Factors associated with elder abuse and neglect in rural Uganda: A cross-sectional study of community older adults attending an outpatient clinic

Examining the Relationship Between Daily Activity Levels and Elder Abuse and Neglect: Bringing Light on Elder Abuse

AIM

To examine the relationship between sociodemographic characteristics, daily activity levels, and elder abuse among older adults in Turkey.

DESIGN

A descriptive, cross-sectional study was conducted across seven provinces.

METHODS

The study was carried out between January and August 2023, involving 448 older adults. Data were collected using the Sociodemographic Form, Mini-Mental State Examination, Barthel Index, and Geriatric Mistreatment Scale.

RESULTS

Approximately one in four participants reported experiencing at least one form of non-sexual elder abuse, with psychological abuse being the most common. Sons and male caregivers were frequently identified as perpetrators. While no significant relationship was found between daily activity dependency and abuse, factors such as lower education, poor self-rated health, intrafamily conflict, and regional variation were significantly associated with increased risk.

CONCLUSION

Elder abuse remains a prevalent and underrecognized issue, shaped by both individual vulnerabilities and contextual dynamics. The absence of a direct link between functional dependency and abuse suggests the need to consider broader social and environmental factors.

IMPLICATION FOR THE PROFESSION AND PATIENT CARE

Routine screening for elder abuse, particularly psychological abuse, should be part of geriatric care. Training healthcare professionals to identify risk factors-such as perceived health, family dynamics, and regional differences-and using culturally sensitive, sociodemographic assessments can improve early detection and intervention. Strengthening collaboration and community-based support is key to ensuring older adults' safety and well-being.

IMPACT

The study highlights elder abuse in Turkey as a complex, regionally variable issue influenced by health perception and family dynamics. It calls for targeted, community-based interventions and stronger collaboration among healthcare providers, nurses, social workers, and policymakers, emphasising the need for improved social security and culturally sensitive training.

REPORTING METHOD

This study followed STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Prevalence of elder abuse and its correlated factors in Iranian community-dowelling older adults: a cross-sectional study

BACKGROUND

The global elderly population is rapidly increasing, with projections estimating that the number of older adults will reach 2.1 billion. Elder abuse, a significant public health issue, leads to serious psychological, physical, and social consequences. Therefore, this study aims to assess the prevalence of elder abuse in Qazvin, Iran, while exploring correlated factors that may act as potential risks or protective factors, especially within the context of post-pandemic COVID-19 conditions.

METHODS

This cross-sectional study, conducted from May to October 2024, included 540 older adults aged 60 and above residing in Qazvin city, Iran. Participants were selected using a multi-stage cluster sampling method. Data were collected through face-to-face interviews using a demographic checklist, the General Health Questionnaire, the Advanced Activities of Daily Living Scale, the Mini-Cog Screening Tool, the Multidimensional Scale of Perceived Social Support, and the Short Version of the Domestic Elder Abuse Assessment Questionnaire. Data analysis was performed using one-sided and two- sided chi-square tests, as well as a logistic regression model.

RESULTS

A total of 540 older adults participated in the study, with a mean age of 72.08 ± 8.08 years. The majority of the participants were married (n = 390, 72.2%) and had an average economic status (n = 348,64.4%). Among the participants, 71.1% (n = 384) reported experiencing at least one form of elder abuse within the past year, with psychological abuse (n = 274, 50.7%) and care neglect (n = 269,49.8%) being the most prevalent forms. The results indicated that elder abuse was significantly associated with good and excellent economic status (OR = 0.335, 95% CI: 0.150-0.749), being homemaker (OR = 2.789, 95% CI: 1.252-6.215), and having better mental health (OR = 0.931,95% CI: 0.885-0.980).

CONCLUSIONS

This study found a high prevalence of elder abuse in Qazvin city, with economic status, employment status, and mental health identified as key predictors. Based on these findings, further in-depth investigations are needed to explore the underlying causes of elder abuse. Additionally, efforts to clarify statistics and raise community awareness about the dimensions and reporting mechanisms of elder abuse are essential. The development of integrated support services to promote the physical and mental health of older adults and reduce their dependency is strongly recommended.

