RESUMEN
OBJECTIVE: To establish the prevalence and patterns of elder abuse, and outcomes of intervention, among patients of four Australian Aged Care Assessment Teams. DESIGN: Descriptive study, with victims identified retrospectively from medical records for the first three months, and prospectively form the remaining nine months, of 1994. SETTING: Four area-based Aged Care Assessment Teams in three States. PATIENTS: Referred patients over 65 years of age who lived in private homes and who met a predetermined definition of elder abuse. MAIN OUTCOME MEASURES: Prevalence of abuse, types of abuse and the effect of interventions. RESULTS: The overall prevalence of elder abuse in the study population was 1.2% (95% CI, 0.4%-2.0%). The rate identified retrospectively was double that identified prospectively. Psychological abuse was the most common form of abuse detected. Patterns of abuse were identified and related to psychopathology of the abuser (30%), dependency of the older person and carer stress (25%), domestic violence (19%), carer abuse (18%) and financial dependency (8%). Interventions and outcomes varied according to the pattern of abuse. CONCLUSION: Our findings on the factors causing elder abuse are consistent with those identified in previous Australian studies. The prevalence of elder abuse detected in this study was lower than that in other Australian and overseas studies. A more uniform approach to detection is necessary, which may be aided by improved identification and management techniques, and appropriate training of health professionals in aged care services in case definition, interventions and management.
Asunto(s)
Abuso de Ancianos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Intervalos de Confianza , Abuso de Ancianos/prevención & control , Abuso de Ancianos/psicología , Femenino , Estudios de Seguimiento , Anciano Frágil , Atención Domiciliaria de Salud , Humanos , Masculino , Nueva Gales del Sur/epidemiología , Prevalencia , Estudios Prospectivos , Derivación y Consulta , Estudios Retrospectivos , Servicio Social , Estrés Psicológico/epidemiología , Resultado del TratamientoRESUMEN
Meprins, membrane-bound oligomeric metalloendopeptidases, contain alpha and/or beta subunits. Their activities have been found in the mouse and rat kidney. The cloned cDNA for the mouse alpha subunit of meprin A (EC cloned cDNA for the mouse alpha subunit of meprin A (EC 3.4.24.18) was used here to survey mRNA expression in kidney of different mouse strains and in various tissues of mice and rats. A single message of 3.6 kilobases was found in kidney of random bred (ICR) and inbred mice (C57BL/6, DBA/2) that contain high meprin A activity and in Sprague-Dawley rat kidney. The alpha subunit message was undetectable in the kidney of C3H/He and CBA mice, inbred strains that do not express meprin A activity. Therefore, meprin A activity in the kidney of mouse strains correlates with the amount of alpha subunit mRNA present. The 3.6-kilobase mRNA meprin alpha subunit message was also detected in the small intestine of the rat but not in mice. No message was detected in brain, heart, skeletal muscle, liver, lung, or spleen of mice or rats. Polymerase chain reaction amplification or Southern blot analysis of genomic DNA revealed that the gene for the alpha subunit is present in all mouse strains as well as in human, monkey, rat, mouse, dog, cow, rabbit, and chicken, but it was not detected in yeast. There is one gene copy present in the mouse genome. The gene was localized to mouse chromosome 17 centromeric to the major histocompatibility complex (H-2) by the interspecific backcrossing method. The localization of this allele to Mep-1, the gene previously found to regulate the expression of meprin A activity in mice, supports the proposal that Mep-1 is the structural gene for the alpha subunit.
Asunto(s)
Mapeo Cromosómico , Metaloendopeptidasas/biosíntesis , Metaloendopeptidasas/genética , Animales , Secuencia de Bases , Southern Blotting , Clonación Molecular , ADN/genética , ADN/aislamiento & purificación , Escherichia coli/genética , Ligamiento Genético , Riñón/enzimología , Sustancias Macromoleculares , Masculino , Ratones , Ratones Endogámicos C3H , Ratones Endogámicos C57BL , Ratones Endogámicos CBA , Ratones Endogámicos DBA , Ratones Endogámicos ICR , Datos de Secuencia Molecular , Oligodesoxirribonucleótidos , Oligonucleótidos Antisentido , Especificidad de Órganos , Reacción en Cadena de la Polimerasa/métodos , ARN/genética , ARN/aislamiento & purificación , Ratas , Ratas Sprague-Dawley , Especificidad de la EspecieAsunto(s)
Abuso de Ancianos/diagnóstico , Anciano , Abuso de Ancianos/etiología , Familia/psicología , HumanosRESUMEN
OBJECTIVE: To establish the rate of occurrence and patterns of elder abuse, and outcomes of intervention, in an Australian population. DESIGN: Retrospective review of medical records over a 12-month period from July 1990 to June 1991. SETTING: An area-based geriatric and rehabilitation service attached to a district hospital. PATIENTS: Referred patients over 65 years of age, who lived in private homes and who met a predetermined definition of elder abuse. RESULTS: The rate of occurrence of elder abuse in the study population was 4.6%, with 29 cases of psychological abuse, 25 cases of physical abuse, 16 cases of neglect, and 13 cases of material/financial abuse. Patterns of abuse were identified and related to dependency of the older person (42%), psychopathology of the abuser (37%), family violence (14%), and carer stress (5%). Interventions and outcomes varied according to the pattern of abuse. CONCLUSION: The rate of occurrence and patterns of abuse of the elderly have been established for the first time in an Australian population. Intervention aimed at reducing the impact of elder abuse is effective, and should be tailored to the pattern of abuse that is occurring.
Asunto(s)
Abuso de Ancianos/epidemiología , Anciano , Australia/epidemiología , Cuidadores , Demencia/complicaciones , Abuso de Ancianos/etiología , Abuso de Ancianos/psicología , Familia , Femenino , Humanos , Masculino , Derivación y Consulta , Estudios Retrospectivos , Estrés Psicológico/complicaciones , ViolenciaRESUMEN
OBJECTIVE: To report a series of older patients who had been physically abused or neglected and to describe their disabilities and social situation, the abuser, interventions offered and outcomes. DESIGN: A retrospective case series. Patients were included if they met the requirements of a predetermined definition of physical abuse or neglect. SETTING: An area-based geriatric and rehabilitation service attached to a district hospital. PATIENTS: Fifteen men and women aged over 65 who met the requirements of our definition of abuse and who were referred to the service over a 12-month period. For each patient an abuser was identified. RESULTS: Risk factors for elder abuse were a high degree of dependency of the elderly person resulting from cognitive or physical impairment; psychopathology in the abuser or stress on the carer. Intervention was effective for a majority of the patients. CONCLUSIONS: The findings are similar to those of overseas studies. Awareness of the problem and early intervention with counseling, provision of appropriate services and accommodation are likely to be successful in limiting the impact of elder abuse.