The prevalence of elder abuse and risk factors: a cross-sectional study of community older adults

Setting and participants

The population of this cross-sectional analytical study consisted of older people aged 60 years and older in Ardabil, northwestern Iran, who were selected through cluster sampling. Two healthcare centers were randomly selected from each region (central, northern, southern, western, and eastern). The older people were determined through simple random sampling in each healthcare center based on their family records.

The inclusion criteria were age 60 and above, willingness to participate in the study, no history of hearing impairment, no history of mental illness (self-reported), and ability to answer the questions.

The study population consisted of 500 older people over the age of 60 who had a history of receiving healthcare services at treatment centers in Ardabil. Based on a previous study and an estimated inactivity of 32% among older people, with a confidence level of 95% (d = 0.05, p = 0.32, z = 1.96), the sample size was calculated to be 334 according to the following formula [15]. Due to cluster sampling, the sample size was increased by 1.5 times, resulting in a final sample size of 500 individuals for examination (Eq. 1).

1

Data collection

The data were collected through interviews with older people in their homes from June to September 2020. These interviews were conducted using a structured interview protocol developed by the researchers and provided by healthcare providers. Phone calls were made to establish an initial agreement for in-home consultations with each selected individual. Then, after explaining the purpose of the study and obtaining informed consent during the visit, participants were privately interviewed.

Data analysis

The data were analyzed by SPSS software version 22 (Armonk NY: IBM Crop) using descriptive statistics (percentage and proportion). To investigate the relationship between the prevalence of abuse and demographic variables, the independent-sample t-test and one-way ANOVA were used. Predictors of participants’ prevalence of abuse were determined using logistic regression. The level of significance was considered to be 0.05.

Elder abuse

The prevalence of elder abuse (75.4%) was significantly higher than the estimated rates in India (50.2%) [18], the China (36.2%) [19], USA (35.0%) [20] and Iran (38.5%) [21]. Other cross-sectional studies reported lower rates of elder abuse at 60.3% and 63.3%, respectively, which were lower than the rates found in our study. Regarding age, 90.4% of participants had experienced at least one form of abuse, which is higher than what was reported in our study [6, 22]. This finding completely differs from studies conducted in developed and developing countries [23]. The prevalence level we observed was also higher than that reported in the Eastern Mediterranean region, where the rates were 43.7% in Egypt [24] and 4–6% in Saudi Arabia [25]. A systematic review conducted by Dong revealed that the prevalence of elder abuse varied significantly, ranging from 2.2 to 79.7%, across five continents [26]. These variations can be attributed to cultural, social, or methodological differences. Despite having a similar definition for elder abuse, the inconsistency in results could be due to the use of different research methods, non-probability sampling, inappropriate tools, and issues related to data collection reliability. According to the disengagement theory, elderly individuals often experience social isolation and receive less attention. Their needs are sometimes neglected, even though they still can contribute [27]. In Iran, one of the main reasons for the high prevalence of elder abuse is the passive and indifferent view towards older people, which has resulted in their exclusion from natural social activities. As mentioned, the percentage of elder abuse in Ardabil was approximately twice the global average and even higher than the national average. This could be attributed to differences in lifestyle, age, gender, marital status, children’s financial status, society’s general culture, and society’s perception of older people.

Emotional neglect and care neglect

Nearly half of all older adults in this study experienced emotional neglect. Neglect was the most prevalent form of abuse in Quddoosi’s study [28]. According to Carl Palmer et al.‘s research, the lowest rates of neglect were reported in Canada (0.4%), followed by Europe (0.5%) and the United States (1.1%) [29]. Conversely, India had the highest prevalence of neglect at 3.4% [30]. Another study in Nanjing, China, focused on the urban population revealed that 35% of older people individuals had experienced emotional abuse and neglect [31]. Christopher et al.‘s study also identified physical abuse as the second most common type of geriatric abuse after neglect [32].

In contrast to previous studies, Saatlou et al. [33] and Yang Ji Yan [34] found that emotional neglect ranked second after psychological abuse, with Mali ranking third in prevalence. According to the Disengagement theory of the older people from society, the older people is being neglected and forgotten, with their needs not being addressed. This neglect starts even before they reach the stage of imminent death when they are still capable of playing a role in society. It can lead to social and functional isolation and a lack of self-esteem [35]. The increasing busyness of work and family for children, especially in big cities and modern life, along with economic problems resulting in multiple jobs, distance, traffic, and mental fatigue, all directly and indirectly contribute to the lack of opportunity and attention given to older people.

