Adult Abuse Research Articles

Emotional Processing and Maltreatment During Childhood as Factors of Vulnerability to Alcohol Abuse in Young Adults

AbstractDifferent studies suggest a strong association between childhood abuse and alcohol use disorders (AUDs). The modulation of the startle response has been used to assess emotional processing in AUDs. The main objective of the study was to investigate the startle reflex responses to different stimuli in young adults with varying types of childhood abuse in comparison with a control group according to their current alcohol consumption and the presence of a parent with alcohol dependence or not. A clinical sample of 606 adolescents, divided into five groups: no abuse, physical neglect, emotional neglect, emotional abuse, physical abuse, and sexual abuse, were assessed on their pattern of alcohol consumption and their family history of alcoholism. The proportion of participants with at least one alcohol-dependent parent was higher in all types of abuse. The proportion of heavy drinkers and alcohol-dependent participants was higher in the groups with physical neglect and sexual abuse. Heavy drinkers and alcohol dependents showed a lower startle reflex response to emotional pictures, especially alcohol-related ones. Adolescents exposed to physical and sexual abuse during childhood showed a mitigated startle response to appetitive and alcohol-related pictures. The results of this exploratory study reveal that childhood maltreatment modulates emotional processing to alcohol-related stimuli during adolescence. The evaluation of these patients’ startle response could be considered a prognostic biomarker for establishing personalized preventive strategies during the adolescent stage to avoid, to a large extent, future problems derived from alcohol consumption.

Financial Abuse of Older Adults: Screening, Prevention, and Interventions by Primary Care Providers.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion. 2023;25(3):22f03434.Author affiliations are listed at the end of this article.

Lifetime Interpersonal Violence or Abuse and Diabetes Rates by Sex and Race

Lifetime exposure to interpersonal violence or abuse has been associated with several chronic diseases, including adult-onset diabetes, yet this pattern has not been confirmed by sex and race within a large cohort. Data from the Southern Community Cohort Study collected between 2002-2009 and 2012-2015 were used to explore the relationship between lifetime interpersonal violence or abuse and diabetes (N=25,251). Prospective analyses of lower-income people living in the southeastern U.S. were conducted in 2022 to examine the risk of adult-onset diabetes associated with lifetime interpersonal violence or abuse by sex and race. Lifetime interpersonal violence or abuse was defined as (1) physical or psychological violence, threats, or abuse in adulthood (adult interpersonal violence or abuse) and (2) childhood abuse or neglect. After adjustment for potentially confounding factors, adult interpersonal violence or abuse was associated with a 23% increased risk of diabetes (adjusted hazard ratio=1.23; 95% CI=1.16, 1.30). Diabetes risks associated with childhood abuse or neglect were 15% (95% CI=1.02, 1.30) for neglect and 26% (95% CI=1.19, 1.35) for abuse. When combining adult interpersonal violence or abuse and childhood abuse or neglect, the risk of diabetes was 35% higher (adjusted hazard ratio=1.35; 95% CI=1.26, 1.45) than those experiencing no violence, abuse, or neglect. This pattern held among Black and White participants, and among women and men. Both adult interpersonal violence or abuse and childhood abuse or neglect increased the risk of adult-onset diabetes in a dose-dependent pattern for men and women, and by race. Intervention and prevention efforts to reduce adult interpersonal violence or abuse and childhood abuse or neglect could not only reduce the risk of lifetime interpersonal violence or abuse but may also reduce one of the most prevalent chronic diseases, adult-onset diabetes.

Increasing disclosures of older adult maltreatment: a review of best practices for interviewing older adult eyewitnesses and victims

The current article provides a contemporary review of the best practices for interviewing older adults about crimes they witnessed or experienced. Specifically, we provide a detailed overview of how investigators can use a range of interviewing adaptations and procedures to acquire detailed and accurate maltreatment disclosures from older adults. In addition to discussing well-established investigative interviewing practices (e.g. rapport building, free-recall, cognitive instructions and prompts), this article also summarizes more recent literature on the benefits of multidisciplinary investigations, use of assistive technology and interview accommodations, along with effective practices for working with minority and marginalized older adults. Lastly, several research, professional and policy recommendations are provided for supporting older adults during investigative interviews.

