[Violence against the elderly: analysis of the reports made in the health sector--Brazil, 2010]

Patterns of abuse of elderly people in Brazil: analysis of notifications

This study aimed to describe the characteristics of elderly people abuse notifications by gender and to assess notification patterns according to gender. We analyzed data from the Brazilian Information System for Notificable Diseases (SINAN) in 2017. We carried out a descriptive analysis of victim characteristics, violence, and the probable perpetrator according to gender. Pearson's χ2 test was used to assess the significance between groups. Then, we verified the main relationships between the studied characteristics and the victim's gender by simple correspondence analysis (SCA). Thus, 17,311 cases/suspicions of elderly people abuse were notified, corresponding to 7.2% of the total number of violence notifications. Of these victims, 50.4% were white, 42.3% were married, and 17.2% had a disability/disorder; 76.9% occurred at home, 62.8% included physical violence, and 49.5% were cases of repeated violence. Most perpetrators were men (62%), and violence by two or more perpetrators was observed in 62.8% of the cases. SCA evidenced inequalities in older adults' gender, which proved to be higher among women. Physical violence was the most common among younger and old individuals, whereas neglect/abandonment tended to occur more frequently among the oldest individuals, and was most often committed by daughters. In sum, this study demonstrated evidence of gender-based violence, especially among older adults. Disability proved to be an essential characteristic for neglect/abandonment in older adults. In this context, policies are needed to reduce gender inequalities and implement a care network for older adults who are victims of violence.

Characterization and completeness of notification sheet of violence against the older adults in Niterói-RJ, 2011-2020

OBJECTIVE

to analyze the profile of violence against the elderly and the degree of completeness of event notification forms in Niterói, Rio de Janeiro, Brazil.

METHODS

this was a descriptive study having as its data source violence notification forms held on the Notifiable Health Conditions Information System for the period 2011-2020; analysis of form completeness was performed according to criteria proposed by the Ministry of Health.

RESULTS

of the 486 registered cases, physical violence was the most reported type of violence (48.1%), followed by psychological violence (22.2%) and self-harm (21.4%); the fields with the highest degree of incompleteness were victim's level of schooling (32.8%) and repeat violence (41.5%).

CONCLUSION

despite the increase in notifications in the period, predominantly of physical violence, completeness of some of the form fields continues to be poor, which reinforces the importance of training professionals to improve the reporting process and data quality.

ANALYSIS OF INTERPERSONAL AND SELF-INFLICTED VIOLENCE IN OLDER ADULTS

ABSTRACT Objective: to identify the prevalence of interpersonal and self-inflicted violence in older adults in the state of Espírito Santo and its association with victim and aggression characteristics. Method: this is a cross-sectional study with data on notifications of elder abuse registered in the state of Espírito Santo, Brazil between 2011 and 2018 in the Notifiable Diseases Information System (SINAN). Violence nature (interpersonal or self-inflicted) and victim and aggression characteristics were assessed. Multivariate analysis was conducted using Poisson regression with robust variance. The association was presented by Prevalence Ratio (PR) and 95% Confidence Interval (95%CI). Results: the prevalence of interpersonal violence was 85.0% (95%CI: 83.3-86.5), and of self-inflicted violence was 15.0% (95%CI: 13.5-16.7). Interpersonal elder abuse was associated with higher prevalence in female victims, aged 80 years or older, black/brown and without disability/disorder, with repetition history, with suspected use of alcohol, outside the residence, in urban areas and motivated by intolerances. On the other hand, self-inflicted violence among older adults was more prevalent in male victims, aged 60 to 69 years, white, with disabilities/disorders, when aggression occurred at home, without repetition history, without suspicion of alcohol use, in rural areas and without intolerance. Conclusion: Victim and aggression characteristics influence the occurrence of interpersonal and self-inflicted violence in older adults.

ANÁLISE DA VIOLÊNCIA INTERPESSOAL E AUTOPROVOCADA NA PESSOA IDOSA

RESUMO Objetivo: identificar a prevalência da violência interpessoal e autoprovocada na pessoa idosa no estado do Espírito Santo e sua associação com as características da vítima e da agressão. Método: estudo transversal com dados das notificações de violência contra a pessoa idosa registradas no estado do Espírito Santo, Brasil entre os anos de 2011 e 2018 no Sistema de Informação de Agravos de Notificação. Foram avaliadas a natureza da violência (interpessoal ou autoprovocada) e as características da vítima e da agressão. A análise multivariada foi conduzida por meio da regressão de Poisson, com variância robusta. A associação foi apresentada por razão de prevalências (RP) e intervalo de confiança de 95% (IC95%). Resultados: a prevalência da violência interpessoal foi de 85,0% (IC95%: 83,3-86,5), e da autoprovocada foi de 15,0% (IC95%: 13,5-16,7). A violência interpessoal contra a pessoa idosa esteve associada a maiores prevalências em vítimas do sexo feminino, com 80 anos ou mais, de cor preta/parda e sem deficiência/transtorno, com histórico de repetição, com suspeita de uso de álcool, fora da residência, em zonas urbanas e motivada por intolerâncias. Já a violência autoprovocada entre pessoas idosas se mostrou mais prevalente em vítimas do sexo masculino, com 60 a 69 anos, de cor branca, com deficiências/transtornos, quando a agressão ocorreu na residência, sem histórico de repetição, sem suspeita de uso de álcool, em zonas rurais e sem motivação por intolerâncias. Conclusão: as características da vítima e da agressão influenciam a ocorrência da violência interpessoal e autoprovocada na pessoa idosa.

