Study on elder abuse and neglect among patients in a medical college hospital, Bangalore, India

The relationship between social support and dimensions of elder maltreatment: a systematic review and Meta-analysis

INTRODUCTION AND AIMS

Many studies have investigated the relationship between social support and the prevention of elder abuse; however, their results are somehow inconsistent in terms of the association. This systematic review and meta-analysis aimed to investigate the published studies on the relationship between social support and the prevention of elder maltreatment.

MATERIALS AND METHODS

An electronic search was conducted until January 2023, using such databases as PubMed, Scopus, and Web of Science. The present research included cross-sectional, longitudinal, and case-control studies. Study selection, data extraction, and risk of bias assessment were conducted by two researchers independently. The Newcastle-Ottawa checklist was utilized to evaluate the quality of studies. The random effects model was employed to perform a meta-analysis.

RESULTS

In total, 32 studies were included in this systematic review, out of which 26 articles were eligible for meta-analysis. The results showed that 68.75% of the studies were of high quality, and there is a significant relationship between social support and elder maltreatment. Accordingly, the lack of social support increased overall maltreatment (odds ratio: 1.24, 95% confidence interval: 1.16-1.33; I2 = 92.3%, p = 0.000)). Moreover, lack of social support had an increasing effect on the level of psychological abuse (1.55, 1.18-2.04; 88.7%, p = 0.000), physical abuse (1.31, 0.42-4.11; 76.3%, p = 0.005), and neglect (2.02, 0.86-4.72; 87.9%, p = 0.000), which shows heterogeneities among the results of the included studies. On the contrary, the lack of social support showed a decreasing effect on financial abuse (0.92, 0.70-1.21; 62.1%, p = 0.022).

CONCLUSION

This systematic review provides evidence that social support in the form of structural or functional support may plays an important role in improving the quality of life of the elderly.

Relationship between emotional elder abuse and developmental function of the family

AIM

This study aimed to assess the relationship between emotional elder abuse and the developmental function of the family.

DESIGN

Community-based correlational cross-sectional study was conducted.

METHODS

Data were collected on 265 older adults from July to October 2019 in Tehran-Iran. The samples were selected by simple random sampling and they completed self-report tools: demographic information, emotional elder abuse developmental function in the family. Data analysis was performed using descriptive and inferential statistics and SPSS software v.16.

RESULTS

Mean score of the developmental function in the family was 67.38 (SD = 3.22, range = 0-129). There was a significant negative correlation between the total score of developmental function in the families and emotional elder abuse. Moreover, there was a relationship between the subscale of care and regulation, being attracted to human relationships, purposeful exchange, and creating representatives and ideas with emotional elder abuse.

Elder abuse and life-course victimization in hospitalized older adults in Sweden: prevalence and associations with mental ill-health

BACKGROUND

The prevalence of elder abuse has only rarely been investigated in Sweden and never in a hospital setting. Therefore, the aims of this study were to: 1) Estimate the prevalence of elder abuse and life-course victimization among hospitalized older adults in Sweden, 2) Explore factors associated with elder abuse in the same sample, and 3) Explore the associations between life-course victimization and mental ill-health.

METHODS

The study was conducted at a university hospital in Sweden. Adults over the age of 65 years admitted to a medical or geriatric acute care ward during spring 2018 were consecutively recruited. The participant rate was 44% (n = 135/306). Participants were assessed via a face-to-face interview about their experiences of elder abuse and abuse earlier in life. Mental ill-health was measured using a self-administered depression assessment (Patient Health Questionnaire-9), along with information about medications and diagnoses retrieved from medical records.

RESULTS

Altogether, 40.7% (n = 55) of the participants reported some form of abusive experience during their life course. The prevalence of elder abuse was 17.8% (n = 24), and 58% (n = 14) of elder abuse victims also reported victimization earlier in life. Being abused before the age of 65 was the only background factor associated with elder abuse (OR = 5.4; 95% CI 1.9-15.7). Reporting abusive experiences both before and after the age of 65 was associated with current anti-depressant medication (OR = 6.6; 95% CI 1.1-39.2), a PHQ-9 result of 10 or more (OR = 10.4; 95% CI 2.1-51.0), and nine or more symptom diagnoses (OR = 4.0, 95% CI 1.0-16.1). Being abused only before or after the age of 65 was not significantly associated with any mental ill-health outcome measure.

