Prevalence and correlates of elder mistreatment in Singapore

"I (am) scared I will hurt him, then I will regret it forever": Singaporean caregiver perspectives and elder abuse risk

The global rise in aging populations presents concern about elder abuse risk. The caregiving burden for older adults predominately rests on informal caregivers, and caregiver stress and burnout are well-documented risk factors for elder mistreatment. In this qualitative study, we explored the perspectives of 19 informal caregivers in Singapore to better understand the contextual nature of the risk of elder abuse and mistreatment. Three themes explored: (i) the unbounded caregiver role and journey to caregiving; (ii) elder abuse risk, including relationship dynamics, caregiver emotions, and achieving compliance through fear, and (iii) protective strategies such as self-control, societal expectations, and external support. The findings present a nuanced picture of elder abuse, suggesting elder abuse risk is inherent in the caregiver role itself, with current prevention relying largely on caregiver self-regulation. Our study proposes that interventions to reduce elder abuse need to be integrated across individual, interpersonal, organizational, community, and societal levels.

Elder Abuse During COVID-19 Pandemic in Canada

The current study attempts to estimate the prevalence rate of, and factors associated with, elder abuse in Ontario, Canada. The data for this study was collected using a cross-sectional study design, which involved a Qualtrics survey. Various recruitment strategies were used to reach respondents, including Facebook advertisements, email listservs, and a Qualtrics research panel. The sample size consisted of 933 adults. The analysis for this study focused on 361 respondents aged 51 years and older. The prevalence rate of abuse was found to be 16.1% during the COVID-19 pandemic. Hierarchical logistic regression results revealed that the model's explanatory fit improved significantly after including family- and community variables. Factors that significantly increased vulnerability to abuse were male gender, living with others, family conflicts, ageism, loneliness, and COVID-19-related stressors. Innovative multisectoral and multilevel interventions are needed to prevent and deal with elder abuse during pandemics.

C. A, Bhandari S, Baral S. Abuse and its associated factors among elderly population of Kamalamai Municipality of Sindhuli District, Nepal

BACKGROUND

The global rise in the elderly population brings attention to the pressing issue of elder abuse, categorized into physical, psychological, neglect, financial and sexual abuse. According to the World Health Organization (2022), one in six individuals aged 60 and older has experienced some form of abuse in community setting necessitating increase in awareness and support for older people. This study aimed to assess abuse and its associated factors among elderly population of Kamalamai Municipality of Sindhuli District, Nepal.

METHODOLOGY

We conducted a community-based cross-sectional study utilizing both qualitative and quantitative methods. We collected data from June 15 to September 15, 2023. The study involved 398 elderly participants (≥60 years). Stratified sampling techniques was used to select participants. For the qualitative study we utilized purposive sampling technique which included two key informant interviews, one in-depth interview and two focus group discussions. We analyzed quantitative data using IBM SPSS version 20 applying bivariate and multivariable logistic regression analysis at a 95% confidence interval. For qualitative data, thematic analysis was done.

RESULTS

The mean ± SD age of the elderly participants was (70.8± 8.08) years. Among the total of 398 study participants, (64.1%) participants reported experiencing different forms of abuse. The study found that neglect (46.0%), psychological abuse (42.5%), and financial abuse (24.4%) were the most common while physical abuse (4.8%) and sexual abuse (2.8%) were less common. Living in a nuclear family (AOR: 2.74, 95% CI: 1.67-4.51) and lower socio-economic status (AOR: 5.42, 95% CI: 2.28-12.92) were significantly associated with increase risk of elder abuse. Qualitative findings revealed mistreatment, vulnerability, negligence, economic factors, family dynamics, loneliness, financial exploitation, food withholding, physical abuse, and emotional attachment as key aspects of elder abuse.

CONCLUSION

This study highlights neglect and psychological abuse were the most common forms of elder abuse. These findings emphasize the urgency of implementing programs at the municipal level such as financial support system for elderly individuals from lower socioeconomic backgrounds and education programs for both elderly individuals and their families and caregivers. These initiatives aim to control and reduce the incidence of elder abuse and ensure comprehensive well-being of elderly population.

