Prevalence and Risk of Abuse among Community-Dwelling Older People with Functional Dependence: A Systematic Review and Meta-Analysis

Abstract

Abuse of older people (AOP) is a significant public health concern, and older adults with functional dependence may be particularly vulnerable to mistreatment. In this systematic review and meta-analysis, we searched 16 electronic databases without language restrictions to identify primary studies published from inception to December 17, 2024, reporting AOP prevalence estimates among functionally dependent older adults (aged ≥60 years) or comparative abuse risk versus independent counterparts. We included only studies assessing abuse occurring within the 1 year preceding data collection. Study quality was appraised using validated risk-of-bias instruments. The meta-analysis was restricted to self-reported data from community-dwelling older adults and employed random-effects models for synthesis. Sensitivity analyses and publication bias were thoroughly evaluated, and subgroup analyses along with meta-regression were conducted to explore heterogeneity. Institutional or proxy-reported studies are summarized separately. Of 14,124 records initially identified, 38 studies met inclusion criteria, with data for 15,782 BADL‑dependent, 3,756 IADL‑dependent, and 12,353 ADL‑dependent (dependence in at least one BADL or IADL item) older adults. In total, 28 studies provided data for prevalence meta-analysis and 20 for risk meta-analysis. The pooled prevalence of AOP was 26.2% (95% CI [18.1, 35.2]) for BADL dependence, 26.0% (95% CI [9.1, 47.8]) for IADL dependence and 23.2% (95% CI [14.5, 33.2]) for ADL dependence, with significant heterogeneity but no significant covariates. Compared with independent counterparts, BADL‑dependent (pooled AOR = 1.53, 95% CI [1.26, 1.85), IADL‑dependent (pooled AOR = 1.63, 95% CI [1.33, 1.98]), and ADL‑dependent elders (pooled AOR = 1.87, 95% CI [1.52, 2.30]) had higher odds of abuse. These findings underscore the urgent need for targeted interventions to prevent AOP and protect vulnerable, functionally dependent seniors.