Family Environmental Risk Factors Research Articles

Maltreatment, family environment, and social risk factors: Determinants of the child welfare to juvenile justice transition among maltreated children and adolescents

This study prospectively examines the transition from the child welfare system into the juvenile justice system among 10,850 maltreated children and adolescents and explores how patterns of risks, including severity and chronicity of maltreatment, adverse family environment, and social risk factors, affect service systems transition. Almost three percent of maltreated children and adolescents had their first juvenile justice adjudication within an average of approximately six years of their initial child protective services investigation (CPS). Social risk factors, including a child’s age at index CPS investigation (older), gender (boys), and race/ethnicity (Black and Hispanic) significantly predicted the risk of transition into the juvenile justice system. Recurrence of maltreatment and experiencing at least one incident of neglect over the course of the study period also increased the risk of transition into the juvenile justice system. However, subtypes of maltreatment, including physical, sexual, and other types of abuse did not significantly predict the risk of juvenile justice system transition. Finally, family environment characterized by poverty also significantly increased the risk of juvenile justice system transition. These findings have important implications for developing and tailoring services for maltreated children, particularly those at-risk for transitioning into the juvenile justice system.

Abstract 2587: Comprehensive colorectal cancer risk prediction to inform personalized screening and intervention

Abstract Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States, despite the fact that it is one of the most preventable and treatable cancers when detected early via screening. The current screening guidelines for CRC are based on age, family history of CRC, and previous screening results. However, multiple environmental and lifestyle risk factors have been established or suspected for CRC, as have many common genetic susceptibility loci. It is critical to utilize this information to better stratify individuals into low- and high-risk groups for optimized and personalized screening and intervention recommendations. Using data from two large consortia (8421 CRC cases and 9767 controls): the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO) and the Colorectal Transdisciplinary study (CORECT), we developed risk prediction models for men and women based on family history, environmental and lifestyle risk factors, and known CRC susceptibility loci identified through genome-wide association studies. We constructed an environmental risk score (E-score) as a weighted sum of 19 established or potential environmental and lifestyle risk factors for CRC with weights obtained from a multivariate logistic regression analysis. Compared to the model that includes only family history, the E-score significantly improves the discriminatory accuracy for both men (AUC = 0.62 vs. 0.53, p-value < 1e-5) and women (AUC = 0.60 vs. 0.52, p-value < 1e-5). Similarly, we also constructed a genetic risk score (G-score) using 50 common variants associated with CRC risk, and the G-score also significantly improves the discriminatory accuracy for both men (AUC = 0.60 vs. 0.53, p-value < 1e-5) and women (AUC = 0.59 vs. 0.52, p-value < 1e-5) over the family history-only model. Compared to the model with family history and E-score, the inclusion of the G-score in the model further improves the discriminatory accuracy for both men (AUC = 0.65 vs. 0.62, p-value = 0.0152) and women (AUC = 0.63 vs. 0.60, p-value = 0.0005). Our risk prediction models are the first to incorporate both comprehensive environmental and lifestyle risk factors, and known CRC common genetic variants. The E- and G-scores are independent risk predictors for CRC, and models that incorporate both scores improve the discriminatory accuracy significantly compared to family history-only models. Using risk-factor distributions available from nationally representative data (e.g., NHANES), we will provide absolute-risk estimates of CRC using both the E- and G-scores. We expect our comprehensive models incorporating both environmental and genetic risk factors to provide more accurate estimation of CRC, which will be useful for recommending individually tailored screening and intervention strategies to prevent this common cancer. Citation Format: Jihyoun Jeon, Sonja I. Berndt, Hermann Brenner, Peter T. Campbell, Andrew T. Chan, Jenny Chang-Claude, Mengmeng Du, Graham Giles, Jian Gong, Stephen B. Gruber, Tabitha A. Harrison, Michael Hoffmeister, Loic LeMarchand, Li Li, John D. Potter, Gad Rennert, Robert E. Schoen, Martha L. Slattery, Emily White, Michael O. Woods, Ulrike Peters, Li Hsu. Comprehensive colorectal cancer risk prediction to inform personalized screening and intervention. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2587.

Paraphilic Sexual Interests and Sexually Coercive Behavior: A Population-Based Twin Study.

