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ORIGINAL ARTICLE
Year : 2022  |  Volume : 49  |  Issue : 2  |  Page : 173-179

Elder abuse in rural Belagavi: A community-based cross-sectional study


Department of Community Medicine, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research (Deemed to be University), Belagavi, Karnataka, India

Date of Submission13-Nov-2021
Date of Acceptance19-Apr-2022
Date of Web Publication23-Aug-2022

Correspondence Address:
Nishtha Malhotra
Department of Community Medicine, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research Deemed to be University, Nehru Nagar, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_156_21

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  Abstract 


Background: Elder abuse is defined by the WHO as: “a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.” Elder abuse has always been considered a western problem and its existence in India has never been acknowledged seriously. The present study aimed to find the prevalence of elder abuse and assess the sociodemographic determinants for the same. Materials and Methods: A cross-sectional, questionnaire-based study was conducted among 400 in elderly population of age ≥60 years, residing for at least 1 year in rural field practice areas of primary health-care Vantamuri in Belagavi taluka and district, Karnataka state, India, by systematic random sampling from January 1, to December 30, 2020. A set of pretested standardized questionnaires consisting of three parts, including “Modified Geriatric Mistreatment Scale” to assess the elder abuse prevalence, were used. Statistical analysis was done by using rates, proportions, and percentages, and the association was tested with Chi-square test and binary logistic regression. Results: Among the 400 elderly participants, the overall prevalence of elder abuse was found to be 68 (17%). Among all these cases, maximum number of them were facing psychological abuse (59, 52%), followed by economic exploitation (24, 21%), neglect (23, 20%), and physical abuse (8, 7%). None of the participants had experienced sexual abuse. Statistically significant association was present between the occurrence of abuse and sociodemographic characteristics such as age ≥70 years, illiteracy, elderly living with family/spouse, and living in a house owned by spouse/others or a rented place. Conclusion: The prevalence of elder abuse was found to be low (17%) as compared to what was expected (35%). Elder abuse exists in India in various forms, and it is imperative to form new policies and strategies by the government, police, health administration, and NGOs to prevent abuse of elderly population in rural India.

Keywords: Cross-sectional study, elderly abuse, rural area


How to cite this article:
Malhotra N, Shivaswamy M S. Elder abuse in rural Belagavi: A community-based cross-sectional study. J Sci Soc 2022;49:173-9

How to cite this URL:
Malhotra N, Shivaswamy M S. Elder abuse in rural Belagavi: A community-based cross-sectional study. J Sci Soc [serial online] 2022 [cited 2022 Oct 3];49:173-9. Available from: https://www.jscisociety.com/text.asp?2022/49/2/173/354264




  Introduction Top


According to the United Nations, elderly or older adults are persons aged 60+ years.[1] Abuse is defined as “speak to someone in an insulting and offensive way or treat with cruelty or violence, especially regularly or repeatedly.”[2] Older adults are often wronged in various ways by their trustworthy people which results in lifelong consequences. This amounts to elder abuse, i.e., “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person” as defined by the WHO.[3] According to the WHO – World Report on Ageing and Health 2016, the prevalence of elder abuse in high- or middle-income countries ranged from 2.2% to 14%. According to the analysis, the most common types included: physical abuse (prevalence, 0.2–4.9%); sexual abuse (prevalence, 0.04%–0.82%); psychological abuse, above a threshold for frequency or severity (prevalence, 0.7%–6.3%); financial abuse (prevalence, 1.0%–9.2%); and neglect (prevalence, 0.2%–5.5%).[3]

India is a country where people always care for their elders, not out of obligation, but because they respect the elderly. However, since there has been a shift from joint family to nuclear family system and change in the societal values, the care for the elderly is overlooked. At present, the elders find themselves absolutely helpless and disappointed because no one in the family or the society thinks about the care that they require once they get old.

The percentage of elderly population has augmented from 5.6% in 1961% to 8.6% in 2011. This number might rise to 315 million by 2050, comprising 20% of the entire population. This longevity of life has been achieved due to betterment which has taken place financially, treatment and management facilities, and drop in the fertility rates. Twenty-nine percentage of the total population resides in urban areas and 71% in rural areas. According to the Indian Population Census of 1991, the elderly males were more in number than elderly females. However, in the past two decades, there was a reversal in this trend, and the elderly females outnumbered the elderly males. Older women being more vulnerable on all frontages compared to older men have posed a major fear for policymakers. The life expectancy at birth between 2009 and 2013 was found to be 69.3 years and 65.8 years for females and males, respectively. It was reported that the average remaining span of life was 18 years and <12 years at 60 and 70 years of age, respectively. There was a hike in the old-age dependency ratio from 10.9% to 14.2% from 1961 to 2011 in India. The ratio was 14.9% for females and 13.6% for males in 2011.[4]