Trafficking in Human Beings and Sexual Trafficking of Children as a Form of it

Research on human trafficking has attracted increasing attention since the early 1980s and is extremely important as it highlights the problems and through it identifies the appropriate ways that can provide solutions. The object of this paper is the treatment of trafficking in human beings and in particular will focus on the sexual trafficking of minors. This topic is very current not only in Albania but also in the international arena (due to it’s nature) and requires the commitment of all states and international organizations to combat human trafficking and protect victims of trafficking as part of the field of human rights. Therefore, this topic is covered in section I of this conference. The research questions of this paper are: what does trafficking in human beings involve, what are the needs of the victims, what is the exploitation and sexual abuse of children, what are the consequences that trafficking leaves on children and why children are recruited. Numerous studies and studies have concluded that trafficking represents "a denial of the individual's rights to freedom, integrity, security and freedom of movement" Victims of human trafficking need, among other things, emotional support , family, health care and especially for reintegration into society. On the other hand, child sexual exploitation is a form of human trafficking and consists of adult sexual abuse and monetary or in-kind reward for the child or a third person or persons. and it is precisely the commercial element that separates sexual exploitation from other sexual crimes.Juveniles are recruited more easily because small victims are the most optimal, useful and lower cost, they are easy to be guided by traffickers and slave owners and to adapt to the new situation. Current studies show that some effects of Sex trafficking is sexually transmitted diseases, diseases and other infections, physical harm, substance abuse and malnutrition.
 
 Received: 05 May 2022 / Accepted: 18 May 2023 / Published: 20 May 2023

Short- and long-term effects of chronic toluene exposure on spatial memory in adolescent and adult male Wistar rats

Addiction to toluene-containing volatile inhalants is of significant medical and social concern, particularly among youth. These concerns are underscored by the fact that the majority of adult abusers of toluene started as teenagers. Surprisingly, however, the lasting effects of chronic toluene exposure, especially in various age groups, have not been well investigated. Recently, we reported that adolescent and adult male Wistar rats show differential responses to chronic toluene exposure in recognition memory tasks. Since different cognitive functions may be differentially affected by drugs of abuse, we used the same model to evaluate the short- and long-term effects of chronic toluene on spatial learning and memory using Morris water maze. Daily exposure to toluene (2000 ppm) for 40 days (5 min/day) resulted in age-dependent behavioral changes. For example, only adolescent animals showed a decrease in time and distance travelled to find the hidden platform 24 h after the last toluene exposure. In contrast, only adult rats exhibited a decrease in acquisition time and distance travelled at 90 days’ post toluene exposure. Our data provide further support for the contention that age-dependent responses should be taken into consideration in interventional attempts to overcome specific detrimental consequences of chronic toluene exposure.

Clinical Presentation and Management of Acute Dystonia from Drug Abuse or Misuse in Adolescents and Young Adults: A Retrospective Cohort Study in Bangkok, Thailand.

