Objectives :

Several studies have assessed elder abuse, while caregiver abuse by the elderly has been less addressed. The present study aims to assess the prevalence and associated factors of caregiver abuse by the elderly in nursing homes of Tehran, Iran.

Methods & Materials:

 This cross-sectional study was conducted in 2018 on 124 caregivers of the elderly who were selected using a convenience sampling method from 14 nursing homes in Tehran, Iran. The caregiver abuse was measured by the Survey of Violence Experienced by Staff (SOVES). The data were analyzed using descriptive and inferential statistics in SPSS v. 24.

Results:

 The mean age of participants was 36.74±8.38 years, and 68.5% were female. The prevalence of caregiver abuse in the previous 12 months was 42.7%. Of these, 37.1% had experienced verbal abuse, 12.9% threats, and 24.2% physical abuse. The chi-square test results revealed a significant association between employment status and caregiver abuse, where full-time caregivers were four times more likely to experience abuse (χ2(1) =7.43, P=0.006, OR=4.03). The age, gender, work experience, direct contact, and receiving educational program had no significant association with caregiver abuse by the elderly.

Conclusion:

 There is a high prevalence of caregiver abuse by the elderly in nursing homes of Tehran. Policymakers should plan and take measures to protect the caregivers in nursing homes.

In the world today, health care systems are confronted with the phenomenon of population movement toward aging. Alzheimer's is a growing disease, and aging is considered an important risk factor. Family caregivers face many challenges in caregiving that make them more susceptible to abuse the person with Alzheimer's. Considering to the needs and quality of life of caregivers and people with Alzheimer's is an important issue. The purpose of this study is to increase awareness in this regard by presenting relevant factors and investigating preventive factors and improving situation.

In this review study, the literature has been systematically searched using articles in English-language databases Web of Science, Pubmed, Scopus, and Persian-language databases SID and Magiran from the beginning to 2019. The keywords Alzheimer's, family caregiver, dementia, abuse and violence and their equivalent in Persian were used in this search. According to the inclusion and exclusion criteria, the articles were selected and entered into the study.

A systematic review of 86 articles was selected. 17 articles were eligible to enter the study. The findings of this study showed that in Asian countries, the overall abuse rate among Alzheimer's patients was between 1.6% and 62.3%, mental abuse between 9.7% and 62.3% and physical abuse between 1.6% and 18%. In Western countries, overall abuse was reported between 5.4% and 51%, psychological abuse between 3.5% and 51% and physical abuse reported between 1.5% and 20%. Different factors are influenced by the caregiver (increased burden of care, depression, anxiety, social level and increased time of care) as well as factors by the caregiver (mental disorder, memory impairment and increased need for ADL).

The results show that by recognizing this issue and its effective factors in a timely manner and implementing programs to increase the ability and resilience of caregivers of Alzheimer's patients to meet the challenges encountered during care and implementing rehabilitation programs for people with Alzheimer's disease can be an important step in preventing abuse and improving conditions and thereby improve the quality of life of caregivers and people with Alzheimer's disease.
Keywords: Alzheimer's; family caregivers; abuse; systematic review

Elder abuse is common and global and it affects the various aspects of health and quality of life in the elderly. Therefore, successful management of elder abuse requires the implementation of various and effective interventions in its prevention. This study aimed to review the axes of intervention in the prevention of elder abuse.

This study is a review, in which 1200 articles about elderly abuse since 2000-2019 were searched using online English databases such as Google Scholar, Pubmed, Scopus, Science Direct, Web of Science. Iranian articles were obtained from SID, Iran Medex, Magiran and Google Scholar websites. Overall, 35 articles were selected which had inclusion criteria.

The study articles were divided into the following axes 1- Reducing the accurrance of risk factor for abuse in family caregivers 2- Increasing the detection rate of prevention in elder abuse 3- Interventions in victims of elder abuse 4- Introducing specialized teams for prevention of elder abuse 5- prevention of caregiver abuse of the elderly in nursing homes 6- prevention and stop of resident-to-resident elder abuse 7- Preventive interventions based on the role of health professionals

Usual forms of intervention programs may include public education, support groups, advocacy service interventions, and coordination in care for the elderly. Although family caregivers are the most vulnerable population providing unpaid care to family members, they have not been investigated as the deserved.

One of the problems that significantly affects the quality of life and health of the elderly is elder abuse, which is usually not reported. The present study was conducted in order to examine the relationship between the possibility of elder abuse and the care burden of caregivers in elderly people with informal caregivers referring to selected hospitals in Tehran.