Elder abuse in rural India: uncovering the interplay between functional impairment and ethnicity

The present study attempted to examine the association of functional limitations and elder abuse among the tribal and non-tribal ethnic groups in West Bengal, India, from a comparative framework. The study revealed that tribal older adults (20%) were in a better position in the field of abuse since they were less abused compared to their non-tribal counterpart (44.5%). Substantially, 58.1% of older people with functional impairment were victims of abuse. Furthermore, non-tribal older adults were 0.07 times more likely to suffer from abuse (AOR: 0.07; CI: 0.02-0.21) than their counterparts. Similarly, functionally dependent respondents had a higher risk of being abused. Non-tribal older adults with functional impairments had higher odds to suffer from abuse compared to tribal older adults with no functional impairments. However, being widowed and having no formal education and with education up to upper primary level were also found to be significant predictors of mistreatment among older adults.

Psychometric properties of instruments for measuring abuse of older people in community and institutional settings: A systematic review

Background

The examination of psychometric properties in instruments measuring abuse of older people (AOP) is a crucial area of study that has, unfortunately, received relatively little attention. Poor psychometric properties in AOP measurement instruments can significantly contribute to inconsistencies in prevalence estimates, casting a shadow of uncertainty over the magnitude of the problem at national, regional, and global levels.

Objectives

This review rigorously employed the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guideline on the quality of outcome measures. It was designed to identify and review the instruments used to measure AOP, assess the instruments' measurement properties, and identify the definitions of AOP and abuse subtypes measured by these instruments, ensuring the reliability and validity of the findings.

Search Methods

A comprehensive search was conducted up to May 2023 across various online databases, including AgeLine via EBSCOhost, ASSIA via ProQuest, CINAHL via EBSCOhost, EMBASE, LILACS, ProQuest Dissertation & Theses Global, PsycINFO via EBSCOhost, PubMed, SciELO, Scopus, Sociological Abstract via ProQuest, Chinese National Knowledge Infrastructure (CNKI), Google Scholar and WHO Global Index Medicus. Additionally, relevant studies were identified by thoroughly searching the grey literature from resources such as Campbell Collaboration, OpenAIRE, and GRAFT.

Selection Criteria

All quantitative, qualitative (addressing face and content validity), and mixed-method empirical studies published in peer-reviewed journals or grey literature were included in this review. The included studies were primary studies that (1) evaluated one or more psychometric properties, (2) contained information on instrument development, or (3) examined the content validity of the instruments designed to measure AOP in community or institutional settings. The selected studies describe at least one psychometric property: reliability, validity, and responsiveness. Study participants represent the population of interest, including males and females aged 60 or older in community or institutional settings.

Data Collection and Analysis

Two reviewers evaluated the screening of the selected studies' titles, abstracts, and full texts based on the preset selection criteria. Two reviewers assessed the quality of each study using the COSMIN Risk of Bias checklist and the overall quality of evidence for each psychometric property of the instrument against the updated COSMIN criteria of good measurement properties. Disagreements were resolved through consensus discussion or with assistance from a third reviewer. The overall quality of the measurement instrument was graded using a modified GRADE approach. Data extraction was performed using data extraction forms adapted from the COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments. The extracted data included information on the characteristics of included instruments (name, adaptation, language used, translation and country of origin), characteristics of the tested population, instrument development, psychometric properties listed in the COSMIN criteria, including details on content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, responsiveness, and interoperability. All data were synthesised and summarised qualitatively, and no meta-analysis was performed.

