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.
AciernoR.HernandezM. A.AmstadterA. B.ResnickH. S.SteveK.MuzzyW.KilpatrickD. G. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. American Journal of Public Health, 100(2), 292–297. https://doi.org/10.2105/AJPH.2009.163089
3.
AmstadterA. B.ZajacK.StrachanM.HernandezM. A.KilpatrickD. G.AciernoR. (2011). Prevalence and correlates of elder mistreatment in South Carolina: The South Carolina elder mistreatment study. Journal of Interpersonal Violence, 26(15), 2947–2972. https://doi.org/10.1177/0886260510390959
4.
BlauP. M. (1964). Exchange and power in social life. John Wiley & Sons.
5.
BorensteinM.HedgesL. V.HigginsJ. P. T.RothsteinH. R. (2009). Introduction to meta-analysis (1st ed.). John Wiley & Sons, Ltd. https://doi.org/10.1002/9780470743386
6.
BrandãoB. M. L. D. S.Araújo-MonteiroG. K. N. D.Santos-RodriguesR. C. D.SoutoR. Q.GomesI. D.ReisI. D. O. (2023). Sociodemographic aspects and functional capacity associated with physical violence in hospitalized elderly people. Rev Rene, 24, e85201. https://doi.org/10.15253/2175-6783.20232485201
7.
BurnesD.PillemerK.RosenT.LachsM. S.McDonaldL. (2022). Elder abuse prevalence and risk factors: Findings from the Canadian longitudinal study on aging. Nature Aging, 2(9), 784–795. https://doi.org/10.1038/s43587-022-00280-2
8.
CadmusE. O.OwoajeE. T. (2012). Prevalence and correlates of elder abuse among older women in rural and urban communities in south western Nigeria. Health Care for Women International, 33(10), 973–984. https://doi.org/10.1080/07399332.2012.655394
9.
Carmona-TorresJ. M.CarvalhalR.Gálvez-RiojaR. M.Ruiz-GandaraÁ.GoergenT.Rodríguez-BorregoM. A. (2020). Elder abuse in the Iberian peninsula and Bolivia: A multicountry comparative study. Journal of Interpersonal Violence, 35(21–22), 4303–4326. https://doi.org/10.1177/0886260517713712
10.
ChandanshiveP.SubbaS. H.ParidaS. P.MishraS. (2022). Prevalence patterns and associated factors of elder abuse in an urban slum of eastern India. BMC Geriatrics, 22(1), 317. https://doi.org/10.1186/s12877-022-02986-9
11.
CohenM.Halevy-LevinS.GaginR.PriltuzkyD.FriedmanG. (2010). Elder abuse in long-term care residences and the risk indicators. Ageing and Society, 30(6), 1027–1040. https://doi.org/10.1017/S0144686X10000188
12.
CooperC.SelwoodA.LivingstonG. (2008). The prevalence of elder abuse and neglect: A systematic review. Age and Ageing, 37(2),–160. https://doi.org/10.1093/ageing/afm194
13.
CurcioC. L.Payan VillamizarC.JiménezA.GómezF. (2019). Abuse in Colombian elderly and its association with socioeconomic conditions and functionality. Colombia Medica, 50(2), 77–88. https://doi.org/10.25100/cm.v50i2.4013
14.
DiasA. L. P.SantosJ. D. S.MonteiroG. K. N. D. A.SantosR. C. D.CostaG. M. C.SoutoR. Q. (2020). Association of the functional capacity and violence in the elderly community. Revista Brasileira de Enfermagem, 73(Suppl 3), e20200209. https://doi.org/10.1590/0034-7167-2020-0209
15.
DongX. Q. (2015). Elder abuse: Systematic review and implications for practice. Journal of the American Geriatrics Society, 63(6), 1214–1238. https://doi.org/10.1111/jgs.13454
DuvalS.TweedieR. (2000). A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association, 95(449), 89–98. https://doi.org/10.1080/01621459.2000.10473905
18.
ErginF.Evci-KirazE. D.SaruhanG.BenliC.OkyayP.BeserE. (2012). Prevalence and risk factors of elder abuse and neglect in a western city of Turkey: A community-based study. Bulletin of the Transilvania University of Braşov, 5(54), 33–50.
ForoutanF.GuyattG.ZukV.VandvikP. O.AlbaA. C.MustafaR.VernooijR.Arevalo-RodriguezI.MunnZ.RoshanovP.RileyR.SchandelmaierS.KuijpersT.SiemieniukR.Canelo-AybarC.SchunemannH.IorioA. (2020). GRADE Guidelines 28: Use of GRADE for the assessment of evidence about prognostic factors: rating certainty in identification of groups of patients with absolute risks. Journal of Clinical Epidemiology, 121, 62–70. https://doi.org/10.1016/j.jclinepi.2019.12.023
21.
