just so much one can tolerate; once it crosses that threshold, you start seeking a shield, seeking help. Perhaps it has passed my bottom line” (Yan, 2015, p. 12). When the abuser becomes ill or weak, the power and control relationship reaches a new balance, and the abused elder gains relief and rights (Band-Winterstein & Avieli, 2022).

Synthesized Finding 4: Adopting Different Response Strategies

Older adults use different coping strategies after abuse. Some older adults choose to passively accept the status quo of abuse. Some older adults prefer to remain positive and take steps to make a difference.

Category 9: Acceptance

Older adults may compare the present difficulties to the suffering they endured when they were young or attribute the abuse to an unfortunate fate, enabling them to passively accept the status quo of the abuse they have suffered (Liu & Hu, 2021). Physical illness prevents abused people from seeking help and has to succumb to the status quo (Simmons et al., 2022). Sometimes, the older adult tries to understand why the abuse occurred and expresses the understanding of the abuser (Dow et al., 2020). Older adults believe that abusers and themselves cause abuse. Older adults allow themselves to forget the experience of abuse and repress their emotions, adopt an avoidant attitude to face it negatively, and try to move on (Giebel et al., 2023; Simmons et al., 2022). Finally, the abuse gradually erodes older adults’ beliefs to take action: “Older people haven’t the confidence to fight back. If you were younger, you probably could do something about it, but you get older and they make you lose your confidence and then you don’t think you can do anything, no matter what you do” (Taylor et al., 2014, p. 230).

Category 10: Take Steps to Try to Change

Older adults try to change their perspective and adopt a positive attitude toward life (Mysyuk et al., 2016), using the strength gained from the outside world to create security and meaning (Ludvigsson et al., 2022). For example, socializing with others and getting social support from the family and community can help reduce low moods (Giebel et al., 2023). Older adults believe that faith can help them get through tough times and cope with stressful events (Giebel et al., 2023). Older adults think they should take a stand and reflect on changing their behavior to avoid becoming victims (Simmons et al., 2022). Besides, older adults felt that addressing their children’s employment and increasing their income would also help improve their situation (Cadmus et al., 2015). Help was sought from family members, friends, and agencies, which included public health services, nonprofit organizations, and domestic violence counseling and support centers: “I needed to deal with the situation. I was trying to seek help; I called public health service, the support center for domestic violence. They were open to help. . . My relatives also offered their support and that meant a lot to me” (Mysyuk et al., 2016, p. 5).

Discussion

This qualitative systematic evaluation summarizes older adults’ attitudes and perceptions of abuse experiences, providing deeper insights into the phenomenon. We identified four themes related to older adults’ perspectives using a meta-synthesis of 22 studies: (a) changes resulting from elder abuse, (b) causes of abuse, (c) barrier factors and facilitating factors to the disclosure of abusive behavior, and (d) adopting different response strategies.

The results of this study suggest that abuse exposes older adults to long-term physical burdens and negative psychological experiences. The impact of abuse on older adults’ mental health is more devastating than the physical burden (Cooper & Livingston, 2014). Previous studies (Dong et al., 2013; Yunus et al., 2019) have noted that abuse can cause older adults to feel anxious, depressed, disappointed, angry, and suicidal. The results of our review suggest that older adults also feel disrespected, guilty, self-depreciated, rejected, and neglected, among other negative psychological experiences (e.g., Awuviry-Newton et al., 2020; Liu & Hu, 2021; Santos et al., 2019). To improve mental health, we can consider the ideas of symbolic interaction theory (Mead, 1934), stating that people gain a sense of self and identity by interacting with the outside world, and people’s understanding of the meaning of things changes in response to social interactions. Thus, the promotion of positive images of older adults and the elimination of age discrimination should continue to be strengthened in the future, which will help enhance the sense of self-worth of older adults and improve their mental health. Additionally, the impact of economic abuse on older adults has received less attention (Wood & Lichtenberg, 2017). In this study, older adults frequently reported being subjected to various forms of financial abuse, resulting in significant financial strain. (e.g., Giebel et al., 2023; Maryam et al., 2022; Wamara et al., 2021). Therefore, measurable and concerted efforts are needed to prevent financial abuse of older adults in the future (Teaster et al., 2023).