Exploring the Lived Experiences of Caregiving for Older Family Members by Young Caregivers in Singapore: Transition, Trials, and Tribulations

Amidst population ageing trends and epidemiological transitions, there has been a growing emergence of young family caregivers, about whom most studies have been conducted in Western countries. Their subjective experiences and perceptions toward caregiving remain underexplored in Asia. This qualitative study explored the lived experiences of caregiving for older family members by young caregivers in Singapore. Interpretative phenomenological analysis was employed to collect and analyse data from semi-structured, in-depth interviews with six young adult caregivers aged between 23 and 29. Interviews were supplemented with photo-elicitation techniques to deepen interview discussions and uncover experiential significance. Findings illustrated transitions into caregiving, challenges across role conflicts and expectations amidst developmental tasks and transitions, and navigation of intergenerational conflicts and ambivalence. Although no definitive conclusions can be reached from this small-scale study, the findings offer important insights into the convergence and intensity of young caregivers' experiences. Given that caregiving challenges are likely to continue amidst Singapore's rapidly ageing population, these necessitate further in-depth research efforts. Implications for policy and practice across multiple stakeholders interfacing with youth and older adults are presented. A whole-of-society approach is called for to enable young caregivers to realise their full potential while contributing to their ageing families and nation.

Prevalence estimates and factors associated with violence among older adults: National Intimate Partner and Sexual Violence (NISVS) Survey, 2016/2017

Abuse of older adults is a public health problem. The National Intimate Partner and Sexual Violence Survey (NISVS) is a nationally-representative, telephone survey for non-institutionalized adults in the United States. To determine the prevalence and factors of intimate partner psychological aggression and physical violence and sexual violence by any perpetrator against older adults, we analyzed NISVS 2016/2017 data (n = 10,171, aged ≥ 60 years). Past 12-month prevalence of psychological aggression, physical violence, and sexual violence was 2.1%, 0.8%, and 1.7%, respectively. Odds of psychological aggression were significantly higher among those with hearing or vision impairment, and lower among those aged ≥70 years. Odds of physical violence were significantly higher for males and for those with hearing or vision impairment. Odds of sexual violence were significantly higher for unpartnered individuals and those with cognitive impairment; and lower for those aged ≥ 70 years. Epidemiologic studies of violence against older adults can inform population-specific prevention strategies.

Assessment tools for elder abuse: scoping review

OBJECTIVE

to map assessment tools for elder abuse and determine the psychometric properties of each one.

METHOD

scoping review developed according to recommendations of the JBI Institute Reviewer's Manual in databases and gray literature.

RESULTS

seventeen tools were identified for measuring situations of elder abuse. They were categorized into 1) Tools for assessment of risk for abuse, and 2) Tools for identification of abuse. According to risk for abuse, Vulnerability to Abuse Screening Scale was the most prevalent in the literature, with factorial analysis acceptable through four domains, and good internal reliability (0,74). Therefore, Assessment Tool for Domestic Elder Abuse comprises the assessment of six types of elder abuse; however, the study shows psychometric limitation since the internal structure was not evaluated by validity evidences.

CONCLUSION

seventeen tools to determine the occurrence or risk for elder abuse were identified with different psychometric properties. We recommend the use of more than one of the tools identified for an appropriate measurement of elder abuse situations given the complexity of the phenomenon and the lack of a single instrument that contemplates all its consequences and forms of expression.

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.

Nurses' Role in Identifying Elder Financial Abuse

One of the current worldwide public health problems is elderly financial abuse (EFA). Although EFA remains a hidden social phenomenon, it has been recognized as a serious concern in the United States, and currently, one in 18 cognitively intact older adults is affected by EFA. Detecting EFA is difficult because the perpetrators are often family members, trusted friends, or guardians. Thus, EFA is frequently unrecognized and grossly under-reported. In the coming decades, EFA will increase as the elderly population continues to grow rapidly worldwide. This article highlights the magnitude of the problem and the role of nurses and other health care providers in identifying, intervening in, and reporting EFA. [J Contin Educ Nurs. 2022;53(1):30-34.].