Screening for Abuse of Older Adults: A Study Done at Primary Health Care Level in Punjab, India

BACKGROUND

Little is known about elder abuse in the domestic environment. In lower-middle income countries like India, the demographic transition is throwing novel challenges. The older adults are relatively more vulnerable because of coexisting medical and psychological problems. Any form of abuse affects mental health and increases the chances of anxiety and depression among the older adults. The study aimed to assess the burden of abuse amongst older adults visiting a primary health care center of north India.

METHODS

This is secondary data analysis conducted on the data collected in the primary study between September 2017 and June 2018 in northern India among 311 older adult patients attending the noncommunicable disease clinic. Diabetes mellitus and hypertension were diagnosed as per standard guidelines. Vulnerability to Abuse Screening Scale (VASS) was used to assess elder abuse. Depression, anxiety, and loneliness were assessed by using the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, and University of California, Los Angeles (UCLA) loneliness 20-item scale, respectively. Multiple logistic regression was carried out to explore the factors associated with elder abuse after ruling out collinearity between independent variables.

RESULTS

About 24% of older adults experienced abuse in the last 12 months. One-fourth of the older adults reported vulnerability, nearly half reported coercion and dejection, and most of them reported experiencing dependence. Participants also had a high prevalence of anxiety (39%), depression (54%), and features suggestive of loneliness (38.6%). Multiple logistic regression analysis showed that abuse was predicted by educational status, per-capita income, and loneliness.

CONCLUSION

About one-fourth of the older adults experience abuse. This highlights the importance of routine screening of older adults at the primary care level.

Analysis of Repeated Violence Against Older Adults in a Brazilian State

Objective: To identify notified cases of repeated violence against older adults and its association with the characteristics of the victims, of the aggressor, and the aggression. Materials and methods: A cross-sectional study was conducted based on data recorded in the Information System for Notifiable Health Problems on interpersonal repeated violence perpetrated against older adults between 2011 and 2018 in Espírito Santo, Brazil. The data were analyzed employing Poisson multiple regression with robust variance. Results: The frequency of repeated violence was 50.1 % (95 % CI: 47.7-52.6). Being 80 years old or more, presenting disabilities or disorders, and having suffered violence by partners and/or children were associated with this condition in both genders. In aged men, violence was more frequently perpetrated by two or more aggressors and during the day, whereas aged women were more frequently assaulted in urban areas. Conclusion: The high frequency of repeated violence and the associations with the characteristics studied reflect the need for care to older adults with disabilities or disorders and the possible signs of burden in family caregivers that may result in situations of violence. Actions aimed at early detection and adequate assistance to the victims and to the aggressors are important to avoid the chronicity of the condition.

Characterization and Prevalence of Elder Abuse in Brazil

We aimed to assess the prevalence and characterize the profile of elder abuse in Brazil in this quantitative descriptive and exploratory study using a document analysis of cases of elder abuse against people aged 60 and over reported to Brazil's Notifiable Disease Information System (Sistema de Informação de Agravos de Notificação-SINAN) from 2009 to 2013. Association between age groups (older adults and non-older adults) and (a) characteristics of the victims (gender, age, and race), (b) characteristics of the violence (type of violence, place of occurrence, and repeated violence) and, (c) characteristics of the perpetrator (gender, suspected alcohol consumption, and victim-perpetrator relationship) were assessed using the chi-square test and odds ratios (OR) with a 95% confidence interval. Statistical significance was set at p< .05. Elder abuse accounted for 5.7% of all cases of violence, with a higher prevalence among women (54.3%). Older men and older white people were more likely to suffer violence compared with their non-older peers (OR=1.75 and OR=1.47, respectively). Financial abuse (OR=5.95), violence resulting from legal intervention (OR=1.24), repeated violence (OR=1.22), and torture (OR=1.08) were at higher chances of occurring among older adults. In all, 30.3% of the cases of elder abuse were perpetrated by their children and 22% of the perpetrators were suspected to have consumed alcohol. Older adults were 30 times more likely to be abused by their children and eight times by caregivers and presented 2.37 more chances of evolving to death due to violence and 1.8 more chances to suffer violence in the household. The cases of elder abuse reported to SINAN highlight the greater fragility of this population group. In addition to reporting this public health problem, governmental and non-governmental actions are necessary to provide older adults with a healthy aging and ensure their rights, dignity, and autonomy.

Presumption of sexual abuse in children and adolescents: vulnerability of pregnancy before 14 years

OBJECTIVES

to investigate the presumption of sexual abuse through the records of live births with mothers up to 13 years of age.

METHODS

this is a quantitative study, with an ecological design, carried out in Maceió, with data from the Brazilian Live Birth Information System from 2009 to 2017, based on Law 12,015/2009, on sexual crimes against the vulnerable, applying the presumption of violence in children under 14 years old.

