The Prevalence of Abuse and risk factors associated with elder abuse

DOI: https://doi.org/10.21203/rs.3.rs-1863036/v1

Abstract

Background:

elder abuse is a neglected problem and many cases remain unreported. This study aimed to identify types of elder abuse and to investigate its associated risk factors.

Methods:

This cross sectional study was conducted on people over 60 years old in Ardabil, Iran. Data were collected using elder abuse questionnaire. Data were analyzed by SPSS version 22, Descriptive statistics, chi-square test and logistic regression. The significance level was P < 0.05.

Results:

Among 500 participants, 377(75.4%) reported that they had experienced at least one type of abuse in the past year. The highest rate of elder abuse was observed regarding Emotional abuse (47.2%) and psychological abuse (40.8%), and the lowest rate was measured for ostracizing (15.4%) and physical abuse (12.4%). Result showed that elder abuse was significantly associated with Having a chronic illness and Number of children 1–4.

Conclusions:

Considering at least eight out of ten elderly people experienced on type of abuse. for the majority of the reported elder abuse cases at least two associated risk factors could be identified. Knowledge about these red flags and a multifaceted strategy are needed to identify and prevent elder abuse.

Introduction

Across the globe, the population of older people is increasing and those aged 60 years and above will be above 2 billion by 2050[1]. One in every six older people aged 60 years and above has suffered at least one form of abuse in their lifetime[2], and their population is becoming more susceptible to various forms of abuse[3]. Elder abuse is a global public health and human right problem[4].The world health organization defines elder abuse ‘The behavior that elderly caregivers do consciously or unconsciously causes a decrease in the quality of life and an increase in physical and mental injuries of the elderly.’[5]. This ABUSE include physical, sexual, mental, economical and neglect[6]. Elder abuse has significantly adverse consequences for the health and well-being of the older population[7]. Studies reveal that abuse of older people can lead to serious physical injuries and long-term psychological consequences, decreased quality of life and premature death[8]. Khalili s showed that the elderly who encountered abuse had higher level of depression in comparison with the others[9].

From this conception, elder abuse is a social phenomenon that can occur in family relationships, therapeutic interactions, institutional homes, and communities[10].

By 2050, an estimate of 320 million older people would have been victims of elder abuse[11].

The number of older people experiencing abuse is predicted to increase as the global population of older people increases. Prevalence of elder abuse in both community and instructional settings estimated a pooled prevalence of 15% when reported by older adults themselves[12]. The overall prevalence of elder abuse was 48.3%. The highest prevalence of elder abuse was related to neglect with a prevalence of 38.4%, and rejection with a prevalence of 11% was reported as the least effective factor on the prevalence of elder abuse. Elder abuse is a complex interplay of individual, relationship, social and cultural factors, and ‘risk factors’ rather than ‘causes ‘is more commonly used in the of elder abuse[13].

Several studies have identified major correlates of elder abuse, which include age, sex, education, living arrangement socioeconomic status, chronic disease and disabilities[14].

Sathya study suggest a significant association of disability and functional ability with elder abuse[2].

Considering the diversity of Iranian culture and the important role of this issue in improving the health and quality of life of the elderly and the limited studies on this issue, conducting research such as the present study becomes necessary and can contribute to filling the existing gap. Therefore, the present study was conducted with the aim of determining the prevalence of abuse and its related factors among the elderly in Ardabil, Iran. It is hoped that the results of this study will help to identify the dimensions of this problem and the related factors to it in order to improve policies and planning in this field.

objectives

1. to estimate the prevalence and types of elder abuse in Ardabil city of Iran.

2. to determine the factors associated with elder abuse.

Methods

Study design

In this cross-sectional study in 2020 the Prevalence of Elder abuse and Associated Factors among the Elderly in Ardabil City were studied. The study population included 500 elderly aged over 60 years who had health care records in health centers in Ardabil city. According to previous study and estimation of inactivity in 32% of the elderly, confidence level of 95% (d = 0.05, p = 0.32, z = 1.96) the sample size was calculated to be 334 according to following formula [15]. It was increased to 1.5 fold due to cluster sampling, and finally 500 Individuals were investigated. (Eq. 1).