To describe the clinical presentation of acute dystonia (AD) from drug abuse or misuse, as well as the emergency department (ED) management and outcomes in adolescents and young adults. This was a retrospective cohort study of patients aged 10-25 years who were admitted to the ED for AD due to intentional abuse or misuse from January 1, 2014, to June 30, 2017. Data were collected from electronic medical records by three investigators with excellent interrater reliability (0.87). Sixty-two cases met the criteria with male predominance (85.5%); the mean age was 16.7 years. Perphenazine was the most common cause of AD (38.7%), followed by haloperidol (32.2%). The most common AD manifestations were torticollis (51.6%), oromandibular dystonia (45.2%), and oculogyric crisis (22.6%). Intravenous (IV) diazepam combined with oral trihexyphenidyl and IV diazepam alone were the most frequently used first treatment in our ED (41.7% and 35.0%, respectively). Overall, the improvement rates from IV diazepam alone or combined with trihexyphenidyl ranged from 46.2%-75.0%. These rates were inferior to those observed with IV benztropine (100%) alone or combined with trihexyphenidyl. All patients were treated on an outpatient basis, except for one who was admitted to a pediatric ward. In recent years, drug-induced AD caused by intentional abuse among adolescents and young adults has become a concern in Thailand. The most common suspected drugs of abuse were first-generation antipsychotics, perphenazine, and haloperidol. The most effective treatment was benztropine.

Childhood Sexual Abuse and Cortical Thinning in Adults With Major Depressive Disorder.

A growing body of evidence reports on the effect of different types of childhood abuse on the structural and functional architecture of the brain. In the present study, we aimed to investigate the differences in cortical thickness according to specific types of childhood abuse between patients with major depressive disorder (MDD) and healthy controls (HCs). A total of 61 patients with MDD and 98 HCs were included in this study. All participants underwent T1-weighted magnetic resonance imaging, and the occurrence of childhood abuse was assessed using the Childhood Trauma Questionnaire. We investigated the association between whole-brain cortical thickness and exposure to any type of childhood abuse and specific type of childhood abuse in the total sample using the FreeSurfer software. No significant difference was reported in the cortical thickness between the MDD and HC groups nor between the "any abuse" and "no abuse" groups. Compared to no exposure to childhood sexual abuse (CSA), exposure to CSA was significantly associated with cortical thinning in the left rostral middle frontal gyrus (p=0.00020), left (p=0.00240), right fusiform gyri (p=0.00599), and right supramarginal gyrus (p=0.00679). Exposure to CSA may lead to cortical thinning of the dorsolateral prefrontal cortex, which is deeply involved in emotion regulation, to a greater extent than other types of childhood abuse.

Dealing with the elder abuse epidemic: Disparities in interventions against elder abuse in trauma centers.

Elder abuse is a major cause of injury, morbidity, and death. We aimed to identify the factors associated with interventions against suspected physical abuse in older adults. Analysis of the 2017-2018 ACS TQIP. All trauma patients ≥60 years with an abuse report for suspected physical abuse were included. Patients with missing information on abuse interventions were excluded. Outcomes were rates of abuse investigation initiation following an abuse report and change of caregiver at discharge among survivors with an abuse investigation initiated. Multivariable regression analyses were performed. Of 727,975 patients, 1405 (0.2%) had an abuse report. Patients with an abuse report were younger (mean, 72 vs 75, p < 0.001), and more likely to be females (57% vs 53%, p=0.007), Hispanic (11% vs 6%, p < 0.001), Black (15% vs 7%, p < 0.001), suffer from dementia (18% vs 11%, p < 0.001), functional disability (19% vs 15%, p < 0.001), have a positive admission drug screen (9% vs 5%, p < 0.001) and had a higher ISS (median [IQR], 9 [4-16] vs 6 [3-10], p < 0.001). Perpetrators were members of the immediate/step/extended family in 91% of cases. Among patients with an abuse report, 1060 (75%) had abuse investigations initiated. Of these, 227 (23%) resulted in a change of caregiver at discharge. On multivariate analysis for abuse investigation initiation, male gender, private insurance, and management at non-level I trauma centers were associated with lower adjusted odds (p < 0.05), while Hispanic ethnicity, positive admission drug screen, and penetrating injury were associated with higher adjusted odds (p < 0.05). On multivariate analysis for change of caregiver, male gender, and private insurance were associated with lower adjusted odds (p < 0.05), while functional disability and dementia were associated with higher adjusted odds (p < 0.05). Significant gender, ethnic, and socioeconomic disparities exist in the management of physical abuse of older adults. Further studies are warranted to expand on and address the contributing factors underlying these disparities. III. Therapeutic/Care Management.

