INTRODUCTION:

It is predicted that by the year 2025, the global population of those aged 60 years and older will more than double, from 542 million in 1995 to about 1.2 billion. The phenomenon of population ageing is becoming a major concern for the policy makers all over the world, for both developed and developing countries, during last two decades. But the problems arising out of it will have varied implications for underdeveloped, developing and developed countries.

There is an emerging need to pay greater attention to ageing-related issues and to promote holistic policies and programmes for dealing with the ageing society.¹

Mistreatment of older adults is increasingly being seen as an important problem and one that is likely to grow as many countries experience rapidly ageing populations.¹ Mistreatment of older adults is an important public health issue. It has a potential risk for significant physical, psychological, financial and social harm.² Mistreatment refers to abuse, neglect, exploitation and abandonment of older persons by family members/spouse/relatives. The subject is identified as mistreated if they report even one subtype of mistreatment, i.e. abuse, neglect, exploitation and abandonment. Abuse includes intentional infliction of physical or mental injury, sexual abuse, or withholding of necessary food, clothing and medical care to treat the physical and mental health needs of an older person by one having the care, custody or responsibility of an older person. Neglect is referred as failure to fulfil other needs for which the victim is helpless to provide for themselves.³ Exploitation refers to misuse of a vulnerable elder’s properties, income or other financial resources.⁴ Abandonment involves desertion of older persons or withdrawal of their care without alternate arrangement by the family, spouse or relatives.

Older men are at risk of abuse in about the same proportion as women. But in cultures where women have inferior social status, elderly women are at special risk of being abandoned when they are widowed and having their property seized. Baseline data collected by Geriatric model care unit of Madras Medical College Hospital in Parivakkam village of Tamilnadu revealed that 75 out of 271 screened elderly people had depression.⁵ Elder abuse is common but little studied and underreported. Awareness of the problem of elder mistreatment and providing physicians with the tools to screen for mistreatment may increase the number of cases that are reported to the agencies responsible for assisting mistreated older people. This study is aimed to assess the prevalence of elder mistreatment and associated psychological distress among older adults in a selected semi-urban area of Dehradun district of Uttarakhand state of India. This is a pilot study before undertaking a large scale study on elder mistreatment and psychological distress in the state. Objectives of the study is to assess the prevalence of elder mistreatment and to determine the association between mistreatment and their psychological distress.

MATERIALS AND METHODS:

Thirty older persons living in a semi-urban community adjacent to Dehradun city of Uttarakhand state who met the inclusion criteria were enrolled in the study during May 2013. Quantitative study approach with cross-sectional survey approach was adopted for the study. Houses in the selected semi-urban area were visited by the researcher to get access to older persons of 60 years and above. Older adults aged 60 years or above and willing to participate in the study were included. Subjects with hearing impairment and moderate to severe cognitive impairment were excluded from the study. Subjects were assessed for the eligibility as per the inclusion and exclusion criteria and enrolled for the study after taking written consent from the subjects. Family members were requested to allow the interview in privacy as we are collecting health related information and the most of the families were cooperative. The direct questions related to mistreatment were asked only in privacy. On the same day, socio-demographic details of the subjects were collected through direct interview using socio-demographic profile. Following that Kessler’s Psychological Distress Scale (K-10) was administered to assess psychological distress and then mistreatment of the subjects was assessed using GAI through semi-structured interview and observation.

Data analysis:

The socio-demographic characteristics and prevalence of abuse, negligence, exploitation and abandonment of study participants were analysed using frequency and percentage. Psychological distress scores were described as means and standard deviation (SD). Pearson correlation was used to find correlation between continuous variables and independent sample ‘t’ test was used to find association between socio-demographic variables and other continuous variables. Chi-square test was performed to find association between socio-demographic variables and mistreatment.

RESULTS:

As shown in table 1, out of 30 subjects, one half (50%) were male, 21 (70%) were married and rest of them were widowed. The mean age of the subjects was 67.37 years with a standard deviation (SD) of 4.04 years. Most (90%) of the subjects belong to Hindu religion and two third (70%) were living in joint family. Majority (60%) of them were living with male child and 30% of the older persons living jointly with all children and family. Most of them (93%) were living permanently with same child and one participant (3.5%) shift from one family to other whenever he wish to shift and another participant (3.5) shifts whenever his child/in-law ask him to shift. Nearly one third (30%) of the subjects were educated up to metric and 80% of them having monthly income more than Rs. 15000/-. A large proportion (57%) of the subjects were still earning either in the form of pension (82%), self-employment (12%) or agricultural (6%).

Figure 1: Bar Diagram showing mistreatment reported by subjects

As given in Figure 1, the frequency and percentage of older persons who were assessed to have evidence of either abuse, neglect, exploitation or abandonment. Three out of 30 participants (10%) had possible evidence of abuse. Every four out of ten participants (40%) assessed to have possible evidence of neglect, 10% had probably evidence of neglect. Overall, majority (53%) of the subjects showed some evidence of neglect. One fifth of them (20%) showed either probable or possible evidence of exploitation while more than one fourth (27%) showed evidence of abandonment.