The current study is a cross-sectional descriptive study that was conducted in 2020 on 370 elderly people who is cognitively or functionally dependent and has a resident family caregiver living in Tehran with family caregivers who were chosen as available samples from outpatients to daily clinics of selected hospitals. Interviews with the elderly and caregivers in outpatient clinics were used to obtain data on abuse, care burden, and demographic factors. The Elderly Abuse by caregivers Questionnaire was used to measure elder abuse, and the Zarit Questionnaire in Persian was employed to assess the burden of care. In this study, descriptive statistics such as mean, standard deviation, and percentages were used to describe the data, and Pearson's correlation coefficient was used to check the correlation between variables and the relationship between quantitative variables from ANOVA test. All related analyzes were performed using SPSS v.25 software. And probability value less than 0.05 was considered as statistical significance.

The average age of caregivers and elderly was 47.04 ± 12.76 and 69.39 ± 8.54 years, respectively. In this study, the average probability of elder abuse by the caregiver was 66.5 and the average care burden of caregivers was 48.3. This study showed that there is a significant relationship between the possibility of elder abuse and care burden (P<0.001). The demographic variables of gender, education, employment and marital status of the caregiver were not significant with the possibility of elder abuse, but the difference of the economic status variable of the caregiver with the possibility of elder abuse was significant (P<0.01). Also, no significant relationship was found between the variables of gender, marital status, and employment of the elderly with the possibility of elder abuse, but a significant relationship was found with the variables of education status and economic status (P<0.01). There was no significant relationship between the duration of disability and the possibility of elder abuse.

The present study reports the high probability of elder abuse towards the elderly under the pressure of caregivers' care, so this highlights the need for timely and continuous attention from the organizations related to this social issue in order to avoid situations that can lead to an increase in the care burden of caregivers and create Identify, control and prevent the occurrence of elder abuse.

