Awareness and knowledge of elder abuse and neglect among dental practitioners in Southwestern England.

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JOSEPH NIMAKO-BOATENG, Nathaniel Essel This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3970640/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background With the population ageing, elder abuse and neglect has become an increasing problem. Most elderly people are retaining their natural teeth and dentists are favourably positioned to detect cases of elder abuse and neglect. This study aimed to investigate the awareness, knowledge and attitudes of dentists in Dorset and Somerset Strategic Health Authority (SHA) regarding elder abuse and neglect. Methods Data was collected using a modified questionnaire from previous studies. The questionnaire was posted to all dentists in the Dorset and Somerset area in the year 2005. Demographic data as well as knowledge on elder abuse and neglect were assessed. Descriptive statistics and chi-square tests were carried out to allow for comparisons. Results A total of 380 out of the invited 496 dentists agreed to participate in the study (response rate 78.4%). Most participants had heard of elder abuse (84.7% [n = 321]) and neglect (78.1% [n = 296]). However, few participants had encountered specific incidents of elder abuse (8.4% [n = 32]) and neglect (11.9% [n = 45]). Dentists who treated patients from residential and nursing homes were significantly more likely to have encountered elder abuse and neglect (p < 0.001; chi-square = 14). Conclusion Incorporation of elder abuse and neglect into the curricula of dental schools and continuous education of dental professionals will help better detect and address these cases. elder abuse elder neglect knowledge dentists BACKGROUND With recent advances in healthcare, people are living longer now. A recent report from the WHO states that globally, between 2000 and 2019, life expectancy has increased by more than 6 years; from 66.8 years in 2000 to 73.4 years in 2019 ( 1 ). In the UK, the 2021 Census showed that the number of people aged 65 years and above were over 11 million in 2021 compared to 9.2 million in 2011 marking a 2.2% increase ( 2 ). With the rise in the ageing population, a concomitant increase in elder abuse and neglect is expected ( 3 , 4 ) According to the WHO, elder abuse is “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust and care, which causes harm or distress to an older person”. WHO also defines elder neglect as “the lack of action of the person involved in a relationship of trust, which leads to the same result” ( 5 ). In the UK, an estimated 210,000 adults between 60 and 74 years experienced domestic abuse in the year ending March 2018 ( 6 ). A 2020 report by Age UK estimated that, about 180,000 women and 98,000 men aged 60 to 74 years were victim-survivors of domestic abuse in England and Wales in 2018/2019 ( 7 ). A recent study found that compared to older adults in unintentional falls, elder abuse victims were more likely to have injuries of the maxillofacial, dental and neck region (67% vs 28%) and were more likely to have these head and neck injuries without injuries to the upper and lower extremities ( 8 ). In another study, 94% of victims of family violence including the elderly had injuries to the head, neck or both ( 9 ). A recent systematic review of the pattern of physical injuries in elder abuse showed that injuries to the maxillofacial, dental and neck region was the second most common site of injury (22.88%) ( 10 ). Another systematic review revealed that the most common injury pattern was in the maxillofacial region (nasal bone fractures) ( 11 ). Likewise, a systematic review to identify types, characteristics and anatomic locations of elder abuse reported that most physical signs were predominantly located on the head, face and maxillofacial area ( 12 ). The recognition of elder abuse is complex. The level of awareness and knowledge on elder abuse in healthcare professionals is still poor and there is a strong need for education and specific training on recognition ( 13 , 14 ) Evidently, most signs of elder abuse occur in anatomical regions primarily concerned with dentists and dentists should be equipped with knowledge and skills to detect these cases of abuse. However, rates of detecting and reporting elder abuse and neglect by healthcare professionals are low, especially among dentists. For instance, a systematic review to assess whether dentists were able to identify and manage cases of elder abuse found that most dentists had insufficient knowledge of elder abuse and were not able to identify and manage these cases in routine clinical care ( 15 ). Other studies also reported low rates of detection among dentists ( 16 , 17 ). This low rate of detection despite the surge in cases may be due to lack of knowledge and awareness of elder abuse by dentists. WHO recommends that a crucial step in the prevention and/or management of elder abuse involves an increase in awareness of the problem ( 18 ). Currently, there are no studies to assess the knowledge and awareness of elder abuse of dental professionals in the UK. The aim of this study was to investigate the awareness, knowledge and attitudes of dentists in Dorset and Somerset Strategic Health Authority (SHA) regarding elder abuse and neglect. METHODOLOGY STUDY DESIGN, SETTING AND POPULATION This was a cross-sectional study of General Dental Practitioners (GDPs) and Community Dental Officers (CDOs) in the Dorset and Somerset Strategic Health Authority (DSSHA). Dorset and Somerset were chosen because they had the highest proportion of people over 65 years in England at the time of the study (2003 midyear population estimates). The DSSHA has 9 Primary Care Trusts (PCTs) of which Bournemouth, North Dorset, Poole, South West Dorset and South and East Dorset are in Dorset while Mendip, Somerset Coast, South Somerset and Taunton Deane are in Somerset. The list of all GDPs in the area as at 2005, was obtained from the Dorset and Somerset Family Health Services while the list of CDOs were obtained from the clinical directors of service. Data was collected using a modified version of a questionnaire used by Holtzman and Bomberg in a national survey of dentists in the USA in 1991. In modifying the questionnaire, criteria which were previously outlined were adopted to maximise the response rate ( 19 – 21 ). Descriptive statistics and chi-square tests were run using SPSS. In all, 496 questionnaires were posted to all GDPs and CDOs in the Dorset and Somerset Strategic Health Authority. Ethical Approval was obtained from the King’s College Local Research Ethics Committee. The study was also registered and approved by the constituent PCTs. The Taunton and Somerset Research & Development consortium gave approval to cover Mendip, Taunton Deane, Somerset Coast and South Somerset PCTs. The other five PCTs gave individual approval after the appropriate documents were forwarded to them through the WREN Research Management and Governance Coordinator at the University of Southampton School of Medicine. Informed consent was obtained from all participating dentists. By choosing to respond to the postal questionnaire the participating dentists gave implied consent. Any dentist who did not consent to the study simply refused to fill the questionnaire and return it. Participants were asked to select more than one option for some questions which explains why some percentages sum up to more than 100%. RESULTS A total of 496 questionnaires were mailed out. Out of these, 11 questionnaires were returned because the dentists were no longer at the addresses leaving 485 valid questionnaires. A total of 386 questionnaires were returned. Out of these, 4 dentists declined to participate in the study. Two more questionnaires were excluded because they were filled in by a dental nurse and a dentist not working in the Dorset and Somerset area. In all, 380 valid questionnaires were returned out of the 485 questionnaires constituting a response rate of 78.4%. Of the 485 valid questionnaires, 23 were mailed to Community Dental Officers (CDO) and 462 were sent to General Dental Practitioners (GDP). In terms of response, 20 CDOs responded (87%) while 360 GDPs responded (77.9%). Characteristics of participants The ages of the participants ranged from 24 to 65 years with the mean age being 43.7 years. Most of the participants were males (n = 262, 69%) while the rest were female (n = 116, 31%). Work experience among the participants ranged from 1 to 42 years with 19.9 years being the mean work experience. Most participants were in group practice (n = 294, 78%) while 60 (16%) were in single-handed practice and 23 (6%) were in other kinds of practices including Community Dental