CONCLUSIONS

Elder abuse and victimization earlier in life are highly prevalent among hospitalized older patients, and our findings underline the importance of a life-course perspective both in research on elder abuse and in clinical practice. Identifying and caring for older adults who have been subjected to abuse should be a priority in health care.

Prevalence patterns and associated factors of elder abuse in an urban slum of eastern India

BACKGROUND

The prevalence of elder abuse in various parts of the world has been reported between 2.2 and 90.4%. According to some studies conducted in India, elder abuse prevalence ranges between 9.6 to 61.7%. Yet, elder abuse is an underreported issue. Most available evidence shows the involvement of close family members and caregivers in the abuse of older adults. Several factors associated with various forms of elder abuse need to be studied further. This study has attempted to capture the prevalence, pattern and associated factors of elder abuse in urban slums.

METHODS

This study was a cross-sectional community-based study conducted between August 2019 to August 2020 in an urban field practice area of the All India Institute of Medical Sciences, Bhubaneswar. It covers four wards of the Bhubaneswar Municipal Corporation, served by the Urban Primary Health Centre, IRC Village, Nayapalli. A total of 360 participants aged 60 years and above were included in this study. They were interviewed using various semi-structured interview schedules. Validated study tools such as Activities of Daily Living (ADL- Barthel Index), Hindi Mental Scale Examination (HMSE), Geriatric Depression Scale (GDS), and Vulnerability to Abuse Screening Scale (VASS) were also used to assess various factors.

RESULTS

Approximately one in five (19.4%) older adults reported some form of abuse. The types of elder abuse reported were physical abuse in 12 (3.3%), verbal abuse in 25 (6.9%), emotional abuse in 40 (11.1%), and financial abuse in 15 (4.2%) older adult participants. The sons and daughters-in-law of the older adult participants were the main perpetrators of abuse reported. Depression and past history of abuse were found significantly associated with any type of abuse.

CONCLUSIONS

The prevalence of elder abuse in this study was considerably high, with 70 (19.4%) out of the 360 participants reporting some form of abuse. Emotional abuse was the most reported, and physical abuse was the least reported type. The most common perpetrators were those on whom the older adults depended, like their sons and daughters-in-law.

Travesty of Life Elders Abuse an Inquiry of Physical and Psychological Abuse

Elder abuse is evil in human society. The present paper unveils this social issue from two major factors psychological and physical abuse. The study sensitizes the subject matter of study by examining the effects of demographic variables like gender and age on elders. For achieving the purpose of the study the research is a design by exploring and validating the factors of measuring elder abuse through the mix method approach, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). To test the established hypotheses of the effects of the demographic variable on elders the two-way ANOVA was applied. The present study verdicts the development of a sound measurement scale with two influence factors. The separate and composite effect of aging and gender type on elder abuse was evidenced. These findings are crucial especially when the prevalence of elder abuse is higher during COVID-19. The limited novel understudied variable opens an avenue for further research in behavioral and demographic variables like marital status. The present study has practical insinuation for caring the elders in any human society like physical and psychological treatment of elders to avoid abusive situations. In addition, the study attempts to validate the novel issues like psychological and physical abuse of elders in the dimensions of demographic variables. Some rare studies in the Indian continent established the motivation of conducting the research on this dimension.

Injury Mechanisms of Hip Fractures in India

Purpose

Hip fractures are a major cause of morbidity and mortality in the elderly; however, the current literature on the injury patterns of hip fractures in India is lacking. Understanding the injury profile of these patients is important to develop targeted interventions to prevent hip fractures.

Materials and Methods

This was a prospective study of all hip fracture patients aged 50 years or older admitted from February 2019 to December 2019. Details about the injury were recorded by an in-person interview. Multivariate logistic regression analysis was used to identify the factors associated with any particular injury mechanism.

