|Year : 2016 | Volume
| Issue : 2 | Page : 150-157
Exploring the role of socioeconomic factors in abuse and neglect of elderly population in Maharashtra, India
Population Research Center, Institute for Social and Economic Change, Bengaluru, Karnataka; School of Habitat Studies, Tata Institute of Social Sciences. Mumbai, Maharashtra, India
|Date of Web Publication||13-Dec-2016|
Room No. 204, Academic Building 2, School of Habitat Studies, Deonar, Mumbai - 400 088, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: The rising proportion of elderly in India exhibits concern for the well-being of this section of the population. It will be important to know what factors are responsible for elder abuse and also who commonly perpetuates abuse among elderly.
Objectives and Aims: The objective of the study is to find out the prevalence of elder abuse and profile of abuser in Maharashtra. The study also tried to examine the differences in elder abuse cases by several socioeconomic characteristics, disability level, chronic conditions, and age cohorts.
Materials and Methods: The data from the United Nations Population Fund survey named "Building Knowledge base of Population Ageing in India" was used. The sample size was 1435 respondents aged 60 and above. Cross-tabulation was done to assess the socioeconomic profile and elder abuse among elderly. Multivariate analysis named logistic regression was performed to know the important determinants of elder abuse and neglect.
Results: Around 35% of elderly in Maharashtra had faced any abuse. The percentage of elderly who faced verbal abuse (30.1%) was highest, followed by economic abuse (22.5%) and physical abuse (18.0%). Neighbors (56.1%), sons (43.1%), relatives (38.6%), and daughter-in-law (31.9%) were involved in the majority of the abuse cases. Education, wealth quintile, living alone, and the presence of any disability and morbidity or injury were the important determinant of elder abuse.
Conclusion: Elder abuse and neglect were quite high in Maharashtra. The policies and strategies need to form in order prevent abuse of elderly population in Maharashtra.
Keywords: Elder abuse, India, Maharashtra, neglect
|How to cite this article:|
Anand A. Exploring the role of socioeconomic factors in abuse and neglect of elderly population in Maharashtra, India. J Geriatr Ment Health 2016;3:150-7
|How to cite this URL:|
Anand A. Exploring the role of socioeconomic factors in abuse and neglect of elderly population in Maharashtra, India. J Geriatr Ment Health [serial online] 2016 [cited 2020 Feb 25];3:150-7. Available from: http://www.jgmh.org/text.asp?2016/3/2/150/195640
| Introduction|| |
With declining fertility and mortality rate, which led to improving child survival and increased life expectancy resulted in increasing old age population in India.  Maharashtra is one of the most industrialized, urbanized, and developed states of India and in the advanced stage of demographic transition. As per 2011 census in Maharashtra, 9.9% (increased from 8.3 in 2001) of the total population is aged 60 years and above. , The increasing proportion of elderly population produces the concern over health, security, shelter, and well-being of the elderly population. , The World Health Organization defines elder abuse 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."  It can also be further divided into physical, psychological or emotional, sexual, and financial abuse.  Abuse and neglect can lead to worsening health, longevity, and well-being at older ages. Some of the abuses such as physical, financial, and sexual are also considered to be criminal offenses in India.  Disrespect, neglect, and verbal abuse may also contribute to influencing various aspects such as social and economic life of the elderly population. With the rapid increase of elderly population, abuse and neglect of the elderly are a growing concern in India. 
