Journal of Geriatric Mental Health

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 5  |  Issue : 2  |  Page : 128--133

Elder abuse and its association with depression and social support: A community-based study from Tezpur, Assam


Ananya Bordoloi, Arif Ali, Sabana Nasrin Islam 
 Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India

Correspondence Address:
Dr. Arif Ali
Department of Psychiatric Social Work, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam
India

Abstract

Background: Abuse among older adults is a sensitive issue that needs an elaborative research study in the Indian context, specifically in rural areas. A drastic change in the sociocultural aspects of looking at this vulnerable group of people is not only limited to urban areas but also touches the simple rural life. Thus, the present study aimed to know about the prevalence of abuse and its associations with depression and social support among the rural older adults. Materials and Methods: A cross-sectional rural community-based study was conducted. The universe of the study comprised older adults residing under Mazgaon Panchayat, Tezpur, Sonitpur district of Assam. Two polling stations were randomly selected, using simple random sampling (lottery method) for the present study. Based on the two electorate lists, 141 older adults aged 60 years and above were listed out. From that list, 102 participants fulfilled the inclusion criteria and completed the interview. A semi-structured sociodemographic data sheet, Mini–Mental Status Examination, Vulnerability to Abuse Screening Scale, Geriatric Depression Scale (GDS), and the Multidimensional Scale of Perceived Social Support were administered to the respondents. Results: The prevalence of vulnerability was 28.4%, dependence was 13.7%, dejection was 45%, and coercion was 2% among the rural older adults. In the GDS, 29.4% of the respondents reported mild depression and 7.8% of respondents reported severe depression. In perceived social support, result shows that the mean score is high in the domain of family (24.62 ± 4.6) followed by significant others (24.52 ± 4.2) and friends (20.94 ± 6.05). Significant positive correlation was found between abuse and depression (r = 0.619, P = 0.01) among the older adults. Vulnerability to abuse has a significant negative correlation with perceived social support (r = −0.443, P = 0.01). Perceived social support and depression contributed significantly to the prediction of vulnerability to abuse among older adults (F(5,96) =18.684, P = 0.000) accounting for 4.93% variance. Conclusions: The older adults in the rural community are prone to vulnerability with a high risk of dejection. Depression strongly contributed to the variance on the overall vulnerability to abuse among older adults. The results of this study may guide in planning and implementing programs regarding prevention and management of abuse among older adults.



How to cite this article:
Bordoloi A, Ali A, Islam SN. Elder abuse and its association with depression and social support: A community-based study from Tezpur, Assam.J Geriatr Ment Health 2018;5:128-133


How to cite this URL:
Bordoloi A, Ali A, Islam SN. Elder abuse and its association with depression and social support: A community-based study from Tezpur, Assam. J Geriatr Ment Health [serial online] 2018 [cited 2019 Sep 23 ];5:128-133
Available from: http://www.jgmh.org/text.asp?2018/5/2/128/248618


Full Text



 Introduction



Elder abuse is becoming an emerging global problem and is causing serious harm; attention of health-care systems, social welfare agencies, policymakers, and the general public on this issue is urgently required.[1],[2] In an Indian study, the prevalence of elder abuse was reported to be 11% (physical 5.3%, verbal 10.2%, economic 5.4%, disrespect 6%, and neglect 5.2%).[3] In India, there has been rise in the prevalence of abuse among older adults. A report from India on elder abuse[4] stated that half of the elderly (50%) reportedly experience of abuse. The magnitude and nature of the problem concerning elder mistreatment is on the rise among older adults.[5] Elder mistreatment is widely prevalent (21%) among elderly persons in rural India.[3] A comparative study on perceived abuse and social neglect among rural and urban geriatric population in India showed that perceived physical abuse (25%) was higher among the elderly residing in rural areas and it was found to be significantly higher among female elderly, whereas perceived psychological abuse (71%), financial abuse (37%), and social neglect (74%) were higher among the elderly residing in urban areas.[6] In the context of mental health, particularly depression is more prevalent in older adults; a community-based cross-sectional study conducted in a rural area found that 9.3% of the elderly had depression.[7] A study conducted in North India reported that the overall prevalence of psychiatric morbidity in rural older adults was found to be 23.7% (95% confidence interval [CI] = 21.89–25.53). Mood (affective) disorders were the commonest (7.6%, 95% CI = 6.51–8.80).[8] Various research studies have found that abused elders may suffer from anxiety, depression, hopelessness, suicide,[9],[10],[11] sadness, and feelings of helplessness.[12],[13],[14] It has been found that lack of social support from family members, friends, and associates has been linked with abusive behavior toward older adults in the context of caregiving.[15],[16],[17],[18] Alexandra Hernandez-Tejada et al.[19] found that low social support increases risk of all forms of mistreatment. The available literature indicates that there is hardly any effort made to understand abuse and depression among older adults in rural areas, especially in northeastern part of India. It is important to address abuse and depression among older adults, particularly in a community and culture where older adults hold a respectful position and are dependent on care from family members. There is a dearth of research in the northeastern part of India on elder abuse, depression, and social support. This study therefore aimed to know the prevalence of abuse and to see its associations with depression and social support among the rural older adults in Tezpur, Assam.