Prior research with selected clinical and forensic samples suggests associations between paraphilic sexual interests (e.g., exhibitionism and sexual sadism) and sexually coercive behavior. However, no study to date used a large, representative and genetically informative population sample to address the potential causal nature of this association. We used self-report data on paraphilic and sexually coercive behavior from 5990 18- to 32-year-old male and female twins from a contemporary Finnish population cohort. Logistic regression and co-twin control models were employed to examine if paraphilic behaviors were causally related to coercive behavior or if suggested links were confounded by familial (genetic or common family environment) risk factors. Results indicated that associations between four out of five tested paraphilic behaviors (exhibitionism, masochism, sadism, and voyeurism, respectively) and sexually coercive behavior were moderate to strong. Transvestic fetishism was not independently associated with sexual coercion. Comparisons of twins reporting paraphilic behavior with their paraphilic behavior-discordant twin further suggested that associations were largely independent of shared genetic and environmental confounds, consistent with a causal association. In conclusion, similar to previously reported predictive effects of paraphilias on sexual crime recidivism, paraphilic behavior among young adults in the general population increases sexual offending risk. Further, early identification of paraphilic interest and preventive interventions with at-risk individuals might also reduce perpetration of first-time sexual violence.

Promoter methylation of glucocorticoid receptor gene is associated with subclinical atherosclerosis: A monozygotic twin study.

Endothelial dysfunction assessed by brachial artery flow-mediated dilation (FMD) is a marker of early atherosclerosis. Glucocorticoid receptor gene (NR3C1) regulates many biological processes, including stress response, behavioral, cardiometabolic and immunologic functions. Genetic variants in NR3C1 have been associated with atherosclerosis and related risk factors. This study investigated the association of NR3C1 promoter methylation with FMD, independent of genetic and family-level environmental factors. We studied 84 middle-aged, male-male monozygotic twin pairs recruited from the Vietnam Era Twin Registry. Brachial artery FMD was measured by ultrasound. DNA methylation levels at 22 CpG residues in the NR3C1 exon 1F promoter region were quantified by bisulfite pyrosequencing in genomic DNA isolated from peripheral blood leukocytes. Co-twin control analyses were conducted to examine the association of methylation variation with FMD, adjusting for smoking, physical activity, body mass index, lipids, blood pressure, fasting glucose, and depressive symptoms. Multiple testing was corrected using the false discovery rate. Mean methylation level across the 22 studied CpG sites was 2.02%. Methylation alterations at 12 out of the 22 CpG residues were significantly associated with FMD. On average, a 1% increase in the intra-pair difference in mean DNA methylation was associated with 2.83% increase in the intra-pair difference in FMD (95% CI: 1.46-4.20; P < 0.0001) after adjusting for risk factors and multiple testing. Methylation variation in NR3C1 exon 1F promoter significantly influences subclinical atherosclerosis, independent of genetic, early family environmental and other risk factors.

Behavioural effects of fetal antidepressant exposure in a Norwegian cohort of discordant siblings.

Potential adverse effects of prenatal antidepressant exposure on child development are still debated. The possibility that associations are due to genetic or familial environmental risk factors rather than antidepressant use per se cannot easily be ruled out in conventional studies. Our objective was therefore to evaluate the association between prenatal antidepressant exposure and behavioural problems in a sibling controlled study. This study used data on 20 180 siblings identified from the population-based Norwegian Mother and Child Cohort Study recruited between 1999 and 2008. The mothers were asked to report antidepressant use at gestational weeks 17 and 30 and 6 months post-partum. Child Behavioral Checklist syndrome scales were used to assess externalizing and internalizing behavioural problems by questionnaires sent to mothers at 18 and 36 months postpartum. We performed unmatched and matched sibling analyses using both random- and fixed-effects linear models, respectively, to determine potential behavioural effects of antidepressant exposure. Prenatal exposure to antidepressants was associated with increased levels of anxiety symptoms in 3 year old children after adjusting for maternal familial effects and confounding by indication (i.e. maternal depression). Effect of prenatal exposure to antidepressants was specific to anxiety, and not associated with emotional reactivity, somatic complaints, sleep problems, attention problems or aggression. Using a sibling design, we showed that prenatal antidepressant use was specifically associated with increased anxiety symptoms after adjusting for maternal familial factors and confounding by indication.