Main Results

We found 15,200 potentially relevant records, of which 382 were screened in full text. A total of 114 studies that met the inclusion criteria were included. Four studies reported on more than one instrument. The primary reasons for excluding studies were their focus on instruments used solely for screening and diagnostic purposes, those conducted in hospital settings, or those without evaluating psychometric properties. Eighty-seven studies reported on 46 original instruments and 29 studies on 22 modified versions of an original instrument. The majority of the studies were conducted in community settings (97 studies) from the perspective of older adults (90 studies) and were conducted in high-income countries (69 studies). Ninety-five studies assessed multiple forms of abuse, ranging from 2 to 13 different subscales; four studies measured overall abuse and neglect among older adults, and 14 studies measured one specific type of abuse. Approximately one-quarter of the included studies reported on the psychometric properties of the most frequently used measurement instruments: HS-EAST (assessed in 11 studies), VASS-12 items (in 9 studies), and CASE (in 9 studies). The instruments with the most evidence available in studies reporting on instrument development and content validity in all domains (relevance, comprehensiveness and comprehensibility) were the DEAQ, OAPAM, *RAAL-31 items, *ICNH (Norwegian) and OAFEM. For other psychometric properties, instruments with the most evidence available in terms of the number of studies were the HS-EAST (11 studies across 5 of 9 psychometric properties), CASE (9 studies across 6 of 9 psychometric properties), VASS-12 items (9 studies across 5 of 9 psychometric properties) and GMS (5 studies across 4 of 9 psychometric properties). Based on the overall rating and quality of evidence, the psychometric properties of the AOP measurement instruments used for prevalence measurement in community and institutional settings were insufficient and of low quality.

Authors' Conclusions

This review aimed to assess the overall rating and quality of evidence for instruments measuring AOP in the community and institutional settings. Our findings revealed various measurement instruments, with ratings and evidence quality predominantly indicating insufficiency and low quality. In summary, the psychometric properties of AOP measurement instruments have not been comprehensively investigated, and existing instruments lack sufficient evidence to support their validity and reliability.

Prevalence and types of elder abuse in Sub Saharan Africa, systematic review and meta-analysis, 2023

BACKGROUND

Elder abuse is a single or repeated act, or lack of appropriate action, which causes harm to an older person. This systematic review and meta-analysis aimed to assess the prevalence of elder abuse in Sub Saharan Africa.

METHODS

This systematic review and meta-analysis involved a comprehensive search of electronic databases, including PubMed, Scopus, Web of Science, African Journals Online and Google Scholar. Cochrane I2 statistics and Eggers test with funnel plot were done to check heterogeneity and publication bias, respectively.

RESULT

Five studies with 2123 elderly people aged 60 and above were included in this review. The pooled prevalence of elder abuse was (46.73 % (45.08-48.38)) with a substantial level of heterogeneity (I2 =99.7 %; p < 0.001). To overcome the effect of high level heterogeneity subgroup analysis was deployed. Accordingly, the subgroup analysis by publication year revealed that the prevalence of elder abuse was highest among studies conducted after 2018 (64.034 (95 % CI: 12.66, 115.4). Similarly, sub-group analysis by country revealed that the prevalence of elder abuse was highest in Ethiopia (63.2(21.276, 105.124).The subgroup analysis by the sampling technique revealed that elder abuse was highest among studies conducted using systematic random sampling technique (84.57 (95 % CI: 79.22, 89.92). Subgroup analysis by type of abuse revealed that physical abuse was highest (29.27 (-7.854, 66.394)) CONCLUSION: The pooled prevalence of elder abuse was high and, physical abuse was the commonest type of abuse. As a result, there should be awareness creation about the caring of elders to minimize abuse.

Dual harm among patients attending a mental health unit in Uganda: a hospital based retrospective study

BACKGROUND

Dual harm encompasses the complex interplay of the co-occurrence of self-harm and aggression. Individuals with dual harm may display a more hazardous pattern of harmful behaviors like homicide-suicide compared to people with sole harm. This study aimed to examine the presence of dual harm among general psychiatry inpatients in a mental health unit in Uganda.

METHODS

A retrospective chart review of 3098 inpatients from January 2018 to December 2021. Dual harm reported experience at admission was based on experiences of self-harm with harm to people or property or both. Logistic regression assessed the association between dual harm and sociodemographics and clinical characteristics.

RESULTS

A total of 29 (1%) patients experienced dual harm, with five having experienced self-harm with both harm to others and property, 23 with harm to people, and one with harm to property. Dual harm was statistically significantly associated with the male gender at bivariate analysis. However, there were no statistically significant factors associated with dual harm at multivariate analysis or sensitivity analysis with the specific types of dual harm.

CONCLUSION

General psychiatry inpatients in Uganda experience dual harm before admission at lower prevalence than in previous literature. However, no investigated sociodemographic and clinical factors could explain these experiences. Further studies looking at dual harm are warranted to understand these unfortunate experiences with serious consequences among patients in Uganda.