Preventing The Abuse Of Residents With Dementia Or Alzheimer’s Disease In The Long-Term Care Setting: A Systematic Review

Figures & data

Figure 1 Preferred reporting items for systematic review flow diagram.

Table 1 Facilitating Themes Associated With Detection And Reduction Of Abuse Of Alzheimer’s And Dementia-Ridden Residents In The Long-Term Environment

Facilitators	Occurrences (By Article Number)	Sum	%
Policies/programs	13*14,17,20,21,22*23,26,28,29*32,34,36*38,41	24	40.67%
Education	16*17,21,31*32,36,37,38,40	14	23.72%
Working conditions	12,13,15,16*20,26,32,39	11	18.64%
Screening/assessment	12*26*36	8	13.55%
Staff characteristics	35,41	2	3.38%

Notes: *Signifies that multiple occurrences of the facilitator were located in the specific article.

Table 2 Barrier Themes Associated With Detection And Reduction Of Abuse Of Alzheimer’s And Dementia-Ridden Residents In The Long-Term Environment

Barriers	Occurrences (By Article Number)	Sum	%
Poor training	13,17,18,24,25,26,27,29,30,34,38*	12	35.29%
Lack of research	18,19,24,34*35*	7	20.59%
Working conditions	13,28,35,39*	5	14.71%
Policies/programs	25*30,34,39	5	14.71%
Screening/assessment	25,30,35	3	8.82%
Staff characteristics	16,26	2	5.88%
		34

Notes: *Signifies that multiple occurrences of the barrier were located in the specific article