Services (CDS). It should be noted that some dentists worked in multiple roles. Most participants were also in general practice (n = 340, 90%). Details are shown in Table 1 . Table 1: Characteristics of participants Variable Number (%) Mean Age (years) 43.7 Sex Male Female 262 (69%) 116 (31%) Mean Work experience (years) 19.9 Type of Practice General Practice Specialty Practice Community Dental Service + PDS Dental Access Center Others 340 (90%) 14 (4%) 25 (7%) 6 (2%) 6 (2%) Type of patients treated Nursing/Residential home Yes No Housebound patients Yes No 296 (78%) 83 (22%) 211 (56%) 168 (44%) Treatment location Nursing/Residential home In surgery only At home Both Housebound patients In surgery only At home Both 119 (40%) 19 (6%) 158 (54%) 21 (10%) 29 (14%) 163 (77%) Knowledge of elder abuse and neglect Most participants had heard of elder abuse (n = 321, 84.7%) and elder neglect (n = 296, 78.1%). However, only a few had encountered specific incidents of elder abuse (n = 32, 8.4%) and neglect (n = 45, 11.9%). Similarly, few participants had treated an abused (n = 11, 2.9%) or neglected (n = 26, 6.9%) elderly patient. Again, few participants reported never hearing of elder abuse (n = 15, 4%) or elder neglect (n = 12, 3.2%). A higher proportion of participants reported having known or treated cases of neglect (n = 60, 18.8%) as compared to cases of abuse (n = 43, 11.3%). Most participants (n = 319, 85%) had not encountered cases of elder abuse or neglect in the last 5 years. Dentists younger than 44 years (n = 36, 21%) encountered more cases of elder abuse as compared to those older than 44 years (n = 23, 11%) and this difference was statistically significant (chi-square = 6.34, p < 0.001). There was no statistically significant difference in the likelihood of encountering a case of elder abuse between dentists working as CDOs and dentists working in other types of practices (chi-square = 3.18, p = 0.087). Females were more likely (22% [n = 26]) to report having seen cases of suspected abuse and neglect in the elderly as compared to their male (13% [n = 34]) counterparts and this difference was statistically significant (chi-square = 5.88; p < 0.05). Work experience did not make any statistical difference with regards dentists encountering elder abuse and neglect (chi-square = 2.76, p = 0.105). Dentists who treated patients in residential and nursing homes were more likely to encounter elder abuse cases than those who did not (chi-square = 14, p < 0.001). Time frame within which most recent incident occurred Of those dentists who had encountered cases of elder abuse or neglect, 26 (44%) reported that the incident had occurred within the last 12 months while 33 (56%) reported that the incident occurred more than a year ago. Within this latter group, the most recent incident had occurred within a 1–5-year time frame for 25 (76%) of the respondents. In summary, 51 out of 59 (86.4%) of cases had occurred within the last 5 years. Persons alerting dentist to possibility of abuse/neglect Most participants (n = 38, 64%) reported that the incident of abuse or neglect was brought to their attention through personal observation. No respondent was alerted by the police or a voluntary organisation. Table 2 summarises these results. Characteristics of abused/neglected elders The cases of elder abuse encountered by participants were 59. The age of the victims ranged from 65 to 94 years with a mean of 77.6 years. There were more females than males (n = 37, 61% vs n = 24, 39%). Most of the victims were living in residential or nursing homes at the time of the incident (n = 33, 55%). Of the cases encountered, 28 (47%) of them were suspected to be inflicted by a member of the nursing staff or residential home. Details are shown in Table 2 . Type of Injury sustained The injuries sustained by victims of elder abuse/neglect encountered by participants ranged from bruises, to fractures. There were also cases of malnutrition. Most of the participants (n = 26, 43%) reported no apparent injuries in the cases they encountered. Some victims of elder abuse and/or neglect may have sustained more than one type of injury. Details are shown in Table 2 . Neglect observed or reported by patient There were 86 reported cases of neglect with the commonest type being neglect of personal hygiene (n = 40,47%). Details are shown in Table 2 . Actions taken by dentist Most participants (n = 24, 39%) spoke to relatives about the possibility of elder abuse. However, 23% (n = 14) took no action. Details are summarised in Table 2 . Comparing knowledge of elder abuse/neglect between PCTs Bournemouth (n = 56, 15%) had the highest number of dentists while North Dorset had the least (n = 23, 6%). There were more cases of elder neglect (n = 86) as compared to elder abuse (n = 59). Cases of neglect were more likely to be first detected by the dentist while abuse cases were more likely to be first reported by someone other than the dentist and this difference was statistically significant (chi-square = 8.42, p < 0.001). Elders were more likely to be abused when living alone or with family and the abuse was more likely to be carried out by family members (n = 7, 87.5%) than when they had other living situations (n = 1, 12.5%) (chi-square = 13.83, p < 0.05). However, they were more likely to be neglected when living in nursing and residential homes (n = 33, 65%) as compared to living alone or with family (n = 18, 35%) (chi-square = 5.73, p < 0.05). There was no statistically significant difference in knowledge of elder abuse/neglect between dentists in the Dorset and Somerset areas (chi-square = 4.9, p = 0.18). Table 2: Participants’ knowledge of elder abuse/neglect Variable Number (%) Elder abuse/neglect first noticed by Dentist Patient Patient’s relative Patient’s friend/neighbour Nursing/Residential home staff Hospital staff 38 (64%) 5 (9%) 6 (10%) 1 (2%) 4 (7%) 5 (8%) Elder abuse first noticed by Dentist Others 1 (12.5%) 7 (87.5) Elder neglect first noticed by Dentist Others 37 (72.5%) 14 (27.5%) Living situation at time of incident Nursing home Alone With spouse Residential home With child Other 23 (38%) 13 (22%) 11 (18%) 10 (17%) 2 (3%) 1 (2%) Suspected abuser Nursing/Residential home staff Unidentified Spouse Friend/Neighbour Child/Sibling Other 28 (46%) 14 (23%) 9 (15%) 4 (7%) 4 (7%) 1 (2%) Type of elder abuse No apparent injury Other injuries Malnutrition Bruises including facial bruising Abrasions Broken dental prosthesis Wounds/ Cuts/ Punctures Fractured/Avulsed teeth Burns/ Scalds Bone/Skull fractures Dislocations/ Sprains 26 (43%) 16 (26%) 14 (23%) 16 (26%) 6 (10%) 4 (7%) 2 (3.3%) 2 (3.3%) 2 (3.3%) 0 (0%) 0 (0%) Type of elder neglect Neglect of personal hygiene Inadequate dental care Inadequate food Inadequate medical care Inadequate housing 40 (66%) 24 (39%) 11 (18%) 8 (13%) 3 (5%) Action taken by dentist Spoke to relatives No action Other Emergency dental treatment Referred to social services Referred to general practitioner Referred to hospital Referred to legal services/police 24 (39%) 14 (23%) 12 (20%) 12 (20%) 6 (10%) 9 (15%) 4 (7%) 0 (0%) DISCUSSION The response rate for this study was 78.4% which was relatively high. The mean age of participants was 43.7 years which was similar to national surveys conducted in Canada (41.1 years) and USA (43.7 years) ( 22 , 23 ). Most participants were in general practice which was similar to the survey conducted in the USA ( 22 ). A higher proportion of respondents treated patients from nursing and residential homes and housebound patients as compared to the surveys conducted in Canada and USA ( 22 , 23 ). This was probably because this study took place in an area with higher numbers of nursing and residential homes. Awareness of elder abuse and neglect Most participants knew about elder abuse (84.7%) and neglect (78.1%) which was in line with other studies. This reflects a general increase in levels of awareness/knowledge of elder abuse ( 22 – 24 ). Fifteen percent of participants had encountered cases of elder abuse or neglect in their practice. This was higher than studies conducted in the USA (10%, 7.2%) ( 16 , 22 ) and Canada (7.2%) ( 23 ). This may be attributed to the increased awareness or knowledge of elder abuse. Additionally, this study was conducted in an area with a high population of the elderly and may offer an explanation for this finding. Although there was no statistically significant difference in knowledge levels between CDOs and GDPs concerning elder abuse or neglect, studies have shown that CDOs are more likely to encounter these cases ( 25 , 26 ) Age and work experience of respondents and awareness of elder abuse and neglect This study found that dentists younger than the mean age of 44 years were more likely to have encountered cases of elder