Trapped in Place: A Systematic Review of Elder Abuse During the COVID-19 Era

Prior to COVID-19, an estimated 1 in 10 adults age >= 60 years experienced abuse annually in the United States. Social isolation is a known risk factor for elder abuse. To understand the possible contributing factors to a reported increase in elder abuse and to increase awareness a systematic review was done. Method(s): We searched Pubmed, Scopus, and Web of Science using the keywords {(elderly or geriatric abuse + COVID-19)} 26 articles were found and 16 meet the inclusion criteria of discussing elderly abuse in the current COVID-19 pandemic. Result(s): 8 articles were expert opinion, 4 were cross-sectional studies, 1 was a literature review article regarding diagnosis and management, 2 were retrospective cohort studies, and 1 was a systematic review regarding geriatric emergencies. They all included women. 6 articles discussed at least 1 minority population, whether it was LTBQ+ people, people with disabilities or racial and/or ethnic minorities depending on the geographic location discussed. 3 articles were international and 1 encompassed North America as a whole, while the other articles were based in the US. All articles except 1 reported concern for increased elderly abuse. Minority groups were more likely to be isolated and less likely to access resources. There were no clear differences for women. Victims of isolation were more likely to have medical needs, while victims of emotional abuse were more likely to report loneliness. Possible explanations for the increase in abuse include a decrease in all in-person services, decreased social/community supports, increased isolation or only interacting with their perpetrators, and increased reliance on their abusers. There were several legal barriers to Adult Protective Services (APS) in-person evaluations in some regions. Also 40% of caregivers reported doing worse financially and 15% reported drinking more alcohol. Telehealth is challenging for sheltering-in-place with an abuser and who also may have more difficulty using telehealth due to high rates of hearing impairment and language barriers. Discussion(s): The numerous contributing factors to the increase in elderly abuse highlight the need to weigh the risks and benefits for in-person care and in-person APS evaluations, along with the re-introduction of social programs. It also highlights the need for providers to be aware of any potential signs or symptoms of abuse in their patients.