가정환경 위험요인과 자아탄력성이 초기 청소년의 문제행동에 미치는 영향

가정환경 위험요인과 자아탄력성이 초기 청소년의 문제행동에 미치는 영향

Familial-Environmental Risk Factors in South African Children With Attention-Deficit Hyperactivity Disorder (ADHD): A Case-Control Study.

We investigated familial and environmental risk factors in a cohort of South African children diagnosed with attention-deficit hyperactivity disorder (ADHD). A prospective, hospital-based case control study was conducted comprising 50 children diagnosed with ADHD and 50 matched non-ADHD controls. The adjusted effect of familial-environmental risk factors on ADHD was determined by systematic assessment. Birth complications, parental psychiatric disorder, maternal ADHD, early childhood trauma, and nonmaternal child care were significant risk factors for ADHD. Prolonged breastfeeding was found to be protective. In a multivariable logistic regression model, 5 criteria (birth complications, breastfeeding <3 months, at least 1 parent with tertiary education, presence of parental psychiatric disorder, and nonmaternal primary caregiver) differentiated ADHD from non-ADHD controls with a sensitivity and specificity of 74% and 86%, respectively. We found a correlation between certain familial and environmental risk factors and ADHD. A 5-criterion multivariable logistic regression model may offer clinical guidance in ADHD diagnosis.

Hierarchical analysis of dietary, lifestyle and family environment risk factors for childhood obesity: the GRECO study.

To facilitate the development of practical public health advice targeted at childhood obesity (OB) prevention and make the intervention programs more effective, one has to promote the most protective habits and limit or modify the risk factors. The objective of the present study was to recognize the most important dietary and physical activity habits, sedentary behaviors, plus parental influences that are associated with childhood overweight (OW) and OB, in a nationwide, cross-sectional sample of Greek school children. Data from 4552 children (10-12 years old) and 2225 of their parents were included in the analysis. Direct anthropometric measurements and information on dietary and physical activity habits was obtained from the children, as was information on parental self-reported anthropometric values, perceptions and family environment information. Multiple logistic regression analysis revealed that the most important predictors of childhood OW/OB were breakfast frequency (odds ratio (OR): 0.95; 95% confidence interval (CI): 0.92-0.97), daily number of meals and snacks (OR: 0.92; 95% CI: 0.87-0.97), the frequency of family meals (OR: 0.86; 95% CI: 0.76-0.99), having both a TV and a PC/video game player in the bedroom (OR: 1.41; 95% CI: 1.18-1.69) and study hours on weekdays (OR: 1.07; 95% CI: 1.02-1.13). In the case of parents, mothers' age (OR: 0.91; 95% CI: 0.86-0.97), maternal (OR: 1.13; 95% CI: 1.06-1.21) and paternal (OR: 1.08; 95% CI: 1.02-1.15) body mass index (BMI) and children's BMI misclassification (OR: 6.22; 95% CI: 3.62-10.71) were significant predictors of children's OW/OB. These findings could guide future investigations or public health initiatives to prevent and confront the childhood OB epidemic more efficiently.

Sexually coercive behavior following childhood maltreatment.

Child maltreatment is associated with adult sexually coercive behavior. The association may be causal or confounders that increase the risk of both childhood victimization and sexually coercive behavior might explain the observed links. We examined if childhood maltreatment was related to sexual coercion independently of familial (genetic or common family environment) risk factors, thereby addressing potential causality. Participants were 6,255 18 to 33-year-old twins from the Finnish population-based study "Genetics of Sex and Aggression" who responded to self-report questionnaires of child maltreatment and sexually coercive behavior. We used generalized estimating equations to elucidate risk of sexual coercion in maltreated compared to unrelated, non-maltreated individuals. To adjust for unmeasured familial factors, we used the co-twin control method and compared sexual coercion risk within maltreatment-discordant twin pairs. Further, we examined possible differential effects of maltreatment subtypes and compared mean differences in maltreatment summary scores between sexually coercive individuals and controls. Sexual coercion was moderately more common among individuals maltreated as children versus unrelated controls (38.3 vs. 22.8%; age- and gender-adjusted odds ratio, aOR=2.31, 95% CI 1.75-3.05) and the risk increase remained similar within maltreatment-discordant twins (OR=2.82, 95% CI 1.42-5.61). Moreover, different maltreatment subtypes predicted sexual coercion equally well and effect sizes remained similar within discordant twin pairs. We conclude that associations between child maltreatment and sexual coercion are largely independent of shared familial confounds, consistent with a causal inference. Importantly, detection and targeted interventions for maltreated children should remain a priority to reduce societal sexually coercive behavior.