After coordination with the Department of Health and Medical Education and obtaining necessary permissions; the Ardabil city was divided into 5 regions (center, north, south, west and east) based on map. From each region, two healthcare centers were randomly selected. In each health care centers the elderly were determined from family records and the subjects were selected randomly based on the population covered by the center. The selected samples were examined by telephone calls. If they did not meet the inclusion criteria or were reluctant to participate in the study, another subject was replaced randomly. If the questionnaire had some missing data, the researchers contacted to the subject to complete the items and if it was not possible, another subject was replaced randomly. Then the researchers visited the houses of the selected samples and completed the questionnaires after fully explaining the objectives of the research. In elderly who did not have the ability to read and write the questionnaire was completed through interview. All methods were carried out in accordance with relevant guidelines.

Data collection

Questionnaire

The first part of the questionnaire contained demographic data including variables (such as age, gender, number of children, educational level, marital status, living arrangements, occupational status and residential situation, living arrangement, Economic dependency, chronic diseases, and use of mobility aids), were recorded. The second part of the questionnaire consisted of 49 questions in 8 subscales such of negligence, psychological, physical, and financial abuse, deprivation of authorities, and ostracizing, and financial and emotional negligence.

This tool can be completed with the options as: yes, no, and never mind. Scores questionnaire are in the range of 0-100; the highest scores indicate the highest level of abuse. Therefore, score 100 shows the maximum level of abuse and zero points to the lack of evidence regarding abuse.

The lowest score as zero devoted to no answers and the highest score as number one devoted to yes. The option never minds had no score; therefore, this option was deleted in interviews.

This tool was designed and validated based for the Iranian elderly who suffered from abuse, considering cultural characteristics of the Iranian community and found reliable, with satisfactory internal consistency (Cronbach α = 0.97) and test-retest reliability (r = 0.99)[16].

Inclusion criteria

inclusion criteria were age over 60 years, Iranian nationality, ability to speak Persian, lack of mental disorder, having full awareness during the study, and ability to answer the questions.

Exclusion criteria

Elderly people who did not willing to participate or did not meet the inclusion criteria were excluded from the study.

data analysis

The data was analyzed by SPSS software- version 22.0. the descriptive statistics for all categorical variables were presented as percentages or proportions in the results.

Employing Pearson correlation coefficient; the logistic regression analysis was used for the multivariate analysis. The significance level for all the tests was considered P value less than 0.05

Result

Out of 500 subjects participating in the current study, 258 (51.6%) were men and 242 (48.2%) were women. The mean age of the population under study was 69.15 ± 7.27 years, and the age ranged 60–70 years had the highest frequency (54.6%). Considering education level, the highest frequency belonged to primary subjects (49.2%) and only 13.2% were educated. Most of the subjects (51.4%) were unemployed and (64%) lived independently. Most of them (70.2%) were married, 83% had their own house. Of the total, 45.4% had no chronic diseases. Regarding mobility aids, 21% of the elderly used no mobility aids. The relationship between demographic and the associated factors, and the elder abuse is shown in Table 1. According to the results of Pearson chi square test, there was a significant statistical relationship between the level of elder abuse and demographic variables such number of children, home situation, illness background. The prevalence of different types of elder abuse is shown in Table 2.

Table 1

The relationship between demographic and the associated factors the elder abuse.

Variable

Category

Confirmed elder abuse a

No elder abuse a

P value*

Gender

Female

184(76)

58(24)

0.75

Male

193(74.8)

65(25.2)

Age (year)

60–69

202(74)

71(26)

0.71

70–79

130(77.4)

38(22.6)

≥ 80

45(76.3)

14(23.7)

Number of children

0

7(63.6)

4(36.4)

0.004

1–4

220(71)

90(29)

≥ 5

150(83.8)

29(16.2)

Marital status

Married

265(75.5)

86(24.5)

0.93

Widowed/single/separated

112(75.2)

37(24.8)

Educational level

Illiterate

145(77.1)

43(24.8)

0.20

Primary

188(76.4)

58(23.6)

Diploma and above

44(66.7)

22(33.3)

Living arrangement

Living with spouse

112(79.4)

29(20.6)

0.21

Living with spouse & children

140(70.7)

58(29.3)

Living with children

75(74.3)

26(25.7)

