From choosing baby's name to helping a teenager choose a college, you'll make . Their ability to defend themselves is limited due to cognitive and physical impairments [77, 85]. 2000;11:7390. 2nd ed. Moore S. Abuse of residents in nursing homes: results of a staff questionnaire. Michigan: Elder Abuse, Nursing Home Neglect, Senior Exploitation Associated factors of abuse at the staff, resident, and nursing home level were evaluated inconsistently. The importance of the concept of values in the prevention of abuse of older people in care homes. J ELDER ABUSE NEGL. Likely targets are older adults who have no family or friends nearby and people with disabilities, memory problems, or dementia. Who are the abusers of older adults? https://doi.org/10.1016/j.jcrimjus.2004.12.003. Two thirds of perpetrators are adult children or spouses. Trauma Violence Abuse. Only one interventional study [74] examined an intervention with components of education and mutual support in a quasi-experimental design. Andela M, Truchot D, Huguenotte V. Work Environment and Elderly Abuse in Nursing Homes: The Mediating Role of Burnout. The sessions were part of a multi-component framework, including education and mutual support. Raising awareness and elaborating evidence-based guidance should have high priority in health care and research. Many studies estimate that about 10% of all people over the age of 65 experience some form of abuse. It is a matter of concern that physical abuse is the second most common type of abuse in non-community settings. Elder Abuse Statistics: Contextualizing Nursing Home Abuse - Dudensing Law Rates of abuse of older people are high in institutions such as nursing homes and long-term care facilities, with 2 in 3 staff reporting that they have committed abuse in the past year. Nursing Home Abuse in Michigan- Elder Abuse Laws https://doi.org/10.1017/S1041610213000501. Two experienced reviewers developed the search strategy. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. JH conducted the search. 2021;134:17889. The large variation in prevalence data raises doubts about the validity of meta-analyses on this topic. Furthermore, higher prevalence rates of observed abuse relative to committed abuse may indicate probable difficulties in admitting ones own misconduct [13, 80]. Elder Abuse | National Institute on Aging Results. Lori L. Rosebush, 58, and Robert H. Stilwill, 56, both of Flint were arraigned . Report on the National Study of Elder Abuse and Neglect. For example, willful ignoring is classified as neglect or physical or psychological abuse, depending on the study, which can lead to overlaps in prevalence surveys [79]. 2018;8: e022260. Jogerst GJ, Daly JM, Dawson JD, Peek-Asa C, Schmuch G. Iowa nursing home characteristics associated with reported abuse. Consequences of abuse for residents are reduced quality of live, psychological and physical symptoms, increased morbidity and premature mortality [4]. Lim J. Rapaport P, Livingston G, Hamilton O, Turner R, Stringer A, Robertson S, Cooper C. How do care home staff understand, manage and respond to agitation in people with dementia? The prevalence rates of abuse varied widely, ranging from 0 to 93% depending on the type of abuse. Inadequate coping strategies, including not knowing personal limits or taking psychotropic medication to relieve stress, were significantly associated with some types of abuse [50, 54, 77]. We conducted a scoping review following the framework provided by Arksey and OMalley [25]. Considering the serious consequences for the residents, particularly for highly vulnerable persons who are dependent on assistance, intervention development is acutely needed. Gerontology. Therefore, it seems essential to conduct a comprehensive assessment in specific situations and to consider all possible associated factors. J NURS RES. Twenty-two out of the 28 studies (78.6%) had a cross-sectional design [13, 34,35,36,37,38, 42, 48, 49, 51, 52, 54, 57, 60,61,62,63, 66, 71,72,73, 76, 77]. Most victims of abuse are women, but some are men. Elder Abuse Surveillance: Uniform Definitions and Recommended Core Data Elements For Use In Elder Abuse Surveillance, Version 1.0. Andela M, Truchot D, Huguenotte V. Job demands, emotional dissonance and elderly abuse: The moderating role of organizational resources. Malmedal W, Iversen MH, Kilvik A. Michigan: Adult Protective Services Fact Sheet. https://doi.org/10.1300/J084v11n03_05. Who is being abused? Dictionary.com. 