The Relationship between Elder Mistreatment and Cognitive Functioning: A Systematic Review

Background and Purpose: Emerging evidence suggests that elder mistreatment (EM) and cognitive functioning are closely intertwined. EM poses risks for cognitive impairment, while impaired cognitive functioning elevates the risk of EM. However, to date, no study has reviewed their relationships, particularly the bidirectional associations. Understanding these dynamics could significantly enhance efforts to prevent older adults from experiencing either EM or cognitive impairment. Thus, we conducted a systematic review to explore and critically evaluate the existing studies probing the relationships between EM and cognitive functioning. The measures utilized to assess both constructs and the associations between their respective domains were examined.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched three databases for English peer-reviewed observational articles published between September 30, 2013 to September 30, 2023. The databases included Social Work Abstract – Academic Search Premier, PAIS Index, and APA PsycINFO. Eligible studies were analyzed inductively, and their findings were synthesized narratively.

Results: A total of 12 articles (5 cross-sectional, 4 longitudinal, 3 case-control), reporting on 10 studies, were eligible and underwent review. A total of 15 different measures of EM and 22 measures of cognitive functioning were used across twelve studies. Overall, findings regarding the relationships between EM and cognitive functioning were largely consistent and directional. Among the twelve reviewed articles, five studies (41.7%) investigated the effects of cognitive functioning on EM, all indicating significant relationships. Four of these studies found negative associations between cognitive functioning and EM; however, one study reported positive associations between the two constructs. Regarding the effects of EM on cognitive functioning, seven out of the twelve reviewed studies (58.3%) were examined. Four of these studies suggested that EM was associated with lower cognitive functioning, two reported mixed results between the two constructs, and only one study found nonsignificant results.

Conclusions and Implications: Our review provides evidence of the association between EM and cognitive functioning. While the majority of existing research indicates a significantly unidirectional link between EM and cognitive functioning, no study has examined the bidirectional associations within the same study framework. Recommendations are made for the design of future studies to explore potential bidirectional dynamics between EM and cognitive functioning and to investigate the underlying mechanisms, thus informing potential intervention in clinical practice.