abuse or neglect as compared to those above 44 years. This was in line with previous studies ( 22 ). An explanation may be that younger dentists are more aware of these cases than the older dentists who may have grown up at a time where corporal punishment was more acceptable. However, there was no association between number of years qualified/practised and the likelihood of encountering elder abuse or neglect. Sex and awareness of elder abuse and neglect Female participants were more likely to encounter cases of elder abuse and neglect when compared to males. Similarly, a study carried out found that more female doctors remembered specific cases of neglect ( 27 ). An explanation of this finding may be that females are perceived as more vulnerable and suffer from abuse more than males, hence pay more attention and are able to detect more cases of abuse or neglect when compared to men. Living situations and occurrence of elder abuse Studies have shown inconsistencies about the association between living situations and elder abuse. In Asian studies, living alone was associated with an increased risk of elder abuse ( 28 – 30 ) whereas studies in the US and Europe report that a shared living environment was a risk factor for elder abuse ( 31 – 34 ) In this study, respondents who treated patients in residential/nursing homes or housebound patients were more likely to have encountered victims of elder abuse. Timeframe of elder abuse and neglect Participants reported that the cases of elder abuse or neglect they encountered occurred within the last 12 months. This was similar to findings from previous studies ( 22 ). This may imply that elder abuse and neglect may be an ongoing phenomenon. Detection of elder abuse Most participants (64%) reported that they detected elder abuse or neglect through personal observation. Similarly, previous studies reported that 62%, 75% and 54% of dentists, respectively, detected elder abuse and neglect through personal observation ( 22 – 24 ). This has implications for training and policy development because dentists can easily detect cases of elder abuse and neglect when equipped with the requisite knowledge. Type of injury sustained by victims With regards to the type of injury sustained by victims, no apparent injury (43%) was the most common finding. However, there is a possibility that other types of ‘invisible’ abuse such as psychological and emotional abuse, financial/material exploitation, sexual abuse may have occurred which were not covered in this study. Action taken by participants In this study, while most participants (39%) took action by reporting to relatives, 23% of them took no action. In contrast, a study in Kanpur, India found that only 26% of participants took action against the abuse they found ( 24 ). Those who took no action may have done so because they may not have known how to manage cases of abuse or neglect. There may also have been no protocol or standards of procedure when dentists encounter these cases. It may also be due to a lack of care or empathy on the part of the participants. There was no difference in knowledge or awareness of elder abuse among dentists serving in PCTs with higher populations of the elderly as compared to those serving in PCTs with lower populations of the elderly. Comparison of number of elder abuse and neglect cases Participants encountered more cases of neglect than abuse. More cases of neglect were first encountered by participants’ personal observation as compared to abuse which were reported by others (family, patients or hospital staff). The study also found that elderly patients living in nursing/residential homes were more likely to be neglected than abused. This highlights the report that falling care standards in nursing or residential homes ( 31 ). However, those living alone or with family were more likely to be abused than neglected. Limitations This study was based on data collected about 2 decades ago and may not reflect current trends. However, a literature search shows that the study has not been replicated in the UK within that period. Data for this study relied on self-report by participants and carried a risk of reporting and recall bias. However, in epidemiological studies, this is the standard way of collecting relevant information and the questionnaires were well established and previously used. Recommendations A nationwide and recent survey of knowledge/awareness of elder abuse should be conducted to ascertain the current trend in the UK. Training of dental students and retraining of dental professionals on elder abuse and neglect will help in detection, reporting and dealing with cases of neglect and abuse ( 35 ). Caregivers and staff of nursing/residential homes should be educated on elder abuse and neglect and perpetrators of these acts should be prosecuted. CONCLUSIONS A response rate of 78.4% to this postal survey suggests that dentists in Dorset and Somerset SHA have considerable interest in the subject of elder abuse and neglect. In this study, most participants had heard about elder abuse and neglect, however most had not encountered cases of abuse and neglect. About a fifth of the participants who had encountered elder abuse and neglect did nothing about it. Participants reported that most victims of neglect resided in nursing/residential homes while elders were more likely to be abused when living alone or with relatives. Abbreviations CDO Community Dental Officer CDS Community Dental Services DSSHA Dorset and Somerset Strategic Health Authority GDP General Dental Practitioner PCT Primary Care Trust SHA Strategic Health Authority Declarations Author Contribution Nimako-Boateng wrote the main manuscript and collected the dataNathaniel Essel prepared the tables and figures and updated the literature review and discussionBoth authors reviewed the manuscipt AVAILABILITY OF DATA AND MATERIALS The datasets generated and/or analysed during the current study are not publicly available due to the fact that this work was done in 2005 at Kings College, University of London as part of an MSc Dissertation under the supervision of Prof Victoria Harrison. The data was left in Kings College and would have been archived by now and is not public, however the original theses is available at King’s College, London. The author is not in a position to provide this on reasonable request by himself. 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Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies. Gerontologist. 2016 Apr;56(Suppl 2):S194–205. Naughton C, Drennan J, Treacy M, Lafferty A, Lyons I, Phelan A, et al. Abuse and Neglect of Older People in Ireland. Dublin; 2010. Sinha S, Archaya P, Jafar H, Bower E, Harrison V, Newton J. The management of abuse: a resource material for the dental team. Stephen Hancocks Ltd; 2005. 47–52 p. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3970640","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":279351205,"identity":"748ae06c-8d1a-4da3-8d0c-c8a529f58ace","order_by":0,"name":"JOSEPH NIMAKO-BOATENG","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYBACxgbGBgaGAwwMBlABOTDJw4AQwacFxGIwJqgFApC0JDYQ0sI8u7l1w48zNgzm7M3PH3zcUZu+4fwCxgdv2xjstuNy2JyDbTd7bqQxWPYcM2yceeZ47oYbD5gN57YxJO9swKFlRmLbDZ4Ph+s33EgwbOZtOwbUcoBNmheoxeAAbi03/3w4zGBwI/1j89+2Y+kGNw6w/yak5TbPDZCWHMNmxraaBIPzDWzMQC12eLXInAH55UzhzN62A4YzbzA2S845J5GAS4vhjPRnN98cA4VY+4YPP9vq5PnOHz744U2ZjT1OLWjBcpiBQQIcNRASG5BH49cxMPBDTLfHoWMUjIJRMApGHgAARA9uZdsSsrIAAAAASUVORK5CYII=","orcid":"","institution":"University of Ghana","correspondingAuthor":true,"prefix":"","firstName":"JOSEPH","middleName":"","lastName":"NIMAKO-BOATENG","suffix":""},{"id":279351208,"identity":"d87c7e37-8f89-4bee-aa12-46a3e4a85722","order_by":1,"name":"Nathaniel Essel","email":"","orcid":"","institution":"University of Ghana","correspondingAuthor":false,"prefix":"","firstName":"Nathaniel","middleName":"","lastName":"Essel","suffix":""}],"badges":[],"createdAt":"2024-02-19 18:16:53","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3970640/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3970640/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62272581,"identity":"f581a185-ab69-499a-9a38-4daede58ccaf","added_by":"auto","created_at":"2024-08-12 10:36:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":636797,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3970640/v1/ad830335-ad82-488b-8d0c-be986c726877.