Screened but Not Recognized: Cultural Gaps in Elder Abuse Identification in Rural China

Abstract

This mixed-methods study examines the gap between standardized screening outcomes and self-recognition of elder abuse among rural Chinese older adults, and the cultural frameworks shaping perceptions of mistreatment. Data from 432 participants aged 60–79 were collected using a three-item NSHAP screening tool, a direct self-report question, and open-ended questions. Thirteen percent screened positive (91.2% psychological, 3.5% physical, and 14.0% financial abuse), with spouses representing the largest single perpetrator category across abuse types. Yet none of the 57 screening-positive participants self-identified as abused. Qualitative findings indicated mistreatment was defined primarily as violations of filial piety—such as neglect, disrespect, disobedience, or failure to provide financial support, typically involving adult children or children-in-law. Spousal conflict or abuse was not mentioned. Findings reveal a cultural disconnect between Western-derived screening tools and local understandings, highlighting the value of culturally responsive approaches to abuse identification that consider filial norms and parent–adult child dynamics.