 Materials and Methods



A cross-sectional rural community-based study was conducted. The universe of the study is comprised of older adults residing under Mazgaon Panchayat, Tezpur, Sonitpur district of Assam. The study was conducted for 6 months (July–December 2016). According to the list of polling stations (2016), under Tezpur legislative assembly constituency, there are 200 polling stations. Under Mazgoan locality, there are 11 polling stations. Two polling stations were selected using simple random sampling technique (lottery method). The total number of voters/populations (18 years and above) in the two electorate lists was 1386. Based on the electorate list, 141 older adults aged 60 years and above were listed out. From that list, 102 participants fulfilled the inclusion criteria and completed the interview. Individuals of both genders, aged 60 years and above, giving consent for interview, and those able to understand and comprehend were included in the study. Presence of severe physical and mental illness in the older adults and those who were institutionalized during the survey period were excluded from the study. Mini–Mental Status Examination (MMSE) was administered to screen the participants for any cognitive impairment. Other physical illnesses were excluded by clinical history. Rights of the participants were protected during the conduct of the study in accordance with the practice of ethical obligations (safety, privacy, consent, and confidentiality). The study was passed in the Scientific Research Committee and Institutional Ethics Committee of the institution with which the authors were affiliated. We explained the meaning and purpose of the study to the participants and obtained their written informed consent.

Measures

Semi-structured sociodemographic data sheet: Relevant sociodemographic details were collected using this pro forma. It consists of name, age, gender, caste, religion, type of house, household ownership, total number of family members, type of family, marital status, living status, educational status, financial status, monthly income of the respondent, and source of incomeMini–Mental Status Examination:[20] MMSE is an instrument for grading the cognitive state of patients. The MMSE is a rating of cognitive function and takes 10 min to administer by a trained interviewer.[20] The MMSE provides measures of orientation, registration, attention and calculation, recall, and languageGeriatric Depression Scale (GDS):[21] The GDS Long Form is a 30-item questionnaire in which participants are asked to answer yes or no to questions about their feelings over the past week. The cutoff scores for the scale are as follows: normal (0–9), mild depressives (10–19), and severe depressives (20–30)[21]Vulnerability to Abuse Screening Scale (VASS):[22] VASS is a screening measure to identify older population at risk for abuse; the VASS is a modified version of the H-S/EAST that contains 12 yes/no questions that are to be filled out by the client. The VASS is divided into four factors: vulnerability, dependence, dejection, and coercion. Each factor has three questions on the survey. Cronbach's alpha of 0.39–0.55 was reported for VASS[22]The Multidimensional Scale of Perceived Social Support (MSPSS):[23] It is a 12-item scale, which divides perceived social support from family members, friends, and from significant others. Norms for the general population have been published, with higher scores indicating more social support. Its internal consistency reliability is 88.

Statistical analysis

Data were analyzed with the help of Statistical Package for the Social Sciences (SPSS, South Asia Pvt. Ltd., Kacharakanahalli, Banglore, India) version 18. Frequency, mean, and standard deviation were used to analyze the sociodemographic profile of the respondents and occurrence of abuse, depression, and perceived social support among the rural older adults. Pearson's correlation coefficient was used to see the correlation between abuse, depression, and perceived social support. Multiple regression analysis was done to see the predictors of abuse among older adults.