RESULTS

nine hundred fifty-three births of children with mothers aged 10 to 13 years were recorded; 1.3% were reported as victims of sexual abuse; 20.3% declared to be married or living in a stable relationship. Records were concentrated in 04 neighborhoods, Guaxuma, Benedito Bentes, Tabuleiro do Martins, and Jacintinho.

CONCLUSIONS

there was a prevalence of pregnancy and marriage in girls under 14 years of age and scarcity of reporting presumed sexual abuse by health professionals.

Aggressions in urgency and emergency care in Brazilian capitals: perspectives of 2011, 2014 and 2017 VIVA Survey

OBJECTIVES

To describe the profile of care provided by aggressions in emergency units from the VIVA Survey 2011, 2014 and 2017 data, and to compare the evolution of six indicators over four (2011 to 2014) and seven years (2011 to 2017).

METHODS

Cross-sectional study, using data from the last three editions of the VIVA Survey carried out in the Federal District and in 19 Brazilian capitals. The types of occurrence were selected: aggression/mistreatment and intervention by a public agent. The weighted frequencies of the characteristics of the people assisted, of the aggressions, injuries and evolution of the cases were calculated, according to sex. Differences between proportions were compared using the χ2 Test. Six indicators were also selected and their evolution over the years was evaluated by means of the percentage variation and the 95% confidence interval.

RESULTS

In most cases of aggression, the individuals were black, young and adult, of both sexes. The main nature of the assaults was physical, reaching over 85% in all investigations, followed by negligence. In the comparison between 2011 and 2017, "neglect" aggressions had a significant increase in both sexes and in children and the elderly; aggressions of a "sexual" nature had a significant increase only in children.

CONCLUSIONS

The VIVA Survey is an important tool for Brazil's Violence and Accident Surveillance System, providing evidence for public health decision-making and for coping with and preventing violence.

Profile of care for violence against the elderly in urgency and emergency services: VIVA analysis Survey 2017

OBJECTIVES

To characterize the profile of violent events among the elderly and to investigate the association between demographic factors and characteristics of violence.

METHODS

Cross-sectional study using data from the Violence and Accidents Survey (VIVA Survey) conducted at the emergency services in 2017. Descriptive analys es of the characteristics of violence were performed, according to demographic factors, followed by the correspondence analysis, using the main characteristics listed in this group, and considering p < 0.05.

RESULTS

Among the studied victims, most were male; the most common type of violence was physical, the most frequently body part affected was the head, the main places of occurrence were home and the public area, and, most often, the perpetrator was unknown. The fact of the aggressor being the victim's partner was associated with violence among the female elderly , as well as the use of threats. At the same time, violence among the male elderly was associated to being assaulted in the street, by strangers, including thorax injuries and the use of sharp objects. Y ounger elders have suffered physical aggression mostly through strength/beating, inflicted by friends and reaching the upper limbs. Among the older elders, the negligence was more related to the household as the location where the violence occurred, aggression perpetrated by relatives, and violence affecting the lower limbs and multiple organs were related to negligence.

CONCLUSION

The study led to insights about the violence suffered by the elderly patients attending urgency and emergency services in Brazil. Knowing the victims' profile is important for directing policies and actions that aim at preventing and addressing the problem of violence against the elderly.

Neglect and psychological abuse of older adults in a Brazilian state: analysis of reports between 2011 and 2018

Abstract Objective: to identify the prevalence of neglect and psychological abuse of older adults and their associations with the characteristics of the victim, the aggressor and the type of aggression in Espírito Santo, Brazil. Method: a cross-sectional study, with data on reports of neglect and psychological abuse of older adults registered in the Espírito Santo Reports of Disease and Harm Information System between 2011-2018. Analyzes were conducted according to the type of abuse and the independent variables were composed of the characteristics of the victim, the aggressor and the type of aggression. For multivariate analysis, Poisson Regression with robust variance was used. Results: during the study period, 296 cases of neglect (18,1%; CI95%: 16,31-20,04) and 193 cases of psychological abuse (11,8%; CI95%: 10,32-13,46) were reported. Neglect was more prevalent against older adults aged 80 years and over, who were black, had a partner, and were disabled, and was often committed by the victim’s son(s) or daughter(s), in their home, in urban areas, in an unmotivated and chronic manner. Psychological abuse was associated with women, perpetrated by men, after alcohol consumption, motivated by intolerance, in the urban area and carried out in a chronic manner. Conclusion: the characteristics of the victim, aggressor and aggression were associated with the occurrence of negligence and psychological abuse differently for each type of abuse. Such abuse is often committed in a veiled manner, and thus goes underreported. It is believed that with the diffusion of knowledge and the carrying out of new studies will contribute to the confrontation, monitoring and prevention of this disease.

