Professional decision making on elder abuse: Systematic narrative review

Social work and health care professionals internationally arerecognizing the need to understand and respond to the abuse ofolder people. Policy and guidance have identified processes butdefinitions of key concepts remain problematic, and the literaturesuggests that practitioners and agencies have little insight or guidancefor decision making. Nine bibliographic databases weresearched for studies on professional decision making regardingabuse of older people. Relevant studies retrieved were appraised forquality using explicit criteria. The findings of the 19 articles meetingthe inclusion criteria were synthesised using a structured narrativeapproach. Common themes identified were abuse factors, situationalfactors, and broader contextual factors. Abuse factors relatingto risk levels and client vulnerability were central; age, gender,and health status were considered as key indicators of vulnerability.The opinion of adult protection workers about the potentialeffectiveness of their intervention was a factor in deciding aboutresponding to alleged or suspected abuse. Professionals struggledwith complex ethical dilemmas created by elder abuse, particularlywhen the victim did not want an investigation. Makingobjective judgements was difficult when faced with complex familyand contextual factors. A structured approach to narrative synthesisof a diverse range of studies retrieved through an explicit search and inclusion process provided a useful summary of key issues forpractice and identified gaps in the research literature.