Abstract

Aim To synthesize what is known about elder abuse and relationship factors associated with abuse between caregivers and older people with memory disorders at home.Background Concerns about abuse in the caring relationship between older people with memory disorders and family caregivers have increased. Abuse is associated with negative outcomes on older people's health, quality of life, and zest for life. Abuse in the caring relationship manifests in financial exploitation, neglect, mistreatment, and physical issues.Design Systematic review.Data Sources Databases including Scopus, PubMed/Medline, SveMed(+), Cinalh, SonINDEX, and ProQuest were searched using keywords about abuse in the caring relationship between older people with memory disorders and family caregivers at home. Articles published between 2005-2019 were retrieved and underwent data analysis and knowledge synthesis.Review Methods The review was presented under the categories of the dyadic approach of elder abuse in connection with the role of caregiver (risk) and care recipient (vulnerability) by Fulmer et al. (2005).Results The search process led to 12 quantitative studies, including an intervention, a prospective, nine surveys, and a cross-sectional structural interview. Findings were synthesized and presented under 'personal', 'physical and psychological', and 'social' domains indicating the bilateral roles of caregiver and care recipient leading to abuse.Conclusion This review depicted factors influencing abuse in the caring relationship between older people with memory disorders and their family caregivers at home. They included family caregivers' psychological issues, knowledge of memory disorders and modifications, previous caring relationship, social support, number of care recipients, and care recipients' functional level.ImpactThis review identifies what influences elder abuse by family caregivers using the dyadic approach and explains how abuse can be prevented through suggested strategies.The review findings are relevant to multidisciplinary healthcare providers and can guide the provision of support, screening and assessment, educational programs, and legislative initiatives.


Authors

Valimaki, Tarja;  Maki-Petaja-Leinonen, Anna;  Vaismoradi, Mojtaba

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  • 1 author
  • 2 reviewers
  • pre-publication peer review (FINAL ROUND)
    Decision Letter
    2020/03/30

    29th March 2020

    Re: JAN-2019-0996.R2: Abuse in the caregiving relationship between older people with memory disorders and family caregivers: A systematic review

    Dear Dr Välimäki,

    Thank you for sending us your paper which has been considered with care. I am pleased to inform you that your paper has now been accepted for publication in the Journal of Advanced Nursing. The average time to online publication of the final version is 5 weeks. However, please see the information below about Accepted Articles.

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    Decision letter by
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    Reviewer report
    2020/03/09

    Thank you very much for revising this paper. I find that you have addressed all of my previous comments and the writing is much improved. I have highlighted a few very minor edits needed.

    Thank you.

    Reviewed by
    Cite this review
  • pre-publication peer review (ROUND 2)
    Decision Letter
    2020/02/26

    26th Feb 2020

    Re: JAN-2019-0996.R1: Abuse in the caregiving relationship between older people with memory disorders and family caregivers: A systematic review

    Dear Dr Välimäki,

    Thank you for sending us the above manuscript. It has been considered with care and the editor and reviewer comments are shown at the end of this email. As these comments indicate, the paper does need revision before we can consider it further, and I look forward to receiving your revised version as soon as possible, and no later than 25th Feb 2020. If this poses any problems, please contact me at jan@wiley.com.

    Please take care to ensure that your revised manuscript addresses all of the editor and reviewer comments. Please also see the sections on general points to remember and search engine optimisation (SEO) at the end of the email.

    EDITOR'S COMMENTS:
    1) There are grammatical errors in the paper which has limited the clarity of the content. Further English editing is needed before the paper can be considered for publication.

    REVIEWER COMMENTS:

    Reviewer: 1

    Comments to the Author
    I'm pleased you have amended the paper which is more much more readable and accessible to a wider readership. The authors did a great job in revising the manuscript and thoroughly addressed reviewer comments. I hope these suggestions assist and look forward to reading your paper in print. Best wishes.

    Reviewer: 2

    Comments to the Author
    Thank you very much for re-submitting this important work. The authors have addressed all of my concerns over content, have clarified their research questions, and I find the added detail (particularly in the findings) to be a great improvement.

    Comment 1: I believe further editing is needed. Here are some examples, but this is not a comprehensive list.