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Awareness and knowledge of elder abuse and neglect among dental practitioners in Southwestern England.","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eWith recent advances in healthcare, people are living longer now. A recent report from the WHO states that globally, between 2000 and 2019, life expectancy has increased by more than 6 years; from 66.8 years in 2000 to 73.4 years in 2019 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In the UK, the 2021 Census showed that the number of people aged 65 years and above were over 11\u0026nbsp;million in 2021 compared to 9.2\u0026nbsp;million in 2011 marking a 2.2% increase (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). With the rise in the ageing population, a concomitant increase in elder abuse and neglect is expected (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAccording to the WHO, elder abuse is \u0026ldquo;a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust and care, which causes harm or distress to an older person\u0026rdquo;. WHO also defines elder neglect as \u0026ldquo;the lack of action of the person involved in a relationship of trust, which leads to the same result\u0026rdquo; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the UK, an estimated 210,000 adults between 60 and 74 years experienced domestic abuse in the year ending March 2018 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). A 2020 report by Age UK estimated that, about 180,000 women and 98,000 men aged 60 to 74 years were victim-survivors of domestic abuse in England and Wales in 2018/2019 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). A recent study found that compared to older adults in unintentional falls, elder abuse victims were more likely to have injuries of the maxillofacial, dental and neck region (67% vs 28%) and were more likely to have these head and neck injuries without injuries to the upper and lower extremities (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In another study, 94% of victims of family violence including the elderly had injuries to the head, neck or both (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). A recent systematic review of the pattern of physical injuries in elder abuse showed that injuries to the maxillofacial, dental and neck region was the second most common site of injury (22.88%) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Another systematic review revealed that the most common injury pattern was in the maxillofacial region (nasal bone fractures) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Likewise, a systematic review to identify types, characteristics and anatomic locations of elder abuse reported that most physical signs were predominantly located on the head, face and maxillofacial area (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The recognition of elder abuse is complex. The level of awareness and knowledge on elder abuse in healthcare professionals is still poor and there is a strong need for education and specific training on recognition (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eEvidently, most signs of elder abuse occur in anatomical regions primarily concerned with dentists and dentists should be equipped with knowledge and skills to detect these cases of abuse. However, rates of detecting and reporting elder abuse and neglect by healthcare professionals are low, especially among dentists. For instance, a systematic review to assess whether dentists were able to identify and manage cases of elder abuse found that most dentists had insufficient knowledge of elder abuse and were not able to identify and manage these cases in routine clinical care (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Other studies also reported low rates of detection among dentists (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis low rate of detection despite the surge in cases may be due to lack of knowledge and awareness of elder abuse by dentists. WHO recommends that a crucial step in the prevention and/or management of elder abuse involves an increase in awareness of the problem (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCurrently, there are no studies to assess the knowledge and awareness of elder abuse of dental professionals in the UK. The aim of this study was to investigate the awareness, knowledge and attitudes of dentists in Dorset and Somerset Strategic Health Authority (SHA) regarding elder abuse and neglect.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSTUDY DESIGN, SETTING AND POPULATION\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study of General Dental Practitioners (GDPs) and Community Dental Officers (CDOs) in the Dorset and Somerset Strategic Health Authority (DSSHA). Dorset and Somerset were chosen because they had the highest proportion of people over 65 years in England at the time of the study (2003 midyear population estimates).\u003c/p\u003e \u003cp\u003eThe DSSHA has 9 Primary Care Trusts (PCTs) of which Bournemouth, North Dorset, Poole, South West Dorset and South and East Dorset are in Dorset while Mendip, Somerset Coast, South Somerset and Taunton Deane are in Somerset.\u003c/p\u003e \u003cp\u003eThe list of all GDPs in the area as at 2005, was obtained from the Dorset and Somerset Family Health Services while the list of CDOs were obtained from the clinical directors of service.\u003c/p\u003e \u003cp\u003eData was collected using a modified version of a questionnaire used by Holtzman and Bomberg in a national survey of dentists in the USA in 1991. In modifying the questionnaire, criteria which were previously outlined were adopted to maximise the response rate (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Descriptive statistics and chi-square tests were run using SPSS.\u003c/p\u003e \u003cp\u003eIn all, 496 questionnaires were posted to all GDPs and CDOs in the Dorset and Somerset Strategic Health Authority.\u003c/p\u003e \u003cp\u003e Ethical Approval was obtained from the King\u0026rsquo;s College Local Research Ethics Committee. The study was also registered and approved by the constituent PCTs. The Taunton and Somerset Research \u0026amp; Development consortium gave approval to cover Mendip, Taunton Deane, Somerset Coast and South Somerset PCTs. The other five PCTs gave individual approval after the appropriate documents were forwarded to them through the WREN Research Management and Governance Coordinator at the University of Southampton School of Medicine. Informed consent was obtained from all participating dentists. By choosing to respond to the postal questionnaire the participating dentists gave implied consent. Any dentist who did not consent to the study simply refused to fill the questionnaire and return it.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eParticipants were asked to select more than one option for some questions which explains why some percentages sum up to more than 100%.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 496 questionnaires were mailed out. Out of these, 11 questionnaires were returned because the dentists were no longer at the addresses leaving 485 valid questionnaires. A total of 386 questionnaires were returned. Out of these, 4 dentists declined to participate in the study. Two more questionnaires were excluded because they were filled in by a dental nurse and a dentist not working in the Dorset and Somerset area. In all, 380 valid questionnaires were returned out of the 485 questionnaires constituting a response rate of 78.4%.\u003c/p\u003e \u003cp\u003eOf the 485 valid questionnaires, 23 were mailed to Community Dental Officers (CDO) and 462 were sent to General Dental Practitioners (GDP). In terms of response, 20 CDOs responded (87%) while 360 GDPs responded (77.9%).\u003c/p\u003e\n\u003ch3\u003eCharacteristics of participants\u003c/h3\u003e\n\u003cp\u003eThe ages of the participants ranged from 24 to 65 years with the mean age being 43.7 years. Most of the participants were males (n\u0026thinsp;=\u0026thinsp;262, 69%) while the rest were female (n\u0026thinsp;=\u0026thinsp;116, 31%). Work experience among the participants ranged from 1 to 42 years with 19.9 years being the mean work experience.\u003c/p\u003e \u003cp\u003eMost participants were in group practice (n\u0026thinsp;=\u0026thinsp;294, 78%) while 60 (16%) were in single-handed practice and 23 (6%) were in other kinds of practices including Community Dental Services (CDS). It should be noted that some dentists worked in multiple roles. Most participants were also in general practice (n\u0026thinsp;=\u0026thinsp;340, 90%). Details are shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Table 1: Characteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNumber (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Mean Age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;43.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e262 (69%)\u003c/p\u003e\n \u003cp\u003e116 (31%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Mean Work experience (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;19.