Childhood Adversities, Midlife Health, and Elder Abuse Victimization: A Longitudinal Analysis Based on Cumulative Disadvantage Theory

OBJECTIVES

Elder abuse victimization is increasingly recognized as a pressing public health concern. However, few empirical studies have investigated whether early life course adversities and midlife sequelae heighten risks for abuse in late life. Guided by cumulative disadvantage theory, the current study examined whether compromised health in middle adulthood (physical, psychological, cognitive) mediates the association between child abuse and elder abuse.

METHOD

This secondary analysis was based on data from the Wisconsin Longitudinal Study, a population-based, multi-wave dataset. We analyzed responses from 5,968 participants (mean age = 71 years; 54% female) on adapted versions of standardized measures: elder abuse victimization (outcome variable), childhood adversities (independent variable), and midlife health (physical health, depressive symptoms, cognitive functioning; mediator variables). Serial multiple mediation models were conducted, controlling for background characteristics.

RESULTS

Rates for any elder abuse and child adversities were, respectively, 16.34% and 47.98%. Multivariate analyses supported the cumulative disadvantage hypothesis. Childhood adversities (0.11, p < .001) and midlife health (physical, -0.10, p < .05; depressive symptoms, 0.09, p < .001; cognitive functioning, 0.02, p < .05) had significant direct effects on elder abuse victimization. Childhood adversities also had an indirect effect on elder abuse through physical health (0.002, p < .05) and depressive symptoms (0.01, p < .001), both in serial.

DISCUSSION

This innovative study advances our understanding mechanisms through which childhood trauma influences abuse in late life. Boosting health in middle adulthood could help prevent elder abuse. Other implications for clinical practice, treatment, and future research on elder abuse are discussed.

Elder mistreatment and life satisfaction of older adults: mediating roles of emotional closeness with children and loneliness

Elder mistreatment is a risk factor in the life satisfaction of older adults, yet understanding of its underlying mechanisms remains limited. This study investigates the mediating role of emotional closeness and loneliness in the association between elder mistreatment and life satisfaction. A sample of 8,717 Chinese older adults is obtained from the 2018 China Longitudinal Aging Social Survey. Results reveal that emotional mistreatment has a negative effect on the life satisfaction of older adults. Moreover, emotional mistreatment is associated with a low level of emotional closeness and a high degree of loneliness, which further decreases life satisfaction. However, emotional closeness with children did not significantly mediate the association between physical mistreatment and life satisfaction. This study advances the comprehension of the influencing path on how elder mistreatment affects the life satisfaction of older adults. Implications for policy and intervention programs are discussed.

Is multimorbidity associated with risk of elder abuse? Findings from the AHSETS study

BACKGROUND

With an increasing number of older adults in low- and middle-income countries (LMIC), the burden of multimorbidity and functional dependence is on the rise. At the same time, a higher prevalence of elder abuse is observed in these populations. There is scarce evidence on the interplay between elder abuse and multimorbidity with no reports from LMIC settings yet. Present study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India.

METHODS

The data for this study was collected as a part of our AHSETS study comprising of 725 older adults residing in rural Odisha, India. Multimorbidity was assessed by the MAQ PC tool while Hwalek-Sengstock elder abuse screening test (HS-EAST) was used to assess the risk of elder abuse. Functional dependence was measured by the Lawton IADL questionnaire. We used ordinal logistic regression models to identify the correlates of elder abuse and test for mediation by functional dependence.

RESULTS

Around 48.8 % (95 % CI:45.13-52.53 %) older adults had multimorbidity while 33.8 % (95 % CI:30.35-37.35 %) had some form of dependence. Out of 725, 56.6 % (CI 52.85-60.19 %) were found to be at low-risk elder abuse and 15.9 % (CI 13.27-18.72 %) being at high-risk. The prevalence of higher risk of elder abuse was greater among females, non-literates, widowed persons, those not currently working and those belonging to lower socio-economic strata. The risk of elder abuse was significantly associated with multimorbidity (AOR = 1.68; 95 %CI: 1.11-2.57) and functional dependence (AOR = 2.08; 95 %CI: 1.41-3.06). Additionally, we found a partial mediation mechanism of functional dependency between the pathway of multimorbidity and elder abuse.