2021. https://www.who.int/news-room/fact-sheets/detail/elder-abuse. In an emergency, dial 911. JAMDA. PubMed Z Evid Fortbild Qual Gesundhwes 2021. doi:https://doi.org/10.1016/j.zefq.2020.12.002. Elder Abuse - State of California - Department of Justice Thus, it is crucial that data collection is non-judgemental and confidentiality in interviews is assured [81]. Rough handling should entail verbal warning of staff. To answer our third review question, we additionally extracted information concerning recipients, facilitators, and characteristics of the intervention, control interventions, outcomes, and main results. It is the mistreatment of an older person, usually by a caregiver. Cooper C, Dow B, Hay S, Livingston D, Livingston G. Care workers abusive behavior to residents in care homes: a qualitative study of types of abuse, barriers, and facilitators to good care and development of an instrument for reporting of abuse anonymously. statement and https://doi.org/10.1177/0733464810389174. Syst Rev. https://doi.org/10.1177/1524838017692798. Sexual abuse could foster uncertainties of staff related to supporting residents with personal and intimate care. Caregiver factors contributing to psychological elder abuse behavior in long-term care facilities: a structural equation model approach. 2009;16:11026. nursing homes, mental health facilities, shelters, group homes, addictions treatment centres and other supportive living settings. 2020;20(1):199. Over 64% of nursing homes and long-term staff reported perpetrating some form of abuse in the past year. For residents with cognitive impairment, reporting abuse is particularly difficult [81, 82]. NCEA - FAQ - Administration for Community Living Habjani A, Lahe D. Are frail older people less exposed to abuse in nursing homes as compared to community-based settings? The high prevalence should receive special attention since the residents are highly vulnerable individuals who are dependent on staff. https://doi.org/10.1016/j.archger.2011.07.006. Factors associated with rushed and missed resident care in western Canadian nursing homes: a cross-sectional survey of health care aides. doi:https://doi.org/10.1177/0886260510362880. 2 charged with murder in Flint elder abuse case - mlive.com Fang B, Yan E. Abuse of Older Persons With Dementia: A Review of the Literature. One researcher extracted data. The action can be intentional or negligent. Age Ageing. Arksey H, OMalley L. Scoping studies: towards a methodological framework. Strategies promoting a critical reflection of situations and of ones own behaviour should be embedded at the institutional level [46]. Health Aff (Millwood). Social isolation is one of the main risk factors in elder abuse. 2011;18:6478. Classifications of abuse comprise emotional or psychological abuse (verbal or non-verbal behaviour, e.g., humiliation, threats, harrassment, isolation), physical abuse (intentional physical force resulting in physical harm or distress, e.g., hitting, pushing, inappropriate use of medication, force-feeding), sexual abuse (forced or unwanted sexual interaction with touching and non-touching acts), financial abuse (unauthorized use of resources, including fraud and theft), and neglect (caregivers failure to meet the persons essential needs, e.g., nutrition, hygiene, medical care) [2]. One study used a structured questionnaire (one week before and one week after the intervention) [74]. https://doi.org/10.7326/M18-0850. Additionally, we treated abuse of unspecific type as a separate category. Dublin; 2010. The abuse of older people, also known as 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, which causes harm or distress to an older . Suspect Abuse FAQ Research, Statistics, and Data Research Theory-informed Research and Practice Research and Data The Growing Older Population Demographic Snapshot of Older Adults in the United States Prevalence of Mistreatment Definitions Types, Signs, and Impact of Elder Mistreatment Staff-to-resident abuse is of particular interest since institutions should protect residents' rights and prevent harm. Ben Natan M, Lowenstein A. We searched MEDLINE (via PubMed), CINAHL, PsycINFO via Ovid, and Cochrane Library. The California Department of Finance projects that the number of California residents aged 65 and older--those who are most likely to need nursing homes or other long term care--will nearly double between 2010 and 2030. Although our review does not provide conclusive results