The rising proportion of elderly in developing countries exhibits concern for the well-being of this section of the population. As experienced in developed countries, the elderly population is often marginalized, economically dependent, and isolated which makes them vulnerable to neglect and abuse. , Various theories were proposed to understand elder abuse and neglect.  The exchange theory describes the dependencies between a victim and a perpetrator relate to tactics and responses developed in their own family life, which continue into adulthood. Social learning theory, which explains the whole issue about the abuse, was learned and practiced in social context. The political economic theory focuses on the challenges faced by old age in a society that leaves people in poverty and takes away their importance in community life. , This theory raises the issues of marginalization of elders in society. The ecological theory combines the role of various factors at individual, community social, and political level.  Although it does not specific to abuse but discuss creating an amicable environment for healthy aging. There were some studies also explain the overburden on caregiver which leading to abuse.  However, as shown in various studies in India, the families are the main institution which provides care and shelter to elderly, different to the developed country scenario (old age home are bigger institutions). The basic assumption would be that the more of abuse cases will happen at familial level. , Although the interest would be to know how the abuse takes place in the Indian scenario. Maharashtra is one of the most urbanized and developed states of India. Being one of the states where elderly population is increasing, the assessment of elder abuse in Maharashtra can provide better insight on the issue. There can be various risk factors such as gender, living arrangements, physical, and mental illness for elder abuse.  The gender gap in survival may also result in increased abuse rate among elderly women.  The presence of disability and morbidity may relate to dependence on others, which can influence elder abuse. Similarly, financial dependency may also be a risk for elder abuse. The systematic literature review finds that one in four elderly is at a risk of abuse, and only small proportion of them is currently detected.  All these studies were performed in developed countries. The elder abuse is a less researched topic in India, and it will be really important to bring out what factors are responsible for elder abuse. The objective of the study is to find out the prevalence of elder abuse and profile of abuser in Maharashtra. The roles of social and economic factors are also important. Therefore, we try to examine the differences in elder abuse cases by several socioeconomic characteristics, disability level, chronic conditions, and age cohorts.
| Materials and Methods|| |
Data source and sampling procedure
This paper used data from the United Nations Population Fund survey named "Building Knowledge base of Population Ageing in India." Households were selected using multistage systematic random sampling. The primary sampling units (PSUs) in the rural areas were villages, whereas the urban wards were the PSUs in the urban areas.  First, the villages in rural areas and wards in urban areas were stratified based on indicators such as population size, the proportion of scheduled caste/tribe population, literacy status, and access to basic amenities such as water and sanitation (based on Census of India, 2001). Then, the number of PSUs to be selected was determined in proportion to the population size of each stratum. Similarly, in each selected ward in urban areas, Census Enumeration Block (CEB) was selected. Since the PSUs were of different sizes, segmentation was done for large PSUs. If a PSU had <300 households, house listing, and mapping in the entire village/or urban ward were undertaken. If the number of projected households in the selected PSU was more than 300, then the PSU was divided into segments (the number of segments depended on the size of the PSU) of nearly equal size and two segments were selected at random for house listing and mapping. The house listing and mapping exercise of all the households in the selected villages and CEBs were carried out. A list of households with at least one elderly person was prepared, and the prescribed number of elderly households (16 households) was selected through systematic random sampling. This had resulted in a sample size of 1435 people aged 60 and above in Maharashtra.
Question about ever experienced any abuse and neglect after reaching 60 years of age and also in the last 1 month were asked. Information regarding types of abuse (physical, emotional, economical, neglect, and disrespect) and abuser was also collected. Emotional abuse means that person is felt isolated by any member of family or society, whereas disrespect means that person is deliberately humiliated. Neglect implies that the needs of the elderly were not fulfilled knowingly. These three terms are related and are the components of psychological abuse. Economic abuse is same as financial abuse.
Elderly currently living with children with or without the spouse were categorized as living with family. Respondents were asked about suffering from any chronic morbidities (arthritis, stroke, angina, diabetes, chronic lung disease, asthma, depression, high blood pressure, Alzheimer's disease, liver or gallbladder illness, osteoporosis, renal or urinary tract infections, and cataract). Elderly suffering from any one or more of these morbidities was categorized as suffering from any morbidity. Similarly, elderly having any one or more of disabilities such as vision, hearing, walking, speaking, and memory were categorized as having any disabilities.