Results

Two hundred and eighty-three hip fractures were included. The mechanism of injury for the majority of patients was a fall from a standing height (n=217, 76.7%) while 60 patients (21.2%) were injured as the result of a road traffic accident (RTA). Slipping on a wet floor (n=49, 22.6%) and change in posture (n=35, 16.1%) were the most commonly reported reasons for falling. Pedestrian injuries were the most common form of RTA (n=29, 48.3%). Increasing age (P<0.001) and female sex (P=0.001) were associated with fall as the mode of injury while sustaining another fracture in addition to hip fracture (P=0.032) was associated with RTA as the mode of injury.

Conclusion

A fall from standing height is the predominant mode of injury among elderly hip fractures especially among women. Environmental hazards and postural changes are responsible for the majority of falls while pedestrian accidents contribute to a majority of the RTAs.

Impact of Sensitization of Family Caregivers upon Treatment Compliance among Geriatric Patients Suffering from Elder Abuse and Neglect

Geriatric patients in various outpatient department (OPDs) have been found to agonize from elder abuse and neglect (EAN). Such suffering imposes depressive states within individuals, which in turn affects treatment compliance. The objective of this study was to evaluate the impact of sensitization (psychotherapeutic) of family caregivers (FCGs) upon two denture treatment parameters (maintenance and treatment satisfaction) among EAN patients and compare the differences in outcome with non-abused patients. A survey of completely edentulous subjects (n = 860, aged 41–80 years) provided a sampling frame of 332 EAN patients from which 150 patients (including FCGs) fulfilling the study criteria were distributed (simple random, convenient) into two groups (Group A—control, Group B—test). FCG sensitization for subjects in Group B was performed by a clinical psychologist in 2–4 short (30 min) sessions. Demographic characteristics (frequency) were measured using a self-reported questionnaire, denture maintenance was measured using a denture hygiene index (scores), and treatment satisfaction was analyzed on a 10-point visual analog scale. Relevant data were calculated for means and absolute/relative frequencies. Any difference between two groups was estimated using an unpaired t-test while the level of relationship was determined by Karl Pearson’s test at a p-value of < 0.05. The results showed highest frequency (38.6%) for neglect, with elder neglect (EN) being most common (38.14% alone and 14% in combination). EN was found more if the FCG was a son (52%), in the age group (21–30 years), and with low education and low income (75%). Patients whose FCGs were counselled (Group B) demonstrated low denture plaque scores (mean = 1.38 ± 0.618), while demonstrating comparatively higher scores in six different parameters of treatment satisfaction. Differences between the two groups for both parameters were also found to be statistically significant. Psychotherapeutic counselling in the form of FCG sensitization brings better results of denture maintenance and treatment satisfaction.

Mediational Role of Self-efficacy between Selected Bio-psychosocial Factors and Elder Self-Neglect among Community-Dwelling Older Malaysian Adults

Elder abuse and neglect have been reported as significant public health and societal problem in many different societies across the world. In Malaysia, older adults recorded a high prevalence of neglect compared to other types of elder abuse. There is a dearth of empirical work on elder self-neglect (ESN) among the older population in Malaysia. This paper aims to explore the mediational role of self-efficacy on the relationship between selected biopsychosocial factors and ESN among community-living older adults in Selangor, Malaysia. This study utilized a cross-sectional survey to gather data from a representative sample of 202 older adults from Selangor. A newly developed scale of 16-items of elder self-neglect (ESN) was used in this study. The results showed that self-efficacy partially mediated the association between ADL, IADL, depression, and capacity of self-care on ESN. Self-efficacy also fully mediated the association between neuroticism, life satisfaction, social network, and education on ESN. These findings provided a deeper understanding of the phenomenon of self-neglect among older Malaysian adults. The results will also serve as a useful reference for professionals and policymakers to develop uniform guidelines, protocols, or programs to handle cases of elder self-neglect in the community.