on all associated factors, we advocate for a comprehensive assessment of each context or situation. J ELDER ABUSE NEGL. https://doi.org/10.1371/journal.pone.0193399. Content source: National Center for Injury Prevention and Control . Disagreements were discussed between the two reviewers until consensus was reached. Detailed data on every study are available in supplementary material S2 and summarised in the following subsection. We retrieved these reviews while searching for further primary studies on staff-to-resident abuse. Since this is a scoping review, we did not assess the quality of the studies. Interventions should be targeted at the individual and institutional level. 2020;8:224. https://doi.org/10.3390/healthcare8030224. Article (ii) Organisational management covered recruitment of more and qualified staff, rotation, and management strategies ensuring rapid response to abuse [50]. What makes an older adult vulnerable to abuse? They may have problems with trust and be wary of others.5 Many victims suffer physical injuries. BMJ Open. PubMedGoogle Scholar. For the residents, however, abuse results in major consequences. Some participants would not report a residents abuse by a colleague since there are other ways to handle the situation. 2020;121:208. All authors substantially revised it critically for important intellectual content and finally approved it. The three non-interview-based studies (21.4%) used a structured questionnaire [65, 68, 69]. FLINT, MI - Two people have been charged in the death of a 68-year-old Flint woman as part of an elder abuse case. Get the Facts on Elder Abuse - The National Council on Aging Other Resources. Overall, 149 participants were included (data available for four out of five studies; median 19, IQR 14 to 43, range 12 to 100) from 42 nursing homes (data available for four out of five studies; median eight, IQR four to 15, range three to 23). Detailed data for every study are available in supplementary material S2 and summarised in the following subsection. PubMed J ELDER ABUSE NEGL. The Bureau of Health Services Abuse Hotline at 1-800-882-6006. Our results yielded a wide range of prevalence estimates for all types of abuse. Tricco AC, Lillie E, Zarin W, OBrien KK, Colquhoun H, Levac D, et al. NCEA - Research Statistics and Data - Administration for Community Living Facing this and the fact that we did not critically appraise the included studies, we cannot draw robust conclusions about the bias risk and its influence on the (true) prevalence of staff-to-resident abuse in nursing homes. 2014;33:6429. In the majority of studies, participants were nurses and nursing aides, followed by relatives or persons responsible for nursing home residents. The National Center on Elder Abuse (NCEA) reports that approximately 10% of nursing home residents experience some form of abuse each year. Frazo SL, Correia AM, Norton P, Magalhes T. Physical abuse against elderly persons in institutional settings. For free text terms, we used wildcards and/or quotation marks to develop the final search strings. 2005;8:1932. One reviewer extracted results on descriptions, experiences, and preventive interventions (second and third review question). BMC HEALTH SERV RES. Int Psychogeriatr. Privacy PLoS ONE. On the staff level, we also identified inconsistent results in studies addressing the influence of job-related characteristics of abusive behavior. Sexual abuse of older nursing home residents: a literature review. The authors declare that they have no competing interests. Cohen M, Shinan-Altman S, Cohen M, Shinan-Altman S. A cross-cultural study of nursing aides attitudes to elder abuse in nursing homes. We did not register the review. https://doi.org/10.1377/hlthaff.2013.1261. A strength of our procedure is the screening of studies performed by two researchers independently in order to minimize the risk of missing eligible studies. INT PSYCHOGERIATR. Eur J Public Health. (iv) Reporting abuse was associated with a potential for improvement. You can contact any one of these entities and get help. Statistics say 1 in 10 older adults experience abuse but this number is probably low as many do not report and suffer in silence. Two reviewers clustered thematically associated factors of staff-to-resident abuse. See supplementary material S2 for the raw data set. 2017;63:16979. An estimated 1 in 10 older adults (age 60 years) experience elder abuse annually in the United States. One study each (3.6%) was