Table 1: Socio-demographic of study subjects n = 30

Socio-demographic Characteristics

Frequency

Percentage

Gender

· Male

· Female

Marital Status

· Married

· Widowed

Religion

· Hindu

· Sikhism

Type of Family

· Joint family

· Nuclear family

Presently living with

· Male child

· Jointly living

· Alone

66.5

3.5

Stay permanently with same child’s family

· Yes

· No

How often shifting from one family to other

· Whenever my child/in-law ask me to shift

· Whenever I wish/choice is mine

· Not applicable

3.5

Educational Status

· No formal Education

· Primary school

· Middle school

· Metric

· Graduate or more

Monthly family income

· Rs 5000-10000

· Rs 10000-15000

· >Rs.15000

Older persons still earning

· Yes

· No

Source of income (N=17)

· Pension

· Still working (self-employed)

· Agricultural

The psychological distress was assessed using Kessler’s Psychological Distress Score. The tool assess the psychological distress on a scale between 5 and 50. The score is interpreted as higher the score greater the psychological distress. The mean psychological distress score of the participants was 27.07±10.62.

Table 2: Association between types of mistreatment and psychological distress of the subjects n = 30

Variable		n	Psychological Distress Score (Mean Rank)	p value
Abuse	No evidence	27	14.85	0.25*
Abuse	Possible Evidence	3	23.33	0.25*
Neglect	No Evidence	14	09.29	0.003^‡
	Possible Evidence	12	21.46
	Probable Evidence	3	20.83
	Definite Evidence	1	15.00
Exploitation	No Evidence	24	13.33	0.026^‡
	Possible Evidence	5	24.10
	Probable Evidence	1	24.50
Abandonment	No Evidence	22	13.18	0.031^‡
	Possible Evidence	6	20.25
	Probable Evidence	2	26.75

*Mann-Whitney ‘U’ test was used, ^‡Kruskal Wallis test was used

Table 2 shows that the psychological distress of older persons who were assessed to have evidence (possible/probably/definite) of neglect, exploitation or Abandonment was significantly higher than that of who showed no evidence. There was no significant difference in psychological distress score of older persons who showed possible evidence of abuse and no evidence of abuse. Association between abuse of older persons (evidence of abuse or no evidence) and selected socio-demographic variables of older persons was calculated using Fisher exact test. As given in table 3, There was a significant association (p=0.02) between marital status and abuse of older persons. The widowed older persons likely to be victim of abuse than that of married older persons who is living with partner. Older persons aged above 70 years were more likely to be exploited than that of their younger counterparts.

Table 3: Association between abuse of older persons and their Socio-demographic variables n = 30

Sociodemographic variables	Abuse	Neglect	Exploitation	Abando-ment
Sociodemographic variables	p value*	p value*	p value*	P value*
Gender	1.00	0.27	0.169	0.215
Age Group	0.207	0.118	0.049	0.195
Marital Status	0.02	1.00	0.207	0.195
Religion	1.00	0.09	0.049	0.545
Type of Family	0.53	1.00	1.00	1.00
Income status of older persons	1.00	0.16	0.34	0.242

*Fisher exact test

DISCUSSION:

Study revealed one in ten older adults (10%) are at risk of being abused. Every other elderly (50%) are at risk of negligence, one fifth of the older persons (20%) showed either probable or possible evidence of exploitation while more than one fourth (27%) showed evidence of abandonment. The findings of the study is consistent with the findings of Nisha et al⁶ and Helpage India⁷. The mean psychological distress score of the participants was 27.07±10.62. The psychological distress was significantly higher among older persons who were assessed to have possible/probable/definite evidence of mistreatment. Findings of studies conducted by Luo Y. et al⁸ and Comijs H.C. et al⁹ are consistent with the findings of present study. Both the studies reported that the mistreatment of older persons was positively associated with higher psychological distress. The widowed older persons had significantly higher risk of abuse than that of married older persons who is living with partner. Older persons aged above 70 years were more likely to be exploited than that of their younger counterparts. Similarly widowed older persons were at more risk of exploitation than that of married older persons who is living with their spouse. Similar findings were reported by Saikia A.M. et al¹⁰, and Dong X. et al¹¹.

In India, ever increasing numbers of older persons, higher prevalence of mistreatment of older persons, under-reporting of incidences and health consequences of abuse makes mistreatment of older persons as an important public health issue. As 90% of mistreatment of older adults are likely to happen within family setting, greater cooperation is required between public health, social and medical system to identify mistreatment of older persons because victims of abuse often hesitate to report the incident as it is matter of their family dignity particularly in rural families¹². Certain societal attitudes exist in Indian rural community may contribute to mistreatment against older persons and make it easier for abuse to go undetected. These factors include the lack of value and respect for older persons and belief that what happens at home is their family matter and it is private. The idea that what happens at home is private can be a major factor in limiting the older person at home in an abusive or neglectful situation. Those outside the family who observe or suspect abuse or neglect may fail to intervene because they believe "it is their family matter and none of my business” or because they are afraid they are misinterpreting a private quarrel.

CONCLUSION:

Elder mistreatment is a serious public health issue. The findings of the study emphasize the need for large scale studies on elder mistreatment, its prevention and consequences.

REFERENCE:

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4. Elder Abuse. Australian Family Physician. Vol. 33, No. 10, Oct 2004. 807-12.

5. Department of Geriatric Medicine, Madras Medical College, Chennai. Developing a model community geriatric care unit WHO project. (internet document). Cited on Mar 2012. Available from: http://whoindia.org/linkfiles/health_care_for_the_elderly_elderly_community_chennai_elderly_project_report.pdf

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12. World Health Organization. A Global Response to Elder abuse and Neglect: Building Primary Health Care Capacity to Deal with the Problem Worldwide: Main Report 2008 [Internet]. [cited 2016 Dec 30]. Available from: http://www.who.int/ageing/publications/ELDER_DocAugust08.pdf

Received on 09.07.2017 Modified on 15.09.2017

Asian J. Nursing Education and Research. 2018; 8(3):329-332.

DOI: 10.5958/2349-2996.2018.00065.4