The prevalence and associated risk factors of elder abuse among older people applied to the family health center in the rural district of Turkey

In this study, face-to-face interviews were conducted with older people who applied to the family health center (N = 152) in the traditional rural district of Turkey. Although the prevalence rate was 23%, the mean value of "Characteristics of the elder that make him or her vulnerable to abuse" subscale (X̄ = .37) was highest among other subscales. The mean values for "Characteristics of potentially abusive situations" (X̄ = .06) and "Overt violation of personal rights and direct abuse" (X̄ = .05) were quite low. The majority of the elder abuse prevalence was composed of participants who were vulnerable to elder abuse. The rural area makes older individuals vulnerable to abuse. Also, risk factors associated with elder abuse in rural areas were interaction with family (p = .000), interaction with neighbors/friends (p = .001), chronic diseases (p = .002), psychiatric diseases (p = .007), gender and marital status (p = .008), and additional income (p = .028), respectively. The only predictor of elder abuse in rural areas was family interaction. There was a significant negative relationship between rural elder abuse and family interaction (T= -4.239, p < .001).

Elder abuse and associated factors in eastern romania

BACKGROUND

This article explores elder abuse in a hospitalised population. We wanted to identify details related to psychological and emotional abuse in the older population in our region and to determine the importance of the Elderly Abuse Suspicion Index (EASI^© ) in comprehensive geriatric assessments.

METHODS

This cross-sectional study conducted between March 2015 and May 2016 included 386 consecutive hospitalised patients over 65 years of age. All patients underwent a geriatric assessment, data were collected about their medical history, and the EASI^© was administered to each. The main outcome was identifying the presence, the type of abuse and the factors associated with abuse.

RESULTS

There were 21.5% of patients who suffered any form of abuse. Women were more frequently abused than men. Emotional abuse was the most common (60.2%) followed by neglect (53%) and physical abuse (22.91%); sexual abuse was absent in our study group. The abused patients had an impaired cognitive function (P = 0.034). They were also malnourished (P ≤ 0.001) and depressed (P = 0.001). The presence of peripheral artery disease, stroke, pneumonia, chronic kidney disease, musculoskeletal diseases and anxiety correlated with the presence of abuse. No statistically significant correlation was found between the degree of independence in instrumental activities of daily living and the presence of abuse (r = 0.105, P = 0.051).

CONCLUSIONS

EASI is a tool for detecting elder abuse and should be included in the standard geriatric assessment to prevent ageism. The number of abused elderly patients is significant, and the multiple factors associated with abuse are diverse.

Prevalence of elder abuse and neglect: screening in Poland families

PURPOSE

Elder abuse and neglect is one of the most important problems of social and health policy among countries around the world. Making a real and reliable assessment of the occurrence of abuse is difficult to implement. The aim of this work is to show the frequency of physical, psychological, sexual abuse and financial exploitation among older adults.

METHODS

Older adults, who were aged ≥ 60 years (N = 200) were qualified for the study. The studied population consisted of 112 women (56.0%) and 88 men (44.0%). The whole project procedure only included filling in the survey questionnaire. The verification of hypotheses was based on tests: Chi square test, Chi square test with continuity correction and logistic regression models.

RESULTS

Within the obtained own results, out of 200 older adults, 77 respondents (38.5%) experienced abuse and neglect during the last 12 months. Most of the respondents (68.8%) experienced various forms of abuse simultaneously. Among those who experienced abuse, 75.3% experienced psychological abuse, 68.8% financial exploitation, 48.1% physical abuse, and 22.1% experienced sexual abuse. The rate of physical (OR 2.48; 95% CI 1.13, 5.44; p = 0.02), verbal (OR 1.94; 95% CI 1.02, 3.67; p = 0.04), sexual (OR 4.05; 95% CI 1.13, 14.5; p = 0.03) and economic (OR 1.98; 95% CI 1.02, 3.83; p = 0.04) abuse is statistically significantly higher, respectively, in women than in men. The level of education is a risk fact for physical abuse (p = 0.02). It has also been shown that singles, people with the income < 233 EUR and people living in urban areas are most often victims of elder abuse and neglect.

CONCLUSIONS

The results suggest that elder abuse and neglect is a fairly common phenomenon. Our data also provide confirmation of other researches conducted in this area.

Prevalence of Elder Abuse and its Association with Psychiatric Morbidity in a Rural Setting

Aim:

The aim of this study was to evaluate the prevalence of elder abuse in a rural setting. In addition, the study aimed to evaluate the association of elder abuse with psychiatric morbidity and demographic factors.

Methodology:

A total of 125 elderly (age ≥55 years) were evaluated for psychiatric diagnosis as per the International Classification of Diseases, 10^th revision (ICD-10) criteria by the qualified psychiatrist and were evaluated on Vulnerability to Abuse Screening Scale for elder abuse.

