Almost half of all nursing home staff witness elderly abuse by relatives

The first major study in Norway to investigate violence and abuse directed at elderly people living in nursing homes committed by their relatives shows that nearly half of employees have seen this kind of behaviour.  

“I don’t think the findings are particularly surprising,” said Anja Botngård, associate professor at the Norwegian University of Science and Technology (NTNU).

She has asked over 3600 nursing home employees from 100 nursing homes in Norway to share what they have witnessed of violence and abuse from visiting relatives.

The results showed that 45.6 per cent of nursing home employees had observed one or more cases of violence or abuse in the past year.

Risk increases with exhaustion

“Psychological abuse is most frequently reported, including shouting, arguing, derogatory remarks and other degrading behaviour. There are examples of other types of abuse as well that have been observed and reported by employees to a lesser extent. Let's hope that it occurs just as rarely as it is reported, but it could be that it is reported less because it happens when no staff are there to witness it,” said Wenche Malmedal, a professor at NTNU's Department of Public Health and Nursing.

Ranked by percentage, here's what the nursing home employees observed:

• 44.8% of employees had seen psychological abuse
• 8.4% had observed physical violence
• 2.7% had observed financial/material abuse
• 0.7% had observed sexual abuse at least once in the past year.

Relatives have no formal responsibility under Norwegian law for the care of elderly people living in nursing homes.

However, many elderly people live at home for a long time before getting a place in a nursing home. During this period, many relatives have to take on a significant caregiving burden.  Botngård says when a family member moves into a nursing home, it can be difficult for their loved ones to let go of the responsibility they have been carrying for a long time.

“Some relatives may also feel that the elderly person is not receiving adequate care in the nursing home, and may therefore continue to feel a sense of responsibility,” said Botngård.

She believes this can lead to relatives taking on more caregiving duties than they actually have the capacity for, which in turn can increase the risk of abuse.

In addition, the caregiving burden can affect the health and quality of life of the person providing the care.

Intimate partner violence can continue in nursing homes

A recent doctoral dissertation by Gunn Steinsheim at NTNU shows that when caregiving relatives become exhausted, the risk of them subjecting elderly people to violence and abuse increases. Her research also shows that when elderly people with dementia act aggressively toward their relatives, it increases the risk of the relatives responding with aggression.

“Shouting and arguing between spouses or between parents and children can go both ways, but when one of them is ill and in need of care, a power imbalance arises between the person providing care and the person receiving it,” Botngård said.

The study by Botngård and her colleagues only focuses on actions that staff have observed.

“Based on our study, we can't say why this happens. Previous research has shown that relatives’ poor mental health, substance abuse issues and financial dependence are strong risk factors,” Botngård said.

‘Relatives’ can include spouses, children, grandchildren and other people closely connected to the elderly person.

Botngård believes the study’s findings must be seen from a life-cycle perspective.

“People who have been subjected to domestic violence may find that the violence continues even though they have moved into a nursing home. Intimate partner violence and abuse from children or grandchildren are also realities in nursing homes. Nursing home staff have a duty to monitor and prevent it,” said Botngård.

An under-researched phenomenon

“The important thing for relatives is that the nursing home staff know how to deal with ageing and dementia, and that they have enough time and resources to provide quality care,” said Botngård. She also emphasized the need for staff to know how to recognize domestic violence and how to handle these types of incidents when they occur.

Botngård believes the study highlights a phenomenon that has largely been overlooked.

“In recent years, growing attention has been given to violence and abuse against elderly people living at home, and neglect in nursing homes. However, elderly people in nursing homes being subjected to violence and abuse by relatives is an under-researched phenomenon – both in Norway and internationally,” said Botngård.

She points out that further research is needed to understand why this occurs, so that effective measures can be developed to prevent these types of incidents.

References:

Botngård A, Eide AH, Mosqueda L, Blekken L, Malmedal W. Relative-to-resident abuse in Norwegian nursing homes: a cross-sectional exploratory study. BMC Geriatr. 2024 Nov 5;24(1):912. doi: 10.1186/s12877-024-05513-0. PMID: 39501198; PMCID: PMC11536973.

Gunn Steinsheim, Stretched to the Limit? Informal caregiver burden and elder abuse among home-dwelling persons with dementia, NTNU Open 2025