Living alone

50(83.3)

10(16.7)

Job

Unemployed

201(78.2)

56(21.8)

0.32

Employed

62(72.1)

24(27.9)

Pensioner

114(72.6)

43(27.4)

Residential situation

Leased

39(92.9)

3(7.1)

0.004

Landlord

300(72.3)

115(27.7)

Children's home

38(87.5)

5(12.5)

Home properties

Apartment

73(83)

15(17)

0.04

Home without a yard

102(68.9)

46(31.1)

Villa house

202(76.5)

62(23.5)

Economic dependency

Independent

237(74.1)

83(25.9)

0.25

Dependent

140(77.8)

40(22.2)

Chronic disease

No

156(68.4)

72(31.6)

0.001

Yes

221(81.2)

51(18.8)

Walking ability

Independent

193(74.8)

65(25.2)

0.11

Dependent

184(76)

58(24)

Use of mobility aids

No

85(82.5)

18(17.5)

0.06

Yes

292(73.6)

105(26.4)
a All data is presented as number or percent.
* Pearson chi square test

Table 2

Prevalence of various types elder abuse.

Any elder abuse

Confirmed elder abuse

No elder abuse

Emotional abuse

236(47.2)

264(52.8)

Caregiver abuse

130(26)

370(74)

Financial neglect

103(20.6)

397(79.4)

Deprivation of authority

184(36.8)

316(63.2)

Psychological abuse

204(40.8)

296(52.9)

Financial abuse

176(35.2)

324(64.8)

Physical abuse

62(12.4)

438(87.6)

Ostracizing

77(15.4)

423(84.6)

Any abuse

377(75.4)

123(24.6)
All data are presented as number or percent.

Among 500 participants, 377(75.4%) reported that they had experienced at least one type of abuse in the past year. The highest rate of elder abuse was observed regarding Emotional abuse (47.2%) and psychological abuse (40.8%), and the lowest rate was measured for ostracizing (15.4%) and physical abuse (12.4%).

To control for confounding factors, logistic regression analysis was performed using elder abuse as the dependent variable, and all variable that reached a P value less than 0.05 in the Pearson test were examined as the independent variables. Result showed that elder abuse was significantly associated with Having a chronic illness and Number of children 1–4 (Table 3).

Table 3

The multivariate logistic regression analysis of odds ratios (OR) for elder abuse among elderly.

Characteristics

β

SE

Wald x2

P

OR (95%CI)

Number of children

  

1–4

0.56

0.25

5.16

0.02

1.79 (1.081–2.88)

Chronic disease

  

yes

-0.52

0.22

5.65

0.01

0.53 (0.38–0.91)

Discussion

In the current study, 75.4% of the subjects had experienced at least a type of abuse within the last year, a result which was quite different in comparison with the results obtained in the studies conducted in developed and even developing countries. This level of prevalence was higher than that of reported in Australia, Canada and England (4–10%)[17, 18], USA (11.4%)[19], Hong Kong (21.4%)[20] and Spine (29.3%)[21]. Dong's systematic review ranged from 2·2% to 79·7% and covered five continents, with large geographic variations that might stem from cultural, social, or methodological differences[7].

Abuse is an old issue associated with the elderly, but is rarely reported and has remained hidden due to lack of an appropriate definition and knowledge. Most of the conducted studies regarding mistreating the elderly have led to disagreement between the researchers and have created an obstacle to compare the results, due to employing different research methods, non-probability sampling, relative agreement on the concept of mistreating the elderly, using improper tools and difficulties associated with reliable data collection. It may be the reason for this statistical difference. The current study showed that Emotional and psychological abuses are the most common types of elder abuse, which is compatible with that of pillmer et al and Yon[12, 22]. Results of Hulya Kulakci showed that most of the subjects had experienced emotional abuse, and physical abuse was experienced the least [23]. High prevalence of Emotional and psychological abuses among the Iranian Elderly Perhaps the relationship between child-parent and parental expectations of their children and the children of parents linked, on the other hand modern life and lack of time and focus on children to address the needs of parents Another likely cause of this type of abuse can be outlined. Also, the present study showed that ostracizing and physical abuse had the lowest prevalence; the studies of Yon[12] and Rubio[24]; confirmed this result. The similarity between types of elder abuse in developed countries and their differences with developing countries is probably due to the fact that elder abuse is influenced by the culture of that society. It should be noted that since other types of elder abuse are usually not visible, they may not be considered elder abuse due to the lack of awareness of the elderly and caregivers.