Posttraumatic Growth, Dissociation and Identification With The Aggressor Among Childhood Abuse Survivors

ABSTRACT Childhood abuse puts individuals at risk for psychopathology and psychiatric symptoms such as posttraumatic stress disorder (PTSD) and anxiety symptoms. At the same time, research has indicated that some survivors report positive transformations in the aftermath of their trauma, known as posttraumatic growth (PTG). Yet the essence of PTG reports is questionable, and some scholars claim that it may reflect maladaptive illusory qualities. Furthermore, according to a recent theoretical model, PTG might be dissociation-based and related to survivors’ bonds with their perpetrators. This study aimed to explore these claims by assessing PTG, dissociation, and identification with the aggressor (IWA), as well as PTSD and anxiety symptoms. An online survey was conducted among 597 adult childhood abuse survivors. Study variables were assessed via self-report measures. Analyses indicated positive associations between PTG, dissociation, and IWA. Three distinct profiles were found, reflecting high, medium, and low scores on PTG, dissociation, and IWA. Profile type explained PTSD and anxiety symptoms above and beyond gender, age, and abuse severity. These findings suggest that whereas some childhood abuse survivors might experience a positive transformation subsequent to their trauma, others’ PTG reports might reflect dissociative mechanisms and pathological attachments to their perpetrators, and thus might be maladaptive.

The Predictive Accuracy of the LSI-R in Female Forensic Inpatients-Assessing the Utility of Gender-Responsive Risk Factors.

Female reoffending has long been a neglected research interest. Accordingly, risk assessment instruments were developed based on the criminological knowledge of male recidivism. While feminist researchers have repeatedly criticized the failure to incorporate gender-responsive risk (GR) factors, opinions on the gender neutrality of existing instruments remain inconsistent. In order to substitute the existing literature, while extending the scope to mentally disordered offenders, the aim of the given study was the prediction of general recidivism in a sample of 525 female forensic inpatients who had been discharged from forensic psychiatric care in Germany between 2001 and 2018. Primarily, ROC analysis was conducted to assess the predictive accuracy of the LSI-R. Subsequently, separate binary logistic regression analyses were performed to determine the predictive utility of GR factors on recidivism. Lastly, multiple binary logistic regression was used to assess the incremental validity of the GR factors. The results showed that the GR factors (i.e., intimate relationship dysfunction, mental health issues, parental stress, adult physical abuse, and poverty) significantly contributed to the prediction of recidivism, while a mixed personality disorder, a dissocial personality, an unsupportive partner, and poverty added incremental validity to the predictive accuracy of the LSI-R. However, given that the added variables could only improve classification accuracy by 2.2%, the inclusion of gender-specific factors should be cautiously evaluated.

Validating Use of ICD-10 Diagnosis Codes in Identifying Physical Abuse Among Young Children.

Evaluate the positive predictive value of International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes in identifying young children diagnosed with physical abuse. We extracted 230 charts of children <24 months of age who had any emergency department, inpatient, or ambulatory care encounters between Oct 1, 2015 and Sept 30, 2020 coded using ICD-10-CM codes suggestive of physical abuse. Electronic health records were reviewed to determine if physical abuse was considered during the medical encounter and assess the level of diagnostic certainty for physical abuse. Positive predictive value of each ICD-10-CM code was assessed. Of 230 charts with ICD-10 codes concerning for physical abuse, 209 (91%) had documentation that a diagnosis of physical abuse was considered during an encounter. The majority of cases, 138 (60%), were rated as definitely or likely abuse, 36 cases (16%) were indeterminate, and 35 (15%) were likely or definitely accidental injury. Other forms of suspected maltreatment were discussed in 16 (7%) charts and 5 (2%) had no documented concerns for child maltreatment. The positive predictive values of the specific ICD-10 codes for encounters rated as definitely or likely abuse varied considerably, ranging from 0.89 (0.80-0.99) for T74.12 "Adult and child abuse, neglect, and other maltreatment, confirmed" to 0.24 (95% CI: 0.06-0.42) for Z04.72 "Encounter for examination and observation following alleged child physical abuse." ICD-10-CM codes identify young children who experience physical abuse, but certain codes have a higher positive predictive value than others.