Table 3 Summary Of Article Findings

Author Last Name	Aim	Sample/Settings	Method	Assessment Tool	Key Findings
Young/August 2018 [^Citation12]	Determining risk factors that can contribute to elder abuse by caregivers and how to prevent and provide treatment to reduce elder abuse.	Existing research/previous studies.	Existing research/previous studies.	Asking patients questions.	Vital for case managers to assess patients for signs of abuse. Do not rely on just asking the patient but investigating too.
Rose/June 2018 [^Citation13]	Preventing the mistreatment or neglect of long-term care (LTC) residents and noticing the signs of abuse is a concern for any risk manager or organizational leader.	1.4 million people are living in 17,000 US nursing homes and an additional 7 million receive assistance with activities of daily living (CDC).	Documenting the abuse and inform the appropriate personnel at the LTC facility.	Interviews with patients and staff members.	The best way to prevent abuse is to look for the signs of abuse and listening to the patients.
Caspi/May 2018 [^Citation14]	Makes first steps towards bridging the major gap in research and practice.	Deaths of 105 elders pertaining to resident-to-resident incidents in long-term care homes.	Use of publicly available information to determine practical patterns.	Mostly newspaper articles and death review reports.	More deaths occurred from resident-to-resident altercations (RRA) inside bedrooms. Findings identified a series of patterns and vulnerability areas for prevention of death. Newly admitted residents (less than 3 months at facility) are more prone to involvement in RRA. Policies and procedures related to roommate assignment needs to be regularly examined by administration and nursing staff.
Jacobsen/September 2017 [^Citation15]	To investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centered care, as an alternative to restraint in residents with dementia in nursing homes.	Two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway.	A mixed-method design combining quantitative and qualitative methods. The qualitative data were collected through ethnographic fieldwork, qualitative interviews, and analysis of 84 reflection notes.	P-CAT (Person-centered Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work).	Leadership is the most important factor promoting staff awareness and person-centered care. Staff must be educated, but leadership involvement is key in implementation of any program.
Wangmo/January 2017 [^Citation16]	To find solutions to help prevent elder abuse.	3 nursing homes, 1 inpatient geriatric center, and 1 regional home care provider. 23 participants were male between 23 and 61 years of age with an average age of 43.6 years. 6 were nursing assistants, 6 were nursing care professionals, and 11 were qualified nurses. The work experience average was 19.4 years. 12 from the 3 nursing homes, 7 from inpatient center, and 4 from the home health care provider.	Face-to-face interviews with 23 nursing care providers between April 2014 and Dec 2014. Interviews were conducted by post-doctorate scholars with a background in philosophy.	T-test for independent observations.	Facilities need to hire more qualified staff, so abuse can be recognized and have appropriate staff to patient ratios.
Rosen/January 2017 [^Citation17]	Identifying common staff responses regarding resident-to-resident elder mistreatment or abuse.	282 certified nursing assistants (CNAs) in 5 urban area nursing homes.	Study was performed in 5 large, not-for-profit, urban nursing homes in New York, based off interviews, a convenience sample of 282 certified nurse assistants (CNAs) who worked the day shift (28.1% of the total CNA workforce at these nursing homes).	Interviews were conducted using a structured questionnaire first inquiring whether the CAN had witnessed any form of physical or verbal abuse by any of the residents.	Nursing home staff report many varied responses to RRA, a common and dangerous occurrence. CNAs seldom documented behaviors or reported them to nurses.
Baker/August 2016 [^Citation18]	Reduce or prevent elderly abuse not just in institutional settings, but in their homes.	More studies should be conducted and reflect on educational training.	Find measures the caregivers of elderly dementia people.	Educational training for caregivers	The purpose of the review was to assess the primary, secondary and tertiary intervention programs to reduce or prevent elderly abuse.
Gimm/July 2016 [^Citation19]	Estimates the prevalence and identifies risk factors of resident aggression and abuse in assisted living facilities	6,848 older Americans in residential care facilities.	Multivariate analyses of resident-level data.	Resident-level data.	Resident aggression and abuse are a growing problem that warrants more attention from policy makers given the rising prevalence of dementia and the aging population in the United States.
Green/May 2016 [^Citation20]	To show that care providers have a duty to safeguard the health and wellbeing of all their residents, staff members, and care providers.	Home, nursing community, assisted living.	Defining 3 areas labeled as “boxes” in the article that explain what promoting well-being is, defining what a vulnerable adult is, and principles associated with safeguarding adults.	Implementing a quiz that checks the safeguards in place for residents.	Working together, with other agencies, groups and regulatory bodies, to ensure that policies and procedures are adequate and that those caring for the individual are fully engaged in supporting them to live free from harm, abuse, and neglect can only result in an increased level of protection and support for the individual.
Fang/May 2016 [^Citation21]	Highlighting the implications of using different informants, sampling strategies, and abuse subtypes in studying abuse of persons with dementia and discussing the relevant cultural consideration.	Studies and data from articles related to abuse of older persons with dementia.	A search was conducted of various databases.	Key terms were reviewed independently by each researcher.	Understanding abuse of persons with dementia, which is important for risk assessment, timely detection, prevention, and intervention of abuse. Methodological issues and their impact on study outcomes are also discussed and critiqued. Findings provide valuable information to direct future social work practice, research, and policy-making. Interdisciplinary and synergistic work from relevant fields is needed to reduce abuse and improve health and safety in persons with dementia.
Shilling/April 2016 [^Citation22]	Informing that elderly can also be victims of financial abuse and medical identity abuse and what consumers can do to combat this problem.	Victims are the elderly from identity theft.	Fidelity Investments and Consumer Financial Protection Bureau data.	Reported cases.	Elders can also be victims of financial abuse. Nursing facilities should be aware of medical identity theft.
