Elder abuse without borders: a systematic review and meta-analysis.

BACKGROUND

Across continents and cultures, elder abuse remains a silent crisis, hidden behind closed doors. Vulnerable older adults face neglect, exploitation, and harm, often from those they trust most. Despite its devastating impact, global awareness and intervention efforts remain inadequate. This study unveils the true scale of the issue, urging immediate action to protect the aging population.

METHODS

We searched multiple databases, including Medline, Web of Science, PubMed, Scopus, International Scientific Indexing, Global Health, Global Index Medicus, Embase, and Google Scholar in December 2024, with an updated search in January 2025. We included observational studies published from 2000 to 2025. The Joanna Briggs Institute (JBI) critical appraisal tool was used to assess the quality of the included studies. The effect size was pooled using a random-effects model. Heterogeneity was explored using Cochrane's Q statistic (chi-square) and inverse variance (I²). Subgroup and sensitivity analyses were performed to assess the influence of individual studies on the overall pooled estimates. Publication bias was evaluated using Begg's and Egger's regression tests.

RESULT

A total of 94 studies from 35 countries were included (n = 776,044). The pooled prevalence of elder abuse was 27.6% (95% CI: 23.5-31.6). By type, emotional/psychological abuse was most prevalent (20.9%, 95% CI: 14.8-26.9), followed by neglect (19.3%, 95% CI: 12.8-25.8), financial/material exploitation (11.7%, 95% CI: 8.5-14.9), verbal abuse (11.0%, 95% CI: 5.5-16.5), physical abuse (7.9%, 95% CI: 5.0-10.8), and sexual abuse (1.5%, 95% CI: 0.7-2.2). Upper-middle-income countries had the highest prevalence (37.0%, 95% CI: 28.0-46.0), with South America (42.0%, 95% CI: 14.0-71.0) and Asia (36.0%, 95% CI: 27.0-45.0) reporting the highest regional rates. Institutional settings showed higher prevalence (29.0%, 95% CI: 20.0-38.0) than community-based studies (27.0%, 95% CI: 23.0-32.0).

CONCLUSION

This meta-analysis reveals that over one-quarter of older adults worldwide experience abuse, with emotional and psychological abuse being the most prevalent. Institutional settings and upper-middle-income countries report significantly higher abuse rates, highlighting the need for targeted interventions. Sexual abuse remains underreported, likely due to stigma, though its low prevalence may still indicate a hidden issue. Regional variations suggest cultural and socioeconomic factors significantly influence abuse patterns. These findings emphasize the urgent need for global screening tools, institutional staff training, community awareness programs, and policy reforms prioritizing elder protection.