The impact of sexual abuse on body experience in adults with mild intellectual disability or borderline intellectual functioning

ABSTRACT Background Research is lacking on body-related consequences of sexual abuse in adults with mild intellectual disability or borderline intellectual functioning (MID-BIF), although the prevalence of abuse is high and body- and movement-oriented diagnostics and therapeutics seem warranted for this group. Method Body experience in adults with MID-BIF who were sexually abused (SA) and were not sexually abused (NSA) was compared using a self-report instrument, the Body Experience Questionnaire-mb, and an instrument to observe non-verbal psychomotor behaviour, the PsyMot-mb. Results The SA group showed significantly higher self-reported body awareness and more observed problems with body acceptance than the NSA group. No significant group differences were found for self-reported body satisfaction and body attitude. Conclusions Adults with MID-BIF who were sexually abused are more aware of their body signals, but less able to adequately attend to, tolerate, and interpret these signals. Therefore, body- and movement-oriented therapies hold promise for this group.

The Psychological Impact of the COVID-19 Pandemic on Alcohol Abuse and Drunkorexia Behaviors in Young Adults.

The COVID-19 outbreak negatively affected young adults' psychological well-being, increasing their stress levels and symptoms of anxiety and depression, and potentially triggering health-risk behaviors. The present study was aimed at investigating the psychological impact of the COVID-19 pandemic on alcohol abuse and drunkorexia behaviors among young adults living in Italy. Participants were 370 emerging adults (63% women, 37% men; Mage = 21.00, SDage = 2.96, range: 18-30) who were recruited through an online survey between November 2021 and March 2022. Participants completed measures of alcohol abuse, drunkorexia behaviors, negative life experiences, and post-traumatic symptoms related to the COVID-19 outbreak. The results showed that the emotional impact and negative life experiences associated with the pandemic predicted both alcohol abuse and drunkorexia behaviors, albeit in different ways. Specifically, the number of negative life experiences during the pandemic and the tendency to avoid COVID-19-related negative thoughts positively predicted alcohol abuse; and the presence of intrusive thoughts associated with the pandemic significantly predicted the frequency of drunkorexia behaviors. Implications for research and clinical practice are discussed.

The impact of social isolation and loneliness on resilient older adults with remitted depressive disorders during the COVID-19 pandemic: two case studies