Emotional invalidation is a transdiagnostic process that can be relevant across a variety of disorders. Emotional invalidation (the perception of others as indifferent to one’s emotions) is associated with difficulty accepting emotions, maladaptive coping with emotions, perception of negative emotions as less controllable and comprehensible, and less psychological flexibility (Linehan, 1993; Leahy, Tirch, & Napolitano, 2011).
Childhood abuse (sexual and emotional abuse) may be considered prototypical experiences of invalidation of emotional experiences (Westpha, Leahy, Pala, & Wupperman, 2016; Leahy, 2015). Childhood abuse communicate that the child’s internal experiences do not matter. Furthermore, abusive caregivers who routinely punish emotional or sexual displays convey that negative emotions are unacceptable and unimportant (Leahy, 2015). Also in cross-sectional studies, childhood abuse has been found to be a predictor of depressive symptoms directly (Infurna et al., 2016; Jascheka, Carter-Pokrasa, Hea, Leea, & Canino, 2016).
Emotional invalidation is linked to a host of internalizing such as depression, anxiety, and social avoidance (Tanaka, Wekerle, Schmuck, & Paglia-Boak, 2011; Hong, & Lishner, 2016).The present study examined the predictive associations among childhood trauma (emotional and sexual), emotional invalidation and depressive symptoms in female college students with current major depressive disorder and with history of major depressive disorder. In summary, the following hypotheses are proposed:Hypothesis 1. Sexual abuse would contribute to the depressive symptoms through emotional invalidation.
Hypothesis 2. Emotional abuse would contribute to the depressive symptoms through emotional invalidation. The present investigation is a descriptive-cross-sectional study. The population of this study was 21,000 female college students in six different branches of Payam-e-Noor University with Persian languages (Baharestan, Eslamshahr, Shahryar, Tehran Souht, Robatkarim and Varamin). Data were obtained from college women enrolled in a clinical research study of mood disorders and behavior from the 2015 to 2016 academic year. Of these, 394 were selected through available sampling, of whom 92 met the criteria for current major depressive disorder (MDD) and 347 who had history of MDD in the last 12 months.
Measures
Beck Depression Inventory:The BDI-II (Beck, Steer, & Brown, 2000) was used to assess depressive symptoms during the last two weeks. It measures the severity of depression and consists of 21 items. The reliability and validity of the BDI-II have been well demonstrated both in clinical and non-clinical samples (Beck et al., 2000).
Structured Clinical Interview for DSM-IV Axis I & II (SCID): SCID is a structured diagnostic measure designed to assess DSM–IV Axis I and II disorders. The SCID showed good reliability in previous studies (Maffei et al., 1997).
Childhood Trauma Questionnaire - Short Form:The CTQ (Bernstein et al., 2003) retrospectively assesses the severity of different types of trauma and provides five subscales: Sexual abuse, emotional abuse, physical abuse, physical neglect, and emotional neglect. Each item is scored on a five-point Likert scale from. The CTQ has demonstrated excellent reliability, convergent, divergent and predictive validity in both clinical and non-clinical populations (Bernstein et al., 2003).
Leahy Emotional Schemas Scale (LESS; Leahy, 2002): This scale is made up of 50 items that are used to assess how one thinks about his own emotions. The LESS is a six-point Likert scale for each question (very true of me = 6 to very untrue of me = 1), it includes items regarding how they have dealt with emotional experiences during the last month. The results showed that depressive symptoms were significantly correlated with emotional (r = 0.46), sexual (r = 0.29) abuse and emotional invalidation (r = 0.51). In the present study, the 95% confidence interval (CI) of the indirect effects was obtained with 5000 bootstrap samples. The final step was to determine if the 95% CI for the estimated indirect effect included zero. An indirect effect is significant at the .05 level if the 95%CI does not include zero.
There was significant indirect effect (path ab) of sexual abuse on depression symptoms through emotional invalidation (CI=0.20 to 0.75). In other words, consistent with that first hypothesis, emotional invalidation significantly mediated the effect of sexual abuse on depression symptoms. In addition, the bootstrapping results indicated that the direct effect of sexual abuse on depression (path c’ = 1.05, p < 0.0001) remained significant when controlling emotional invalidation, thus suggesting partial mediation.
In addition, according to the bootstrapping results, emotional invalidation significantly mediated the effect of emotional abuse on depression symptoms (CI = 0.33 to 0.65). The direct effect of emotional abuse on depression (path c’ = 1.06, p < 0.0001) also remained significant when controlling emotional invalidation, thus suggesting partial mediation. The present study aimed to clarify whether emotional invalidation would explain the effect of childhood trauma (sexual and emotional abuse) on depressive symptoms. Consistent with our hypotheses, emotional invalidation partially mediated the effect of sexual and emotional abuse on depression. It is important to note, however, that this finding is consistent with previous studies (Leahy et al., 2011; Linehan, 1993; Infurna et al., 2016; Jascheka et al., 2016). Results from the current study suggested that one pathway by which sexual and emotional abuse may affect depressive symptoms is via emotional invalidation.
This finding can be explained by reffering to attachment theory. First, during the process of forming and maintaining attachment during early childhood, the rudiments of empathy, mirroring, and validation include the caregiver’s responsiveness to the child’s distress, which reinforces the child’s mental representation—“My feelings make sense to others.” Second, responsive soothing of the child’s feelings by the caregiver encourages the child to believe, “My distressed feelings can be soothed.” Initially, it is proposed that this “soothing” occurs through the caregiver’s attention and reassurance but later is “internalized” by the child in self-calming and optimistic self-statements, similar to Bowlby’s idea of internal working models, in this case the internal representation that one’s feelings make sense and can be calmed. Third, the child’s communication of feelings to the caregiver becomes an opportunity not only for expressing feelings but for the caregiver to link emotional states to external events that “cause” the feeling—“You’re upset because your brother hit you.” This attempt to comprehend the cause of feelings and to share them with the caregiver can also assist in differentiating these feelings—“It sounds like you are angry and hurt”—and in constructing a theory of mind that can be applied to both self and others. Indeed, without an adequate theory of mind, the child will be impaired in showing validation toward others and will be unable to soothe her own feelings and the feelings of others (Leahy et al., 2011).

Backgroung: The elderly are among the vulnerable groups in society، and elder abuse by caregivers is one of the forms of violence known as a public health problem throughout the world. The present study aimed to investigate different forms of elder abuse during hospital stay. Using non-random convenience sampling، this cross-sectional study was conducted on 200 elderly people over the age of 65 admitted to Meybod Hospital in 2012. A structured interview and a researcher-made questionnaire entitled “Studying the Abuse of the Hospitalized Elderly” were used to collect information. Most study samples were women (52%) and the 65 to 70 age group (65%). The prevalence of physical، psychological and financial abuses، as well as neglect and self-neglect were 11. 8%، 9. 68%، 5. 08%، 21. 17% and 21. 14%، respectively. There was a significant difference between men and women in terms of physical (P = 0. 02)، psychological and self-neglect (P = 0. 01) abuses. There was also a significant difference between the age groups in terms of physical (P = 0. 005) and neglect (P = 0. 02) abuses. Despite the great emphasis our culture puts on respecting patients and the elderly، the hospitalized elderly experience different types of abuse. Therefore، an accurate understanding of elder abuse in hospitals could increase the awareness and sensitivity of people، managers، personnel and organizations associated with this phenomenon so that they can take effective measures for prevention and design of a system identifying the elderly at risk.