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType of Practice\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eGeneral Practice\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSpecialty Practice\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eCommunity Dental Service + PDS\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eDental Access Center\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eOthers\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e340 (90%)\u003c/p\u003e\n \u003cp\u003e14 (4%)\u003c/p\u003e\n \u003cp\u003e25 (7%)\u003c/p\u003e\n \u003cp\u003e6 (2%)\u003c/p\u003e\n \u003cp\u003e6 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eType of patients treated\u003c/p\u003e\n \u003cp\u003eNursing/Residential home\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHousebound patients\u003c/p\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e296 (78%)\u003c/p\u003e\n \u003cp\u003e83 (22%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e211 (56%)\u003c/p\u003e\n \u003cp\u003e168 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment location\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNursing/Residential home\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIn surgery only\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003eAt home\u003c/p\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eHousebound patients\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eIn surgery only\u003c/p\u003e\n \u003cp\u003eAt home\u003c/p\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e119 (40%)\u003c/p\u003e\n \u003cp\u003e19 (6%)\u003c/p\u003e\n \u003cp\u003e158 (54%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21 (10%)\u003c/p\u003e\n \u003cp\u003e29 (14%)\u003c/p\u003e\n \u003cp\u003e163 (77%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge of elder abuse and neglect\u003c/h2\u003e \u003cp\u003eMost participants had heard of elder abuse (n\u0026thinsp;=\u0026thinsp;321, 84.7%) and elder neglect (n\u0026thinsp;=\u0026thinsp;296, 78.1%). However, only a few had encountered specific incidents of elder abuse (n\u0026thinsp;=\u0026thinsp;32, 8.4%) and neglect (n\u0026thinsp;=\u0026thinsp;45, 11.9%). Similarly, few participants had treated an abused (n\u0026thinsp;=\u0026thinsp;11, 2.9%) or neglected (n\u0026thinsp;=\u0026thinsp;26, 6.9%) elderly patient. Again, few participants reported never hearing of elder abuse (n\u0026thinsp;=\u0026thinsp;15, 4%) or elder neglect (n\u0026thinsp;=\u0026thinsp;12, 3.2%). A higher proportion of participants reported having known or treated cases of neglect (n\u0026thinsp;=\u0026thinsp;60, 18.8%) as compared to cases of abuse (n\u0026thinsp;=\u0026thinsp;43, 11.3%). Most participants (n\u0026thinsp;=\u0026thinsp;319, 85%) had not encountered cases of elder abuse or neglect in the last 5 years.\u003c/p\u003e \u003cp\u003eDentists younger than 44 years (n\u0026thinsp;=\u0026thinsp;36, 21%) encountered more cases of elder abuse as compared to those older than 44 years (n\u0026thinsp;=\u0026thinsp;23, 11%) and this difference was statistically significant (chi-square\u0026thinsp;=\u0026thinsp;6.34, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThere was no statistically significant difference in the likelihood of encountering a case of elder abuse between dentists working as CDOs and dentists working in other types of practices (chi-square\u0026thinsp;=\u0026thinsp;3.18, p\u0026thinsp;=\u0026thinsp;0.087).\u003c/p\u003e \u003cp\u003eFemales were more likely (22% [n\u0026thinsp;=\u0026thinsp;26]) to report having seen cases of suspected abuse and neglect in the elderly as compared to their male (13% [n\u0026thinsp;=\u0026thinsp;34]) counterparts and this difference was statistically significant (chi-square\u0026thinsp;=\u0026thinsp;5.88; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eWork experience did not make any statistical difference with regards dentists encountering elder abuse and neglect (chi-square\u0026thinsp;=\u0026thinsp;2.76, p\u0026thinsp;=\u0026thinsp;0.105). Dentists who treated patients in residential and nursing homes were more likely to encounter elder abuse cases than those who did not (chi-square\u0026thinsp;=\u0026thinsp;14, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTime frame within which most recent incident occurred\u003c/h2\u003e \u003cp\u003eOf those dentists who had encountered cases of elder abuse or neglect, 26 (44%) reported that the incident had occurred within the last 12 months while 33 (56%) reported that the incident occurred more than a year ago. Within this latter group, the most recent incident had occurred within a 1\u0026ndash;5-year time frame for 25 (76%) of the respondents. In summary, 51 out of 59 (86.4%) of cases had occurred within the last 5 years.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePersons alerting dentist to possibility of abuse/neglect\u003c/h2\u003e \u003cp\u003eMost participants (n\u0026thinsp;=\u0026thinsp;38, 64%) reported that the incident of abuse or neglect was brought to their attention through personal observation. No respondent was alerted by the police or a voluntary organisation. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarises these results.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eCharacteristics of abused/neglected elders\u003c/h2\u003e \u003cp\u003eThe cases of elder abuse encountered by participants were 59. The age of the victims ranged from 65 to 94 years with a mean of 77.6 years. There were more females than males (n\u0026thinsp;=\u0026thinsp;37, 61% vs n\u0026thinsp;=\u0026thinsp;24, 39%). Most of the victims were living in residential or nursing homes at the time of the incident (n\u0026thinsp;=\u0026thinsp;33, 55%). Of the cases encountered, 28 (47%) of them were suspected to be inflicted by a member of the nursing staff or residential home. Details are shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eType of Injury sustained\u003c/h2\u003e \u003cp\u003eThe injuries sustained by victims of elder abuse/neglect encountered by participants ranged from bruises, to fractures. There were also cases of malnutrition. Most of the participants (n\u0026thinsp;=\u0026thinsp;26, 43%) reported no apparent injuries in the cases they encountered. Some victims of elder abuse and/or neglect may have sustained more than one type of injury. Details are shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eNeglect observed or reported by patient\u003c/h2\u003e \u003cp\u003eThere were 86 reported cases of neglect with the commonest type being neglect of personal hygiene (n\u0026thinsp;=\u0026thinsp;40,47%). Details are shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eActions taken by dentist\u003c/h2\u003e \u003cp\u003eMost participants (n\u0026thinsp;=\u0026thinsp;24, 39%) spoke to relatives about the possibility of elder abuse. However, 23% (n\u0026thinsp;=\u0026thinsp;14) took no action. Details are summarised in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eComparing knowledge of elder abuse/neglect between PCTs\u003c/h2\u003e \u003cp\u003eBournemouth (n\u0026thinsp;=\u0026thinsp;56, 15%) had the highest number of dentists while North Dorset had the least (n\u0026thinsp;=\u0026thinsp;23, 6%).\u003c/p\u003e \u003cp\u003eThere were more cases of elder neglect (n\u0026thinsp;=\u0026thinsp;86) as compared to elder abuse (n\u0026thinsp;=\u0026thinsp;59). Cases of neglect were more likely to be first detected by the dentist while abuse cases were more likely to be first reported by someone other than the dentist and this difference was statistically significant (chi-square\u0026thinsp;=\u0026thinsp;8.42, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eElders were more likely to be abused when living alone or with family and the abuse was more likely to be carried out by family members (n\u0026thinsp;=\u0026thinsp;7, 87.5%) than when they had other living situations (n\u0026thinsp;=\u0026thinsp;1, 12.5%) (chi-square\u0026thinsp;=\u0026thinsp;13.83, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, they were more likely to be neglected when living in nursing and residential homes (n\u0026thinsp;=\u0026thinsp;33, 65%) as compared to living alone or with family (n\u0026thinsp;=\u0026thinsp;18, 35%) (chi-square\u0026thinsp;=\u0026thinsp;5.73, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThere was no statistically significant difference in knowledge of elder abuse/neglect between dentists in the Dorset and Somerset areas (chi-square\u0026thinsp;=\u0026thinsp;4.9, p\u0026thinsp;=\u0026thinsp;0.18).