With the rise in the number of elderlies, the country is experiencing a tectonic shift demographically, popularly known as the “Grey Tsunami,” which will result in a sudden and massive rise in the elderly population in the next two decades with a simultaneous rise in their needs and our nation is totally unprepared to manage it in future. It is disappointing to see that the older population in our country might head toward destitution and poor health in their old age days, after sacrificing so much for their children in the prime of their lives and contributing in the nation's progress. Furthermore, poor economic and social security makes the elderly helpless and dependent. Elder abuse, once considered a western problem, has now started gripping its existence in India but has never been acknowledged seriously. However, the elderly have started realizing that they are often perceived as a burden by their children. The younger and older family members find it difficult to cope up. The unwanted behavior of the younger family members is experienced as abnormal by the elder family member. This isolation, lack of attention, care, and their exclusion in taking important decisions in the family matters makes them feel neglected and disregarded leading to loneliness and depression.[5]

Objectives

  1. To measure the prevalence rate of elder abuse residing in rural area
  2. To find the sociodemographic determinants of elder abuse.



  Materials and Methods Top


This community-based cross-sectional study was conducted for 12 months (January 1, 2020–December 31, 2020) among the elderly population of age ≥60 years, residing for at least 1 year in rural field practice areas of primary health-care (PHC) Vantamuri (rural) in Belagavi taluka of Belagavi district, Karnataka state, India. The sample size was calculated by assuming the prevalence of elder abuse as 35% from a previous study done in Maharashtra in 2016.[6] The sample size was calculated using the formula n = 4pq/d2, where n is the sample size, p is the prevalence of elder abuse, and q = 100-p. After adding “no response rate” as 10%, it came to 402, by considering 95% confidence interval (CI) and absolute error (d) as 5%.

According to Census India 2011 data, the elderly population in the state of Karnataka comprises about 7.7% of its total population. The average decadal increase in the elderly population among states between 2001 and 2011 was 1%, according to census India 2001 and 2011. The total population residing in PHC Vantamuri rural field practice area is 39,952 as per the CNAA survey done in 2018 (Ref: As per the written information received by the Medical Officer, Vantamuri). This when multiplied by 7.7% + 1% = 8.7% and divided by the estimated sample size (i.e., 400) gave the value of every nth house which was approached in the community for data collection.







If two or more elderly were present in one house, only one person was randomly included. If the study subject was not available at first attempt, two more attempts were made by the investigator to collect data. Otherwise, the house was skipped and the next house was taken for sampling.

Data collection was done by means of personal interview by the researcher in the house-to-house visits. Written informed consent was obtained from all the study participants before the onset of data collection, and data confidentiality was maintained. At first, the cognition level of the participants was tested using Mini-Cognitive test.[6] The eligible candidates were then further asked about their sociodemographic profile and their experience of elder abuse (using Modified Geriatric Mistreatment Scale)[7] in the preceding 12 months period. Data were collected by personal interview by the investigator using a predesigned pretested pro forma. The characteristics noted were age, gender, marital status, address, religion, reservation category, type of family, family members, living arrangements, qualification status, occupation, ownership of the house, and income (self and household). Pamphlets containing information on elder abuse in local language were prepared and distributed to the participants in all four subcenters after taking their personal interview.

Data collected using the questionnaire were coded and entered into Microsoft Excel. Data management was done in Microsoft Excel and analysed using IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Descriptive data were expressed in percentages and frequencies. Chi-square test, univariate, and multivariate binary logistic regression were used for finding the association between categorical variables.