Univariate and bivariate analysis were done to see the socioeconomic profile, morbidity scenario, living arrangements, and elder abuse among elderly. Multivariate analysis named logistic regression was performed to know the important determinants of elder abuse and neglect. Stata Statistical Software (Version 12, StataCorp. 2011) was used to perform these analyses.
| Results|| |
Socioeconomic profile of elderly in Maharashtra
[Table 1] shows the socioeconomic profile of elderly in Maharashtra. The majority (66.3%) of elderly belong to age group of 60-69 years. Percentage of female elderly was little higher (52.2%) than the male elderly. Educational attainment was quite low among elderly. About 74.0% of the elderly were either not educated or had <4 years of education. More than half of the elderly were economically dependent and another 24.0% elderly were partially economically dependent. Elderly in Maharashtra was found to be less educated and economically dependent on family members or others. The table showed that the sampled population was representing the elderly population of Maharashtra.
|Table 1: Socioeconomic characteristics of sampled elderly population of Maharashtra|
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Abuse and neglect of elderly in Maharashtra
About 35.0% of elderly in Maharashtra had ever faced abused after completing 60 years [Figure 1]. The percentage of elderly who faced abuse in the last 1 month was around 30%. In the type of abuse, the percentage of elderly who faced verbal abuse (30.1%) was highest, followed by economic abuse (22.5%) and physical abuse (18.0%). The percentage of elderly who faced disrespect and neglect was 24.4% and 19.5%, respectively. Neighbors (56.1%) were involved in the majority of the abuse cases [Figure 2]. In 38.6% of the cases, relatives were the abuser. Son (43.1%) and daughter-in-law (31.9%) were also involved in a high percentage of elder abuse cases.
|Figure 1: Percentage of elderly faced abuse and neglect after reaching age 60 years in Maharashtra|
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Age group 80 years and above had the highest percentage of elderly who faced abuse and neglect [Table 2]. Similarly, a higher percentage of female elderly reported abuse and neglect compared to male elderly. The percentage of elderly who reported abuse and neglect in rural areas was higher compared to elderly in urban areas. Elderly having eight and above years of education had the lowest percentage of abused elderly in education categories. Elderly in the highest category of wealth quintile had the lowest percentage of elderly faced abused and neglected. Elderly who were fully economically dependent had reported more abuse compared to the elderly who were economically independent. In the living arrangement categories, the elderly living alone had the highest percentage of elderly who faced abuse and neglect compared to all the other categories. Elderly who had no disability, morbidity, or injury had a lower percentage of elderly who reported abuse and neglect compared to the elderly who had any disability, morbidity, or injury. Elderly with disability and morbidity makes them dependent on others which could be the reason; they were more vulnerable to abuse and neglect.
|Table 2: Percentage of elderly faced abuse and neglect by selected background characteristics|
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Determinants of elder abuse and neglect
Elderly aged 80 years and above had significantly higher odds of getting physically, verbally, and economically abused compared to elderly in the age group 60-69 years [Table 3]. Odds of facing abused in the last month also significantly higher among elderly in the age group 80 years and above compared to the elderly in the age group 60-69 years. In religion categories, elderly in Muslim religion had significantly higher odds of verbal, economic abuse, and disrespect compared to elderly in Hindu religion. Similarly, elderly belonging to the other backward caste had significantly lower odds of getting neglected and disrespected compared to the elderly in the scheduled caste/tribe. Elderly in the no caste/tribe category of had significantly higher odds of getting abused in the last month compared to elderly in the scheduled caste/tribe. Elderly having education of 8 years and above had significantly lower odds of abuse and neglect compared to elderly having <5 years of education. Increasing wealth quintile categories also significantly associated with lower odds of abuse and neglect among elderly compared to the lowest wealth quintile category. The living arrangement also significantly associated with elderly abuse and neglect. Elderly living with family or others had significantly lower odds of getting abused compared to elderly living alone. Odds of verbal abuse, neglect, and disrespect were higher among elderly who had any disability compared to elderly who did not have any disability. Elderly not having any morbidity or injury had significantly lower odds of verbal abuse, economic abuse, neglect, and disrespect compared to the elderly who had any morbidity or injury.