\u003c/p\u003e \u003cp\u003e\u003cstrong\u003eTable 2: Participants\u0026rsquo; knowledge of elder abuse/neglect\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"444\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.01801801801801%\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.98198198198198%\" valign=\"top\"\u003e\n \u003cp\u003eNumber (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.01801801801801%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eElder abuse/neglect first noticed by\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDentist\u003c/p\u003e\n \u003cp\u003ePatient\u003c/p\u003e\n \u003cp\u003ePatient\u0026rsquo;s relative\u003c/p\u003e\n \u003cp\u003ePatient\u0026rsquo;s friend/neighbour\u003c/p\u003e\n \u003cp\u003eNursing/Residential home staff\u003c/p\u003e\n \u003cp\u003eHospital staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.98198198198198%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e38 (64%)\u003c/p\u003e\n \u003cp\u003e5 (9%)\u003c/p\u003e\n \u003cp\u003e6 (10%)\u003c/p\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003cp\u003e4 (7%)\u003c/p\u003e\n \u003cp\u003e5 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.01801801801801%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eElder abuse first noticed by\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDentist\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.98198198198198%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (12.5%)\u003c/p\u003e\n \u003cp\u003e7 (87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.01801801801801%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eElder neglect first noticed by\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eDentist\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.98198198198198%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37 (72.5%)\u003c/p\u003e\n \u003cp\u003e14 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.01801801801801%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiving situation at time of incident\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNursing home\u003c/p\u003e\n \u003cp\u003eAlone\u003c/p\u003e\n \u003cp\u003eWith spouse\u003c/p\u003e\n \u003cp\u003eResidential home\u003c/p\u003e\n \u003cp\u003eWith child\u003c/p\u003e\n \u003cp\u003eOther\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.98198198198198%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (38%)\u003c/p\u003e\n \u003cp\u003e13 (22%)\u003c/p\u003e\n \u003cp\u003e11 (18%)\u003c/p\u003e\n \u003cp\u003e10 (17%)\u003c/p\u003e\n \u003cp\u003e2 (3%)\u003c/p\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.01801801801801%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuspected abuser\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNursing/Residential home staff\u003c/p\u003e\n \u003cp\u003eUnidentified\u003c/p\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003cp\u003eFriend/Neighbour\u003c/p\u003e\n \u003cp\u003eChild/Sibling\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.98198198198198%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e28 (46%)\u003c/p\u003e\n \u003cp\u003e14 (23%)\u003c/p\u003e\n \u003cp\u003e9 (15%)\u003c/p\u003e\n \u003cp\u003e4 (7%)\u003c/p\u003e\n \u003cp\u003e4 (7%)\u003c/p\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.01801801801801%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of elder abuse\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNo apparent injury\u003c/p\u003e\n \u003cp\u003eOther injuries\u003c/p\u003e\n \u003cp\u003eMalnutrition\u003c/p\u003e\n \u003cp\u003eBruises including facial bruising\u003c/p\u003e\n \u003cp\u003eAbrasions\u003c/p\u003e\n \u003cp\u003eBroken dental prosthesis\u003c/p\u003e\n \u003cp\u003eWounds/ Cuts/ Punctures\u003c/p\u003e\n \u003cp\u003eFractured/Avulsed teeth\u003c/p\u003e\n \u003cp\u003eBurns/ Scalds\u003c/p\u003e\n \u003cp\u003eBone/Skull fractures\u003c/p\u003e\n \u003cp\u003eDislocations/ Sprains\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.98198198198198%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26 (43%)\u003c/p\u003e\n \u003cp\u003e16 (26%)\u003c/p\u003e\n \u003cp\u003e14 (23%)\u003c/p\u003e\n \u003cp\u003e16 (26%)\u003c/p\u003e\n \u003cp\u003e6 (10%)\u003c/p\u003e\n \u003cp\u003e4 (7%)\u003c/p\u003e\n \u003cp\u003e2 (3.3%)\u003c/p\u003e\n \u003cp\u003e2 (3.3%)\u003c/p\u003e\n \u003cp\u003e2 (3.3%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.01801801801801%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of elder neglect\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNeglect of personal hygiene\u003c/p\u003e\n \u003cp\u003eInadequate dental care\u003c/p\u003e\n \u003cp\u003eInadequate food\u003c/p\u003e\n \u003cp\u003eInadequate medical care\u003c/p\u003e\n \u003cp\u003eInadequate housing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.98198198198198%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40 (66%)\u003c/p\u003e\n \u003cp\u003e24 (39%)\u003c/p\u003e\n \u003cp\u003e11 (18%)\u003c/p\u003e\n \u003cp\u003e8 (13%)\u003c/p\u003e\n \u003cp\u003e3 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"68.01801801801801%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAction taken by dentist\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSpoke to relatives\u003c/p\u003e\n \u003cp\u003eNo action\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003cp\u003eEmergency dental treatment\u003c/p\u003e\n \u003cp\u003eReferred to social services\u003c/p\u003e\n \u003cp\u003eReferred to general practitioner\u003c/p\u003e\n \u003cp\u003eReferred to hospital\u003c/p\u003e\n \u003cp\u003eReferred to legal services/police\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.98198198198198%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24 (39%)\u003c/p\u003e\n \u003cp\u003e14 (23%)\u003c/p\u003e\n \u003cp\u003e12 (20%)\u003c/p\u003e\n \u003cp\u003e12 (20%)\u003c/p\u003e\n \u003cp\u003e6 (10%)\u003c/p\u003e\n \u003cp\u003e9 (15%)\u003c/p\u003e\n \u003cp\u003e4 (7%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe response rate for this study was 78.4% which was relatively high. The mean age of participants was 43.7 years which was similar to national surveys conducted in Canada (41.1 years) and USA (43.7 years) (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost participants were in general practice which was similar to the survey conducted in the USA (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA higher proportion of respondents treated patients from nursing and residential homes and housebound patients as compared to the surveys conducted in Canada and USA (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This was probably because this study took place in an area with higher numbers of nursing and residential homes.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAwareness of elder abuse and neglect\u003c/h2\u003e \u003cp\u003eMost participants knew about elder abuse (84.7%) and neglect (78.1%) which was in line with other studies. This reflects a general increase in levels of awareness/knowledge of elder abuse (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFifteen percent of participants had encountered cases of elder abuse or neglect in their practice. This was higher than studies conducted in the USA (10%, 7.2%) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and Canada (7.2%) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This may be attributed to the increased awareness or knowledge of elder abuse. Additionally, this study was conducted in an area with a high population of the elderly and may offer an explanation for this finding.\u003c/p\u003e \u003cp\u003eAlthough there was no statistically significant difference in knowledge levels between CDOs and GDPs concerning elder abuse or neglect, studies have shown that CDOs are more likely to encounter these cases (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAge and work experience of respondents and awareness of elder abuse and neglect\u003c/h2\u003e \u003cp\u003eThis study found that dentists younger than the mean age of 44 years were more likely to have encountered cases of elder abuse or neglect as compared to those above 44 years. This was in line with previous studies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). An explanation may be that younger dentists are more aware of these cases than the older dentists who may have grown up at a time where corporal punishment was more acceptable.\u003c/p\u003e \u003cp\u003eHowever, there was no association between number of years qualified/practised and the likelihood of encountering elder abuse or neglect.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSex and awareness of elder abuse and neglect\u003c/h2\u003e \u003cp\u003eFemale participants were more likely to encounter cases of elder abuse and neglect when compared to males. Similarly, a study carried out found that more female doctors remembered specific cases of neglect (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). An explanation of this finding may be that females are perceived as more vulnerable and suffer from abuse more than males, hence pay more attention and are able to detect more cases of abuse or neglect when compared to men.