    Abstract

    P1. Line 12. I suggest: “Abuse is associated with…”

    P2. Line 3. I suggest: “The review findings are relevant to multidisciplinary health care providers, and can guide the provision of support…”

    P2 Line 24. I suggest: “Identified as a main health concern, there is scarce evidence regarding how abuse occurs… “

    P2 Line 49. Please correct APA, Yon et al., 2017

    P2 Line 56 I suggest: “Standardized tools for estimating the prevalence of material exploitation or the misappropriation of older people’s money are lacking”.

    P3 Line 3 I suggest: “The concept of elder abuse refers to elder abuse, neglect or mistreatment”.

    P3 Line 21. Please clarify this line. “Caregiver risk factors associated with abuse were…”
    Are psychosocial stress-related characteristics, psychiatric illnesses and psychological problems risk factors for abuse?
    Are the stress-related characteristics a result of CGs being abused themselves?

    P3 Line 28. I suggest: “Care recipient risk factors for abuse were…” Grammar

    P5 Line 6 prerequisites

    P5 Line 11 I suggest: “Despite the impact of abuse on the well-being and quality of life of…..little attention has been paid to understanding the nature of elder abuse and relationship factors associated with risk”

    P6 Line 22 I suggest: “ (PRISMA) Statement (…) was used to guide this review”

    P7 Line 38. I suggest: “…had frequent discussions…”

    P8 Line 3: I suggest: “…libraries and underwent a careful assessment.” Remove “only those studies” (repetitive, not necessary)

    Thank you.

    To revise your manuscript, log on to ScholarOne Manuscripts: http://mc.manuscriptcentral.com/jan

    Please use red font to indicate the revised portions of your manuscript (no tracked changes or strike-through please).

    Please ensure that you detail the changes you have made in the 'comments to decision letter' section of the submission process. I would be grateful if you could also upload your response as a separate, anonymous file (in the 'upload files' stage of the submission process) when you submit your revised paper.

    GENERAL POINTS TO REMEMBER:

    • It is essential that you format your manuscript using the author guidelines for the type of paper you submitted: https://onlinelibrary.wiley.com/page/journal/13652648/homepage/forauthors.html

    • Use APA style for citations and references – please see the author guidelines: https://www.apastyle.org/learn/faqs/index.

    • Your revised word count must not exceed 5000 words for the text, exclusive of the abstract, references, tables and figures.

    • Format the headings like this: main headings upper case, major sub-headings lower case, subsidiary sub-headings italics.

    • The international relevance of the topic should be indicated in the Introduction section of the paper.

    • Please ensure your Background and Discussion include up-to-date literature.

    • The Conclusion section should not be a summary or repetition of previous content. This section should provide a discussion of the implications for practice or policy and recommendations for further work.

    • For Review and Discussion papers, provide the inclusive years of literature searched in both the abstract and the text (not the year(s) when the literature was searched).

    • The abstract should not include abbreviations or references.

    • Please include up to 10 key words, including nurse or nursing, which should follow the abstract. Please note these do not have to match the keywords selected in ScholarOne, which are to assist with assigning reviewers.

    SEARCH ENGINE OPTIMISATION:

    Tips for making sure articles can be easily found online are available in the attached PDF.

    Please ensure that your keywords accurately reflect the content of your manuscript.

    I look forward to receiving your revised paper. Please do not hesitate to contact me at jan@wiley.com if there is anything in this letter that needs more explanation.

    Thank you choosing JAN for your paper.

    Yours sincerely,

    Professor Yu Doris
    Editor
    Journal of Advanced Nursing

    Decision letter by
    Cite this decision letter
    Reviewer report
    2020/01/27

    Thank you very much for re-submitting this important work. The authors have addressed all of my concerns over content, have clarified their research questions, and I find the added detail (particularly in the findings) to be a great improvement.

    Comment 1: I believe further editing is needed. Here are some examples, but this is not a comprehensive list.

    Abstract

    P1. Line 12. I suggest: “Abuse is associated with…”

    P2. Line 3. I suggest: “The review findings are relevant to multidisciplinary health care providers, and can guide the provision of support…”

    P2 Line 24. I suggest: “Identified as a main health concern, there is scarce evidence regarding how abuse occurs… “

    P2 Line 49. Please correct APA, Yon et al., 2017

    P2 Line 56 I suggest: “Standardized tools for estimating the prevalence of material exploitation or the misappropriation of older people’s money are lacking”.

    P3 Line 3 I suggest: “The concept of elder abuse refers to elder abuse, neglect or mistreatment”.