  Results Top


The present study was undertaken in the rural field practice areas of PHC Vantamuri in Belagavi taluka of Belagavi district, Karnataka state of India, among 400 elderly (≥60 years) population. Out of all 402 elderly approached, 400 were included in the study and 2 participants were excluded, as they could not pass the mini-cognitive test. Out of 400 study participants, 255 (63.7%) elderly belonged to the age group of 60–69 years. The mean age of the study participants was 68.18 ± 7.12 years with a range of 60–91 years and the median age was 66 years. It was noted that 252 (63%) elderly were females and 148 (37%) elderly were males. Among 400 participants, 255 (63.7%) were married, 144 (36%) were widowed, and only one (0.3%) was single. Majority 350 (87.5%) followed Hinduism, 46 (11.5%) were Muslim, and 4 (1%) participants followed Christianity. Out of 400 elderly participants, 158 (39.5%) belonged to other backward classes category, followed by 126 (31.5%) from scheduled tribe category, 91 (22.75%) belonged to general category, and 25 (6.25%) were from scheduled castes category. Most of them were living in a joint family (313, 78.25%), followed by 87 (21.75%) living in a nuclear family. Out of all the participants studied, 354 (88.5%) lived with their families, followed by 24 elderly who lived only with their spouse (6%), 17 elderly who lived alone (4.3%), and 5 subjects lived with a relative and any other person (1.25%). Literacy status of the study participants revealed that 255 (63.7%) and 145 (36.25%) were illiterate and literates, respectively. With respect to occupation, it was observed that 201 (50.2%) were unemployed/retired, 114 (28.5%) were employed and 87 (21.8%) were homemakers. According to the study participants' house ownership status, it was noted that 239 (59.75%) elderly owned their house, whereas 83 (20.75%) lived in a house owned by their spouse, 62 (15.5%) lived in a house owned by others, and 16 (4%) reported to be living in a rented house. Among the 400 study subjects, 141 (35.25%) belonged to Class V, 140 (35%) to Class IV, 71 (17.75%) to Class III, 32 (8%) to Class II, and 10 (2.5%) belonged to Class I socioeconomic status according to modified BG Prasad's Classification 2021 [Table 1].[8]
Table 1: Distribution of study participants according to their sociodemographic characteristics (n=400)

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Among the 400 elderly participants, the percentage of prevalence of elder abuse was found to be 17% (68 victims). Among all these cases, maximum number of them were facing psychological abuse (59, 52%), followed by economic exploitation (24, 21%), neglect (23, 20%), and physical abuse (8, 7%). None of the participants had experienced sexual abuse [Table 2] and [Graph 1].
Table 2: Distribution of participants according to the experience of elder abuse and its forms

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Chi-square test showed statistically significant association present between the participants who had experienced any kind of abuse and who were aged ≥70 years (P = 0.001), married (P = 0.02), living with family/spouse (P = 0.002), illiterate (P = 0.001), and lived in house owned by spouse/others/rented (P = 0.009) [Table 3].
Table 3: Chi-square analysis showing association between the sociodemographic profile of participants and their experience of elder abuse (n=400)

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Univariate binary logistic regression analysis was done to check the strength of association between the sociodemographic profile of the study participants and their experience of elder abuse. Results showed that elderly aged 60–69 years compared to elderly aged ≥70 years were 0.404 times (95% CI: 0.238–0.686, P = 0.001) less likely to experience abuse. Single/widowed elderly compared to married elderly participants were 1.852 times (95% C.I. 1.093–3.138, P = 0.02) more likely to experience abuse. Illiterate elderly compared to literate elderly were 2.792 times (95% CI: 1.468–5.312, P = 0.002) more likely to experience abuse. Elderly participants who owned their house compared to elderly participants who lived in a house owned by spouse/others or a rented place were 0.499 times (95% CI: 0.295–0.846, P = 0.04) less likely to experience abuse. Elderly participants who lived with their family/spouse compared to elderly living alone or with relative/any other person were 0.267 times (95% CI 0.109–0.653, P = 0.004) less likely to experience abuse [Table 4].
Table 4: Univariate and Multivariate binary logistic regression analysis between the sociodemographic profile of participants and their experience of elder abuse (n=400)

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Independent variables showing statistically significant association using univariate binary logistic regression were selected for multivariate binary logistic regression analysis which was done to remove the effect of confounders and check the strength of association between the sociodemographic profile of the study participants and their experience of elder abuse. Results showed that elderly aged 60–69 years compared to elderly aged ≥70 years were 0.424 times (95% CI: 0.238–0.755, P = 0.004) less likely to experience abuse. Illiterate elderly compared to literate elderly were 2.213 times (95% CI: 1.132–4.327, P = 0.02) more likely to experience abuse. Elderly participants who owned their house compared to elderly participants who lived in a house owned by spouse/others or a rented place were 0.47 times (95% CI: 0.269–0.821, P = 0.008) less likely to experience abuse. Elderly participants who lived with their family/spouse compared to elderly living alone or with relative/any other person were 0.317 times (95% CI: 0.114–0.884, P = 0.028) less likely to experience abuse [Table 4].


  Discussion Top


In the present study, out of 400 rural elderly study participants, 255 (63.7%) belonged to the age group of 60–69 years. The mean age of the study participants was 68.18 ± 7.12 years with a range of 60–91 years and median age was 66 years.

Among the 400 elderly participants, the overall prevalence of elder abuse was found to be 68 (17%). Among all these cases, maximum number of them were facing psychological abuse (59, 52%), followed by economic exploitation (24, 21%), neglect (23, 20%), and physical abuse (8, 7%). None of the participants had experienced any sexual abuse.