based on structured interviews [50], document analysis [44], or did not report details on data collection methods [58]. Abuse of older people - World Health Organization (WHO) To report abuse outside of Wisconsin, contact the National Adult Protective Services Association. Another 18 studies (64.3%) investigated physical abuse [9, 13, 34,35,36,37,38, 42,43,44, 48, 49, 52, 58,59,60, 71, 75,76,77]. The second study looked at Medicare claims for the treatment of potential abuse or neglect of older adults, regardless of. 2009;14:37786. This single study (3.6%) did not report details on reference time [54]. To address our study objectives, we searched MEDLINE (via PubMed), CINAHL, PsycINFO via Ovid, and Cochrane Library in June 2020. Further research should investigate the composition and content of preventive interventions and their potential to reduce abusive behaviours. J ELDER ABUSE NEGL. Ben Natan M, Lowenstein A, Eisikovits Z. Psycho-social factors affecting elders maltreatment in long-term care facilities. The state of the current research comprises primarily cross-sectional studies, few secondary data analyses and qualitative studies, and only one quasi-experimental study addressing the prevention of staff-to-resident abuse. Institutional abuse - Characteristics of victims, perpetrators and organsations. Four qualitative studies described the need for interventions addressing staff education and organizational conditions [46, 47, 50, 64]. Not all authors confirmed this approach [35, 71]. Charpentier M, Soulires M. Elder Abuse and Neglect in Institutional Settings: The Residents Perspective. The prevalence of staff-to-resident abuse observed by staff was reported in nine out of 28 studies (32.1%) (Table 1; details on every study are available in supplementary material S2). BMC Geriatr 22, 563 (2022). 2018;30:36884. Twenty-six studies (92.9%) used statistical methods for data analysis [9, 13, 34,35,36,37,38, 42, 44, 48, 49, 51, 52, 54, 57,58,59,60,61,62,63, 66, 71,72,73, 76, 77]. Two studies (40.0%) used grounded theory methodology for data analysis [47, 64]. Staff-to-resident abuse in nursing homes: a scoping review, https://doi.org/10.1186/s12877-022-03243-9, https://www.who.int/news-room/fact-sheets/detail/elder-abuse, https://doi.org/10.1016/j.eurpsy.2016.07.002, https://doi.org/10.1080/08946566.2011.558798, https://doi.org/10.1186/s12913-020-05969-x, https://doi.org/10.1186/s12913-019-4861-z, https://doi.org/10.1017/s1041610216002027, https://doi.org/10.1136/bmjopen-2018-022260, https://doi.org/10.1016/j.jcrimjus.2004.12.003, https://doi.org/10.1377/hlthaff.2013.1261, https://doi.org/10.1016/j.jamda.2007.09.001, https://doi.org/10.1080/1364557032000119616, https://doi.org/10.1016/j.jclinepi.2021.03.001, https://doi.org/10.1186/s13643-020-01542-z, https://doi.org/10.1136/bmjopen-2021-056353, https://doi.org/10.1016/j.jclinepi.2020.01.005, https://doi.org/10.1186/s13643-016-0384-4, https://doi.org/10.1111/j.1466-7657.2009.00771.x, https://doi.org/10.7748/nm2010.12.17.8.20.c8143, https://doi.org/10.1016/j.archger.2011.07.006, https://doi.org/10.1080/08946566.2011.608056, https://doi.org/10.1111/j.1547-5069.2011.01438.x, https://doi.org/10.1080/08946566.2012.751838, https://doi.org/10.1017/S104161021200227X, https://doi.org/10.1016/j.jflm.2015.09.002, https://doi.org/10.1016/j.gerinurse.2016.12.016, https://doi.org/10.1080/08946566.2018.1514343, https://doi.org/10.1371/journal.pone.0193399, https://doi.org/10.3390/healthcare8030224, https://doi.org/10.1108/JHOM-02-2020-0031, https://doi.org/10.1186/s12913-020-5047-4, https://doi.org/10.1080/08946560902997553, https://doi.org/10.1080/08946560902779910, https://doi.org/10.1080/08946566.2011.534708, https://doi.org/10.1016/j.jamda.2005.12.006, https://doi.org/10.1080/08946560903005174, https://doi.org/10.1111/j.1471-6712.2008.00611.x, https://doi.org/10.1108/14668203200600005, https://doi.org/10.1017/S1041610211000391, https://doi.org/10.1177/10573802011003004, https://doi.org/10.1017/S1041610208008211, https://doi.org/10.1007/s10459-008-9122-6, https://doi.org/10.1111/j.1440-1800.2006.00321.x, https://doi.org/10.1016/j.zefq.2020.12.002, https://doi.org/10.1007/s00391-021-01945-0, https://doi.org/10.1016/S2214-109X(17)30006-2, https://doi.org/10.1017/S1041610213000501, https://doi.org/10.1080/08946566.2020.1819926, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. 