Simone/January 2016 [^Citation23]	To identify types of elder abuse and to investigate its associated risk factors.	People 60 years or older who had contacted the Independent Complaints Authority for Old Age in the Canton of Zurich, Switzerland.	Retrospective analysis of 903 dossiers created by means of data collection by phone and email.	Dossiers created by the Independent Authority for Old Age.	Importance should be placed upon the need of a multi-faceted strategy involving the facility and caregivers, but also physicians and the community and policymakers to identify and prevent elder abuse.
Van der Lee/November 2015 [^Citation24]	Gain insight into what determines caregiver burden and what characteristics of patient and caregiver can cause caregiver burden.	Participants from urban region in Netherlands and selected from outpatient nursing home care. Have cognitive disorder, 65 or older, and informed consent signed by caregiver.	Longitudinal study. Data collected 3 times; at baseline, at end of treatment, and at 9 months. Study conducted in a psychiatric skilled nursing home.	Sense of Competence Scale that reflects perceived ability to cope with caring for patient. Scale contains 23 items rated on a 4-point scale. Self-perception of interpersonal behavior measured by Interpersonal Checklist of 160 items rated as yes or no. Caregiver health-related quality of life measured on EuroQol. Caregiver general burden scale measured on scale from 0 (not at all) to 100 (extremely). Caregiver emotional distress measured on scale from 0 (not at all) to 5 (extremely).	Caregivers need training to help reduce caregiving burden which can contribute to elder abuse.
Hirst/October 2015 [^Citation25]	Defining what is known about resident-to-resident abuse and what gerontological nurses can do about the widespread problem.	Residents in long-term care facilities.	Collecting a body of research literature regarding aggression and violence between long-term care residents.	Previous research and literature.	Resident-to-resident abuse is more prevalent than staff-to-resident abuse, but it is researched much less. RRA tends to target those residents with cognitive impairment. Staff needs to be educated on RRA to facilitate recognition. Guidelines should be provided to staff when RRA occurs. Ensure accurate and complete documentation to facilitate reporting. Aggression and violence between long-term care residents has been largely overlooked by researchers.
Hirst/August 2015 [^Citation26]	To identify effective approaches to preventing and addressing abuse and neglect of older adults within health care settings.	62 studies focusing on identifying, assessing, and responding to abuse and neglect of older adults.	Systematic review of literature and submittal of article citations from expert panel members. Additionally, screening of literature for inclusion and reliability.	Expert panel and guided questions to determine appropriate study selection and data sources.	“Abuse and neglect of older adults remains under-explored.” Abuse and neglect of older adults is more likely more prevalent than reported. There exists a knowledge and training deficit around the abuse and neglect of older adults. The continued culture of de-valuing older adults will continue to allow these older adults to remain highly susceptible to all forms of abuse.
Dempsey/March 2015 [^Citation27]	There should be improvements to enhance a person’s quality of life with dignity in an appropriate setting of palliative care.	Dementia patients in a clinical setting.	Advanced planning to the specific care of the diseases.	Training to clinical staff.	People with dementia often do not receive the palliative care as do other terminally ill patients.
Ferrah/January 2015 [^Citation28]	To examine the published research on the frequency, nature, contributing factors, and outcomes of RRA in nursing homes.	Studies and data from articles related to older adults.	This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.	Key terms were reviewed independently by each researcher.	RRA is ubiquitous with serious consequences for residents. Although physical injuries were rarely reported, each study described the negative social and psychological effects of RRA.
Halphen/August 2014 [^Citation29]	To show that neglect can be self-inflected in addition to others who are non-strangers.	Domestic/out-patient clinic.	Interview by APS.	Mental exam and physical exam.	In the rushed clinical environment, it is easy to miss the patient who desperately needs help. It often takes help from reliable third parties, such as APS, to gather the information needed to fully appreciate the challenges faced by elderly patients.
Burnett/August 2014 [^Citation30]	Healthcare professionals should report elderly abuse.	Elderly people with dementia in a clinical, residential, or home setting.	Reporting standards and clinical screenings.	Investigate. More training.	Abuse, sexual abuse, financial exploitation, caregiver neglect, psychological emotional abuse, abandonment and self-neglect. According to the article, about 80% of real elder abuse cases go unreported.
Tronetti/August 2014 [^Citation31]	Becoming aware of different types of elder abuse and recognizing the different stages of dementia that also affects types and level of abuse.	Previous studies; interviews of caregivers and the abuse victims.	Clinicians speak with patients in a safe, comfortable, and private setting. Patient is fed and rested but not over-sedated.	Functional Assessment Staging Tool (FAST) and the Mini Mental Status Exam (MMSE).	Patients with history of partner abuse and minorities are at higher risk for abuse. Healthcare providers need training on how to recognize signs of abuse as well as risk factors.
Manthorpe/June 2014 [^Citation32]	To present findings from an updated investigation of secondary sources of data about the abuse of older people with dementia. Additionally, this study aimed to identify the different ways in which data on abuse of older people in hospital and care home settings are collected and collated, highlight areas where there can be confidence in the reliability of information, identify gaps in the information sources, and make recommendations to policy makers.	Various sources, including data from local authorities, government statistics, regulators, pressure groups, and reports of inquiries and reviews.	Primarily “desk research” involving an exploration of what data are collected about elder abuse, why, by whom and about what. Following “desk research”, interviews with key informants were undertaken.	Desk research and interviews.	Consistent work with local agencies should persist in order to collect appropriate data pertaining to financial abuse and other mistreatment so that policies can continue to evolve to protect the elderly. Dementia care professionals need to be educated and on high alert to the risks associated with dementia ridden residents and their exposure to abuse and neglect.