Profile of violence against older individuals registered at the Dial 100 in the period 2011-2015 in Brazil

OBJECTIVE: To analyze the profile of the reports of violence and abuse against older people registered in the Dial 100 helpline from 2011 to 2015. METHODS: This was a descriptive, retrospective study, based on a sample of 130 164 denunciation reports of the Dial 100. The data collection considered the following variables: city, sex, age, race, place of abuse, type of abuse, and the victim’s relationship with the suspect. RESULTS: The greatest number of reports was registered in the Southeast (42.27%), and the lowest in the North (6.79%). When we analyze the complaints per 100 000 inhabitants, we found as leading states in the ranking of complaints of violence against older people: Amazonas, Federal District, and Rio Grande do Norte. The main profile of possible victims was age from 76 to 80 years, predominantly women, and white. The main abusers were the victim’s children and grandchildren. The most frequent type of abuse was negligence (36.72%), followed by psychological abuse (28.46%), and financial abuse (20.45%). CONCLUSION: The Dial 100 helpline is one of the most effective tools for breaking the silence and invisibility of abuse and violence against older adults, offering a panorama of abuse denunciation in our country.

Analysis of violence against older adults in police reports

OBJECTIVE

To analyze a historical series of cases of elder abuse as described in police reports.

METHOD

Descriptive, retrospective and documentary study based on police reports issued at the older adult police department whose information was collected through an instrument developed by the researchers.

RESULTS

Five categories were identified: 1 - physical violence; 2 - violence report; 3 - psychological violence; 4 - habits related to psychoactive substance use; 5 - reasons for violence.

CONCLUSION

Elder abuse is a complex issue that requires intervention on the part of nurses by the report of incidents and provision of support to the victim.

Distribuição da morbimortalidade por violência em idosos no Rio Grande do Norte

Objetivo: analisar a morbimortalidade decorrente da violência e maus tratos contra idosos no Rio Grande do Norte (RN) (Brasil), no período de 2000 a 2010, e analisar sua distribuição espacial.Metodologia: estudo ecológico, utilizando o índice de Moran Local-lisa, com valor de p < 0,05, considerado para significância estatística. No estudo da morbimortalidade em idosos por agressões no RN, separada por sexo, os dados foram coletados a partir do datasus. A população estudada foi o grupo dos idosos residentes no estado do RN que faleceram ou foram internados em função de violência ou maus tratos no período analisado.Resultados: a mortalidade e morbidade por agressões no RN da população idosa entre 2000 e 2010 apontam maior incidência no sexo masculino (90 %) do que no feminino (85 %). Na análise geoespacial da mortalidade, destacou-se que no sexo feminino há maior concentração de casos nas áreas leste e central do estado e masculino nas regiões oeste e Agreste. Os dados sobre morbidade apontam concentração nas regiões leste e Agreste para as mulheres e para os homens nas regiões leste, oeste e central. Não houve significância estatística, provavelmente em função de número reduzido de ocorrências e isso pode indicar subnotificações.Conclusão: a identificação das áreas desfavoráveis aponta à necessidade de averiguar a existência de casos não notificados de violência contra idosos a fim de levantar dados que possam embasar a construção de estratégias conjuntas de enfrentamento a essas violações envolvendo saúde, assistência social e sociedade civil.

Report of multiple abuse against older adults in three Brazilian cities

This study analyses the multiple abuse against older adults reported to the elder abuse police units of three Brazilian cities from 2009 to 2013. This is a longitudinal and retrospective study carried out through the analysis of police reports (PRs) in the elder abuse police units of three Brazilian cities: Ribeirão Preto (SP), Teresina (PI), and João Pessoa (PB). Descriptive statistical analysis consisted of absolute and percentage frequencies. The chi-square test, Fisher's Exact test, and Relative Risk (RR) were used to analyze the data, with a 95% Confidence Interval (CI) and a significance of 5%. A total of 2,313 reports of older adult abuse were analyzed, of which 245 (10.6%) were related to reports of multiple abuse, 49.4% in Ribeirão Preto, São Paulo, 22.9% in João Pessoa, Paraíba, and 27.8% in Teresina, Piauí. Most of the victims of recurrent older adult abuse are female and younger elderly. Psychological abuse was the most recurrent, followed by financial abuse, occurring in the victim's own home. In João Pessoa, older women and elderly living with their abusers were at a higher risk of report of multiple abuse acts. In Ribeirão Preto, living with the aggressor was a risk factor for multiple violent acts. In the total population of the study, living without companion and not living with the aggressor were identified as protective factors against recurrent violence. The need to implement social and legal actions to improve safety for the more vulnerable groups is emphasized.

Economic-financial and patrimonial elder abuse: a documentary study

ABSTRACT Objective: To analyze economic-financial and patrimonial cases of elder abuse, recorded in the specialized police station for security and protection of the elderly of a capital city in the northeast region of Brazil. Method: A cross-sectional study was carried out with data extracted from police reports and inquiries recorded in the abovementioned police station. Descriptive and inferential statistics were carried out by means of Pearson’s chi-square test or Fisher’s exact test, and multivariate logistic regression. Results: The sample was made up of 555 police reports. The data showed that financial abuse presented a prevalence of 58.9%, and that older elderly people (67.9%), men (70.4%), and single (75.0%) presented a higher percentage of financial abuse compared with other types of violence, often occurring in public places, with 3.1 more chances of occurrence than at the elderly’s home. Regarding aggressors, women (73.5%), without suspicion of alcohol use (66.4%), and non-family members committed more financial abuse, evidencing 2.97 more chances of practicing it. Conclusion: In the period studied, financial abuse increased in its magnitude when compared with other types of violence, a fact that justifies researching the theme in order to prevent it.