AuthorsCatherine Gonzalez M.D. and Nancy Donovan M.D. IntroductionSocial Isolation and loneliness (SI/L) representing objective and subjective deficits in social relationships and interactions, are important factors affecting the mental health of older adults. They are also major risk factors for cognitive decline, cardiovascular disease, and premature mortality. During the COVID-19 pandemic, instituted measures such as social distancing, stay-at-home regulations, public closures, and activity limitations, increased social isolation and loneliness for many. It is important for clinicians to recognize how SI/L contributed to worsening psychiatric symptoms during the acute pandemic, the extent to which they still persist and their potential long lasting sequelae. Method/CaseThese case presentations will highlight the impact of SI/L in two elderly patients receiving psychiatric care in an academic outpatient geriatric psychiatry clinic during the COVID-19 pandemic.The first case is a 75-year-old man with history of depression following the death of his wife who was euthymic and stable on a low dose of an SSRI since 2017. Between 2017-2020, he was active, well-functioning, attended religious services weekly, engaged in group grief counseling at his temple, took university extension classes, and visited regularly with family and friends. Due to the COVID-19 pandemic and social restriction measures, he lost all in person connections (counseling, classes, services), and stopped seeing others out of fear of infection and increasing depression. As restrictions eased, many of his former activities returned, albeit virtually but he has been struggling to reconnect, continuing to experience SI/L and depression. Symptoms have only partially improved with CBT and supportive therapy.The second case is a 77-year-old woman with a history of major depression since adulthood, well controlled on low dose SSRI and as needed sleep medication. In the fall of 2019, she had a brief recurrence of depressive symptoms in context of adult son's alcohol abuse and his need to live with her. Symptoms improved as she was active in her church, had many friends and had future trips plans to complete as part of her ‘bucket list’. In spring/summer 2020, depression relapsed as she felt isolated and unsupported during the pandemic and being a witness to son's ETOH and mental health problems without a clear treatment plan/next step. Throughout the last two years, she has been grieving the loss of her ‘pre-covid life’ and the realization that she might not complete her ‘bucket-list’ items. Furthermore, her physical health has been worsening, which has been difficult for her overall well-being. ResultsThese cases highlight the ongoing challenges of the COVID-19 pandemic, in particular its negative impact on geriatric mental health via worsening of SI/L. Even after multiple pandemic surges, vaccines and new treatments, the effects of isolation and social distancing have long lasting effects. In these two cases, high functioning and resilient older adult patients were negatively impacted by isolating public health measures during the pandemic. Recovery, while slow, has been based on re-establishing the quality and quantity of social relationships, re-engagement in meaningful activities and coming to terms with the unique stresses and losses during the pandemic.

Research on the Abuse, Neglect, and Financial Exploitation of Older Adults (DOJ)

Federal Grants & ContractsVolume 47, Issue 6 p. 4-5 Grants Alerts Research on the Abuse, Neglect, and Financial Exploitation of Older Adults (DOJ) First published: 14 February 2023 https://doi.org/10.1002/fgc.32865Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume47, Issue616 February 2023Pages 4-5 RelatedInformation

Association of Neural Connectome With Early Experiences of Abuse in Adults

More than 10% of children experience sexual, physical, or emotional abuse, and abuse experienced during sensitive neurodevelopmental periods is associated with a greater risk of psychiatric disorders. To investigate the extent to which a history of abuse is associated with alterations in the intrinsic functional connectome of the adult brain independent from the restriction of associated psychiatric conditions. This cohort study assessed data from 768 adult participants from the greater Sydney, Australia, area who were included in the study without diagnostic restrictions and categorized based on a history of childhood sexual, physical, and/or emotional abuse. Data were collected from January 1, 2009, to December 31, 2015; data analysis was performed from October 1, 2020, to March 31, 2022. Outcomes were structured psychiatric interview responses, self-report of the frequency and extent of various types of negative experiences in childhood and adolescence, and intrinsic functional connectivity derived from 5 functional magnetic resonance imaging tasks and estimated among 436 brain regions, comprising intranetwork and internetwork connectivity of 8 large-scale brain networks. Among the 647 individuals with usable data (330 female [51.0%]; mean [SD] age, 33.3 [12.0] years; age range, 18.2-69.2 years), history of abuse was associated with greater likelihood of a current psychiatric illness (odds ratio, 4.55; 95% CI, 3.07-6.72; P < .001) and with greater depressive, anxiety, and stress symptoms (mean difference, 20.4; 95% CI, 16.1-24.7; P < .001). An altered connectome signature of higher connectivity within somatomotor, dorsal, and ventral attention networks and between these networks and executive control and default mode networks was observed in individuals with a history of abuse experienced during childhood (n = 127) vs those without a history of abuse (n = 442; mean difference, 0.07; 95% CI, 0.05-0.08; familywise, Bonferroni-corrected P = .01; Cohen d = 0.82) and compared with those who experienced abuse in adolescence (n = 78; mean difference, 0.06; 95% CI, 0.04-0.08]; familywise, Bonferroni-corrected P < .001; Cohen d = 0.68). Connectome alterations were not observed for those who experienced abuse in adolescence. Connectivity of this signature was transdiagnostic and independent of the nature and frequency of abuse, sex, or current symptomatic state. Findings highlight the associations of exposure to abuse before and during adolescence with the whole-brain functional connectome. The experience of child abuse was found to be associated with physiologic changes in intrinsic connectivity, independent of psychopathology, in a way that may affect functioning of systems responsible for perceptual processing and attention.