Compared to previous studies (Burnes et al., 2021; Fettig et al., 2024; Johannesen & LoGiudice, 2013; Marzbani et al., 2023; Wei & Balser, 2024), we summarized the common causes of elder abuse and provided additional evidence. On the social side, low social support and changes in cultural values are common factors contributing to the occurrence of abuse (e.g., Cadmus et al., 2015; Heravi-Karimooi et al., 2011). Low social support includes lacking social attention and intervention (Awuviry-Newton et al., 2020; Heravi-Karimooi et al., 2011), weakening neighborhood relations (Khosravi et al., 2019), and others. Changes in cultural values include a lack of traditional values (Cadmus et al., 2015; Khosravi et al., 2019), a focus on individualism and efficiency (Liu & Hu, 2021; Taylor et al., 2014; von Humboldt et al., 2022), and others. Professionals should analyze specific causes according to different cultural backgrounds. On the caregiver side, perpetrators’ unfortunate childhood experiences and a lack of secure family relationships are common factors (e.g., Ribeiro et al., 2023; Taylor et al., 2014). Caregiver stress theory also suggests that elder abuse occurs when caregivers are unable to manage caregiving responsibilities (Steinmetz & Anisden, 1983). Additionally, the stress process model (Pearlin et al., 1990) states that caregiver stress arises as a result of exposure of caregivers to primary stressors, such as the dependency level of the cared-for person, cognitive state, and the effect of secondary stressors, such as family conflict and self-esteem, possibly leading to psychological distress and exacerbating the likelihood of elder abuse (Cooper & Livingston, 2014). On the side of older adults, existing health problems, dependence on caregivers, low income, and living alone are common factors (e.g., Mysyuk et al., 2016; Santos et al., 2019). Moreover, prior studies (Burnes et al., 2021; Wei & Balser, 2024; Yan et al., 2015) suggest that females, lower education levels, and race contribute to abuse. The findings of this study suggest that the burden on older adults caring for family members may also increase the risk of maltreatment (e.g., Wamara et al., 2021). Previous research has overlooked this area (Wei & Balser, 2024). Older adults said that their children were abusing them by leaving their grandchildren in their care and not offering any assistance (Wamara et al., 2021). However, adequate research on protective factors is still lacking (Fettig et al., 2024). Additionally, future longitudinal studies should explore how different factors change over time.

Underreporting of abuse is estimated to be as high as 80% (WHO, 2008), and understanding older adults’ perceptions of abuse is critical to addressing underreporting (Fraga Dominguez et al., 2021). The synthesized results of this study suggest that for older adults themselves, older adults’ cultural values focused on family harmony, lack of proper perception of abuse, and concerns about consequences are common barrier factors to the disclosure of abuse (e.g., Dow et al., 2020; Simmons et al., 2022; Yan, 2015), consistent with previous findings in the literature (Fraga Dominguez et al., 2021; Gill, 2022). Additionally, older adults indicated that the most common external barrier factor was a lack of social support. For example, older adults lack appropriate protective services and institutions (e.g., McGarry et al., 2010; Yan, 2015). This study provides updated evidence on the facilitators of the disclosure of abuse by older adults, including social support, trusting relationships with others, increasing health and safety problems, using written questionnaires, concerns about the future of the abuser, and shifts in rights and control relationships after the abuser becomes ill (e.g., Band-Winterstein & Avieli, 2022; Santos et al., 2019; Simmons et al., 2022; Yan, 2015). Besides, previous studies pointed to betrayal by trusted persons also as a facilitating factor (Fraga Dominguez et al., 2021). This study revealed the critical role that social support plays in the disclosure of abuse. Another study (Marzbani et al., 2023) confirmed its importance and suggested that the development and implementation of social support interventions is a practical component for preventing all types of elder abuse. Additionally, professionals should focus on the role of written questionnaires in facilitating the disclosure of abuse and explore the ability of artificial intelligence, machine learning algorithms, and big data to identify and intervene in abuse.

The results of this study revealed that older adults have two different coping strategies to face abuse. On the one hand, some older adults passively accept the status quo due to incorrect attribution and poor health. For example, older adults stated that they suffered due to their lousy fate (Liu & Hu, 2021) and gradually lost their confidence to fight back as they grew older (Taylor et al., 2014). Tolerance to abuse is also prevalent among other populations (Girard et al., 2023). On the other hand, some older adults adopt positive response strategies to abuse, such as taking a stand (Simmons et al., 2022), adopting a positive attitude, and reaching out for help (Mysyuk et al., 2016). This process is consistent with post-traumatic growth theory (Tedeschi & Calhoun, 1996). This suggests that older adults can eventually overcome helpless acceptance by mastering the experience of adverse events (Maier & Seligman, 2016). Accordingly, building expectations for a better future to improve the status quo is necessary and may be the best natural defense against feelings of helplessness (Maier & Seligman, 2016). Informal and formal support networks play an important role in older adults’ coping with abuse (e.g., Giebel et al., 2023; Mysyuk et al., 2016), suggesting strengthening peer support and different areas, such as public services. Additionally, older adults indicated that personal beliefs and addressing their children’s employment would help them cope with the status quo (Cadmus et al., 2015; Giebel et al., 2023). The reasons older adults chose two different coping measures in future studies deserve continued attention, which will help develop interventions to promote proactive coping strategies among older adults. Table 3 summarizes the critical findings.