Violência contra idosos em um município do sul de minas gerais: uma análise documental

Objetivo: analizar los casos de violencia contra ancianos en un municipio del sur de Minas Gerais (Brasil), en un periodo de 13 años. Materiales y método: estudio cuantitativo, retrospectivo, documental y analítico, que utilizó datos del Consejo Municipal del Anciano. La recolección de los datos referentes al periodo de 2004 a 2016 se dio en el primer semestre de 2017. Para el análisis de tendencia de los casos de violencia, se empleó la regresión lineal simple. Resultados: se registraron 389 denuncios; sin embargo, solo 273 caracterizaban denuncios de violencia contra el adulto mayor. En cuanto al agresor, el 39,56 % era de sexo masculino y el 43,59 % eran hijos de las víctimas. En relación con el tipo de violencia, se destacó la negligencia (34,80 %), seguida de la violencia psicológica (16,12 %) y financiera (8,79 %). Se evidenció una relación estadísticamente significativa entre el sexo de la víctima (p = 0,017), la relación entre víctima y denunciante (p < 0,001) y la relación entre víctima y agresor (p < 0,001), con el tipo de violencia. Conclusión: la violencia contra el adulto mayor en tal municipio implica, sobre todo, a los familiares de los individuos. Hay necesidad de capacitar a los profesionales que atienden estos casos y hay que elaborar una herramienta completa y estandarizada para el registro de incidencias y ampliación de investigaciones en el área, con el fin de que se implanten acciones que combatan la violencia contra el anciano.

Violência velada e revelada contra idosos em Minas Gerais-Brasil: análise de denúncias e notificações

RESUMO O estudo caracterizou a violência contra idosos, a partir de denúncias e notificações registradas no Disque Direitos Humanos e Sistema de Informação de Agravos de Notificações (Sinan) em 2011 e 2012. Ocorreram 2.337 denúncias (13%) e 1.886 notificações (5%) contra idosos. A taxa de denúncia aumentou três vezes, e a de notificação duplicou no período. Verificou-se que as vítimas, na maioria, são mulheres, agredidas no domicílio (90%) por conhecidos (90%), com predomínio (80%) da tipologia por negligência/abandono, nas duas fontes. O aprimoramento da vigilância contribui para revelar a violência em todos os seus disfarces, efetivar políticas públicas e estimular reflexão/ação da sociedade.

Violence against the Brazilian elderlies: an analysis of hospitalizations

OBJECTIVE

to identify the prevalence of physical aggression and neglect and abandonment in the hospitalizations of Brazilian elderly people for violence and assault from 2008 to 2013 and the association of these causes with socio-demographic variables related to hospitalization.

METHOD

quantitative, descriptive, cross-sectional study with elderlies hospitalized for assault.

INCLUSION CRITERIA

to be 60 years old or over, to have been hospitalized in the Unified Health System (SUS) for assault or neglect and abandonment, between 2008 and 2013. The data were collected in February 2016, in Datasus database and descriptive and inferentially, using the Chi-square distribution, in the Epi Info 3.5.4 program.

RESULTS

the prevalence of hospitalizations due to assaults and violence prevailed among 60 and 69 years old men in the public sector. For abandonment and neglect, there was a higher prevalence in women, over 80 years old, in the public sector.

CONCLUSION

nurses must be able to identify and prevent violence against the elderly.

Violence and Primary Health Care in Brazil: an integrative literature review

Violence is a challenge for health services in Brazil, especially within primary care. This study analyses national publications on violence and Primary Health Care. An integrative literature review was conducted resulting in a final sample of 18 articles. The most predominant theme was violence against women (nine articles), followed by violence against children and adolescents (four articles), and violence against the elderly (three articles). The population group that accounted for the least number of publications was men, with two articles. The studies show the invisibility of violence in primary healthcare services in Brazil and the need to reorganize the work process beyond a complaint-based approach towards a sociocultural approach based on intersectorality. Comprehensiveness and intersectorality are essential elements of an effective violence care network.

Violence against the elderly: the conceptions of nursing professionals regarding detection and prevention

OBJECTIVE

To analyze the conceptions of the nursing professionals working in Basic Health Units regarding the detection and prevention of violence against the elderly.

METHODS

Descriptive, exploratory, qualitative study. Performed in two BHUs in Mossoró/RN, using a semi-structured interview script, from March to August of 2013. Sample composed of four nurses and six nursing technicians. The content analysis, pre-analysis, material exploration, and treatment of results were performed.

RESULTS

Four categories were identified: Strategies used to identify violence against the elderly; Types of violence against the elderly; Conduct used after finding a suspicion of violence; SUS and the problem of violence against the elderly. Many professionals recognize/distrust possible cases, however, they do not know how to proceed. The dimension of the problem requires that pragmatic interventions be performed in the clinical setting and in the social context.