On the other hand, there has been significant progress in the telecommunications industry in recent years. This has brought about a substantial change in communication methods. The current generation relies heavily on SMS, Telegram, Instagram, WhatsApp, etc., to communicate with others. However, most older people individuals do not have access to these facilities or possess the necessary ability to use them. Over time, this weakens communication between the older people and their children and grandchildren. As a result, emotional neglect increases.

Financial neglect and abuse

One-third of the elder population experienced financial abuse, which was higher than the reported rates in other African countries such as Nigeria (13.3%) [36], Egypt (27%) [24], and South Africa (24.4%) [37]. Older adults who are financially stable or dependent are often targeted by disadvantaged youth due to their vulnerabilities associated with old age. These vulnerabilities include a higher risk of neurocognitive disorders and functional dependence, making it difficult for them to manage their finances or seek financial assistance when needed [6]. Additionally, they may be more susceptible to making poor financial decisions and falling victim to fraudulent schemes. The increase in functional dependency as individuals age is a significant factor that increases the likelihood of various types of abuse, excluding sexual abuse, due to their increased vulnerability and need for assistance in daily activities. Elderly individuals with a high functional dependence impose a significant care burden on others, increasing the likelihood of abuse [38]. The study’s findings confirm that financial misconduct occurs in 35.2% of cases.

Physical abuse

The percentage of older adults experiencing physical abuse in this study (12.4%) was higher than what was reported in a systematic review of 20 studies conducted in most countries (0.2–4.9%) [39]. However, it is essential to note that the studies included in the review by Pillemer et al. (2016) measured physical abuse using a scale that primarily focused on intimate partner violence, excluding abuse from other potential perpetrators such as children, neighbors, and others – which were considered in our study [29]. This difference in measurement methods may explain the significant disparity in reported prevalence rates. On the other hand, our study’s prevalence of physical abuse was lower than reported in a Nigerian study (47.0%) [40]. This discrepancy may be attributed to the fact that other non-physical and not easily visible mistreatment may not be recognized as abusive behavior due to a lack of awareness among people. Consequently, these unrecognized forms of mistreatment may contribute to higher rates of overall misbehavior.

Factors associated with elder abuse

Elder abuse is a particularly intricate type of domestic violence that can be affected by numerous factors.

This study found that the severity of elder abuse escalated when the number of children increased, precisely when there were either 1–4 or 5 children.

The results of this study align with the research conducted by Pengcheng Du et al. [41]. Additionally, the original survey of Aslan and Arsi found a positive correlation between the number of children and various forms of abuse and neglect towards older individuals, including physical, psychological, financial, and sexual abuse [42]. It is probable that when there are more children in a family, some may have a greater likelihood of avoiding responsibilities towards their aging parents, while those obligated to provide care become more vulnerable to objections from their spouses. Consequently, this situation leads to increased abuse towards older people parents by their children.

Our research has found that chronic illness contributes to elder abuse, which aligns with the findings of studies conducted in other countries [43, 44]. This discovery is consistent with previous research [45, 17]. Unsurprisingly, individuals with disabilities often rely on others for assistance in their daily activities [46]. Other studies have also supported these findings [43, 44]. However, Murphy did not find a direct correlation between the physical dependency of older people individuals and elder abuse. Caring for aging parents with physical disabilities and chronic illnesses requires significant support and often involves personal sacrifices from caregivers and other family members [46] .

Similarly, Wolf emphasized in his study that there is no direct link between the physical dependency of older adults and elder abuse [47]. Caring for physically disabled or ill parents requires a lot of support and can often lead to sacrificing one’s career, which can impact the well-being of family members. It can create significant stress in one’s job and affect economic, mental, and physical health. The overwhelming pressure to provide daily care for elder parents can also lead to mistreatment. Additionally, older adults with chronic illnesses and physical impairments may be unable to defend themselves or report their abusers to the police due to their vulnerability and fear of neglect.

Limitation

This study is cross-sectional, and a prospective study should be conducted to find a causal relationship. Since the information regarding elder abuse was self-reported, it may be influenced by participants’ perceptions and biases. In the present study, the characteristics of abusers were not assessed, while mental disorders, substance abuse, and alcohol consumption may increase the risk of elder abuse. Lastly, the current research utilized an Iranian native tool and even considered a specific type of harassment and distress as elder abuse in the past year. Therefore, the prevalence of elder abuse may be higher than the current situation.

Ethics approval and consent to participate

The proposal of this study was approved by the ethics committee of Ardabil University of Medical Sciences with the code of ethics IR.ARUMS.REC.1398.038. Before inclusion in the study, participants were informed of the research purpose and method, and informed written consent was obtained from them. All procedures were performed according to the Helsinki declaration. Participation in this study was voluntary and the participants were informed that they could withdraw from the study at any stage. Ethical considerations such as the principles of confidentiality, anonymity, and confidentiality of information were also observed.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.