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLiving situations and occurrence of elder abuse\u003c/h2\u003e \u003cp\u003eStudies have shown inconsistencies about the association between living situations and elder abuse. In Asian studies, living alone was associated with an increased risk of elder abuse (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) whereas studies in the US and Europe report that a shared living environment was a risk factor for elder abuse (\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn this study, respondents who treated patients in residential/nursing homes or housebound patients were more likely to have encountered victims of elder abuse.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eTimeframe of elder abuse and neglect\u003c/h2\u003e \u003cp\u003eParticipants reported that the cases of elder abuse or neglect they encountered occurred within the last 12 months. This was similar to findings from previous studies (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This may imply that elder abuse and neglect may be an ongoing phenomenon.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eDetection of elder abuse\u003c/h2\u003e \u003cp\u003eMost participants (64%) reported that they detected elder abuse or neglect through personal observation. Similarly, previous studies reported that 62%, 75% and 54% of dentists, respectively, detected elder abuse and neglect through personal observation (\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This has implications for training and policy development because dentists can easily detect cases of elder abuse and neglect when equipped with the requisite knowledge.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eType of injury sustained by victims\u003c/h2\u003e \u003cp\u003eWith regards to the type of injury sustained by victims, no apparent injury (43%) was the most common finding. However, there is a possibility that other types of \u0026lsquo;invisible\u0026rsquo; abuse such as psychological and emotional abuse, financial/material exploitation, sexual abuse may have occurred which were not covered in this study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eAction taken by participants\u003c/h2\u003e \u003cp\u003eIn this study, while most participants (39%) took action by reporting to relatives, 23% of them took no action. In contrast, a study in Kanpur, India found that only 26% of participants took action against the abuse they found (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Those who took no action may have done so because they may not have known how to manage cases of abuse or neglect. There may also have been no protocol or standards of procedure when dentists encounter these cases. It may also be due to a lack of care or empathy on the part of the participants.\u003c/p\u003e \u003cp\u003eThere was no difference in knowledge or awareness of elder abuse among dentists serving in PCTs with higher populations of the elderly as compared to those serving in PCTs with lower populations of the elderly.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eComparison of number of elder abuse and neglect cases\u003c/h2\u003e \u003cp\u003eParticipants encountered more cases of neglect than abuse. More cases of neglect were first encountered by participants\u0026rsquo; personal observation as compared to abuse which were reported by others (family, patients or hospital staff).\u003c/p\u003e \u003cp\u003eThe study also found that elderly patients living in nursing/residential homes were more likely to be neglected than abused. This highlights the report that falling care standards in nursing or residential homes (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). However, those living alone or with family were more likely to be abused than neglected.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study was based on data collected about 2 decades ago and may not reflect current trends. However, a literature search shows that the study has not been replicated in the UK within that period.\u003c/p\u003e \u003cp\u003eData for this study relied on self-report by participants and carried a risk of reporting and recall bias. However, in epidemiological studies, this is the standard way of collecting relevant information and the questionnaires were well established and previously used.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eA nationwide and recent survey of knowledge/awareness of elder abuse should be conducted to ascertain the current trend in the UK.\u003c/p\u003e \u003cp\u003eTraining of dental students and retraining of dental professionals on elder abuse and neglect will help in detection, reporting and dealing with cases of neglect and abuse (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCaregivers and staff of nursing/residential homes should be educated on elder abuse and neglect and perpetrators of these acts should be prosecuted.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eA response rate of 78.4% to this postal survey suggests that dentists in Dorset and Somerset SHA have considerable interest in the subject of elder abuse and neglect.\u003c/p\u003e \u003cp\u003eIn this study, most participants had heard about elder abuse and neglect, however most had not encountered cases of abuse and neglect. About a fifth of the participants who had encountered elder abuse and neglect did nothing about it.\u003c/p\u003e \u003cp\u003eParticipants reported that most victims of neglect resided in nursing/residential homes while elders were more likely to be abused when living alone or with relatives.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCDO\u0026nbsp; \u0026nbsp; \u0026nbsp;Community Dental Officer\u003c/p\u003e\n\u003cp\u003eCDS\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Community Dental Services\u003c/p\u003e\n\u003cp\u003eDSSHA\u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; Dorset and Somerset Strategic Health Authority\u003c/p\u003e\n\u003cp\u003eGDP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; General Dental Practitioner\u003c/p\u003e\n\u003cp\u003ePCT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Primary Care Trust\u003c/p\u003e\n\u003cp\u003eSHA \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Strategic Health Authority\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eNimako-Boateng wrote the main manuscript and collected the dataNathaniel Essel prepared the tables and figures and updated the literature review and discussionBoth authors reviewed the manuscipt\u003c/p\u003e\u003ch2\u003eAVAILABILITY OF DATA AND MATERIALS\u003c/h2\u003e \u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to the fact that this work was done in 2005 at Kings College, University of London as part of an MSc Dissertation under the supervision of Prof Victoria Harrison. The data was left in Kings College and would have been archived by now and is not public, however the original theses is available at King\u0026rsquo;s College, London. The author is not in a position to provide this on reasonable request by himself. Data are however available from the corresponding author upon reasonable request and with permission of Kings College\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-life-expectancy-and-healthy-life-expectancy#:~:text=Situation%20and%20trends,to%2073.4%20years%20in%202019. 2019. Global Health Estimates: Life expectancy and leading causes of death and disability. \u003c/li\u003e\n\u003cli\u003eOffice for National Statistics. https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/datasets/domesticabusefindingsfromthe\u003cbr\u003ecrimesurveyforenglandandwalesappendixtables. 2018. Domestic abuse: findings from the Crime Survey for England and Wales - Appendix tables. \u003c/li\u003e\n\u003cli\u003eCowen HJ, Cowen PS. Elder Mistreatment: Implications for Public Health Dentistry. J Public Health Dent. 2001 Sep;61(3):131\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eGrossman MD, Miller D, Scaff DW, Arcona S. When Is an Elder Old? Effect of Preexisting Conditions on Mortality in Geriatric Trauma. Journal of Trauma and Acute Care Surgery. 2002 Feb;52(2):242\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eWHO/INPEA. Missing voices: views of older persons on elder abuse. Geneva; 2002. \u003c/li\u003e\n\u003cli\u003eCrime Survey for England and Wales. https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/bulletins/domesticabuseinenglandandwales/yearendingmarch2018. 