Epstein/April 2014 [^Citation33]	How to increase the awareness and reality that caretakers of elderly suffer from the people they are taking care of.	Home, nursing community, assisted living.	In January 2011, the National Alzheimer’s Project Act was signed into law, which led to the publication of the first National Plan to Address Alzheimer’s Disease in May 2012. This plan proposes to develop effective treatments for Alzheimer’s by 2025, enhance care quality and efficiency, and expand supports for people affected and their caregivers.	Being a part of the family made the experience firsthand.	Attention and awareness to caregivers and care takers need to be given as well as the patients who are victim of dementia, because the caretakers suffer as well.
Dong/April 2014 [^Citation34]	To have all parties involved at the community, state, and federal levels.	Review the relationship between elder abuse and dementia.	Research conducted to gather information.	Lack of funds for implementing such research and training exists through federal and state programs relating to elder abuse and dementia.	There is a shortage of evidence-based intervention studies which could help victims of elderly abuse and their family members. They also identified the gaps in understanding minorities of elderly dementia people.
Downes/January 2013 [^Citation35]	To find risk factors for abuse and neglect, and characteristics of perpetrators.	Analyze literature on abuse of older people with dementia who are in a community dwelling.	Find strategies to prevent and manage cases of those living with dementia.	Research to provide evidence.	Find preventive measures to use that assist in elderly abuse of people with dementia.
Miller/October 2012 [^Citation36]	To study the effective role of the Ombudsman and ensure proper application of the Long-Term Care Ombudsman Program to improve nursing home quality of life and quality of care.	Residents, resident families, administration, staff, and advocates in a nursing home environment.	Ombudsman programs investigating complaints of abuse and neglect, and thus referring such allegations to local Adult Protective Services offices and designated state agencies.	Administration on Aging National Long-Term Care Ombudsman Program Report.	Elder abuse is a community concern, and action must be taken at local, state, and federal levels. Detection and prevention are keys to combat elder abuse. Staff must be better trained to properly recognize, and report abuse and neglect. Ombudsman and administrators should focus attention on developing and supporting resident and family councils.
Manthorpe/September 2012 [^Citation37]	To explore current responses of local adult safeguarding systems and consider barriers and facilitators to minimizing risks of financial abuse for people with dementia.	A purposively sampled group of 15 Adult Safeguarding Coordinators in England in 2011.	Undertaking of qualitative interviews and a framework analysis delineating themes in the transcripts.	Interviews and review of transcripts.	Healthcare professionals need to be more aware of the potential of financial abuse in patients with dementia, including the new risks associated with electronic crime. Monitoring of people with dementia needs to be sustained.
Sharpp/April 2012 [^Citation38]	To understand how to prevent abuse and what type of training would benefit the caregivers in preventing of the abuse.	The setting was one large unit (>30 beds) that provided care to residents with dementia in a for-profit ALF in the Western United States.	Ethnographic study used participant observation and interviews to obtain data. Data was collected and analyzed over a period of 6 months.	The residents’ functional and mental status was assessed using Katz Basic Activities of Daily Living (ADL) Scale and the Mental Status Questionnaire (MSQ).	Four major themes emerged from the data: (a) Caregivers Level of Knowledge of Dementia, (b) Caregivers’ Lack of Knowledge in Preventing or Assessing Acute Illnesses, (c) Limitations in Monitoring and Reporting Resident Changes, and (d) Inappropriate Medication Administration.
Morgan/January 2012 [^Citation39]	Preventing combative behaviors in aggressive residents.	Eleven rural nursing homes located in a mid-Western Canadian province.	A prospective event-reporting log that details incidents of combative behaviors and focus groups to further explore CNAs’ perceptions of events following analysis of the diary data.	Prospective structured event-reporting diary to collect data on nurse aide attributions for resident behavior, as well as other constructs derived from attribution models (eg, caregiver emotions and behaviors) and circumstances of the incident.	Certified nursing aide’s opinions on certain incidents of combative behavior from residents with dementia, and the causes of this abusive behavior towards staff and patients residing in the nursing home. Staff cannot completely eliminate these types of behaviors but can only limit them. The staff must do their part and not just accept these behaviors as part of the job. The current study findings underscore the need to focus attention on the contextual and organizational level factors that increase the risk to front-line caregivers within long-term care settings. Many of these behaviors place the other residents at risk due to phenomenon of affecting the quality of care for these non-aggressive residents.
Schiamberg/January 2012 [^Citation40]	To investigate the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care.	A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care in Michigan.	An empirical study investigating a random sample and creation of a logistic regression model.	Telephone survey.	Limitations in ADLs, older adult behavioral difficulties, and previous victimization are leading factors to a greater likelihood of physical abuse. Emotional closeness points to the importance of family members overseeing nursing care of older adults.
Peri/January 2012 [^Citation41]	Exploration of the relationship between individuals and violence as being the product of multiple levels that influence the abuse of elders.	Elder Abuse and Neglect Prevention (EANP) participants who were now in safe situations.	Qualitative methods were used to capture data about elder abuse and neglect from a range of stakeholders. Face-to-face interviews focus group interviews and telephone interviews.	Ecological framework and the ecological model.	Research has highlighted a need for more concerted efforts to help individuals and families to prepare for positive ageing.