In the “Elder Abuse study – 2018” by Help Age India, 25% of elders had stated that they had experienced elder abuse. The findings also showed that the most common form of elder abuse prevalent was disrespect and verbal abuse (50%) followed by neglect (34%), economic exploitation (22%), and beating/slapping (12%). 1% elderly had stated that they were victims of sexual abuse.[5] A study conducted in Maharashtra in 2016 used data from the “BKPAI” survey with a sample size of 1,435 elders and showed the prevalence of elder abuse around 35%.[8] Another study conducted in Mumbai in 2018 used data from “BKPAI” survey with a sample size of 9,850 elders and found that the prevalence of elder abuse was 10%.[9] A cross-sectional study conducted among 243 elderly in rural Puducherry in 2019 found the prevalence of elder abuse to be 50.2%.[10] The variation with respect to elder abuse prevalence could have been due to differences in the level of awareness and knowledge about elder abuse.

Compared to studies conducted in India, a survey conducted in Ireland among community-dwelling people aged 65 years or more showed the prevalence of overall abuse and neglect of only 2.2%.[11] The Malaysian Elder Mistreatment Project, a population-based survey conducted in 2017 among 4118 elderly in Malaysia, also showed the prevalence elder abuse of 4.5%.[12] Similar results have been found in other studies conducted to find the prevalence of elder abuse that showed that the most common forms of abuse prevalent were verbal abuse, disrespect, and neglect.[9],[13],[14],[15],[16]

Statistically significant association was found in the present study, with Chi-square analysis done between the participants who had experienced abuse and who were aged ≥70 years, married, living with family/spouse, illiterate and lived in a house owned by spouse/others or a rented place. Similar statistical associations were found in a study conducted in Saurashtra, India, in 2018 among 100 elderly patients with depression, where illiterate elderly reported more abuse compared to educated participants.[15]

Univariate and multivariate binary logistic regression analysis was done to check the strength of association between the sociodemographic profile of the study participants and their experience of elder abuse in the present study. Results showed that elderly aged ≥70 years, illiterate elderly, elderly living with family/spouse, and lived in a house owned by spouse/others or a rented place were more likely to experience abuse. These associations were found to be similar to the ones found in a study conducted in Puducherry in 2019 among 243 elderly individuals where higher age group and absence of formal education were found to be independent predictors of elder abuse.[10] Similar association between higher age group and elder abuse was also seen in a study conducted in Tehran, Iran, in 2017 among 260 elderly women.[17] Significant association between independent variable of living arrangements with family members and elder abuse was also seen in a study conducted in Japan in 2013 among 26,229 elderly people.[18],[19]


  Conclusion Top


Elder abuse being a sensitive issue is seldom discussed in the society. As the demography of our country is changing with increase in the number of elderly and their life expectancy, with increased urbanization and modernization, more and more elderly find themselves left alone and neglected.

The overall prevalence of elder abuse in rural area was found to be low (17%) as compared to what was expected (35%). Among all these cases, maximum number of them were facing psychological abuse (59, 52%), followed by economic exploitation (24, 21%), neglect (23, 20%), and physical abuse (8, 7%). None of the participants had experienced any sexual abuse. Statistically significant association was present between the occurrence of abuse and sociodemographic characteristics such as age ≥70 years, illiteracy, elderly living with family/spouse, and living in a house owned by spouse/others or a rented place.

This wide gap of knowledge among the elderly (especially who are facing abuse) demands the attention of the government and police authorities to take actions for increasing awareness among the elderly for various portals available to report elder abuse.

Despite having strengths of the study such as recruiting participants in the study after screening them through “Mini Cognitive Test” and using validated questionnaire like “Geriatric Mistreatment Scale,” there were certain limitations in the study such as response bias which could have been subjected by the participants as questionnaire included sensitive questions, there was no qualitative component explored, the study can be generalized only in rural areas, and the cases of abuse included in the study were self-reported.

Ethical clearance

The study protocol was approved by the institutional ethical committee J. N Medical College, Belagavi, Karnataka, for Human Subjects' Research. Written informed consent was taken from all participants before taking part in the study.

Acknowledgments

We would like to thank the Dr. Abhinandan Wali, Medical officer PHC Vantmuri (rural) and Dr. (Mrs.) N.S. Mahantashetti, Principal, JNMC, Belagavi, and ASHA workers of all the four subcenters for their help in translation required during interviews and recruiting participants in the study which involved asking them sensitive questions about their family and themselves. We also thank the study subjects who participated in the study. We thank Dr. (Mrs.) N. S. Mahantashetti, Principal, JNMC, Belagavi, for the administrative support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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