FundinhoJ. F.PereiraD. C.Ferreira-AlvesJ. (2021). Theoretical approaches to elder abuse: A systematic review of the empirical evidence. The Journal of Adult Protection, 23(6), 370–383.
22.
GilA. P. M.KislayaI.SantosA. J.NunesB.NicolauR.FernandesA. A. (2015). Elder abuse in Portugal: Findings from the first national prevalence study. Journal of Elder Abuse & Neglect, 27(3), 174–195. https://doi.org/10.1080/08946566.2014.953659
23.
Giraldo-RodríguezL.Mino-LeónD.Aragón-GrijalvaS. O.Agudelo-BoteroM. (2022). The revictimization of older mexican women: Understanding the accumulation of multiple victimizations throughout a lifetime. BMC Geriatrics, 22(1), 41. https://doi.org/10.1186/s12877-021-02734-5
24.
Giraldo-RodríguezL.Rosas-CarrascoO. (2013). Development and properties of the geriatric mistreatment scale. Geriatrics & Gerontology International, 13(2), 466–474. https://doi.org/10.1111/j.1447-0594.2012.00894.x
25.
Giraldo-RodríguezL.Rosas-CarrascoO.Mino-LeónD. (2015). Abuse in Mexican Older Adults with Long-Term Disability: National Prevalence and Associated Factors. Journal of the American Geriatrics Society, 63(8), 1594–1600. https://doi.org/10.1111/jgs.13552
26.
Gómez RicárdezL. A.Rodríguez AbregoG.Krug LlamasE. (2007). Prevalencia y factores asociados a violencia familiar en adultos mayores de ocozocoautla (chiapas, méxico). Revista Española De Geriatría Y Gerontología, 42(1), 27–34. https://doi.org/10.1016/S0211-139X(07)73518-7
27.
GratãoA. C.TalmelliL. F.FigueiredoL. C.RossetI.FreitasC. P.RodriguesR. A. (2013). Dependência funcional de idosos e a sobrecarga do cuidador [Functional dependency of older individuals and caregiver burden]. Revista Da Escola de Enfermagem Da U S P, 47(1), 137–144. https://doi.org/10.1590/s0080-62342013000100017
28.
HertantiN. S.NguyenT. V.ChuangY.-H. (2025). Global prevalence and risk factors of fatigue and post-infectious fatigue among patients with dengue: A systematic review and meta-analysis. Eclinicalmedicine, 80, 103041. https://doi.org/10.1016/j.eclinm.2024.103041
29.
HoyD.BrooksP.WoolfA.BlythF.MarchL.BainC.BakerP.SmithE.BuchbinderR. (2012). Assessing risk of bias in prevalence studies: Modification of an existing tool and evidence of interrater agreement. Journal of Clinical Epidemiology, 65(9), 934–939. https://doi.org/10.1016/j.jclinepi.2011.11.014
30.
JeonG.-S.ChoS.-I.ChoiK.JangK.-S. (2019). Gender differences in the prevalence and correlates of elder abuse in a community-dwelling older population in korea. International Journal of Environmental Research and Public Health, 16(1), 100. https://doi.org/10.3390/ijerph16010100
31.
JohannesenM.LoGiudiceD. (2013). Elder abuse: A systematic review of risk factors in community-dwelling elders. Age and Ageing, 42(3), 292–298. https://doi.org/10.1093/ageing/afs195
32.
Kelley-MooreJ. A.SchumacherJ. G.KahanaE.KahanaB. (2006). When do older adults become “disabled”? Social and health antecedents of perceived disability in a panel study of the oldest old. Journal of Health and Social Behavior, 47(2), 126–141. https://doi.org/10.1177/002214650604700203
33.
KitawT. A.BaylieA.TekleB. A.TilahunB. D.GetieA.AbateB. B.FelekeS. F.ZemariamA. B.AzmerawM.YilakG.SeidS.HaileR. N. (2025). Elder abuse without borders: A systematic review and meta-analysis. BMC Public Health, 25(1), 2268. https://doi.org/10.1186/s12889-025-23548-9
34.
KogaC.HanazatoM.TsujiT.SuzukiN.KondoK. (2020). Elder abuse and social capital in older adults: The Japan gerontological evaluation study. Gerontology, 66(2), 149–159. https://doi.org/10.1159/000502544
35.
KongJ.JeonH. (2018). Functional decline and emotional elder abuse: A population-based study of older korean adults. Journal of Violence, 33(1), 17–26. https://doi.org/10.1007/s10896-017-9941-4
KshatriJ. S.BhoiT.BarikS. R.PaloS. K.PatiS. (2021). Is multimorbidity associated with risk of elder abuse? Findings from the AHSETS study. BMC Geriatrics, 21(1), 413. https://doi.org/10.1186/s12877-021-02347-y
38.
LawtonM. P.BrodyE. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9(3), 179–186.
39.