2019. Domestic abuse in England and Wales: year ending March 2018. \u003c/li\u003e\n\u003cli\u003eAgeUK. No Age Limit: the blind spot of older victims and survivors in the Domestic Abuse Bill. London; 2020 Sep. \u003c/li\u003e\n\u003cli\u003eRosen T, LoFaso VM, Bloemen EM, Clark S, McCarthy TJ, Reisig C, et al. Identifying Injury Patterns Associated with Physical Elder Abuse: Analysis of Legally Adjudicated Cases. Ann Emerg Med. 2020 Sep;76(3):266\u0026ndash;76. \u003c/li\u003e\n\u003cli\u003eOchs HA, Neuenschwander MC, Dodson TB. Are head, neck and facial injuries markers of domestic violence? The Journal of the American Dental Association. 1996 Jun;127(6):757\u0026ndash;61. \u003c/li\u003e\n\u003cli\u003eMurphy K, Waa S, Jaffer H, Sauter A, Chan A. A Literature Review of Findings in Physical Elder Abuse. Canadian Association of Radiologists Journal. 2013 Feb 1;64(1):10\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eLee M, Chansakul A, Rotman JA, Rosen A. Elder Abuse. Radiol Clin North Am. 2023 Jan;61(1):65\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003evan Houten ME, Vloet LCM, Pelgrim T, Reijnders UJL, Berben SAA. Types, characteristics and anatomic location of physical signs in elder abuse: a systematic review. Eur Geriatr Med [Internet]. 2022 Feb 13;13(1):53\u0026ndash;85. Available from: https://link.springer.com/10.1007/s41999-021-00550-z\u003c/li\u003e\n\u003cli\u003eCorbi G, Grattagliano I, Sabb\u0026agrave; C, Fiore G, Spina S, Ferrara N, et al. Elder abuse: perception and knowledge of the phenomenon by healthcare workers from two Italian hospitals. Intern Emerg Med. 2019 Jun 29;14(4):549\u0026ndash;55. \u003c/li\u003e\n\u003cli\u003eTouza Garma C. Influence of health personnel\u0026rsquo;s attitudes and knowledge in the detection and reporting of elder abuse: An exploratory systematic review. Psychosocial Intervention. 2017 Aug;26(2):73\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eSilva LO, Souza‐Silva BN, de Alc\u0026acirc;ntara Rodrigues JL, Rigo L, Cericato GO, Franco A, et al. Identification and management of elder physical abuse in the routine of dentistry \u0026ndash; a systematic review. Gerodontology. 2017 Mar 4;34(1):3\u0026ndash;12. \u003c/li\u003e\n\u003cli\u003eMcDowell JD, Kassebaum DK, Fryer GE. Recognizing and reporting domestic violence: A survey of dental practitioners. Special Care in Dentistry. 1994 Mar 12;14(2):49\u0026ndash;53. \u003c/li\u003e\n\u003cli\u003eLove C, Gerbert B, Caspers N, Bronstone A, Perry D, Bird W. Dentists\u0026rsquo; attitudes and behaviors regarding domestic violence. The Journal of the American Dental Association. 2001 Jan;132(1):85\u0026ndash;93. \u003c/li\u003e\n\u003cli\u003eWHO. Tackling abuse of older people: five priorities for the United Nations Decade of Healthy Ageing (2021\u0026ndash;2030). Geneva; 2022. \u003c/li\u003e\n\u003cli\u003eBoynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. BMJ. 2004 May 29;328(7451):1312\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eDillman DA. Mail and Telephone Surveys - The Total Design Method. John Wiley and Sons; 1978. \u003c/li\u003e\n\u003cli\u003eEdwards P. Increasing response rates to postal questionnaires: systematic review. BMJ. 2002 May 18;324(7347):1183\u0026ndash;1183. \u003c/li\u003e\n\u003cli\u003eHoltzman JM, Bomberg T. A national survey of dentists\u0026rsquo; awareness of elder abuse and neglect. Special Care in Dentistry. 1991 Jan 28;11(1):7\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eMayer L, Galan D. Elder abuse and the dentists\u0026rsquo; awareness and knowledge of the problem--a national survey. J Can Dent Assoc. 1993 Nov;59(11):921\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eRamesh G, Pathak S, Mishra G, Raj A, Pathak R, Sant V, et al. Elder Abuse among Dental Patients and Assessment of Knowledge Regarding Elder Abuse among Dental Practitioners of Kanpur. University Journal of Dental Sciences. 2016;1(2). \u003c/li\u003e\n\u003cli\u003eBecker DB, Needleman HL, Kotelchuck M. Child abuse and dentistry: orofacial trauma and its recognition by dentists. The Journal of the American Dental Association. 1978 Jul;97(1):24\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSaxe MD, McCourt JW. Child abuse: a survey of ASDC members and a diagnostic-data-assessment for dentists. ASDC J Dent Child. 1991;58(5):361\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eWong SHLF. Discussing partner abuse: does doctor\u0026rsquo;s gender really matter? Fam Pract. 2006 Apr 4;23(5):578\u0026ndash;86. \u003c/li\u003e\n\u003cli\u003eJeon GS, Cho SI, Choi K, Jang KS. Gender Differences in the Prevalence and Correlates of Elder Abuse in a Community-Dwelling Older Population in Korea. Int J Environ Res Public Health. 2019 Jan 1;16(1):100. \u003c/li\u003e\n\u003cli\u003eWu L, Chen H, Hu Y, Xiang H, Yu X, Zhang T, et al. Prevalence and Associated Factors of Elder Mistreatment in a Rural Community in People\u0026rsquo;s Republic of China: A Cross-Sectional Study. PLoS One. 2012 Mar 20;7(3):e33857. \u003c/li\u003e\n\u003cli\u003eLee YS, Kaplan CP, Perez-Stable EJ. Elder Mistreatment among Chinese and Korean Immigrants: The Roles of Sociocultural Contexts on Perceptions and Help-Seeking Behaviors. J Aggress Maltreat Trauma. 2014 Jan 2;23(1):20\u0026ndash;44. \u003c/li\u003e\n\u003cli\u003eDST-SCPD. Protection of vulnerable adults (POVA) scheme in England and Wales for care homes and domiciliary care agencies (2004) . 2004 Jun. \u003c/li\u003e\n\u003cli\u003eJohannesen M, LoGiudice D. Elder abuse: a systematic review of risk factors in community-dwelling elders. Age Ageing. 2013 May;42(3):292\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003ePillemer K, Burnes D, Riffin C, Lachs MS. Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies. Gerontologist. 2016 Apr;56(Suppl 2):S194\u0026ndash;205. \u003c/li\u003e\n\u003cli\u003eNaughton C, Drennan J, Treacy M, Lafferty A, Lyons I, Phelan A, et al. Abuse and Neglect of Older People in Ireland. Dublin; 2010. \u003c/li\u003e\n\u003cli\u003eSinha S, Archaya P, Jafar H, Bower E, Harrison V, Newton J. The management of abuse: a resource material for the dental team. Stephen Hancocks Ltd; 2005. 47\u0026ndash;52 p. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"elder abuse, elder neglect, knowledge, dentists","lastPublishedDoi":"10.21203/rs.3.rs-3970640/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3970640/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWith the population ageing, elder abuse and neglect has become an increasing problem. Most elderly people are retaining their natural teeth and dentists are favourably positioned to detect cases of elder abuse and neglect. This study aimed to investigate the awareness, knowledge and attitudes of dentists in Dorset and Somerset Strategic Health Authority (SHA) regarding elder abuse and neglect.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eData was collected using a modified questionnaire from previous studies. The questionnaire was posted to all dentists in the Dorset and Somerset area in the year 2005. Demographic data as well as knowledge on elder abuse and neglect were assessed. Descriptive statistics and chi-square tests were carried out to allow for comparisons.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 380 out of the invited 496 dentists agreed to participate in the study (response rate 78.4%). Most participants had heard of elder abuse (84.7% [n\u0026thinsp;=\u0026thinsp;321]) and neglect (78.1% [n\u0026thinsp;=\u0026thinsp;296]). However, few participants had encountered specific incidents of elder abuse (8.4% [n\u0026thinsp;=\u0026thinsp;32]) and neglect (11.9% [n\u0026thinsp;=\u0026thinsp;45]). Dentists who treated patients from residential and nursing homes were significantly more likely to have encountered elder abuse and neglect (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; chi-square\u0026thinsp;=\u0026thinsp;14).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIncorporation of elder abuse and neglect into the curricula of dental schools and continuous education of dental professionals will help better detect and address these cases.\u003c/p\u003e","manuscriptTitle":"Awareness and knowledge of elder abuse and neglect among dental practitioners in Southwestern England.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-15 17:44:15","doi":"10.21203/rs.3.rs-3970640/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4e9062a0-1b15-4dff-99b8-b23b82813383","owner":[],"postedDate":"March 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-12T10:28:18+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-15 17:44:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3970640","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3970640","identity":"rs-3970640","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}