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Elder Abuse in American Indian Communities

An Integrative Review

Crowder, Jolie PhD, MSN, RN, CCM1; Burnett, Camille PhD, MPA, APHN-BC, RN, BScN, DSW2; Laughon, Kathryn PhD, RN, FAAN2; Dreisbach, Caitlin MSDS, BSN, RN1

doi: 10.1097/JFN.0000000000000259
Review Articles

Background American Indian elders have one of the lowest life expectancies in the United States. Disproportionate disease burden, socioeconomic disparities, and higher rates of violence across the lifespan are thought to contribute to higher rates of elder abuse. Elder abuse and higher rates of trauma exposure are linked with adverse outcomes.

Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the methodology and assessment of the literature on elder abuse among American Indians.

Results Of the nine studies published in the last 30 years, rates of elder abuse varied by study, location, and tribal affiliation from 4.3% to 45.9%. Large studies with comparison populations found higher rates for American Indians. There was a consensus for three risk factors: substance abuse, mental health problems, and caregiving issues. Importance of tribal norms, the notion of respect conferred to elders, and the concept of acculturation were major culturally relevant themes. Perceived tribal norms and strengths, for example, respect for elders, were at odds with abuse experiences, particularly financial exploitation and neglect. Historical trauma, shame, and fear impacted reporting. There was little consistency in study designs, most were qualitative or mixed methods, samples were small, there was no common measurement tool or time frame for abuse, and there was only one intervention study.

Implications High rates of abuse suggest healthcare providers should be encouraged to screen and intervene despite the lack of empirical evidence. Providers should not assume that traditional culturally ascribed strengths, such as honor and respect for elders, provide any degree of protection against elder abuse.

Author Affiliations:1University of Virginia

2College of Nursing, University of Kentucky, Lexington.

The authors declare no conflict of interest.

Correspondence: Jolie Crowder, PhD, MSN, RN, CCM, University of Virginia, 5320 Sammie Kay Lane, Centreville, VA 20120. E-mail:

Received April 30, 2019; Accepted July 22, 2019

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© 2019 by the International Association of Forensic Nurses. All rights reserved.
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