    P3 Line 21. Please clarify this line. “Caregiver risk factors associated with abuse were…”
    Are psychosocial stress-related characteristics, psychiatric illnesses and psychological problems risk factors for abuse?
    Are the stress-related characteristics a result of CGs being abused themselves?

    P3 Line 28. I suggest: “Care recipient risk factors for abuse were…” Grammar

    P5 Line 6 prerequisites

    P5 Line 11 I suggest: “Despite the impact of abuse on the well-being and quality of life of…..little attention has been paid to understanding the nature of elder abuse and relationship factors associated with risk”

    P6 Line 22 I suggest: “ (PRISMA) Statement (…) was used to guide this review”

    P7 Line 38. I suggest: “…had frequent discussions…”

    P8 Line 3: I suggest: “…libraries and underwent a careful assessment.” Remove “only those studies” (repetitive, not necessary)

    Thank you.

    Reviewed by
    Cite this review
    Reviewer report
    2020/01/20

    I'm pleased you have amended the paper which is more much more readable and accessible to a wider readership. The authors did a great job in revising the manuscript and thoroughly addressed reviewer comments. I hope these suggestions assist and look forward to reading your paper in print. Best wishes.

    Cite this review
  • pre-publication peer review (ROUND 1)
    Decision Letter
    2019/12/15

    16th Dec 2019

    Re: JAN-2019-0996: Abuse in the caregiving relationship between older people with memory disorders and family caregivers: A systematic review

    Dear Dr Välimäki,

    Thank you for sending us the above manuscript. It has been considered with care and the editor and reviewer comments are shown at the end of this email. As these comments indicate, the paper does need revision before we can consider it further, and I look forward to receiving your revised version as soon as possible, and no later than 15th Jan 2019. If this poses any problems, please contact me at jan@wiley.com.

    Please take care to ensure that your revised manuscript addresses all of the editor and reviewer comments. Please also see the sections on general points to remember and search engine optimisation (SEO) at the end of the email.

    REVIEWER COMMENTS:

    Reviewer: 1

    Comments to the Author

    Thank you for the opportunity to review this paper which is a systematic review of elder abuse within the relationship between family caregivers and persons with dementia. This is a very important topic, and there is great benefit in synthesizing what is known about variables characterizing relationships that are associated with abuse, in order to prevent, screen for and mitigate abuse.

    Comments:
    1) Title: The title is appropriate and descriptive.
    I wonder if stating 'older people with dementia' would be more accurate for this paper than stating 'memory disorders'? or were people without dementia also included in the studies?

    2) Research question: This study addresses an important research question.
    I believe the authors could articulate the question more clearly on p4 and in the abstract. For example the authors could clarify, "this study aimed to synthesize what is known about/what is the nature of elder abuse and relationship factors associated with abuse between caregivers and persons with dementia".. or alternatively for example "what characteristics of caregiver and care recipient interactions have been explored in relation to elder abuse..."

    3) Background literature review: The authors have identified relevant literature to frame this review, including both a theoretical model and past empirical studies.
    a) I wonder if the authors could cite more recent studies than 1993 to describe the prevalence of physical and verbal harms experienced by caregivers from care recipients.
    b) I think discussing overall presence of elder abuse and the challenges of studying abuse would be relevant in the background
    c) I think the authors could describe the types of abuse (verbal, physical, psychological, financial) in more detail in the background, and remove these descriptions from the results
    d) I think the authors could emphasize/clarify the gaps in current knowledge more strongly to argue the importance of this review
    e) I would suggest referring to the model and figure describing caregiver/care receiver relationships earlier in the background, and defining the domains more explicitly to help the reader grasp the significance of the model and relevance to your study

    4) Methods: The authors describe methods for rigour and systematic screening, e.g., cite Equator guideline, performed independent double screening, agreed upon articles through discussion, and used the dyadic model for analysis.
    a) I would suggest stating the authors 'screened' titles and abstracts as opposed to 'reading' as this is a bit more familiar
    b) The authors describe discussing ‘next steps’ however this sounds contrary to following a rigorous protocol for SR. I wonder if discussions were aimed at resolving discrepancies around the inclusion/exclusion of articles? And agreeing upon data extracted?
    c) I would suggest removing the word ‘online discussion’ because I’m not sure the format (i.e., online) is important for readers
    d) Can the authors please synthesize the strengths and limitations of the studies? Was bias assessed? The authors mentioned a specific value was not given because weighting of the components was not equal, and that evaluation was based on the Equator model (i.e., structure etc.). Were any studies excluded because of the quality?
    e) What were the reasons for exclusion of articles and #s to be included in the PRISMA please after full-text screening?
    f) I would suggest labeling your method of analysis for clarity as ‘direct-content analysis’ (Hsieh & Shannon, 2007) or ‘theory-driven analysis’ whereby you used the conceptual model as a framework of codes or categories by which to analyze the data.
    g) I would suggest moving the full list of search terms to a table or appendix.
    h) I would suggest citing the Prisma Figure 1 in Methods and moving the citation of Table 1 to Results.