Table 3.

Critical Findings.

• The physical and psychological burdens and financial pressures that abuse places on older adults are persistent over time.

• Social factors, caregiver factors, and the older adult’s factors are the three leading causes of abuse.

• Social support plays a vital role in elder abuse and is a major external factor influencing older adults to disclose abuse and seek help.

• Internal barrier factors to the disclosure of abuse by older adults mainly include the cultural values of older adults focusing on family harmony, lack of proper perception of abuse, and fear of consequences.

• Facilitating factors for disclosure of abuse by older adults include social support, trusting relationships with others, increasing health and safety problems, use of written questionnaires, concerns about the future of the abuser, and shifts in rights and control relationships after the abuser becomes ill.

• It is not only the caregiver’s burden of caregiving that may increase the risk of abuse, but also the older person’s burden of caring for other family members.

• Older adults choose two different ways of dealing with abuse: accepting the status quo and taking steps to try to change it.

• Both informal support networks and formal help-seeking play essential roles as older adults actively cope with the experience of abuse.

• Faith plays an active role in older adults’ response to abuse.

• Older adults believe that addressing their children’s employment issues and increasing their income will help improve the abuse.

Empirical and Intervention Implications

Our findings provide an empirical basis for guiding elder abuse prevention and intervention. The results of this study suggest that older adults have inadequate knowledge of abuse, which may lead to the concealment of abuse experiences and negative coping styles. However, existing educational programs are primarily for healthcare professionals and the general public (Atkinson & Roberto, 2024), and insufficient attention has been paid to educational programs for the older adult population. Therefore, future research should develop appropriate educational programs to raise awareness of abuse among older adults themselves. The expertise of professionals on the issue of elder abuse should also be enhanced to reduce silence. Multidisciplinary teams should work together to provide older adults with greater social support. Besides, helping older adults prepare for the future after abuse occurs and building expectations for a better life may be effective measures to improve the situation. Finally, it is essential to note that cultural sensitivity is a critical component in developing elder abuse prevention methods. Future research should also explore the effectiveness of existing interventions and assessment tools in different cultural contexts and build on what is already available to develop interventions tailored to the actual needs of older adults. Table 4 summarizes the implications for practice, policy, and research.

Table 4.

Summary of Implication of Review for Practice, Policy, and Research.

• Attention must be paid to designing and implementing social support interventions, and improving social support for older adults should be prioritized.

• Appropriate educational programs need to be developed to raise awareness of abuse among older adults and professionals, especially among older adults themselves.

• Written questionnaires should be used as an important way to screen for elder adult abuse.

• In the aftermath of abuse, the focus should be on the older adult’s control over their future, helping them to develop expectations for a better life, change perceptions of suffering, and maintain positive attitudes, thereby improving self-efficacy and problem-solving skills.

• Enhancing the social status of older adults, promoting a positive image of older adults, and eliminating age discrimination will be conducive to enhancing their sense of self-worth and ameliorating the negative psychological experience caused by abuse.

• Financial fraud puts enormous financial pressure on older adults, and interventions are needed to reduce financial fraud against older adults.

• Future longitudinal studies should also examine how risk and protective factors change over time and how these different risk factors interact.

• Further research is needed on why older adults choose two different coping measures, which will help develop interventions to promote positive coping strategies among older adults.

• The enhancement of public services should be accompanied by the strengthening of other areas, such as peer support.

• Society’s efforts to provide employment opportunities for children and increase their income will help to reduce abuse.

• Researchers need to assess the validity of existing interventions and assessment tools in different cultural contexts and improve their ability to research effective prevention interventions.

• There is a lack of research on the perceptions of abuse experiences of marginalized populations such as disabled older adults and homeless older adults, as well as exploring the abuse experiences of older adults in different settings such as hospitals, nursing homes, and others.

• Interdisciplinary teams should be established to promote solutions to the global problem of elder adult abuse.