Young M (2018). Stay alert to signs of elder abuse: think of falls, residence violence. Relias. Retrieved from https://www.reliasmedia.com/articles/143140-stay-alert-to-signs-of-elder-abuse-think-of-falls-resident-violence Accessed 1008, 2019.

 Google Scholar

Rose VL. Preventing abuse, neglect, and exploitation of residents in nursing homes. Ann Long-Term Care. 2018;26(3):11–13. doi:10.25270/altc.2018.06.00034

 Google Scholar

Caspi E. The circumstances surrounding the death of 105 elders as a result of resident-to-resident incidents in dementia in long-term care homes. J Elder Abuse Negl. 2018;30(4):284–308. doi:10.1080/08946566.2018.147451529851550

 PubMed Web of Science ®Google Scholar

Jacobsen FF, Mekki TE, Førland O, et al. A mixed method study of an education intervention to reduce use of restraint and implement person-centered dementia care in nursing homes. BMC Nurs. 2017;16(1):55. doi:10.1186/s12912-017-0263-x28936121

 PubMed Web of Science ®Google Scholar

Wangmo T, Nordstrom K, Kressig RW. Preventing elder abuse and neglect in geriatric institutions: solutions from nursing care providers. Geriatr Nurs. 2017;38:385–392. doi:10.1016/j.gerinurse.2016.12.01628139262

 PubMed Web of Science ®Google Scholar

Rosen T, Lachs MS, Teresi J, Eimicke J, Haitsma KV, Pillemer K. Staff-reported strategies for prevention and management of resident-to-resident elder mistreatment in long-term care facilities. J Elder Abuse Negl. 2015;28(1):1–13. doi:10.1080/08946566.2015.102965925894206

 PubMed Web of Science ®Google Scholar

Baker PR, Francis DP, Hairi NN, Othman S, Choo WY. Interventions for preventing abuse in the elderly. Cochrane Database Syst Rev. 2016;8.

 Google Scholar

Gimm G, Chowdhury S, Castle N. Resident aggression and abuse in assisted living. J Appl Gerontol. 2018;37(8):947–964. doi:10.1177/073346481666194727469497

 PubMed Web of Science ®Google Scholar

Green D. Safeguarding and protection of vulnerable adults. Nurs Res Care. 2015;17(5):293–296. doi:10.12968/nrec.2015.17.5.293

 Google Scholar

Fang B, Yan E. Abuse of older persons with dementia: a review of the literature. Trauma Violence Abuse. 2018;19(2):127–147. doi:10.1177/152483801665018527247138

 PubMed Web of Science ®Google Scholar

Shilling D. New trends in financial abuse and identity theft. Family & Intimate Partner Violence Q. 2016;8(4).

 Google Scholar

Simone L, Wettstein A, Senn O, Rosemann T, Hasler S. Types of abuse and risk factors associated with elder abuse. Swiss Med Wkly. 2016;146(0304).