An assessment of risk factors for early death among a sample of previously incarcerated youth

Most previous research regarding early death prior to, or during, young adulthood among previously detained delinquent youth has focused predominantly on males or on their cause of death. This study extends previous research by evaluating potential factors that are associated with early death in a random sample (N = 999) of formerly detained youthful offenders in New York stratified by gender (50% female). Existing case records were referenced with the National Death Index to determine if the formerly detained youth were deceased by the time they would have reached age 28. Regression analyses were run to determine if any of 16 sociodemographic, offense history, weapons/gang involvement, mental health, substance use, child maltreatment, child welfare, or family environmental risk factors measured in their childhood or adolescence were associated with early death. Two additional regression analyses were run to determine if those risk factors differentially impacted early death for males vs. females. Of the variables measured, however, only gender was significantly related to early death – compared to females, males were 2.3 times more likely to have prematurely died. Additionally, in the model run separately for females, being an African-American female was protective against early death. These findings are compared to findings from the existing literature.

Teenage Pregnancy in Adolescents With an Incarcerated Household Member

This study examines the association between the incarceration of a household member and adolescent pregnancy, and evaluates whether this association extends beyond that of other variables associated with sexual health. We used data from 12 waves of the National Longitudinal Survey of Youth: Child and Young Adult. After eliminating males and individuals who did not respond to key questions, a sample of 1,229 girls (ages 14-19) was analyzed. Girls who experienced the incarceration of a household member faced more demographic and family environment risk factors than those who did not. Regression analyses demonstrated that the addition of a household incarceration variable afforded superior prediction of teenage pregnancy relative to the prediction based on demographic and family features alone. Programs that are directed toward reducing teen pregnancy will benefit from attention to the home situation of the at-risk girl, particularly the experience of household member incarceration and related family dynamics.

Within-Family Environmental Transmission of Drug Abuse

CONTEXT Drug abuse (DA) strongly runs in families. Does this result solely from genetic factors or does the family environment contribute? OBJECTIVE To determine the familial environmental contribution to the risk for DA. DESIGN Follow-up in 9 public databases (1961-2009) in siblings and spouses. SETTING Sweden. PARTICIPANTS A total of 137199 sibling pairs and 7561 spousal pairs containing a proband with DA and matched control probands. MAIN OUTCOME MEASURES Drug abuse recorded in medical, legal, or pharmacy registry records. RESULTS In the best-fit model, which contained significant linear, quadratic, and cubic effects, among full sibling pairs containing a proband with DA, the relative risk for DA in the sibling declined from more than 6.0 for siblings born within 2 years of each other to less than 4.5 when born 10 years apart. Controlling for age differences in full sibling pairs, the hazard rate for DA in a sibling when the affected proband was older vs younger was 1.42 (95% CI, 1.31-1.54). In the best-fit model, which contained significant linear, quadratic, and cubic effects, among spousal pairs containing a proband with DA, the relative risk for DA in the spouse declined from more than 25.0 within 1 year of proband DA registration to 6.0 after 5 years. CONCLUSIONS Controlling for genetic effects by examining only full siblings, sibling resemblance for the risk for DA was significantly greater in pairs closer vs more distant in age. Older siblings more strongly transmitted the risk for DA to their younger siblings than vice versa. After one spouse is registered for DA, the other spouse has a large short-lived increase in DA risk. These results support strong familial environmental influences on DA at various life stages. A complete understanding of the familial transmission of DA will require knowledge of how genetic and familial environmental risk factors act and interact over development.