    5) Results reporting: The authors have used a conceptual model of elder abuse to categorize and understand the data within the included studies.
    a) Within the personal domain, I think it would be helpful to focus on the demographics/life history of caregivers / care recipients that were linked or explored relative to abuse. Currently the authors first describe ‘verbal abuse’ which makes it seem the personal domain is focused on verbal abuse.
    b) Similarly it seems the Physical and Psychological domain initially focuses on physical and psychological abuse and measurement, instead of physical/psychological factors linked to abuse
    c) In all results paragraphs it would be helpful if authors clarified the variables considered when opening the paragraph and describe the abuse outcomes afterwards. I believe explicitly stating 2-3 prominent variables would be helpful for readers to understand what was examined in that domain, and what relationships to abuse (and types) were found
    For example, perhaps open the personal domain paragraph by outlining “Factors/characteristics including gender, age, attitude relative to elder abuse were examined”
    “Gender of the caregiver was explored relative to elder abuse in (n=2) studies, and relationships were found…..”….
    “Age of the care recipient was linked to elder abuse in (n=x) studies….”
    “Specifically, characteristics of caregivers (including gender, etc) were linked to verbal abuse in (n=x) studies”.

    6) Discussion: The authors identify literature to compare to the findings of the review and highlight significant variables explored in relation to elder abuse in the review (e.g, stress, previous relationship, social support.)
    a) I think it would be helpful if the authors clarified and organized these key findings a bit more in the discussion.
    b) Did any studies discuss reporting of abuse as a problem? I think it is an important point the authors make in regards to reporting and disclosure, and the difficulty of studying this problem when it is often hidden.

    7) Limitations: The authors identify relevant, appropriate limitations.
    a) I think an additional limitation is the difficulty in extracting data into single theoretical categories when they frequently overlap, and distinguishing categories from one another. For example: the authors discuss interventions to help caregivers psychological health under the personal domain, and then discuss psychological health in the following domain.

    8) Conclusion: Important and helpful strategies are outlined, however I think they would fit more appropriately in the discussion section as implications

    9) Writing Style: The paper flows well and it is interesting to read.
    a) A few paragraphs are very long and would benefit from separating into 2, and similarly some sentences are very long and shortening would help readers understand the argument / main point.
    b) I think overall editing to make the paper more concise and addressing a few spelling errors would be beneficial
    c) I suggest avoiding comments during results reporting, e.g., ‘only 2 studies..’ value laden, leave for discussion section
    d) I suggest avoid personifying literature, p3 “The current literature” could be replaced with “Interactional factors have not been identified within current literature…”

    In summary, I think the authors have completed an important review and that knowledge around the interacting characteristics of caregivers and care recipient relationships related to abuse are important for nurses to be aware of.

    Reviewer: 2

    Comments to the Author
    Firstly, I congratulate to the authors! I consider that they had done a great work! Thank you for giving me the opportunity to revise this manuscript. I found this paper particularly interesting.
    I appreciate you will have put in a lot of effort in preparing your paper and there are a number of points which I offer to assist with further developing the manuscript:
    - In page 4, “search methods” section, I think that the authors can use parenthesis for the synonyms in search strategy. Ej: (old OR elder OR aged OR senior) AND (dementia OR Alzheimer OR “cognitive impairment*”) AND ….
    - I consider that the PRISMA flow chart (Figure 1) it would be better described at end of “search outcomes” section.
    - How were the quality of each article evaluated? Explain it! It would be interesting show the results of quality analysis of each article.
    - In “limitation section”, other limitation could be that the search strategy might not be fully comprehensive.
    Finally, the authors present the differing aspects of your research in an appropriate way and this allows the reader to follow the study and understand the approaches, analysis and discussion of findings. I hope that your publication will be publish in Journal of Advanced Nursing.

    To revise your manuscript, log on to ScholarOne Manuscripts: http://mc.manuscriptcentral.com/jan

    Please use red font to indicate the revised portions of your manuscript (no tracked changes or strike-through please).

