title: Physical abuse against elderly persons in institutional settings.
abstract: BACKGROUND
  People over 65 years old are expected to be an increasing group exposed to abuse. Despite the well-studied intra-familial abuse, institutional abuse still lacks a proper understanding about its determinants and characteristics.
  
  
  OBJECTIVE
  The general objective of this study is to provide a better knowledge about physical abuse against elderly people in institutional settings, in order to contribute to a timely detection, correct forensic diagnosis and prevention of these cases.
  
  
  METHODS
  A retrospective study was conducted through the analysis of forensic medical exams performed in the North Forensic Medical Services of Portugal, between 2004 and 2013, to elderly persons allegedly victims of physical abuse in an institutional setting by a caregiver (n = 59).
  
  
  RESULTS
  All the alleged cases occurred in nursing homes and in most of them (93.2%) the charges were against the institution and not focussing on a particular individual. The alleged victims were mainly female (79.7%), 75 years or older (75.9%), presenting a severe disability (55.9%) and 47.2% being unable to communicate. No injuries or post-traumatic pain were found in 55.9% of the cases to support the charge of physical abuse. Only in 6.8% of the cases were the forensic medical findings suggestive of physical abuse and, although this was not the object of the examination, 69.1% were considered suggestive or highly suggestive of neglect. A statistically significant association was found between the alleged victim's degree of disability and the occurrence of neglect (p = 0.003).
  
  
  CONCLUSIONS
  The sample's size seems to be underestimated, probably due to lack of detection and/or reporting. The condition of these persons, mainly related with their inability to perceive abusive behaviours and/or to disclose them (mostly by physical and/or mental disability), as well as their reluctance to press charges due to fear of reprisal, affects significantly the detection and diagnosis of physical abuse, particularly in whom injuries are not obvious. In anticipation to the rapid ageing of the population, it is urgent to analyse and understand this emerging issue so that social policies and regulation may be developed, in an effort to protect the elderly, as well as to make improvements in the professionals' skills.
authors.affiliation: Department of Legal Medicine and Forensic Sciences, Faculty of Medicine of Porto University, Portugal; North Branch of the National Institute of Legal Medicine and Forensic Sciences, Porto, Portugal; Abel Salazar Biomedical Science Institute, Porto, Portugal; Forensic Science Center - CENCIFOR, Coimbra, Portugal. Electronic address: lalanda77@hotmail.com.
authors.forename: Sofia Lalanda
authors.initials: SL
authors.lastname: Frazão
authors.affiliation: Department of Legal Medicine and Forensic Sciences, Faculty of Medicine of Porto University, Portugal.
authors.forename: Ana Margarida
authors.initials: AM
authors.lastname: Correia
authors.affiliation: Institute of Public Health, Faculty of Medicine of Porto University, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Norton
authors.affiliation: Department of Legal Medicine and Forensic Sciences, Faculty of Medicine of Porto University, Portugal; North Branch of the National Institute of Legal Medicine and Forensic Sciences, Porto, Portugal; Abel Salazar Biomedical Science Institute, Porto, Portugal; Forensic Science Center - CENCIFOR, Coimbra, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Magalhães
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019548:Crime Victims / Q000706:statistics & numerical data; D006233:Persons with Disabilities; D004552:Elder Abuse / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011174:Portugal; D012189:Retrospective Studies; D017678:Sex Distribution
keywords: Abuse; Caregiver; Elder; Forensic medicine; Institutional setting; Nursing home