Aging and its subsequent issues must be considered as the main challenges of the future. Studies on abuse of the elderly are very limited. This study which was conducted in 2013 and aimed to determine the prevalence and types of domestic abuse in the elderly referred to health care centers in Gorgan and Aq-Qala cities¡ Gorgan Province¡ Iran.
Methods & Materials: In this cross-sectional analytical study¡ through a random sampling¡ 465 elders aged 65 or older (125 men and 254 women)¡ residing in the health care centers in Gorgan and Aq-Qala¡ were enrolled. A face-to-face interview was carried out with all participants at the health care centers. First¡ their cognitive states were evaluated using the Iranian version of abbreviated mental test score and if they obtained the score of 6 or higher they would be entered in the study¡ after taking their informed consents. Then¡ the domestic elder abuse questionnaire for elderly people and a questionnaire designed by the authors for collecting demographic and personal data was administered. Descriptive (percentage¡ frequency¡ mean and standard deviation) and inferential statistics (The Chi-square¡ t-test) were performed using SPSS (version 16).
The total frequency of elder abuse was 63.3%. The highest frequencies were related to care neglect (59.8%) and psychological abuse (53.3%) and the lowest ones belonged to physical abuse (8 %) and abandonment (8.2%). Some factors¡ including sex (P Because of the high level of elder abuse by family¡ providing awareness programs for seniors¡ caregivers and health care providers seems to be essential to prevent and reduce the neglect and abuse of older people.

Elder abuse is an increasingly intangible phenomenon that has created numerous ethical issues for care teams and caregivers. Although different studies have concentrated on various ethical issues regarding abuse, no study has arrived at a comprehensive conclusion. Therefore, the present study aimed to determine the existing ethical challenges in this context. For this purpose, two researchers familiar with systematic search approach examined national and international journals on PubMed, Excerpta Medica Database (EMBASE), Scientific Information Database (SID) and similar databases between January and February 2017. They were able to find 116 articles that met the inclusion and exclusion criteria, and finally selected 15 articles based on the predesigned questions. The findings were classified in five subtitles as follow: 1) the common definition of elder abuse, 2) a comprehensive legislation on elder abuse, 3) comprehensive ethical principles about elder abuse, 4) ethical considerations regarding patients without competency, and 5) reporting and sharing information about elder abuse. The study results revealed no common definition and no legislation about elder abuse, and also showed that health care providers’ observance of ethical principles depends on the ethical and legal conditions of the community. Nowadays, elder abuse is a serious problem in many countries. Cultural and religious differences are the reasons for lack of a common definition and legislations, which comprises the biggest obstacle to protecting the rights of elderly people. It is clear that ethical principles should be respected as far as a person has competency. Furthermore, localization of clinical guidelines related to this issue leads to proper functioning of health care providers, especially nurses as the first line of treatment.

One of the important and usual missed causes of pediatric traumas is child abuse. This ominous phenomenon, which can be presented physically, psychologically, sexually, and emotionally has grown significantly in recent years. Many children are not diagnosed in the early stages of evaluation. Battered Child Syndrome is used to describe the clinical condition of the child serious physical abuse by parents or caregivers. Medical staff should always keep the syndrome in their mind for those brought to the emergency department with trauma. In this report, we described a patient complained of dysphagia following a falling from a height and multiple epidural hematomas and final diagnosis of battered child syndrome.

Child abuse is a significant public health and social problem worldwide. It can be described as a failure to provide care and protection for children by the parents or other caregivers. This study aimed at evaluating the effectiveness of psychosocial interventions in abused children and their families.

This quasi-experimental study was conducted in the psychosocial support unit of a pediatric hospital in Bandar Abbas, Iran, from 2012 to 2013. The participants consisted of child abuse cases and their parents who referred to the psychosocial support unit to receive services. Services delivered in this unit included parenting skills training, psychiatric treatments, and supportive services. The effectiveness of the interventions was assessed with Child Abuse Questionnaire, General Health Questionnaire (GHQ), and Strengths and Difficulties Questionnaires (SDQ). Participants were assessed at baseline, at 3, and 6 months follow-ups. ANOVA with repeated measures and Friedman test were used to evaluate the effect of the interventions.

A total of 68 children and their parents enrolled in this study, of whom 53% were males. Post-intervention follow-ups revealed significant changes in mother's general health questionnaire (p Our findings revealed that psychosocial interventions effectively improved child-parents interaction and mental health of parents. The effectiveness of interventions based on subgroup analysis and implications of the results have been discussed for further development of psychosocial interventions in the health system.