The familial and other environmental risk factors in children with attention deficit hyperactivity disorder

The familial and other environmental risk factors in children with attention deficit hyperactivity disorder

Parent-Offspring Body Mass Index Associations in the Norwegian Mother and Child Cohort Study: A Family-based Approach to Studying the Role of the Intrauterine Environment in Childhood Adiposity

In the present study, the authors investigated the role of the intrauterine environment in childhood adiposity by comparing the maternal-offspring body mass index (BMI) association with the paternal-offspring BMI association when the offspring were 3 years of age, using parental prepregnancy BMI (measured as weight in kilograms divided by height in meters squared). The parent-offspring trios (n = 29,216) were recruited during pregnancy from 2001 to 2008 into the Norwegian Mother and Child Cohort Study conducted by The Norwegian Institute of Public Health. Data from self-administered questionnaires were used in linear regression analyses. Crude analyses showed similar parental-offspring BMI associations; the mean difference in offspring BMI was 0.15 (95% confidence interval: 0.13, 0.16) per each 1-standard-deviation increase in maternal BMI and 0.15 (95% confidence interval: 0.13, 0.17) per each 1-standard-deviation increase in paternal BMI. After all adjustments, the mean difference in offspring BMI per each 1-standard-deviation increment of maternal BMI was 0.12, and the mean difference in offspring BMI per each 1-standard-deviation increment of paternal BMI was 0.13. There was no strong support for heterogeneity between the associations (P > 0.6). In conclusion, results from the present large population-based study showed similar parental-offspring BMI associations when the offspring were 3 years of age, which indicates that the maternal-offspring association may be explained by shared familial (environmental and genetic) risk factors rather than by the intrauterine environment.

Deficient Emotional Self-Regulation and Adult Attention Deficit Hyperactivity Disorder: A Family Risk Analysis

A growing body of research suggests that deficient emotional self-regulation (DESR) is prevalent and morbid among patients with attention deficit hyperactivity disorder (ADHD). Family studies provide a method of clarifying the co-occurrence of clinical features, but no family studies have yet addressed ADHD and DESR. Participants were 83 probands with and without ADHD and 128 siblings. All were assessed for axis I DSM-IV conditions with structured diagnostic interviews. The authors defined DESR in adult probands and siblings using items from the Barkley Current Behavior Scale. Analyses tested hypotheses about the familial relationship between ADHD and DESR. Siblings of ADHD probands were at elevated risk of having ADHD, irrespective of the presence or absence of DESR in the proband. The risk for DESR was elevated in siblings of ADHD plus DESR probands but not in siblings of ADHD probands. ADHD and DESR cosegregated in siblings. The risk for other psychiatric disorders was similar in siblings of the ADHD proband groups. The pattern of inheritance of ADHD with DESR preliminarily suggests that DESR may be a familial subtype of ADHD. Our data suggest that DESR is not an expression of other axis I DSM-IV disorders or of nonfamilial environmental factors. The authors cannot exclude contribution of non-axis-I DSM-IV disorders to risk for DESR and cannot determine whether the cosegregation of ADHD in DESR within families is a result of genes or familial environmental risk factors. Further investigation of DESR and its correlates and treatment both in and outside the context of ADHD is warranted.

Are family variables associated with ADHD, inattentive type? A case–control study in schools

Attention-deficit/hyperactivity disorder (ADHD) seems to be associated with significant psychosocial adversity. However, few studies assessed the role of environmental, social and interpersonal factors specifically in ADHD, inattentive type (ADHD-I). Thus, this study aims to investigate whether family environment risk factors are associated with ADHD-I. In a case-control study, we assessed a non-referred sample of 100 children and adolescents with ADHD-I and 100 non-ADHD controls (6-18years old). They were systematically evaluated through structured diagnostic interviews. The following family adversity measures were used: Rutter's family adversity index (marital discord, low social class, large family size, paternal criminality, maternal mental disorder), Family Environment Scale (FES) (subscores of cohesion, expressiveness and conflict) and Family Relationship Index (FRI) (based on the subscores above). After adjusting for confounding factors (social phobia and maternal history of ADHD), the odds ratio (OR) for ADHD-I increased as the number of Rutter's indicators increased. Families of children with lower FES cohesion subscores presented higher OR for ADHD-I (OR 1.24; 95% confidence interval 1.05-1.45). Lower levels of FRI, a general index of family relationship, were also related to higher risk of ADHD-I (OR 1.11; 95% confidence interval 1.03-1.21). Our findings suggest that family adversity (in general), low family cohesion and low FRI (in particular) are associated with an increase in the risk for ADHD-I. However, the cross-sectional nature of the study limits our ability to infer causality.