2017;19:13045. J HEALTH ORGAN MANAG. Fourthly, reporting abuse may be subject to recall bias by staff members (especially when reporting about observed abuse). Five of the interview-based studies used semi-structured interviews [39, 40, 53, 70, 78] and three studies relied on focus group interviews [41, 45, 56]. https://doi.org/10.1080/08946560902779910. 2019;21:16989. One study (3.6%) [44] reported sociodemographic and health-related abused residents. 2015;36:5460. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Elder Abuse. The reference time frame was mentioned in 20 studies (71.4%), varying between three months and unlimited, mostly one year (n=11/20, 55%). The Coding Manual for Qualitative Researchers. For data analysis, three studies (21.4%) applied descriptive statistics [65, 68, 69]. 2013;25:73341. Women and Elder Abuse - Nursing Home Abuse Guide JH, LA, and AZ were responsible for the study design. CAS From perpetrator to victim in a violent situation in institutional care for elderly persons: Exploring a narrative from one involved care provider. You can also access the Locator by calling 1-800-677-1116 .The Eldercare Locator is a public service of the U.S. Administration on Aging. 2019;29:5867. Preventing elder abuse and neglect in geriatric institutions. Staff-related factors of staff-to-resident abuse were mentioned in 16 of the 28 studies (57.1%) (Table 2; details on every study are available in supplementary material S2). Hirst SP. Yon Y, Mikton CR, Gassoumis ZD, Wilber KH. This limitation should be kept in mind when interpreting our data. Our results, however, reveal that research on preventive interventions is sparse. We did not request any additional data from the authors. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. https://doi.org/10.7748/nm2010.12.17.8.20.c8143. Access to all data that was used in this study is open. In our manuscript, we use the term staff for all members of the nursing team indiscriminate of their qualification level (e.g., registered nurses and nursing assistants). https://doi.org/10.1108/JAP-03-2017-0008. The mistreatment may be: Physical, sexual, or emotional abuse Neglect or abandonment https://doi.org/10.1093/eurpub/cky093. Kamavarapu YS, Ferriter M, Morton S, Vllm B. Blumenfeld Arens O, Fierz K, Ziga F. Elder Abuse in Nursing Homes: Do Special Care Units Make a Difference? Schiamberg LB, Oehmke J, Zhang Z, Barboza GE, Griffore RJ, von Heydrich L, et al. Furthermore, our review also provides inconclusive results with regard to associated factors on the institutional level, including facility- and staff-related characteristics, for example, staff density, turnover, work organization and culture. And in Texas, a woman . By submitting this form, you agree to receive telephone calls and text messages at anytime, which include hours outside of business hours (8:00 am PST - 9:00 Int J Older People Nurs. BMJ Open. London: SAGE Publications; 2013. NURS TIMES. Staff-to-resident abuse in nursing homes: a scoping review Nurs Res Pract. In addition, we did not include reviews, commentaries, opinion papers, policy statements, and study protocols as well as studies published as books, theses, reports, conference proceedings, and abstract-only publications. Elder Abuse Statistics - Number of Nursing Home Neglect Each Year Two studies (7.1%) were based on multiple data collection methods. Statistics on Elderly Abuse | Safer Senior Care Study of factors that affect abuse of older people in nursing homes. PubMed Elder abuse in nursing homes: Prevention and resolution strategies and barriers. NURS MANAGE. Buzgov R, Ivanov K. Elder abuse and mistreatment in residential settings. Physical, sexual, and financial abuse are considered as most serious types of abuse. We included quantitative, qualitative, and mixed-methods studies following the IMRad format (Introduction, Methods, Results, and Discussion). Shinan-Altman S, Cohen M. Nursing aides attitudes to elder abuse in nursing homes: the effect of work stressors and burnout. The final search strings for all databases are part of supplementary material S1. https://doi.org/10.1177/0886260518803606. https://doi.org/10.1186/s12877-022-03243-9, DOI: https://doi.org/10.1186/s12877-022-03243-9. Staff-resident relationships in nursing homes are characterized by imbalances of power and residents dependency on staff to satisfy their needs [12, 13]. Factors Affecting Mistreatment of the Elderly in Long-Term Care Facilities. Adelheid Zeller. Abuse was described as contradicting leaders trust in their staff. Consequences of