Limitations and Strengths

This qualitative systematic evaluation is the first of its kind to synthesize the perceptions of older adults from different countries and cultures regarding their experiences of abuse, contributing to a better and more comprehensive understanding of the phenomenon from the older adults’ perspective. The limitations of this study are as follows: First, only studies published in English were included, which may have led to language bias. Second, the included studies were mainly from Europe, Asia, and Africa; therefore, the generalizability of this study to other settings may be limited. Third, although a systematic search was conducted using appropriate search strategies, only English language articles published in journals were included; gray literature and dissertations were not searched. Finally, there are differences in the definition of elder abuse due to cultural differences, social norms, and legislation, which may have created some bias in our results. Due to racial and cultural differences in elder abuse, future research on elder abuse in different racial groups and different regions should be strengthened to increase geographic and cultural diversity. Additionally, future research should focus on increasing the diversity of research subjects and research settings, such as disabled older adults, homeless older adults, and older adults of different religions, as well as exploring the experiences of abuse of older adults in different settings, such as hospitals and nursing homes, to develop a more comprehensive understanding of the phenomenon that can guide tailor-made interventions.

Conclusion

This study aimed to synthesize older adults’ perceptions of their experiences of abuse and to reveal, from the older adults’ perspectives, the changes caused by the abuse, the reasons for the abuse, the barriers and facilitators to disclosure of the abuse, and the different coping strategies that older adults have adopted. The results suggest that research exploring older adult maltreatment experiences is limited and that further exploration of the specific reasons why older adults cope differently would help improve their lives. This study emphasizes that social support is vital in this issue and that improving social support for older adults should be prioritized. The results of this study highlight a general lack of correct knowledge regarding abuse among older adults and professionals, especially among older adults. Therefore, the development of effective educational programs remains an essential step toward preventing abuse. This synthesis clarifies the gaps in current research and provides evidence for subsequent studies. It is crucial to include the voices and perspectives of older adults in developing future interventions and policies and personalizing them to their needs.

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Footnotes

Acknowledgements

The authors would like to thank all participants in this study for their friendly cooperation and all authors of included original studies.

Author Contributions

Research idea and study design:Yue Li, Wenting Ji, Julan Guo; literature search, data extraction and analysis: Yue Li, Wenting Ji, Julan Guo, Mingjin Cai, Xiaoyan Gong, Xuemei Xie; drafting of the manuscript: Yue Li, Wenting Ji, Julan Guo; critical revision of the manuscript for important intellectual content: Jing Gao, Chaoming Hou, Xiaohui Dong. All authors contributed to manuscript revision and read and approved the submitted version.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Yue Li

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Yue Li, MSc, focuses her research on the experiences of older adults in the aftermath of abuse, with an emphasis on understanding why abuse occurs, the impact on the physical and mental health of older adults, factors that influence disclosure, and how older adults cope after abuse occurs. Her research interests include older adult health, domestic violence, elder abuse, and primary health care.

Wenting Ji, MD. Her research focuses on improving older adults’ health, emphasizing exploring interventions’ effectiveness from the perspective of physiological mechanisms. She researches various aspects of quality of life for older adults, primarily focusing on elder abuse, caregiving, and health and social services.

Xiaohui Dong, MD, specializes in the management of chronic conditions affecting older adults, including elder abuse. She employs rigorous research methodologies and focuses on enhancing the physical and mental well-being and overall quality of life of older individuals.

Julan Guo, MSc, has clinical and research expertise in mental health nursing. Her previous clinical experience as a nurse spanned multiple disciplines, giving her experience in various areas. She currently conducts research in health services utilization and population aging.

Mingjin Cai, MSc, specializes in qualitative scientific research and evidence-based practice. Her research interests include elder abuse prevention and care of older adults with dementia and their family caregivers. Her work focuses on improving the well-being of vulnerable populations and enhancing the quality of life of older adults.

Xiaoyan Gong, MSc, promotes elder abuse prevention and intervention issues using methods related to evidence-based practice, and her research interests include older adult maltreatment experiences and social debility, working to develop psychosocial interventions to support vulnerable populations.

Xuemei Xie, MSc, specializes in evidence-based and community-engaged health research with older adult populations. Her research interests are in older adult mental health and care, elder abuse, and how these interact with healthcare and various chronic diseases.

Chaoming Hou, MM, is an associate professor at the School of Nursing, Chengdu University of Traditional Chinese Medicine. He is currently a member of several societies, including the Chinese Society of Traditional Chinese Medicine’s Division of General Practice and the Chinese Society of Geriatrics and Healthcare Medicine Research, among others. He emphasizes improving older adults’ physical and mental health through evidence-based practice.

Jing Gao, MSc, doctoral supervisor, is the Dean of the School of Nursing at Chengdu University of Traditional Chinese Medicine. Her research focuses on geriatric and community-based care, with a focus on the physical and mental health of older adults in community and institutionalized settings, geriatric nursing workforce development, and elder abuse, and informs practice and policy through her research.

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