PATHOPHYSIOLOGY OF DEPRESSION: DO WE HAVE ANY SOLID EVIDENCE OF INTEREST TO CLINICIANS?

Due to the clinical and etiological heterogeneity of major depressive disorder, it has been difficult to elucidate its pathophysiology. Current neurobiological theories with the most valid empirical foundation and the highest clinical relevance are reviewed with respect to their strengths and weaknesses. The selected theories are based on studies investigating psychosocial stress and stress hormones, neurotransmitters such as serotonin, norepinephrine, dopamine, glutamate and gamma-aminobutyric acid (GABA), neurocircuitry, neurotrophic factors, and circadian rhythms. Because all theories of depression apply to only some types of depressed patients but not others, and because depressive pathophysiology may vary considerably across the course of illness, the current extant knowledge argues against a unified hypothesis of depression. As a consequence, antidepressant treatments, including psychological and biological approaches, should be tailored for individual patients and disease states. Individual depression hypotheses based on neurobiological knowledge are discussed in terms of their interest to both clinicians in daily practice and clinical researchers developing novel therapies.

The dopamine receptor D4 gene (DRD4) moderates family environmental effects on ADHD.

Attention-Deficit/Hyperactivity Disorder (ADHD) is a prime candidate for exploration of gene-by-environment interaction (i.e., G x E), particularly in relation to dopamine system genes, due to strong evidence that dopamine systems are dysregulated in the disorder. Using a G x E design, we examined whether the DRD4 promoter 120-bp tandem repeat polymorphism, previously associated with ADHD, moderated the effects of inconsistent parenting and marital conflict on ADHD or Oppositional-Defiant Disorder (ODD). Participants were 548 children with ADHD and non-ADHD comparison children and their parents. Homozygosity for the DRD4 promoter 120-bp tandem repeat insertion allele increased vulnerability for ADHD and ODD only in the presence of inconsistent parenting and appeared to increase susceptibility to the influence of increased child self-blame for marital conflict on ADHD inattention. DRD4 genotypes may interact with these proximal family environmental risk factors by increasing the individual's responsivity to environmental contingencies.

Phenotypic and measurement influences on heritability estimates in childhood ADHD

Twin studies described a strongly heritable component of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. However, findings varied considerably between studies. In addition, ADHD presents with a high rate of comorbid disorders and associated psychopathology. Therefore, this literature review reports findings from population-based twin studies regarding the influence of subtypes, assessment instruments, rater effects, sex differences, and comorbidity rates on ADHD heritability estimates. In addition, genetic effects on the persistence of ADHD are discussed. By reviewing relevant factors influencing heritability estimates more homogeneous subtypes relevant for molecular genetic studies can be elicited. A systematic search of population-based twin studies in ADHD was performed, using the databases PubMed and PsycInfo. Results of family studies were added in case insufficient or contradictory findings were obtained in twin studies. Heritability estimates were strongly influenced by rater effects and assessment instruments. Inattentive and hyperactive-impulsive symptoms were likely influenced by common as well as specific genetic risk factors. Besides persistent ADHD, ADHD accompanied by symptoms of conduct or antisocial personality disorder might be another strongly genetically determined subtype, however, family environmental risk factors have also been established for this pattern of comorbidity.

Abuso e negligenza nell’anziano. Un problema contemporaneo

Background Abuse of the elderly is a growing problem in public health. The importance of this issue has been emphasized both by the scientific community and by the media. US literature reveals that nowadays, every year, about 2 million elderly people are victims of abuse. Mistreatment of the elderly is largely a hidden problem both from a quantitative and a qualitative standpoint. Materials and methods We conducted a comprehensive literature search on the abuse of the elderly through international databases backed up by a search of the references of all the relevant articles. Results Commonly mistreatment is attributed to the relationship with the caregiver, self-neglect, emotional, psychological and physical abuse as well as financial exploitation. Abuse is generally associated with aspects of the patient/caregiver relationship, frequently conditioned by family history, environmental and psychopathological risk factors and by the burden the caregiver sustains. Conclusions Healthcare workers need to be attentive and aware of the warning signs of the situations in which abuse occurs. Health professionals have an ethical and legal responsibility to report and work to prevent abuse even when only suspected. Interdisciplinary teams can have a significant impact on the issue of abuse in the elderly and prevent major detriment on the quality of their life.