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

Elder abuse, depression, anxiety, and stress in community-dwelling older adults

BACKGROUND

Elder abuse as an important public health issue is associated in the literature with various physical and psychological symptoms. The aim of the study is to determine the relationship between elder abuse and depression, anxiety, and stress in the elderly living in the community.

METHOD

The cross-sectional study was completed with 729 older people. Data were collected through a face-to-face interview and a survey form. The Geriatric Mistreatment Scale (GMS) was used to evaluate elder abuse and the Depression Anxiety Stress Scale-21 (DASS-21) was used to evaluate depression, anxiety, and stress. Multivariate regression analysis was performed to determine the relationship between elder abuse and depression, anxiety, and stress.

RESULTS

Of the participants, 20.9% were exposed to at least one type of abuse, 9.2% experienced physical abuse, 18.2% experienced psychological abuse, 4.4% experienced neglect, and 7.0% had financial abuse. The general prevalence of moderate to very severe depression, anxiety, and stress among the elderly was respectively 17.1%, 16%, and 10%. As a result of multivariate analysis it was determined that neglect (t = 6245; ß = 4952) and economic abuse (t = 3865; ß = 3350) had statistically significant effects on depression; psychological abuse (t = 2924; ß = 0,992), economic abuse (t = 3127; ß = 3517) and neglect (t = 5913; ß = 4810) had statistically significant effects on anxiety, while psychological (t = 5023; ß = 1756) and economic abuse (t = 5719; ß = 5238) had statistically significant effects on stress (P < 0.05).

CONCLUSION

As a result of the study, it was seen that the prevalence of abuse and depression, anxiety, and stress was high in the elderly. There was also a strong relationship between types of elder abuse and depression, anxiety, and stress. It is recommended that health professionals working with older people to screen them for types of abuse and mental symptoms with the help of appropriate screening tools.

Association between Multimorbidity and Psychological Distress among Older Adults in India: The Moderating Role of Elder Abuse

OBJECTIVES

In this study, we examine the association between multimorbidity and psychological distress and to what extent elder abuse mediates the association.

METHODS

We analyzed cross-sectional nationally representative data from the "Building Knowledge Base on Population Ageing in India (BKPAI)." Multivariate logistic regression was used to understand the association between multimorbidity and psychological distress. We used Karlson-Holm- Breen (KHB) method to understand the role of elder abuse in mediating the association between multimorbidity and psychological distress.

RESULTS

Older adults who ever experienced abuse (OR = 1.92 95%CI = 1.62, 2.26, p < .001) or in last one month (OR = 2.09 95%CI = 1.65, 2.64, p < .001) reported higher odds of psychological distress. Further, older adults with four or more chronic diseases are thrice more likely to report psychological distress (OR = 3.03 95%CI = 2.38, 3.82, p < .001). The results further suggest the mediating role of abuse on the association between multimorbidity and psychological distress.

CONCLUSIONS

The results suggest the role of elder abuse on the association between multimorbidity and psychological distress among older population in India.

CLINICAL IMPLICATIONS

Creating an environment to reduce the abuse among older adults who have multimorbidity will be essential to reducing the psychological distress among older adults in India.

Exploring food insecurity and multimorbidity in Indian socially disadvantaged people: cross-sectional findings from LASI, 2017-18

OBJECTIVES

The present study aimed to examine the association of multimorbidity status with food insecurity among disadvantaged groups such as Scheduled Castes (SCs), Scheduled Tribes (STs), and Other Backward Class (OBCs) in India.

METHOD

The data for this study was derived from the first wave of the Longitudinal Ageing Study in India (LASI),2017-18, focusing on 46,953 individuals aged 45 years and over who belong to SCs, STs, and OBCs groups. Food insecurity was measured based on the set of five questions developed by the Food and Nutrition Technical Assistance Program (FANTA). Bivariate analysis was performed to examine the prevalence of food insecurity by multimorbidity status along with socio-demographic and health-related factors. Multivariable logistic regression analysis and interaction models were used.

RESULTS

The overall prevalence of multimorbidity was about 16% of the study sample. The prevalence of food insecurity was higher among people with multimorbidity compared to those without multimorbidity. Unadjusted and adjusted models suggested that people with multimorbidity were more likely to be food insecure than people without multimorbidity. While middle-aged adults with multimorbidity and men with multimorbidity had a higher risk of food insecurity.

CONCLUSION

The findings of this study suggest an association between multimorbidity and food insecurity among socially disadvantaged people in India. Middle-aged adults experiencing food insecurity tend to reduce the quality of their diet and consume a few low-cost, nutritionally deficient meals to maintain caloric intake, putting them again at risk for several negative health outcomes. Therefore, strengthening disease management could reduce food insecurity in those facing multimorbidity.

The association between chronic disease and depression in middle-aged and elderly people: The moderating effect of health insurance and health service quality

Background

Depression in chronic disease patients was an important public health problem. However, limited work has been done on how to alleviate the depression of chronic disease patients. This paper attempted to explore the alleviating effect of health insurance and health service quality.

Methods

A total of 11,500 middle-aged and elderly people were drawn from four waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS). We analyzed the effect of chronic disease on depression in middle-aged and elderly people in China, and explored the mechanism of action from health insurance and health service quality.

Results

After adjusting for sociodemographic factors, any chronic disease (coefficient 1.471, p < 0.01) and multiple chronic diseases (coefficient 1.733, p < 0.01) could significantly increase the depression score. Any chronic disease increased the depression score (165.3 and 147.4% in non-health insurance group and health insurance group, respectively), the multiple chronic diseases increased the depression score (190.6 and 173.5% in non-health insurance group and health insurance group, respectively). Any chronic disease increased the depression score (161.3 and 139.5% in lower health service quality group and higher health service quality group, respectively), the multiple chronic diseases increased the depression score (228.4 and 162.9% in lower health service quality group and higher health service quality group, respectively). And similar results were obtained after using depression status instead of depression score.

Conclusions

Chronic disease and multiple chronic diseases were important determinants of depression in middle-aged and elderly people. Health insurance and health service quality were the key factors in relieving the depression of chronic disease patients. Several strategies were urgently needed: paying attention to the mental health of chronic disease patients, increasing the participation rate of health insurance, further improving the quality of health service, and alleviating the psychological harm caused by chronic disease.

Multimorbidity and its associated risk factors among older adults in India

Background

Health at older ages is a key public health challenge especially among the developing countries. Older adults are at greater risk of vulnerability due to their physical and functional health risks. With rapidly rising ageing population and increasing burden of non-communicable diseases older adults in India are at a greater risk for multimorbidities. Therefore, to understand this multimorbidity transition and its determinants we used a sample of older Indian adults to examine multimorbidity and its associated risk factors among the Indian older-adults aged 45 and above.

Methods

Using the sample of 72,250 older adults, this study employed the multiple regression analysis to study the risk factors of multimorbidity. Multimorbidity was computed based on the assumption of older-adults having one or more than one disease risks.

Results

Our results confirm the emerging diseases burden among the older adults in India. One of the significant findings of the study was the contrasting prevalence of multimorbidity among the wealthiest groups (AOR = 1.932; 95% CI = 1.824- 2.032). Similarly women were more likely to have a multimorbidity (AOR = 1.34; 95% CI = 1.282—1.401) as compared to men among the older adults in India.

Conclusion

Our results confirm an immediate need for proper policy measures and health system strengthening to ensure the better health of older adults in India.