 Google Scholar

van der Lee J, Bakker TJ, Duivenvoorden HJ, Dröes RM. Do determinants of burden and emotional distress in dementia caregivers change over time? Aging Ment Health. 2017;21(3):232–240. doi:10.1080/13607863.2015.110219626586266

 PubMed Web of Science ®Google Scholar

Hirst SP. Resident-to-resident abuse. J Gerontol Nurs. 2015;41(12):3–4.

 Web of Science ®Google Scholar

Hirst SP, Penney T, McNeill S, Boscart VM, Podnieks E, Sinha SK. Best-practice guideline on the prevention of abuse and neglect of older adults. Can J Aging. 2016;35(2):242–260. doi:10.1017/S071498081600020927086668

 PubMed Web of Science ®Google Scholar

Dempsey L, Dowling M, Larkin P, Murphy K. The unmet palliative care needs of those dying with dementia. Int J Palliat Nurs. 2015;21(3):126–133. doi:10.12968/ijpn.2015.21.3.12625815761

 PubMedGoogle Scholar

Ferrah N, Murphy BJ, Ibrahim JE, et al. Resident-to-resident physical aggression leading to injury in nursing homes: a systematic review. Age Ageing. 2015;44(3):356–364. doi:10.1093/ageing/afv00425630802

 PubMed Web of Science ®Google Scholar

Halphen JM, Burnett J. Elder abuse and neglect: appearances can be deceptive. Psychiatr Times. 2014;31(8):14–15.

 Google Scholar

Burnett J, Achenbaum WA, Murphy KP. Prevention and early identification of elder abuse. Clin Geriatr Med. 2014;30(4):743–759. doi:10.1016/j.cger.2014.08.01325439639

 PubMed Web of Science ®Google Scholar

Tronetti P. Evaluating abuse in the patient with dementia. Clin Geriatr Med. 2014;30(4):825–838. doi:10.1016/j.cger.2014.08.01025439644

 PubMed Web of Science ®Google Scholar

Manthorpe J. The abuse, neglect and mistreatment of older people with dementia in care homes and hospitals in England: the potential for secondary data analysis: innovative practice. Dementia. 2015;14(2):273–279. doi:10.1177/147130121454117724962001

 PubMedGoogle Scholar

Epstein-Lubow G. A family disease: witnessing firsthand the toll that dementia takes on caregivers. Health Aff. 2014;33(4):708–711. doi:10.1377/hlthaff.2012.1351

 Web of Science ®Google Scholar

Dong X, Chen R, Simon MA. Elder abuse and dementia: a review of the research and health policy. Health Aff. 2014;33(4):642–649. doi:10.1377/hlthaff.2013.1261

 Web of Science ®Google Scholar

Downes C, Fealy G, Phelan A, Donnelly N, Lafferty A. Abuse of Older People with Dementia: A Review. National Centre for the Protection of Older People; 2013;1–23.

 Google Scholar

Miller M. Ombudsmen on the front line: improving quality of care and preventing abuse in nursing homes. Generations. 2012;36(3):60–63.

 Web of Science ®Google Scholar

Manthorpe J, Samsi K, Rapaport J. Responding to the financial abuse of people with dementia: a qualitative study of safeguarding experiences in England. Int Psychogeriatr. 2012;24(9):1454–1464. doi:10.1017/S104161021200034822464777

 PubMed Web of Science ®Google Scholar

Sharpp TJ, Kayser-Jones JS, Young HM. Care for residents with dementia in an assisted living facility. Res Gerontol Nurs. 2012;5(3):152–162. doi:10.3928/19404921-20120410-0122533941

 PubMed Web of Science ®Google Scholar

Morgan DG, Cammer A, Stewart NJ, et al. Nursing aide reports of combative behavior by residents with dementia: results from a detailed prospective incident diary. J Am Med Dir Assoc. 2012;13(3):220–227. doi:10.1016/j.jamda.2011.07.00321872535

 PubMed Web of Science ®Google Scholar

Schiamberg LB, Oehmke J, Zhang Z, et al. Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home. J Elder Abuse Negl. 2012;24(1):65–83. doi:10.1080/08946566.2011.60805622206513

 PubMed Web of Science ®Google Scholar

Peri K, Fanslow J, Hand J, Parsons J. Keeping older people safe by preventing elder abuse and neglect. Soc Policy J N Z. 2012;35:159–173.

 Google Scholar