Elder Abuse and Neglect: A Systematic Review of Observational Studies. J ADULT PROTECT. The World Health Organization defines elder abuse as a single or recurrent act resulting in harm or distress of an older person in a trust relationship [1]. J ELDER ABUSE NEGL. Abuse can occur in a person's own home or in a community living arrangement such as assisted living settings, personal care homes or nursing homes. The objective of this article is to describe abuse and neglect of adults age 65 and older in Michigan nursing homes, as reported by members of their families. One study each (2.2%) was conducted in Germany [77], Korea [54], Portugal [44], Slovenia [37], Sweden [78], and Uruguay [43]. Myhre J, Malmedal WK, Saga S, Ostaszkiewicz J, Nakrem S. Nursing home leaders perception of factors influencing the reporting of elder abuse and neglect: a qualitative study. Following recent guidance to minimise the risk of missing relevant studies, two reviewers independently screened titles, abstracts, and full texts against eligibility criteria [31]. Accessed 28 Apr 2020. Pillemer K. Maltreatment of patients in nursing homes: overview and research agenda. INT NURS REV. 2014;15:197209. In addition, nursing competence in long-term care is often not adequate and may entail abuse [14]. https://doi.org/10.1111/j.1471-6712.2008.00611.x. One study each (20.0%) focussed on physical [46] or psychological abuse [74]. Due to this, we cannot answer our research questions unequivocally. (iii) Organisational culture focussed the encouragement of an open, supportive, reflective, and cooperative team culture facilitating to learn from each other (e.g., by fostering open-mindedness in discussing ethical dilemmas) (Q3, S. 1: 302) [46, 47, 50, 64]. Statistically significant pre-post effects comprised decreased psychological abusive behaviour on the part of nurses and improved knowledge about gerontology nursing. This refers to team relationships, work experience and workload [34, 50, 51, 76]. Abusers are both women and men. Your US state privacy rights, Two of them additionally used regression analysis [68, 69]. D2020 - 008 What are the consequences? World Health Organization. Thesaurus.com. Raw data per study. Supplementary Material S1. Two studies (40.0%) used purposive sampling [50, 64]. One analysis by the Associated Press estimated that there were about 40,000 excess deathsbeyond the normal number in a given yearin nursing homes nationwide that were not from Covid-19. Staff-to-resident abuse is of particular interest since institutions should protect residents rights and prevent harm [6]. A Secondary Data Analysis of the Swiss Nursing Homes Human Resources Project. Inadequate care in Norwegian nursing homes-as reported by nursing staff. Overall, the 47 study reports were published between 2000 and 2021, half of them since 2012 [9, 13, 36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57]. Someone else needs to step in and help." - National Institute on Aging (NIA) Nursing Home Abuse Statistics - Elderly Care Every week, eight 90-min group-sessions took place with ten to twelve nurses. Atlanta, Georgia: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2016. Elder Abuse: Federal Requirements for Oversight in Nursing Homes and https://doi.org/10.1136/bmjopen-2021-056353. Hirt J, Vetsch J, Heinrich S. Facilitators and barriers to implement nurse-led physical activities for people with dementia in nursing homes: a protocol for a mixed-methods systematic review. 2020;34:65571. Family members reports of abuse in Michigan nursing homes. BMC Health Serv Res. Three studies (21.4%) recruited on convenience [45, 53, 55] and one study each (7.1%) used a random [65] or theoretical sample [56]. To answer our third review question on preventive interventions, we identified five studies [36, 39, 45,46,47, 50, 64, 74]. To report or not report? One of them used a structured questionnaire and a document analysis [9], the other one unstructured interviews and a document analysis [75]. https://doi.org/10.1016/j.jclinepi.2021.03.001. Predominantly, abuse of unspecified type (n=3, 60.0%) [47, 50, 64]. Furness S. Recognising and addressing elder abuse in care homes: views from residents and managers. 2008;23:2838. https://doi.org/10.1007/s10459-008-9122-6. J AM MED DIR ASSOC. 2017;38:38592. Z Gerontol Geriat 2021. doi:https://doi.org/10.1007/s00391-021-01945-0.
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elder abuse in nursing homes statistics