    Please ensure that you detail the changes you have made in the 'comments to decision letter' section of the submission process. I would be grateful if you could also upload your response as a separate, anonymous file (in the 'upload files' stage of the submission process) when you submit your revised paper.

    GENERAL POINTS TO REMEMBER:

    • It is essential that you format your manuscript using the author guidelines for the type of paper you submitted: https://onlinelibrary.wiley.com/page/journal/13652648/homepage/forauthors.html

    • Use APA style for citations and references – please see the author guidelines: https://www.apastyle.org/learn/faqs/index.

    • Your revised word count must not exceed 5000 words for the text, exclusive of the abstract, references, tables and figures.

    • Format the headings like this: main headings upper case, major sub-headings lower case, subsidiary sub-headings italics.

    • The international relevance of the topic should be indicated in the Introduction section of the paper.

    • Please ensure your Background and Discussion include up-to-date literature.

    • The Conclusion section should not be a summary or repetition of previous content. This section should provide a discussion of the implications for practice or policy and recommendations for further work.

    • For Review and Discussion papers, provide the inclusive years of literature searched in both the abstract and the text (not the year(s) when the literature was searched).

    • The abstract should not include abbreviations or references.

    • Please include up to 10 key words, including nurse or nursing, which should follow the abstract. Please note these do not have to match the keywords selected in ScholarOne, which are to assist with assigning reviewers.

    SEARCH ENGINE OPTIMISATION:

    Tips for making sure articles can be easily found online are available in the attached PDF.

    Please ensure that your keywords accurately reflect the content of your manuscript.

    I look forward to receiving your revised paper. Please do not hesitate to contact me at jan@wiley.com if there is anything in this letter that needs more explanation.

    Thank you choosing JAN for your paper.

    Yours sincerely,

    Professor Yu Doris
    Editor
    Journal of Advanced Nursing

    Decision letter by
    Cite this decision letter
    Reviewer report
    2019/11/16

    Firstly, I congratulate to the authors! I consider that they had done a great work! Thank you for giving me the opportunity to revise this manuscript. I found this paper particularly interesting.
    I appreciate you will have put in a lot of effort in preparing your paper and there are a number of points which I offer to assist with further developing the manuscript:
    - In page 4, “search methods” section, I think that the authors can use parenthesis for the synonyms in search strategy. Ej: (old OR elder OR aged OR senior) AND (dementia OR Alzheimer OR “cognitive impairment*”) AND ….
    - I consider that the PRISMA flow chart (Figure 1) it would be better described at end of “search outcomes” section.
    - How were the quality of each article evaluated? Explain it! It would be interesting show the results of quality analysis of each article.
    - In “limitation section”, other limitation could be that the search strategy might not be fully comprehensive.
    Finally, the authors present the differing aspects of your research in an appropriate way and this allows the reader to follow the study and understand the approaches, analysis and discussion of findings. I hope that your publication will be publish in Journal of Advanced Nursing.

    Reviewed by
    Cite this review
    Reviewer report
    2019/10/26

    Thank you for the opportunity to review this paper which is a systematic review of elder abuse within the relationship between family caregivers and persons with dementia. This is a very important topic, and there is great benefit in synthesizing what is known about variables characterizing relationships that are associated with abuse, in order to prevent, screen for and mitigate abuse.

    Comments:
    1) Title: The title is appropriate and descriptive.
    I wonder if stating 'older people with dementia' would be more accurate for this paper than stating 'memory disorders'? or were people without dementia also included in the studies?

    2) Research question: This study addresses an important research question.
    I believe the authors could articulate the question more clearly on p4 and in the abstract. For example the authors could clarify, "this study aimed to synthesize what is known about/what is the nature of elder abuse and relationship factors associated with abuse between caregivers and persons with dementia".. or alternatively for example "what characteristics of caregiver and care recipient interactions have been explored in relation to elder abuse..."

