Screened but Not Recognized: Cultural Gaps in Elder Abuse Identification in Rural China

This mixed-methods study examines the gap between standardized screening outcomes and self-recognition of elder abuse among rural Chinese older adults, and the cultural frameworks shaping perceptions of mistreatment. Data from 432 participants aged 60-79 were collected using a three-item NSHAP screening tool, a direct self-report question, and open-ended questions. Thirteen percent screened positive (91.2% psychological, 3.5% physical, and 14.0% financial abuse), with spouses representing the largest single perpetrator category across abuse types. Yet none of the 57 screening-positive participants self-identified as abused. Qualitative findings indicated mistreatment was defined primarily as violations of filial piety-such as neglect, disrespect, disobedience, or failure to provide financial support, typically involving adult children or children-in-law. Spousal conflict or abuse was not mentioned. Findings reveal a cultural disconnect between Western-derived screening tools and local understandings, highlighting the value of culturally responsive approaches to abuse identification that consider filial norms and parent-adult child dynamics.