CONCLUSIONS

Elder abuse and multimorbidity are emerging as issues of significant concern among rural elderly in Odisha, India. Multimorbidity and functional dependence are associated with significantly higher odds of elder abuse among rural older adults. Further, we report the role of functional dependence as a partial mediator between multimorbidity and elder abuse. Therefore, potential interventions on reducing the economic, physical and care dependence among multimorbid patients may reduce the risk of elder abuse.

Frailty Syndrome: A Risk Factor Associated With Violence in Older Adults

OBJECTIVE

The objective of this study was to analyze the association between frailty syndrome as a risk factor associated with violence in older adults.

METHOD

A cross-sectional study, carried out with older adults, in an emergency care unit of a northeastern Brazilian city was conducted. Three instruments were used: a form for sample characterization (i.e., demographics) and two more scales, namely, the Edmonton Frail Scale and the Hwalek-Sengstock Elder Abuse Screening Test. The results were analyzed through descriptive and inferential statistics, using chi-square or Fisher's exact tests, Spearman's correlation test, and simple logistic regression.

RESULTS

The sample included 146 older adults who were over 70 years old (56.6%), male (56.2%), and at risk of violence (69.86%). Among the categorical variables, there was an association between risk and being of a higher age (80.7%, p < 0.001), unemployed (73.7%, p < 0.05), having more than six children (80.8%, p < 0.05), and frail older adults (88.1%, p < 0.001). There was a correlation (p < 0.05) between the numerical variables of the scales of violence and frailty, with a coefficient of 0.40. The simple logistic regression model showed that frailty syndrome increases the risk of violence among older adults.

CONCLUSIONS

It was concluded that frailty is a factor that increases the occurrence of risk of violence and provides information to guide nursing action in the field of forensic sciences.

Elder Mistreatment in an Italian Population: Prevalence and Correlates

This study aimed to examine the prevalence of elder mistreatment (EM) in an Italian population and to determine the risk factors. The sample consisted of 393 older adults (M_age = 77.07; standard deviation = 9.45) of whom 60.1% were females. The prevalence of EM was of 20.1%. Older elders who were separated, divorced, with a poor state of health, and problems of autonomy were more likely to experience EM. The most common forms of EM were physical/sexual (9.9%) and emotional mistreatment (9.9%). The most common perpetrators were paid caregivers and members of the victim's family. A path analysis model suggested that limited autonomy and poor perceived health status appeared to be predictors of EM. We conclude that the results of this study have important implications in terms of reducing mistreatment of older adults. Understanding EM is essential to promoting equality, tolerance, and supportive attitudes and developing better prevention policies and practices.

Gender Differences in the Prevalence and Correlates of Elder Abuse in a Community-Dwelling Older Population in Korea

Background: We examined gender differences in the prevalence estimates and correlates of elder abuse in a community-dwelling older population in Korea. Methods: We analyzed responses from the Living Profiles of Older People Survey (LPOPS), which comprises a nationally representative sample of non-institutionalized Korean older adults living in the community. A total of 10,184 older persons (4179 men and 6005 women) were included in the analysis. Results: The overall rate of elder abuse was 9.9%, and emotional elder abuse was the most frequent type. Of the men and women subjects, 8.8 and 10.6%, respectively, had experienced elder abuse. We observed significant gender differences in the correlates of elder abuse. Educational attainment was significantly associated with elder abuse in men but not in women. Poor self-rated health was significantly associated with elder abuse in women but not in men. Household income and relationship with children were significantly associated with elder abuse in both men and women. Conclusion: Our results suggest that the factors that make elderly persons vulnerable to elder abuse may differ by gender. A better understanding of the risk factors for elder abuse across genders will facilitate the development of elder abuse prevention strategies, practices, and policies.