    3) Background literature review: The authors have identified relevant literature to frame this review, including both a theoretical model and past empirical studies.
    a) I wonder if the authors could cite more recent studies than 1993 to describe the prevalence of physical and verbal harms experienced by caregivers from care recipients.
    b) I think discussing overall presence of elder abuse and the challenges of studying abuse would be relevant in the background
    c) I think the authors could describe the types of abuse (verbal, physical, psychological, financial) in more detail in the background, and remove these descriptions from the results
    d) I think the authors could emphasize/clarify the gaps in current knowledge more strongly to argue the importance of this review
    e) I would suggest referring to the model and figure describing caregiver/care receiver relationships earlier in the background, and defining the domains more explicitly to help the reader grasp the significance of the model and relevance to your study

    4) Methods: The authors describe methods for rigour and systematic screening, e.g., cite Equator guideline, performed independent double screening, agreed upon articles through discussion, and used the dyadic model for analysis.
    a) I would suggest stating the authors 'screened' titles and abstracts as opposed to 'reading' as this is a bit more familiar
    b) The authors describe discussing ‘next steps’ however this sounds contrary to following a rigorous protocol for SR. I wonder if discussions were aimed at resolving discrepancies around the inclusion/exclusion of articles? And agreeing upon data extracted?
    c) I would suggest removing the word ‘online discussion’ because I’m not sure the format (i.e., online) is important for readers
    d) Can the authors please synthesize the strengths and limitations of the studies? Was bias assessed? The authors mentioned a specific value was not given because weighting of the components was not equal, and that evaluation was based on the Equator model (i.e., structure etc.). Were any studies excluded because of the quality?
    e) What were the reasons for exclusion of articles and #s to be included in the PRISMA please after full-text screening?
    f) I would suggest labeling your method of analysis for clarity as ‘direct-content analysis’ (Hsieh & Shannon, 2007) or ‘theory-driven analysis’ whereby you used the conceptual model as a framework of codes or categories by which to analyze the data.
    g) I would suggest moving the full list of search terms to a table or appendix.
    h) I would suggest citing the Prisma Figure 1 in Methods and moving the citation of Table 1 to Results.

    5) Results reporting: The authors have used a conceptual model of elder abuse to categorize and understand the data within the included studies.
    a) Within the personal domain, I think it would be helpful to focus on the demographics/life history of caregivers / care recipients that were linked or explored relative to abuse. Currently the authors first describe ‘verbal abuse’ which makes it seem the personal domain is focused on verbal abuse.
    b) Similarly it seems the Physical and Psychological domain initially focuses on physical and psychological abuse and measurement, instead of physical/psychological factors linked to abuse
    c) In all results paragraphs it would be helpful if authors clarified the variables considered when opening the paragraph and describe the abuse outcomes afterwards. I believe explicitly stating 2-3 prominent variables would be helpful for readers to understand what was examined in that domain, and what relationships to abuse (and types) were found
    For example, perhaps open the personal domain paragraph by outlining “Factors/characteristics including gender, age, attitude relative to elder abuse were examined”
    “Gender of the caregiver was explored relative to elder abuse in (n=2) studies, and relationships were found…..”….
    “Age of the care recipient was linked to elder abuse in (n=x) studies….”
    “Specifically, characteristics of caregivers (including gender, etc) were linked to verbal abuse in (n=x) studies”.

    6) Discussion: The authors identify literature to compare to the findings of the review and highlight significant variables explored in relation to elder abuse in the review (e.g, stress, previous relationship, social support.)
    a) I think it would be helpful if the authors clarified and organized these key findings a bit more in the discussion.
    b) Did any studies discuss reporting of abuse as a problem? I think it is an important point the authors make in regards to reporting and disclosure, and the difficulty of studying this problem when it is often hidden.

    7) Limitations: The authors identify relevant, appropriate limitations.
    a) I think an additional limitation is the difficulty in extracting data into single theoretical categories when they frequently overlap, and distinguishing categories from one another. For example: the authors discuss interventions to help caregivers psychological health under the personal domain, and then discuss psychological health in the following domain.

    8) Conclusion: Important and helpful strategies are outlined, however I think they would fit more appropriately in the discussion section as implications

    9) Writing Style: The paper flows well and it is interesting to read.
    a) A few paragraphs are very long and would benefit from separating into 2, and similarly some sentences are very long and shortening would help readers understand the argument / main point.
    b) I think overall editing to make the paper more concise and addressing a few spelling errors would be beneficial
    c) I suggest avoiding comments during results reporting, e.g., ‘only 2 studies..’ value laden, leave for discussion section
    d) I suggest avoid personifying literature, p3 “The current literature” could be replaced with “Interactional factors have not been identified within current literature…”

    In summary, I think the authors have completed an important review and that knowledge around the interacting characteristics of caregivers and care recipient relationships related to abuse are important for nurses to be aware of.

    Reviewed by
    Cite this review
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