|Table 3: Odds ratio of abuse and neglect among elderly by selected background characteristics|
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| Discussion|| |
High proportion of the elderly had belonged to age group of 60-69 years in Maharashtra, which was also found in some of the studies in India.  Aging in India is an upcoming phenomenon, which could possibly explain the high percentage of elderly belonging to age group 60-69 years. Elderly in Maharashtra had low education levels, and economic dependency which is very consistent with the previous studies were done in India and Bangladesh. , The elderly health and well-being in developing countries will be affected by lower socioeconomic conditions. Several studies have also reported as living with family is the most common living arrangements among elderly in India, which was also found true in the case of elderly in Maharashtra. ,
The prevalence of elder abuse among the elderly was found to be relatively high in Maharashtra compared to different studies worldwide and in India. Prevalence had varied in different settings USA (13.5%), UK (2.6%), Bangladesh (34.1), India (23.1%), and Chennai (14.0%). ,,,, The differences across the studies were huge and may point toward differences in cultural settings, defining, and measuring abuse rates. Methods of measuring abuse rates such as cross-sectional or cohort studies may also contribute to the differences. In our study, abuses were cross-sectional, self-reported by the respondents. The high reported prevalence of elder abuse in Maharashtra suggests the requirement for preventive action. In theoretical perspectives, elderly in Maharashtra are more prone to face abuse within the family because living with family is the most common living arrangements. This theory proposed about caregiver may not justify in Indian settings. Some theories necessitating the importance of political and community environment may also hold value. The role of the family in providing required care and safe milieu is most important.  Disseminating information and providing knowledge about the care of elderly at the familial level may contribute to reducing abuse cases in Maharashtra. As the living with family is most common living arrangements, the majority of abuser will be the family members. Similar to our study, The HelpAge India also found that son and daughter-in-law were involved in the majority of elder abuse cases.  In addition, we find that the relative and neighbors are also involved in a high proportion of abuse cases in Maharashtra. Abuse and neglect are not a random event among elderly in Maharashtra. The percentage of elderly who ever faced abused after reaching age 60 years and those who faced in the last month is almost very similar in our study. This indicated the continuation of abuse among elderly. There are also chances that prevalence may be under-reported, elderly may not report abuses due to the associated stigma.
Very few studies in India have been done to bring out the important risk factors responsible for elder abuse and neglect. Similar factors as in our study were also reported in the different studies. , Our study breaks the myth that elderly in urban areas are more prone to elder abuse and neglect. The higher percentage of elderly living in rural areas had faced abuse and neglect compared to the elderly living in urban areas in Maharashtra, which was not found significant after adjusting for other variables. Similarly, the more abuse cases were reported by elderly women, but gender differences were not found significant. Increasing age, income, and education level also found to be influencing elder abuse, very similar to as shown in different studies. , Having any disability or morbidity also linked to significantly increasing elder abuse among elderly. Increasing chronic morbidities and disabilities with increasing age may result in the incapability of performing the daily task and lead to physical dependency on others among elderly, which make the elderly population more prone to abuse and neglect.  This paper had tried to bring attention to elder abuse among the ever increasing elderly population of Maharashtra. However, more research is also required impact of abuse and neglect among the elderly population.
Limitations of the study
This study is descriptive and explorative study as the elder abuse is not well researched in India. The study is based on a cross-sectional household survey and because of that, the direction of the relationship between socioeconomic characteristics and elder abuse cannot be established. However, it does shed light on socioeconomic groups more prone to elder abuse and can be targeted to limit the abuse among elderly. The assessment of elder abuse was self-reported which may have some response bias. This reporting biases could also affect the results.
| Conclusion|| |
Elder abuse and neglect are a very serious social issue. As the proportion of elderly is increasing, the need to provide safer social and familial environment among elderly is becoming very critical. More than one out of three elderly aged 60 years and above had reported abuse and neglect after reaching age 60 years in Maharashtra (verbal abuse and disrespect were the most common type of abuse). Little more than 1 out of 6 elderly also reported physical abuse among elderly in Maharashtra, which is the most severe type of abuse. Living with the family was found to be very common among elderly, but in a high proportion of the abuse cases, neighbors, and relatives was involved along with son and daughter-in-law. Belonging to lower wealth quintile, low educational attainment, living alone, and the presence of any disability and morbidity or injury were associated with abuse and neglect of elderly in Maharashtra.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]