FINAL CONSIDERATIONS

There is a need for continuing education for professionals and greater communication between the bodies responsible for reporting and embracement.

Treatment for cases of violence by Brazilian emergency services focusing on family relationships and life cycles

This article analyzes data regarding cases of domestic violence treated by the emergency services through the following: the sociodemographic characteristics of the people who were treated; the events themselves; the evolution of care (from childhood to old age by gender); and the factors that differentiate cases of domestic violence compared to those committed by non-family members. Data from 24 Brazilian state capitals and the Federal District were analyzed, comprising 86 emergency services: a total of 4,893 individuals were surveyed. Of those people who were treated by emergency services, 26.6% suffered domestic violence: 40.0% were children/adolescents, 57.2% were adults and 2.8% were elderly. The adjusted model, which compared victims of violence committed by other family members with those who were not family members, showed that males were less likely to suffer from domestic violence; those that had fewer years of education were at increased risk; and that women were more likely to commit domestic violence compared to the category of "both genders". This study reinforces the fact that health sector professionals need to be able to deal with domestic violence by providing support, performing good practices, abiding by care protocols, taking care of injuries, and facilitating access to other services.

Notification of intrafamily violence against elderly women in the city of São Paulo

Abstract Objective: the aim of the present study was to characterize the population of elderly women who have suffered sexual and physical violence and describe the characteristics of this aggression. Method: a cross-sectional study was carried out using secondary data from the Violence and Accident Surveillance Information System, which registers reports of physical and sexual violence against the female population aged 60 and older. Results: in 2013 289 acts of physical violence against elderly women in the city of São Paulo were recorded, and sexual violence was reported in ten cases. Conclusion: physical and sexual violence occurred mainly in the family environment, with the majority of aggressors male and a family member or known to the victim. In their direct and daily dealings with elderly health service users at all levels of complexity, doctors should know how to investigate and identify cases of violence, properly approach patients, act in coordination with other professionals and apply interventions that are effective for each case.

Cross-sectional study on the association between frailty and violence against community-dwelling elderly people in Brazil

BACKGROUND

The physical, emotional and cognitive limitations that may be present in the aging process, coupled with family unpreparedness, may lead to greater dependence among the elderly. This favors development of frailty syndrome and greater levels of violence against the elderly. The objective here was to analyze the association between violence against the elderly and frailty; and the geographic distribution of violence against the elderly according to the presence of frailty syndrome.

DESIGN AND SETTING

Cross-sectional study on 705 community-dwelling elderly people in Uberaba (MG), Brazil.

METHODS

The Fried frailty phenotype and conflict tactics scale were used. Data were analyzed using descriptive statistics, the chi-square test and a logistic regression model. The intensity of the events and the relationship between clusters of violence and frailty status were assessed by means of kernel estimation.

RESULTS

The adjusted analysis indicated that pre-frailty and frailty were associated with physical and verbal aggression (odds ratio, OR = 1.51; 95% confidence interval, CI: 1.04-2.19; OR = 2.12; 95% CI: 1.29-3.47), frailty was associated with physical aggression (OR = 2.48; 95% CI: 1.25-4.94) and pre-frailty and frailty were associated with verbal aggression (OR = 1.48; 95% CI: 1.03-2.15; OR = 2.15; 95% CI: 1.31-3.52), respectively. Regardless of frailty status and its relationship with violence, clusters of occurrences were larger in similar regions in the southeastern part of the municipality; but superimposition of overlays relating to aggression showed that for frail individuals the clusters were smaller than for non-frail and pre-frail individuals.

CONCLUSIONS

The condition of frailty was associated with greater chances of violence against the elderly.

Violência cometida por pessoa conhecida - Brasil, 2013

Resumo O objetivo deste artigo é descrever a prevalência de violência cometida por pessoas conhecidas segundo características demográficas. Trata-se de estudo descritivo, a partir dos dados obtidos em inquérito de base populacional, a Pesquisa Nacional de Saúde, realizada no Brasil em 2013. Foram analisados dados da população adulta (≥ 18 anos) em 64.348 domicílios. Calcularamse as prevalências e seus respectivos intervalos de confiança de 95% (IC95%) segundo sexo, faixa etária, escolaridade, cor/raça, zona de residência e região geográfica. A prevalência de violência cometida por pessoa conhecida foi de 2,5% (IC95% 2,3-2,7), significativamente maior nas mulheres (3,1%; IC95% 2,8-3,5) quando comparadas aos homens (1,8%; IC95% 1,6-2,1), na população jovem de 18 a 29 anos (3,2%; IC95% 2,8-3,7) em relação aos mais velhos (1,1%; IC95% 0,8-1,3) e nos residentes das Regiões Norte (3,2%; IC95% 2,5-3,8) e Nordeste (3,0%; IC95% 2,5-3,8) em comparação aos da Região Sudeste (2,0%; IC95% 1,6-2,3). A violência foi observada em maior prevalência no sexo feminino, comprovando a ocorrência da ‘violência de gênero’ e confirmando sua existência em todas as regiões geográficas e nos diferentes grupos populacionais do Brasil, em 2013.

