REAGERA – Responding to Elder Abuse in Geriatric Care


In international studies and Swedish reports about 15% of older women and men report that they have been subjected to emotional, physical, sexual, financial abuse or neglect. The perpetrator is most often reported to be an intimate partner, other relatives or staff working in long-term care.

Only a few studies explore older adults own experience of being exposed to abuse. Elder abuse is strongly associated with ill-health, but the abuse is often unknown to care givers. Health care professionals are reluctant to ask questions due to lack of training, time constraints, and fear of offending the patient. Using a screening instrument as a tool to identify older adults subjected to abuse has been suggested, but a validated instrument in Swedish has been lacking. Also, little is known about what kind of interventions older adults themselves want.

The long-term goal of the REAGERA (Responding to Elder Abuse in GERiAtric care) project is to improve the identification of abused older adults and the response given to them within the health care system. Data collection took place in 2018 and the results have inspired two new research project; one in which abusive experiences among people living with dementia is investigated and one in which the effects of an educational intervention for health care professionals about elder abuse is evaluated.

Specific aims

• Study 1: Investigate health care professionals’ preparedness to identify and handle elder abuse among patients
• Study 2: Validate a screening instrument for elder abuse.
• Study 3: Explore victims’ experiences of elder abuse.
• Study 4: Explore preferred intervention for elder abuse among victims.

In study 1 health care professionals responded to a questionnaire about their own experience of speaking with older patients subjected to different forms of abuse. Only about half of respondent had ever spoken to an older patient about abuse. A high sense of professional responsibility to ask questions about abuse and being less concerned about inflicting damage to the therapeutic relationship were significantly associated with having experiences of speaking to older patients about abuse. The results have been published in two different articles; one describing the questionnaire used, and one describing the results of the study.

In study 2 a screening instrument (REAGERA-S) was tested among Swedish speaking in-hospital patients, age 65 years and older who were cognitively and physically well enough to participate in the study. The results were satisfactory: sensitivity for life-time abuse was 72% and for elder abuse 88%. More about REAGERA-S and the validation results can be found here.

REAGERA-S is freely available and the English translation can be downloaded here. Though the instrument so far has only been validated in Swedish, it has also been translated to Arab, Bosnian, Farsi, French, Croatian, Polish, Serbian, Somali and Spanish. If you wish to take part of one of the translations, use the instrument on a regular basis or use it for research, please contact the copyright holder Johanna Simmons.

Among those participating in the REAGERA study 41% reported any life-course experiences of abuse and 18% reported abusive experiences since the age of 65. Reporting abusive experiences before the age of 65 was the only background factor significantly associated with elder abuse and reporting abusive experiences both before and after the age of 65 was associated with several indicators of mental ill-health. Details concerning the prevalence of abuse and associated factors can be found in this publication.

In study 3 and 4, qualitative interviews were conducted with older men and women and the results have been published in two different articles; one exploring the experience of elder abuse and one exploring how the older adults had managed their abusive experiences, including the kind of help they had received or whished that they had received. Previous life-course experiences, both positive and negative, as well as vulnerability due to ageing or diseases and dependence on others for activities in daily living, were important factors influencing the experience of elder abuse. In part the older adults used self-reliant coping strategies to manage their abusive experiences, but they had often also sought help from formal or informal helpers. Health care professionals could play an important role in facilitating help-seeking and one of the most expressed needs was simply someone to talk to about the abusive experiences.

This project was funded by the Swedish Crime Victim Fund and Region Östergötland.

REAGERA-logo-eng Photo credit: Nicolina Wiklund