Neglect, abuse and violence against older women: Definitions and research frameworks

The aging of the global population with women living longer than men, resulting in the feminization of aging, focuses attention on the intersection of gender and age. Women across the lifespan can be victims of violence but there has been little attention to date to the neglect, abuse and violence against older women. Because of this gap in knowledge and remedies, little is known about neglect, abuse and violence against older women, particularly its prevalence as well as evidence-based prevention and intervention strategies. Several definitions of neglect, abuse and violence are reviewed here, along with conceptual frameworks that operationalize these definitions differently, resulting in differences in findings on prevalence as well as fragmentation in the way that older women victims of abuse are viewed. Three definitions of older adult abuse are discussed, including those formulated by the Toronto Declaration, the National Research Council, and the United States Center forDisease Control. Each focuses on a different aspect of abuse of older women: active ageing, old age dependency, and domestic violence in later life. A fourth conceptual framework, the human rights perspective, shows promise for addressing abuse of older women in a more holistic manner than the other definitions, but Is not fully developed as a way of understanding neglect, abuse and violence against older women. This is the first of a four-part series on older women and abuse.

Reliability and validity of the Turkish version of the elder abuse suspicion index in community-dwelling older adults.

Elder abuse is among the most important ethical issue during the management of older population. The elder abuse suspicion index (EASI) was developed for evaluating abuse in older adults. We aimed to assess the reliability and validity of the Turkish version EASI-Türkiye (TR) among older adults. This study included 89 community-dwelling older adults. The EASI-TR and other scales, including HwalekSengstock Elder Abuse Screening Test-Türkiye (HS/EAST-TR), YGDS, Yesavage Geriatric Depression Scale (YGDS), Instrumental Activities of Daily Living (IADL), and Activities of Daily Living (ADL) were administered to all participants. Internal consistency and external validity were assessed. EASI-TR revealed an excellent test-retest reliability and acceptable level of internal consistency (Cronbach's α = 0.711). The item-total correlations ranged between 0.296 and 0.701, except for the second item. This test showed significant correlations with the HS/EAST-TR and IADL (p < 0.05), demonstrating good external validity. The EASI-TR appears to have acceptable reliability and validity in screening for abuse in older adults. This tool may recognize cases that require additional evaluation in managing of ethical issues.

Alcohol abuse in older adults with type 2 diabetes mellitus in primary health care: a cross-sectional study.

This cross-sectional study aimed to analyze alcohol abuse in older adults with type 2 diabetes mellitus in primary health care. Household data were collected from March to October 2018 in the Family Health Strategy in Ribeirão Preto, São Paulo through face-to-face interviews with a form application. The pattern of alcohol consumption was estimated with the Alcohol Use Disorders Identification Test-C. A total of 338 older adults with type 2 diabetes mellitus participated, and 19.2% (95%CI 15.0-23.4) engaged in alcohol abuse. Among them, we observed a higher frequency of males (63.1%), aged 60 to 64 years (35.4%), economic class C (49.2%), 1-4 schooling years (53.8%), and multimorbidity (92.3%). There was a negative association between alcohol abuse and drug therapy adherence (PR = 0.55; 95%CI 0.36-0.86). The frequency of alcohol abuse and non-adherence to drug treatment among those with a high consumption pattern is troubling since it can lead to diabetes complications. Therefore, we underscore the importance of multidimensional elderly care and health education in primary care.