 Results



The mean age of respondents was 69.03 ± 5.71 years; majority of the respondents were male (57.8%), while female respondents was 42.2%, majority of the respondents were married (77.5%), 64.7% belonged to general category and 98.8% respondents were Hindu. It has been found that most of the respondents have completed study till elementary (47.1%), whereas 34.3% have completed graduation and above and 17.6% respondents have studied till higher secondary. It was found that 97% of the respondents were living in their own house; belong to nuclear type of family (56.9), and living with their spouse and children (58.8%). Majority of the respondents were financially independent (58.8%), with a monthly income of more than Rs. 10,000 (52.9%) and dependent on pension (52.0%). It was found that 37.3% of the respondents belong to upper middle class, 32.4% belong to upper class, 16.7% are from upper lower class, and the rest of the 13.7% respondents belong to lower middle socioeconomic status.

The VASS in [Table 1] illustrates the domain-wise findings. The domain of vulnerability shows a prevalence of 28.4% among the rural older adults. Under the domain of vulnerability, 14.7% of the respondents felt that their closed one made them feel bad recently, 9.8% of the respondents felt that their closed one tried to hurt or harm them recently, and 3.9% of the respondents were afraid of someone in their family. In the domain of dependence, 13.7% of the respondents were dependent. Under the domain of dependence, 5.9% of the respondents did not have trust on their family members, 4.9% of the respondents did not have their privacy at home, and 2.9% of the respondents cannot take their own medication and get around by themselves. In the domain of dejection, 45% of the respondents reported dejection. In the domain of dejection, it was found that 18.6% of the respondents often feel sad or lonely, 13.7% of the respondents feel uncomfortable with someone in their family, and 12.7% of the respondents feel that nobody wants them around. The prevalence of coercion in the study was 2%. Under this domain, 1.0% of the respondents are forced to do things that they did not want to do and 1.0% respondents' belongings were taken without respondents' consents.{Table 1}

[Table 2] illustrates the prevalence of depression among the older adults by using the GDS (Long Form). The results show that out of 102 respondents, 64 (62.7%) respondents were under the normal range, 30 (29.4%) reported mild depression, and 8 (7.8%) respondents reported severe depression.{Table 2}

[Table 3] shows the results of mean perceived social support of the older persons under the three domains of social support including family, significant others, and friends by using MSPSS. The result shows that the mean score was high in the domain of family (24.62 ± 4.6) followed by significant others (24.52 ± 4.2) and friends (20.94 ± 6.05).{Table 3}

The data in [Table 4] illustrates that vulnerability to abuse has a significant positive correlation with geriatric depression (r = 0.619, P < 0.01). Domain-wise vulnerability (r = 0.276, P < 0.01), dependence (r = 0.357, P < 0.01), dejection (r = 0.692, P < 0.01), and coercion (r = 0.305, P < 0.01) have a significant positive correlation with depression.{Table 4}

[Table 5] depicts that vulnerability to abuse has a significant negative correlation with perceived total score of perceived social support (r = −0.443, P < 0.01). Domain wise, the scores reveal that vulnerability domain of VASS has a significant negative correlation with family (r = −0.313, P < 0.01), significant others (r = −0.252, P < 0.01), and friends (r = −0.202, P < 0.05). Dependence has a significant negative correlation with family (r = −0.357, P < 0.01), significant others (r = −0.404, P < 0.01), and friends (r = −0.217, P < 0.05). Dejection domain of VASS shows significant negative correlation with family (r = −0.524, P < 0.01), significant others (r = −0.415, P < 0.01), and friends (r = −0.269, P < 0.01). Coercion domain of VASS has a negative correlation with family (r = −0.230, P < 0.05), significant others (r = −0.270, P < 0.01), and friends (r = −0.016).{Table 5}

As shown in the regression summary [Table 6], domains of MSPSS (family, significant others, and friend) and GDS contributed significantly to the prediction of vulnerability to abuse among older persons (F(5,96) =18.684, P < 0.01) accounting for 49.3% variance. The remaining 50.7% was attributed to variables not included in the study. Depression strongly contributed to the variance on the overall vulnerability to abuse among older persons (β = 0.457, t = 5.653, P = 0.000, P < 0.01).{Table 6}