which results in more abuses. Elder abuse is a kind of severely complicated family violence, and many factors may affect it. In the current study, different associated variables, such as number of children, home situation and illness background the results showed significant statistical relationship between them and the level of elder abuse. Hence, results of the current study are compatible with those of the previous ones[15], and showed that the married elderly people and those who lived with their spouse encountered higher levels of abuse[25, 26]. The study of Li Wu, showed that the elderly people who live alone usually experience higher levels of abuse[27], and other studies indicated that being widowed can be considered as the high risk for experiencing abuse[28]; this may result from the fact that cohabitation increases the risk of conflicts and contacts; therefore, the level of abuse may increase in contrast. In the current study, elderly men were at higher risk of abuse than women; while, in the studies of Li Wu, Garre, and oh women had experienced higher abuse [21, 27, 29].This difference may result from different sampling methods, more men rather women in the population under study, or elderly women are more respectable and usually experience lower levels of abuse; This is because elderly women have responsibilities at home such as cooking or taking care of grandchildren. Also in the current study, adequate income, and having their own home were among the factors which increase the risk of financial abuse. But Hulya Kulakci's study found that these are risk factors for elder abuse[23].Chie Koga reported that having poor self-rated health, and having mild or severe depression are the factors for elder abuse [28].

Based on the findings of this study, it was expected that elderly people who live alone or have a good financial situation would experience less abuse, but contrary to this expectation, the findings showed that these people experienced higher levels of abuse. This may be due to high levels of emotional abuse. These elderly people are usually neglected by their children because they are financially independent and not dependent on their children. Also, abusers may have financial problems and be financially dependent on their elderly parents, which increase the level of abuse. Results of the current study showed no significant relationship between abuse, education level and job; while, in some other studies the level of education [23] and having a job[30], were considered as the factors associated with increasing abuse. Results of the current study showed the high prevalence of abuse among the elderly of Ardabil, Iran, and at least eight out of ten elderly people experienced one type of abuse.

Limitation

The following cases are among the limitations of the current study: It was a cross-sectional study and to find the cause affect relationship, a prospective study should be conducted. Since the information regarding elder abuse was self-reporting it may result from perception and prejudice of the participants. In the current study the characteristics of abusers have not been evaluated, while mental disorder, using drugs and alcohol may increase the risk of abuse. Finally, the current study used an Iranian local tool and has considered even a type of abuse within the last year as elder abuse; therefore, it may have estimated elder abuse higher than real current situation.

Conclusion

Eight out of ten elderly people who participated in the study reported at least one case of misbehavior towards themselves, and factors such as the number of children, the condition of the house, and the history of illness are effective risk factors. Advised with an interdisciplinary approach and discovers and adopts appropriate strategies for a team and identification of the victims, the creation of a coherent social and economic services, strengthening Social support networks and development of laws for the protection of the elderly, great steps are being taken in order to solve this important health and social problem.

Declarations

Acknowledgements 

The authors wish to thank the elderly who participated in the study for their cooperation. 

Authors’ contributions

 All authors (RN, ZKH, LGH, FGH) contributed to the study protocol and design. Data collection, manuscript drafting and tables preparation was done by RN and ZKH. Resources for data collection were provided by ZKH and LGH. Data analysis and manuscript review was done by ZKH. The author(s) read and approved the final manuscript.

Funding

The financial resources of the study were provided by Ardabil University of Medical Sciences, Iran.

Ethics approval and consent to participate

The study was approved by the Research Council and Research Ethics Committee of Ardabil University of Medical Sciences, No. IR.ARUMS.REC.1398.038 in 2020. The objectives of the study were explained to all the participants, and all of them signed a written informed consent before participation in the study. All the participants were informed that participation in the study is voluntary and were assured that their personal information would be treated confidentially. Informed consent was obtained from all participants prior to the study. Researchers were committed to consider the participant’s rights in accordance to the principles explained in the Declaration of Helsinki.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare no conflicting interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.

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