LexinY.TingtingL.CuilanC.YingZ. (2019). Abusive Tendencies and Their Causes Among Primary Caregivers of Home-Based Functionally Dependent Elderly. Chinese Journal of Gerontology, 39(1), 192–195.
40.
LiC. (2014). Epidemiological characteristics of the injuries and impact factors among the elderly people in Chenzhou [Doctoral dissertation, Central South University]. https://d.wanfangdata.com.cn/thesis/Y2684952
41.
Li W. (2011). Investigating related factors and health outcomes of elder mistreatment [Master’s thesis, Huazhong University of Science and Technology]. https://d.wanfangdata.com.cn/Thesis/D228934
42.
LiY. (2023). Development and application of the Chinese version of older adult financial exploitation measure [Master’s thesis, Tianjin University of Traditional Chinese Medicine]. https://doi.org/10.27368/d.cnki.gtzyy.2023.000625
43.
LuN.LiuJ.LouV. W. Q. (2016). Exploring the reciprocal relationship between caregiver burden and the functional health of frail older adults in China: A cross-lag analysis. Geriatric Nursing, 37(1), 19–24. https://doi.org/10.1016/j.gerinurse.2015.08.014
44.
MahoneyF. I.BarthelD. W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14, 61–65.
MauryaP.ChattopadhyayA.RaoS.SharmaP. (2024). Understanding elder abuse in India: Contributing factors and policy suggestions. Journal of Population Ageing, 17(1), 5–32. https://doi.org/10.1007/s12062-022-09399-x
47.
MinfeiY. (2020). Study on the abuse tendency and related factors of caregivers of disabled elderly people in old-age care institutions [Master’s thesis, Guangdong Pharmaceutical University]. https://doi.org/10.27690/d.cnki.ggdyk.2019.000276
NobelsA.MeersmanC.LemmensG.KeygnaertI. (2023). “Just something that happened?”: Mental health impact of disclosure and framing of sexual violence in older victims. International Journal of Geriatric Psychiatry, 38(12), e6036. https://doi.org/10.1002/gps.6036
52.
OrfilaF.Coma-SoléM.CabanasM.Cegri-LombardoF.Moleras-SerraA.Pujol-RiberaE. (2018). Family caregiver mistreatment of the elderly: Prevalence of risk and associated factors. BMC Public Health, 18(1), 167. https://doi.org/10.1186/s12889-018-5067-8
PaivaM. M. D.TavaresD. M. D. S. (2015). Violência física e psicológica contra idosos: Prevalência e fatores associados. Revista Brasileira de Enfermagem, 68(6), 1035–1041. https://doi.org/10.1590/0034-7167.2015680606i
55.
Pérez-RojoG.SanchoM.del BarrioE.YanguasJ. J. (2011). Estudio de prevalencia de malos tratos a personas mayores en la Comunidad Autónoma del País Vasco. Servicio Central de Publicaciones del Gobierno Vasco.
56.
PillemerK.BurnesD.RiffinC.LachsM. S. (2016). Elder abuse: Global situation, risk factors, and prevention strategies. The Gerontologist, 56 (Suppl 2), S194–205. https://doi.org/10.1093/geront/gnw004
57.
Piña-EscuderoS. D.ChodosA.WeinsteinC. A.AllenI. E.Ávila-FunesJ. A.RitchieC. (2021). Subjective cognitive decline and elder mistreatment in mexican community-dwelling older adults. Archives of Gerontology and Geriatrics, 92, 104242. https://doi.org/10.1016/j.archger.2020.104242
58.
Piña-EscuderoS. D.García-LaraJ. M. A.Avila-FunesJ. A. (2017). Frailty is not associated with mistreatment. Journal of Frailty & Aging, 6(4), 202–205. https://doi.org/10.14283/jfa.2017.29
59.
PostL.PageC.ConnerT.ProkhorovA.FangY.BiroscakB. J. (2010). Elder abuse in long-term care: Types, patterns, and risk factors. Research on Aging, 32(3), 323–348. https://doi.org/10.1177/0164027509357705
QueirozZ. P. V. D.LemosN. D. F. D.RamosL. R. (2010). Fatores potencialmente associados à negligência doméstica entre idosos atendidos em programa de assistência domiciliar. Ciência & Saúde Coletiva, 15(6), 2815–2824. https://doi.org/10.1590/S1413-81232010000600019
SantosA. J.NunesB.KislayaI.GilA. P.RibeiroO. (2019). Older adults’ emotional reactions to elder abuse: Individual and victimisation determinants. Health & Social Care in the Community, 27(3), 609–620. https://doi.org/10.1111/hsc.12673
65.
SathyaT.PremkumarR. (2020). Association of functional limitations and disability with elder abuse in India: A cross-sectional study. BMC Geriatrics, 20(1), 220. https://doi.org/10.1186/s12877-020-01619-3
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