 Discussion



The result indicates that 28.4% reported vulnerability, 13.7% dependence, 45% dejection, and 2% coercion in the VASS. In one of the studies, it has been found that 8% of the older population reported vulnerability, 6% coercion, 18% dependence, and 22% dejection.[24] When compared with the previous finding, the prevalence of elder abuse is high in the present study. One study conducted in Guwahati, Assam, reported that the prevalence of elder abuse was 9.31% and neglect was the most common type of abuse reported by the elderly population.[25] Grover and Malhotra[26] stated that the prevalence of elder abuse varies from one study to another. Dong et al.[27] in a systematic review on elder abuse reported that studies from India have reported a prevalence rate of about 14%. Elder mistreatment in rural areas was reported by 36.2% of the participants where prevalence rates of psychological mistreatment, caregiver neglect, physical mistreatment, and financial mistreatment were 27.3%, 15.8%, 4.9%, and 2.0%, respectively.[28]

The prevalence of depression among the older people by using the GDS (Long Form) shows that 30 (29.4%) respondents were found in the category of mild depression and 8 (7.8%) respondents fell in the category of severe depression. Depression, particularly mild depression, is common in the rural population of older adults.[29] Radhakrishnan and Nayeem[30] found the prevalence of depression among geriatric population in a rural area to be 37.8% (mild depression) and 21% (severely depressed).[28] The prevalence of geriatric depression (International Classification of Diseases-10) was found to be 12.7% (95% CI = 10.64–14.76%) in rural elder population in South India.[31] In a cross-sectional study[32] based on a 15-item GDS (Short Form), it was found that 207 (62.73%) respondents secured scores between 6 and 10 which is suggestive of depressive syndrome among them. The prevalence of depression among the elderly in India is high.[26]

The finding of the present study shows that the respondents are getting better social support from the family. Melchiorre et al.[18] revealed that social support has a strong impact on older population. A lack of support network and poor family or social relations may be a risk factor for elder abuse. Low levels of social support are related to older age and abuse, particularly psychological abuse. Ali and Hazarika[33] also found that older adult population in rural area were getting more social support from family, followed by friends and significant others. In the present study, vulnerability to abuse has a significant positive correlation with GDS (r = 0.619, P = 0.01). A study revealed that depression was independently associated with elder abuse and neglect.[27] In this study, it has been reported that elder abuse victims were significantly more depressed than nonvictims.[34] Different types of elder mistreatment were found to be associated with different risk factors, and depression was the consistent risk factor for the three most common mistreatment subtypes.[28] In accordance with the findings of the present research, Chokkanathan[5] concluded that overall mistreatment was positively associated with depressive symptoms. The higher levels of chronicity and multiple mistreatments further increased depressive symptoms. The finding of the present study shows that vulnerability to abuse has significant negative correlation with the total score of MSPSS (r = −0.443, P = 0.01). Studies have shown that levels of social support were related to older age and abuse.[18],[19] In regression analysis, MSPSS and GDS contributed significantly to the prediction of vulnerability to abuse among older persons. Depression strongly contributed to the variance on the overall vulnerability to abuse among older persons (β = 0.457, t = 5.653). Nisha et al.[35] found a statistically significant association between elder abuse lack of social support and depression among the elderly patients. Wu et al.[28] found that different types of elder mistreatment were associated with different risk factors, and depression was the consistent risk factor. Manthorpe et al.[36] identified loneliness, depression, and poor quality of life as risk factors of abuse and neglect of older people living in the community.

The present study certainly had some limitations. First, the sample size of the present study reduced from 141 respondents to 102 respondents after meeting the inclusion criteria. For this reason, the findings cannot be generalized due to small sample size. Second, the study mainly focused on rural population; urban and rural comparison could have brought clearer picture on older adults in northeast Indian context. Third, only depression was assessed; other mental health conditions were not taken into consideration in the present study.

 Conclusions



The older adults in the rural community are prone to vulnerability with a high risk of dejection. Older adults suffering from depression are also at a risk of being abused. Mild depression was found to be common followed by severe depression among the rural older adults. A positive correlation was found between abuse and depression which signifies that abuse is a risk factor for depression. Findings implied that in order to prevent possible abuse among older adults in Assam, researchers, social workers, and policymakers should focus more on primary caregivers who care for the older adults. Prevention and early intervention are the two strong ways of dealing with the problems of older adults. Working with multidisciplinary treatment team can be another aspect of dealing with possible difficulties of older adults. The results of this study may guide in planning and implementing programs regarding prevention and management of abuse among older adults.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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