A Path to Prevention of Elder Abuse in Long-term Care. Prevalence Study Among Staff in Long-term Care. (APPEAL)

Globally, studies indicated that 16% of community dwelling older adults have been exposed to some form of abuse in the past 12 months. Furthermore, a global meta-analysis about AOP in long-term care facilities used staff as respondents and found that the pooled estimate of overall self-reported perpetration of staff to resident abuse during the past 12 months was 64.2% (95% CI 53.3-73.9%). Similar findings was also reported in a study from Norway in which the overall prevalence of observed staff-to-resident abuse was 76% and 60% of respondents report self-perpetration of abusive acts during the past 12 months. Resident-to-resident aggression was even more common, observed by 88% of respondents.

This study is part of the Swedish national research program APPEAL (A Path to Prevention of Elder Abuse in Long-term care) with the long-term goal to co-create an intervention for abuse of older people (AOP) in nursing homes together with stakeholders, i.e., staff, managers, care recipients and relatives.

Study design and data collection:

A cross-sectional study design will be used with slightly different data collection modes.

1. Population sample. Statistics Sweden combine data from the Swedish Occupational Register with data about industry codes (SNI-codes) to make a national randomized sample of staff working in home care services (n=12000) and nursing homes (n=11000) in Sweden. Data will be collected through a digital survey. Data will be combined with available register data from Statistics Sweden, including for example sex, age, civil state and occupational related data.
2. Workplace sample. Sweden has 290 Municipalities. The Swedish Association of Local Authorities and Regions (SALAR) have an official categorization of the municipalities based on e.g., urban area size, proximity to a larger urban area, and commuting patterns. One municipality in each of the nine categories has been randomly selected for participation. In the randomization process, geographical location of the municipalities has been considered to assure national representativeness, meaning that in case several municipalities in the same geographical region were selected a new randomization was conducted. Staff in each selected municipalities will be invited to participate through managers in each organization. Data will be collected through a digital questionnaire. Organizations will be encouraged to set a side time at a staff meeting for completing the questionnaire. If this is not possible, a link to the questionnaire will be sent out by e-mail. Data will be collected anonymously.

Material:

The questionnaire used in the previously mentioned Norwegian study about AOP in long-term care facilities has been translated and culturally adapted. In addition, items about background characteristics of respondents as well as risk factors for AOP on both an individual and system level are included, e.g., workload and perceived support at the workplace and ageist attitudes.

Analysis:

Primary outcomes will be proportion of staff reporting different types of abuse (psychological, physical, sexual, financial abuse and neglect) in different relational contexts, i.e., self-perpetrated, staff-to-resident and relative-to resident abuse, and in long-term care facilities resident-to-resident abuse.

Secondary outcome will be staff reported own exposure to different forms of abuse at the workplace, including by residents, co-workers, relatives and managers.

Logistic regression analysis will be used to investigate associations between reporting different forms of abuse and potentially explanatory factors.

Study Overview

• Status: Not yet recruiting
• Conditions: Elder Abuse; Elder Mistreatment; Long Term Care; Abuse Physical; Abuse Verbal; Abuse Domestic; Abuse Neglect; Violence and Victimization; Abuse, Sexual

• Study Type: Observational
• Enrollment (Estimated): 6000

Contacts and Locations

• Study Contact: Name: Johanna Simmons; Phone Number: +46 (0) 13 281000; Email: Johanna.simmons@liu.se

Study Locations

• Sweden
  • Linköping, Sweden
    • Linköping University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Two samples are used.

1. Population sample. Statistics Sweden combine data from the Swedish Occupational Register with data about industry codes (SNI-codes) to make a national randomized sample of staff working in home care services (n=12000) and nursing homes (n=11000) in Sweden.
2. Workplace sample. The Swedish Association of Local Authorities and Regions (SALAR) have an official categorization of the 290 municipalities in Sweden based on e.g., urban area size, proximity to a larger urban area, and commuting patterns. One municipality in each of the nine categories has been randomly selected for participation. Staff in each selected municipalities will be invited to participate through managers in each organization.

Description

Inclusion Criteria:

• Working in home care services or a long-term care facility in Sweden
• Working in direct contact with older adults (e.g., providing care, nursing, rehabilitation to older adults)

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Random sample; Random sample of staff working in home care services or long-term care facilities according to national registers
Workplace sample; Staff working in home care services and long-term care facilities in a selected number of municiaplities who accepted participation in the study

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-reported perpetration of abuse	Proportion of staff reporting perpetration of abuse of older people during the past 12 monts	Day1. Cross sectional study using only one point of data collection. Participants are enrolled by returing a questionnaire including items about abuse. The timeframe used in the questionnaire is experiences of abuse during the past 12 months.
Staff-to-resident abuse	Proportion of staff reporting witnessing abuse of older people by another staff member during the past 12 monts	Day1. Cross sectional study using only one point of data collection. Participants are enrolled by returing a questionnaire including items about witnessing acts of abuse during the past 12 months.
Relative-to-resident abuse	Proportion of staff reporting witnessing abuse by a relative during the past 12 months	Day1. Cross sectional study using only one point of data collection. Participants are enrolled by returing a questionnaire including items about witnessing acts of abuse during the past 12 months.
Resident-to-resident aggression	Proportion of staff reporting witnessing resident-to-resident abusive behaviours in the past 12 months	Day1. Cross sectional study using only one point of data collection. Participants are enrolled by returing a questionnaire including items about witnessing acts of abuse during the past 12 months.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Staff exposure to abuse	Proportion of staff reporting exposure to abuse at the workplace during the past 12 months	Day1. Cross sectional study using only one point of data collection. Participants are enrolled by returing a questionnaire including items about expsoure to abuse at the workplace during the past 12 months

Collaborators and Investigators

• Sponsor: Linkoeping University
• Collaborators: Karolinska Institutet; Norwegian University of Science and Technology; City of Gothenburg

Publications and helpful links

Helpful Links

• Project website

Study record dates

Study Major Dates

• Study Start (Estimated): March 24, 2026
• Primary Completion (Estimated): October 31, 2026
• Study Completion (Estimated): April 30, 2027

Study Registration Dates

• First Submitted: March 20, 2026
• First Submitted That Met QC Criteria: March 20, 2026
• First Posted (Actual): March 27, 2026

Study Record Updates

• Last Update Posted (Actual): March 27, 2026
• Last Update Submitted That Met QC Criteria: March 20, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Home care; Long-term care facilities; Home health care; Abuse of older people
• Additional Relevant MeSH Terms: Behavior; Sexual Behavior; Coitus
• Other Study ID Numbers: 2026-01231-02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: We plan to share IPD upon reasonable request and as appropriate according to rules and regulations in Sweden.
• IPD Sharing Access Criteria: Data will be shared upon reasonable request by contacting the principal investigator.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No