[Challenges facing health professionals in the notification of violence: mandatory implementation and follow-up procedures]

The notification of the occurrence or suspicion of violence is mandatory for health professionals and is a key tool for epidemiological surveillance and the definition of public policies for prevention and intervention. However, professionals feel unprepared for this assignment, which renders underreporting prevalent. To address this issue, the objective is to identify the means available to the professional to submit notification as well as ensure due process follow-up. For this purpose, research and document analysis was conducted in Brazilian legislation, ordinances, and government programs, codes of ethics and consultation of the literature in databases on the subject over a period of five years to establish a brief comparative analysis with other countries. The conclusion drawn is that while some measures are inapplicable, knowledge about the appropriate process for the notification and routing to specific organs will enable healthcare professionals to make the appropriate decisions for the protection and safety of the victim, besides the measures in order to change this situation of violence in the country.

Mortalidade e anos de vida perdidos por violências interpessoais e autoprovocadas no Brasil e Estados: análise das estimativas do Estudo Carga Global de Doença, 1990 e 2015

RESUMO: Objetivo: Analisar a mortalidade e os anos de vida perdidos por morte ou incapacidade (Disability-Adjusted Life Years - DALYs) por violências interpessoais e autoprovocadas, comparando 1990 e 2015, no Brasil e nas Unidades Federadas, utilizando estimativas produzidas pelo estudo Carga Global de Doença 2015 (GBD 2015). Métodos: Análise de dados secundários das estimativas do GBD 2015, com produção de taxas padronizadas de mortes e DALYs. A principal fonte de dados de óbitos foi o Sistema de Informações sobre Mortalidade, submetido à correção do sub-registro de óbitos e redistribuição de códigos garbage. Resultados: De 1990 a 2015, observou-se estabilidade das taxas de mortalidade por homicídios, com variação percentual de -0,9%, passando de 28,3/100 mil habitantes (II 95% 26,9-32,1), em 1990, para 27,8/100 mil (II 95% 24,3-29,8), em 2015. As taxas de homicídio foram mais altas em Alagoas e Pernambuco, e ocorreu redução em São Paulo (-40,9%). As taxas de suicídio variaram em -19%, saindo de 8,1/100 mil (II 95% 7,5-8,6), em 1990, para 6,6/100 mil (II 95% 6,1-7,9), em 2015. Taxas mais elevadas ocorreram no Rio Grande do Sul. No ranking de causas externas por Disability-Adjusted Life Years (DALYs), predominaram as agressões por arma de fogo, seguidas de acidentes de transporte e em sexto lugar lesões autoprovocadas. Conclusões: O estudo aponta a importância das causas externas entre jovens e homens na morte prematura e em incapacidades, constituindo um problema prioritário no país. O estudo Carga Global de Doença poderá apoiar políticas públicas de prevenção de violência.

Psychometric properties of the Vulnerability to Abuse Screening Scale for screening abuse of older adults

OBJECTIVE

Adapt and evaluate the psychometric properties of the Vulnerability to Abuse Screening Scale to identify risk of domestic violence against older adults in Brazil.

METHODS

The instrument was adapted and validated in a sample of 151 older adults from a geriatric reference center in the municipality of Belo Horizonte, State of Minas Gerais, in 2014. We collected sociodemographic, clinical, and abuse-related information, and verified reliability by reproducibility in a sample of 55 older people, who underwent re-testing of the instrument seven days after the first application. Descriptive and comparative analyses were performed for all variables, with a significance level of 5%. The construct validity was analyzed by the principal components method with a tetrachoric correlation matrix, the reliability of the scale by the weighted Kappa (Kp) statistic, and the internal consistency by the Kuder-Richardson estimator formula 20 (KR-20).

RESULTS

The average age of the participants was 72.1 years (DP = 6.96; 95%CI 70.94–73.17), with a maximum of 92 years, and they were predominantly female (76.2%; 95%CI 69.82–83.03). When analyzing the relationship between the scores of the Vulnerability to Abuse Screening Scale, categorized by presence (score > 3) or absence (score < 3) of vulnerability to abuse, with clinical and health conditions, we found statistically significant differences for self-perception of health (p = 0.002), depressive symptoms (p = 0.000), and presence of rheumatism (p = 0.003). There were no statistically significant differences between sexes. The Vulnerability to Abuse Screening Scale acceptably evaluated validity in the transcultural adaptation process, demonstrating dimensionality coherent with the original proposal (four factors). In the internal consistency analysis, the instrument presented good results (KR-20 = 0.69) and the reliability via reproducibility was considered excellent for the global scale (Kp = 0.92).

CONCLUSIONS

The Vulnerability to Abuse Screening Scale proved to be a valid instrument with good psychometric capacity for screening domestic abuse against older adults in Brazil.