Results:

More than half (58.4%) of the participants had one psychiatric disorder, with depression being the most common. Elder abuse was seen in more than one-third (41.6%) of the study participants. Those with psychiatric morbidity had significantly higher prevalence of abuse. None of the demographic factors was associated with abuse.

Conclusion:

Elder abuse is highly prevalent in rural setting, especially among those with psychiatric morbidity.

Implications:

Considering the high prevalence of elder abuse, there is an urgent need to address the problem. Public awareness, education, and sensitization of people toward the abuse are need of the day.

A study on elder abuse in an urban resettlement colony of Delhi

Background:

In India, proportion of elderly is increasing with decrease in mortality rate and increase in life expectancy. There is a paucity of studies on elder abuse, a problem faced frequently by an elderly. The present study planned to find out the prevalence of abuse and associated risk factors among community dwelling elderly in an urban resettlement colony of east Delhi.

Methods:

It is a community-based cross-sectional study. This study was done among elderly residents aged 60 years and above in an urban resettlement colony of east Delhi. Study participants were interviewed using a pretested, semi-structured questionnaire. Data were collected regarding sociodemographic profile and prevalence of abuse. Simple descriptive tables were generated to denote frequencies. Cross-tabulation and chi-square test were applied to study the association between various sociodemographic characteristics and elder abuse.

Results:

A total of 125 elderly were interviewed. Twelve (9.6%) reported experience of abuse. All abused participants faced neglect, four faced verbal abuse, and two participants reported physical and one financial abuse. Abused elderly belonged to a higher age group >70 years and did not have regular contact with family and friends (P = 0.00; no involvement in social activities (P = 0.001). Abuse was more likely when “finances were managed by others” (P = 0.02) and having dependency for daily needs (P = 0.00).

Conclusion:

Elder abuse is prevalent in India. The victims of abuse lack social support and network and are reluctant to report abuse.

Prevalence and Predictors of Abuse in Elderly Patients with Depression at a Tertiary Care Centre in Saurashtra, India

CONTEXT

Elder abuse has devastating consequences such as poor quality of life, psychological distress and loss of property and security. Abuse of elderly patients with depression has not been adequately researched in India.

AIMS

To explore the prevalence and predictors of abuse and its relation to various sociodemographic variables in elderly patients with depression.

SETTINGS AND DESIGN

A cross-sectional, observational study carried out at a tertiary care centre in Jamnagar.

METHODS AND MATERIALS

In all, 100 elderly patients with depression, attending Out Patient Department of Psychiatry at Shree M. P. Shah Government Medical College and Guru Gobind Singh Hospital, Jamnagar, were selected using simple random sampling by lottery method. Actual Abuse Tool and Elder Abuse Suspicion Index were used to detect abuse. Geriatric Depression Scale was used to assess depression, and Mini Mental State Examination was used to rule out dementia.

STATISTICAL ANALYSIS

Descriptive statistics, Chi-square test, and binary logistic regression were used.

RESULTS

The prevalence of abuse was 24%. Among those who had experienced abuse, 50% had experienced psychological abuse, 17% had experienced neglect, 8% had experienced exploitation and 4% had experienced physical abuse. About 54% of patients with severe depression had experienced abuse. Daughters-in-law (54%) and sons (42%) were the most common perpetrators. Illiteracy and severe depression were found to be the predictors of abuse.

The impact of urbanization on mental health in India

PURPOSE OF REVIEW

India has experienced rapid urbanization in the last few decades. This review focuses on recent research related to the effects of urbanization on mental health with a specific focus on various population groups in urban India.

RECENT FINDINGS

With a specific focus on recent research undertaken amongst special populations such as youth, women and the elderly, the findings demonstrate increasing rates of substance use and technology addiction among youth; high self-harm rates in various groups such as adolescents and women; the effects of violence and abuse on the mental health of women; psychological distress among the elderly in modern urban India.

SUMMARY

The article highlights the direct and indirect effects of urbanization on mental health of various populations and emphasizes the need to develop individual-level and policy-level strategies to manage problems arising out of the same.