Elder psychological abuse: narrative review of evidence and gaps in research – Frontiers

Systematic Review on Elder Psychological Abuse: A Public Health Imperative for Achieving Sustainable Development Goals

Introduction: The Global Context of Elder Abuse and the SDGs

Elder abuse represents a significant global public health and human rights challenge, directly contravening the principles of the Sustainable Development Goals (SDGs). As an often-overlooked form of violence, its impact undermines progress toward several key goals. This report summarizes a systematic review of elder psychological abuse, highlighting the critical need for focused action to protect vulnerable populations and advance the 2030 Agenda for Sustainable Development.

The issue is intrinsically linked to the following SDGs:

• SDG 3 (Good Health and Well-being): Elder abuse has severe consequences for the physical and mental health of older persons, directly hindering the goal of ensuring healthy lives and promoting well-being for all at all ages.
• SDG 10 (Reduced Inequalities): The targeting of older adults, a vulnerable demographic, is a stark form of inequality. Addressing this abuse is essential for creating more inclusive and equitable societies.
• SDG 16 (Peace, Justice and Strong Institutions): This goal explicitly calls for the reduction of all forms of violence. Elder abuse is a violation of human rights that weakens the fabric of peaceful and just societies.

Materials and Methods

A systematic search of the PubMed database was conducted to identify relevant literature. The search strategy employed a combination of terms related to older people, emotional and psychological violence, and abuse. Studies focusing primarily on physical abuse were systematically excluded to isolate research on the psychological dimensions of the phenomenon.

Results: Key Findings and Implications for SDGs

The review identified ten studies meeting the inclusion criteria, spanning diverse geographical contexts (USA, Poland, Taiwan) and settings (community, institutional). The analysis revealed critical gaps that impede progress on the SDGs.

1. Absence of a Shared Definition: There is no universally accepted definition of elder psychological abuse, making it difficult to measure, compare, and address the problem systematically. This ambiguity hinders the development of effective policies aligned with SDG 16.
2. Lack of Structural Conceptualization: The phenomenon lacks a clear conceptual framework, complicating research and intervention design.
3. Extreme Variability in Prevalence: Reported prevalence rates vary widely, a direct consequence of inconsistent definitions and socio-cultural heterogeneity. This lack of reliable data undermines efforts to monitor progress towards targets within SDG 3 and SDG 16.
4. Reduced Reporting Rates: The issue is significantly under-reported, rendering the true scale of the problem invisible and hampering the allocation of resources needed to achieve SDG 10 by protecting vulnerable groups.

Discussion: Addressing Gaps to Advance Sustainable Development

The available literature on elder psychological abuse is limited and fragmented. The identified shortcomings present substantial barriers to achieving the Sustainable Development Goals. The lack of standardized tools for categorization and assessment means that the health and social systems required to support SDG 3 are ill-equipped to identify and assist victims. Furthermore, without a clear legal and social consensus on what constitutes psychological abuse, the institutions tasked with delivering justice under SDG 16 cannot function effectively to protect the rights of older persons.

Conclusion and Recommendations for SDG-Aligned Action

The systematic review underscores an urgent need for concerted international action. To align efforts with the 2030 Agenda, the following steps are recommended:

• Promote Global Partnerships (SDG 17): Foster international research collaboration to establish a single, universally accepted definition of elder psychological abuse.
• Develop Standardized Tools: Create and validate reliable assessment instruments for the identification and classification of abuse. This will generate the robust data needed to inform policies and track progress toward SDG 3 and SDG 16.
• Strengthen Institutions and Policies: Integrate elder abuse prevention and response mechanisms into national public health and justice systems, thereby reinforcing the commitment to SDG 10 and SDG 16.
• Enhance Research Capacity: Dedicate further research to explore the phenomenon in-depth, ensuring that interventions are evidence-based and contribute effectively to the well-being of aging populations worldwide.

Analysis of SDGs in the Article on Elder Abuse

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on elder abuse connects to several Sustainable Development Goals (SDGs) due to its focus on health, well-being, inequality, and violence against a vulnerable population.

• SDG 3: Good Health and Well-being: The article explicitly frames elder abuse as a “substantial global public health” problem. Psychological and emotional abuse directly impacts the mental health and well-being of older persons, which is a core component of this goal.
• SDG 10: Reduced Inequalities: Elder abuse is an issue that disproportionately affects a specific age group, making older persons a vulnerable population. The article’s focus on abuse against the elderly relates to the goal of empowering and promoting the inclusion of all, irrespective of age, and ensuring equal opportunity.
• SDG 16: Peace, Justice and Strong Institutions: The article identifies elder abuse as a “human rights problem” and a form of “violence.” This directly aligns with SDG 16, which aims to reduce all forms of violence and promote justice for all. The lack of reporting and standardized definitions mentioned in the article also points to weaknesses in institutional responses to this issue.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, the following specific SDG targets are relevant:

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Explanation: The article focuses heavily on “psychological abuse,” “emotional abuse,” and “verbal abuse.” These forms of violence directly undermine the mental health and well-being of the elderly, making this target highly relevant.
2. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
   • Explanation: Elder abuse is a form of exclusion and victimization based on age. Addressing it is crucial for promoting the social inclusion and protection of older persons. The article’s mention of “exclusion” as a search term reinforces this connection.
3. Target 16.1: Significantly reduce all forms of violence and related death rates everywhere.
   • Explanation: The article’s central theme is a specific form of violence—psychological abuse against the elderly. It describes this as one of the “lesser known and studied forms of violence.” Therefore, efforts to understand and combat it contribute directly to achieving this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article implies several indicators by discussing the challenges in measuring the problem of elder abuse.

• Prevalence of psychological abuse: The article notes the “extreme variability in the prevalence of the phenomenon.” This directly implies that a key indicator for measuring the problem is the rate or proportion of the elderly population subjected to psychological violence. This aligns with the official SDG indicator 16.1.3: Proportion of population subjected to physical, psychological or sexual violence in the previous 12 months.
• Reporting rates of elder abuse: The text mentions “reduced reporting rates” as a significant issue. Therefore, the number or proportion of elder abuse cases reported to authorities or relevant institutions can serve as an indicator. An increase in reporting could signify better awareness and more trust in support systems, which is a form of progress.
• Standardized assessment tools: The article concludes by highlighting the “lack of standardized categorization and assessment tools.” The development and adoption of such tools would be a crucial process indicator, measuring the capacity of health and social systems to identify and address the problem, which is necessary to track progress on the prevalence indicators accurately.

4. SDGs, Targets and Indicators Table

Source: frontiersin.org