Letter to the Editor: Caregiver‐Related Risk Factors Contributing to AbuseTendency in Nursing Homes: A Structural Equation Model

We read with great interest the empirical study by Huang et al. (2026) titled ‘Caregiver-Related Risk Factors Contributing to AbuseTendency in Nursing Homes: A Structural Equation Model’. As researchers and clinicians specialising in elderly care and the mental health of caregivers, we highly appreciate the author's rigorous use of structural equation modelling (SEM) to reveal the complex connections between nursing stress, difficulty, job burnout, and abuse tendencies. They consider work burnout as a key mediating factor, filling a critical gap in previous related research and providing actionable evidence for reducing elder abuse in nursing homes, a problem with profound clinical and social significance in an aging society. The results of this study strongly resonate with our clinical observations. The prevalence of abusive tendencies among nursing staff is 40.7%, highlighting the urgent need for targeted intervention measures. The evidence that nursing difficulties and stress indirectly affect abusive tendencies through job burnout is consistent with the nursing staff stress theory. We attach great importance to the author's emphasis on modifiable factors, as it directs attention towards feasible system-level improvements (such as optimising staffing ratios and enhancing nursing capabilities) rather than individual blame, which is a key shift in addressing the issue of elder abuse. In our practice, implementing regular fatigue screening and resilience building programs for nursing staff has achieved initial positive results in reducing emotional exhaustion, which is consistent with the recommendations of this study. However, there are several considerations that may further strengthen the translation of these findings in clinical practice and future research: The cross-sectional design limits causal inference regarding relationship directionality. A longitudinal study that tracks nursing staff over a long period of time can elucidate how changes in nursing burden and fatigue affect abusive tendencies, providing stronger evidence for intervention timing. Although this study focuses on risk factors, identifying protective factors such as social support, organisational recognition, and flexible work arrangements can complement intervention strategies. For example, previous studies have shown that sufficient social support can buffer the impact of nursing stress on burnout, and incorporating these variables into future models may provide a more comprehensive understanding. Subgroup analysis: This study noted a significant gender imbalance, with 95% of caregivers being female, as well as the impact of nursing qualifications and dependency on caregivers on abusive tendencies. Further subgroup analysis: Comparing male and female nursing staff, as well as nursing staff with different training backgrounds, can reveal more risk characteristics, enabling more tailored intervention measures to be taken. The sample is limited to nursing homes in Wenzhou, Zhejiang Province. Reproducing this study in different geographical regions (such as rural and urban areas) and cultural backgrounds in China or internationally will validate the universality of the model, especially considering the differences in nursing home resources and nursing culture. Although the author suggests conducting fatigue screening and resilience programs, practical guidance on implementation will improve clinical applicability. The intervention research of testing these strategies in the future can provide evidence for scalable and cost-effective solutions. In summary, Huang et al.'s research has made valuable contributions to this field by elucidating the mediating role of job burnout in the tendency of nursing staff to abuse. Their research findings emphasise the need for a multi-faceted approach that prioritises the mental health of nursing staff and system level improvements. We believe that addressing the above issues will further enhance our ability to prevent elder abuse and create a safer and more supportive nursing environment for caregivers and residents of nursing homes. We look forward to conducting future research based on this influential work. Sanglin Zhao and Deng Hao: Conception, design, and writing original draft; all authors were involved in the final approval of the manuscript. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report.