Maus-tratos contra idosos em Porto Alegre, Rio Grande do Sul: um estudo documental

Resumo Este estudo objetivou verificar a prevalência e os tipos de maus-tratos sofridos por idosos, registrados na Delegacia de Proteção ao Idoso do município de Porto Alegre, Rio Grande do Sul. Além disso, buscou descrever o perfil da vítima e do agressor e identificar os motivos relacionados à ocorrência de maus-tratos nesse grupo etário. Realizou-se um estudo documental e retrospectivo com base nos boletins de ocorrência da Delegacia de Proteção ao Idoso de Porto Alegre registrados nos meses de abril e maio de 2011. Dos 224 boletins de ocorrência avaliados, 175 denunciavam situações de maus-tratos. Os maus-tratos psicológicos foram os mais frequentes, seguidos pelo abuso financeiro ou material. A vítima, na maioria dos casos, foi do sexo feminino e de baixa escolaridade. O agressor, geralmente, era do sexo masculino e familiar da vítima. Os resultados demonstram uma incidência significativa de maus-tratos contra idosos no município de Porto Alegre.

Physical and sexual aggression against elderly persons reported in the city of São Paulo

Objectives : To characterize the population of elderly people who have suffered physical and sexual violence, and describe the features of this aggression based on the Information System for Violence and Injury Surveillance (ISVIS) of the Municipal Health Department of the city of São Paulo. Method : A cross-sectional, retrospective study was performed of all cases of elderly victims of physical and sexual violence reported in São Paulo in 2013. Results : A total of 602 cases of elderly victims of physical abuse were reported, of which 52.3% were male. In the same period there were ten reported cases of elderly victims of sexual assault, 90% of whom were female. The main diagnosis of injury was head trauma (33.2%) and 65.0% of victims were discharged from hospital immediately. Conclusion : Physical abuse with the use of physical force was higher among male elderly persons, and sexual assault was higher among women. Most of the attacks took place at the residence of the elderly person, and were committed by family members.

Comparação do perfil de idosos ativos e não ativos do Programa Bolsa Família

OBJETIVOS: Descrever o perfil dos idosos do Cadastro Único da Assistência Social (CADÚNICO), da Secretaria Municipal de Assistência Social de Betim-MG e verificar se há diferença nas condições de vida entre ativos e não ativos inseridos no Programa Bolsa Família (PBF). METODOLOGIA: Estudo transversal com base nos dados secundários obtidos no CADÚNICO no período de janeiro de 2004 a janeiro de 2011. Os idosos foram divididos em dois grupos: ativos (aqueles que recebiam o benefício) e não ativos (aqueles que, apesar de cadastrados, não o recebiam). As variáveis sociodemográficas e de saúde analisadas para comparação entre os grupos foram: sexo, faixa etária, renda, raça/cor, escolaridade, estado civil, situação no mercado de trabalho, moradia e deficiência. RESULTADOS: Dos 8.555 idosos cadastrados, 14,1% eram ativos no PBF. A média de idade foi de 68 anos (mediana de 67 anos), com maior proporção de mulheres (58,0%). A mediana de distribuição da "renda" entre ativos foi de R$60,00 (Q1= R$40,00 e Q3= R$100,00) e de R$100,00 entre não ativos (Q1= R$60,00 e Q3= R$170,00). À medida que a escolaridade aumenta, menor a chance de o idoso estar ativo no PBF. Já para os idosos solteiros e divorciados, a chance de estar ativo no PBF era maior [OR 1,79 (IC 1,54-2,09); OR 1,46 (IC 1,20-1,78), respectivamente]. Sobre a presença ou ausência de deficiências, não houve diferença significativa entre os dois grupos. De modo geral, os idosos viviam em casa própria, construída com tijolo/alvenaria, com rede pública de água e esgoto, com iluminação própria e lixo coletado. CONCLUSÃO: O Programa Bolsa Família representa garantia necessária de renda mínima para o idoso em situação de vulnerabilidade social. Por outro lado, a comparação do perfil de idosos ativos e não ativos põe em relevo a limitação do programa, a saber, ser direcionado apenas aos mais necessitados, sendo incapaz de se estender, como direito, a todos cuja situação assim exige.

Perfil da violência contra a pessoa idosa na cidade do Recife-PE

OBJETIVO: Descrever o perfil da violência contra a pessoa idosa na cidade do Recife-PE. METODOLOGIA: Estudo descritivo de corte transversal, realizado no período de 2009-2012 na cidade do Recife-PE. Os dados foram obtidos do Sistema VIVA, que faz parte do Sistema de Informação de Agravos de Notificação (Sinan-Net); as variáveis foram apresentadas conforme a Ficha de Notificação/Investigação Individual de Violência Doméstica, Sexual e/ou Outras Violências. RESULTADOS: Foram estudados 242 casos; a maior parte das vítimas era do sexo feminino (59,00%), tendo como agressor predominantemente o filho do sexo masculino. A violência física foi a forma de agressão mais observada (44,96%), ocorrida, principalmente, nas residências (47,52%). CONCLUSÃO: Observou-se incremento na notificação de casos de violência contra a pessoa idosa; o perfil epidemiológico mais frequente dessa violência na cidade do Recife é semelhante ao apresentado pela literatura, em que as vítimas são do sexo feminino, pardas e sofreram violência física em sua residência perpetrada pelo filho do sexo masculino. Espera-se, com este estudo, auxiliar a construção de uma rede de proteção que impacte positivamente na redução dos casos de violência contra a pessoa idosa.