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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 2  |  Page : 301-305

Elderly abuse among patients admitted to the family health unit of Meet Rady village (Kalubia Governorate)


1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Psychiatry, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission02-May-2013
Date of Acceptance20-Oct-2013
Date of Web Publication26-Sep-2014

Correspondence Address:
Safaa El-Sayed El Siefy
MBBCh, Qaluobia Governorate, Benha City
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.141681

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  Abstract 

Background
Elder abuse in general is an important issue and must be addressed by family physicians who have intimate knowledge of patients' medical, functional and social problems.
Objective
The aim of the study was to estimate the prevalence of the abuse among geriatrics and to determine the types of elder abuse.
Patients and methods
This study was a cross-sectional study for all registered elderly people, aged 60 years and above, who attended the outpatient clinic of Meet Rady village; there were 123 patients during the period from April 2012 to April 2013. This study included 23 patients with elderly abuse, 13 female patients and 10 male patients, aged 60 years and above. All these patients were subjected to predesigned questionnaire and their data were retrieved by checking their files.
Results
The prevalence of elderly abuse in the primary healthcare was 23%. Negligence and financial abuse were the most common types of abuse in primary healthcare. Elderly abuse increases in people with low socioeconomic status. The quality of life that affects prevalence is higher in the abused group versus the nonabused group. The prevalence of good quality of life was 33% and the prevalence of bad quality of life was 67%. The prevalence of psychiatric disorders was 12% and about two-third of them had elderly abuse.
Conclusion
The continuous rise in elderly mistreatment in the society is a new challenge for the healthcare providers and needs an integrated effort from all the workers involved in the health service.

Keywords: Elder abuse, quality of life


How to cite this article:
Farahat TM, El Meselhy HM, El Abedin Rajab AZ, El Siefy SE. Elderly abuse among patients admitted to the family health unit of Meet Rady village (Kalubia Governorate). Menoufia Med J 2014;27:301-5

How to cite this URL:
Farahat TM, El Meselhy HM, El Abedin Rajab AZ, El Siefy SE. Elderly abuse among patients admitted to the family health unit of Meet Rady village (Kalubia Governorate). Menoufia Med J [serial online] 2014 [cited 2019 Nov 23];27:301-5. Available from: http://www.mmj.eg.net/text.asp?2014/27/2/301/141681


  Introduction Top


In almost every country, the proportion of people aged above 60 years is growing faster than any other age group because of both longer life expectancy and declining fertility rates [1]. This population ageing can be seen as a success story for public health policies and for socioeconomic development, but it also challenges society to adapt and to maximize the health and functional capacity of older people as well as their social participation and security [2].

Conventionally, 'elderly' has been defined as a chronological age of 65 years or above, whereas those from 65 through 74 years of age are referred to as 'early elderly' and those above 75 years of age as 'late elderly' [3].

The ageing process is of course a biological reality, which has its own dynamic, largely beyond human control. It is also subject to the constructions by which each society makes sense of old age [4]. In the developed world, chronological time plays a paramount role. The age of 60 or 65 years, roughly equivalent to retirement ages in most developed countries, is said to be the beginning of old age [5].

Elder abuse is not a universally accepted term, and some have used the terms 'inadequate care' and 'elder mistreatment' in recognition that a forensic approach may not be the most useful [6]. However, elder abuse is defined as intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trusted relationship with the elder [7].

Elder abuse has different types such as physical abuse, sexual abuse, emotional abuse, financial abuse, neglect, abandonment and self-neglect [8]. Psychological or emotional elder abuse means mental anguish by means of threat, humiliation, fear or other cruel conduct. It may be inflicted by verbal or nonverbal communication cues [9].


  Patients and methods Top


Type of the study

This study was a cross-sectional study.

Sampling technique

It was cross-match sample for all registered elderly people, aged 60 years and above, who attended the outpatient clinic of family health unit in Meet Rady village.

The aim of the study was to estimate the prevalence of elderly abuse among geriatrics and to determine the types of elder abuse.

Communication with local health authorities in family health unit of Meet Rady village (Benda City, Qaluobia Governorate) was performed to orient them regarding the objectives and procedure of the study to obtain the official permission for the conduction of the study and their cooperation throughout the study.

Communication with all participants which were all volunteers to orient them about the objectives of the study to get their consent.

Two redesigned questionnaires were used to collect data for this study:

(a) The first questionnaire was used to collect data related to sociodemographic status, lifestyle and health status of the patients.

Furthermore, the questionnaire assessed the following:

Lifestyle history:

  1. Smoking (if yes, cigarette or shisha).
  2. Regular coffee or tea drinking.
  3. Physical activity: elderly people activity in home or work or at leisure time.
  4. Health status assessment: main health complaint and chronic health problems.
  5. General health perception.
  6. House stay due to illness.
  7. Participation in social activities.
  8. Participation in religious activities.


(b) The second questionnaire was used to assess the quality of life. It included the following items:

Data were collected by interviewing the elders or their relatives using the quality of life questionnaire of Hawthorne and Richardson (1996).

The questionnaire contained 15 items and every item was given a score from 4 (best response) to 1 (worst response).

The scores were collected with each other for every participant, and according to the quality index the following classification was suggested for the degree of quality:

  1. Good quality: at least 75%.
  2. Fair quality: 50 to less than 75%.
  3. Poor quality: less than 50%.


(c) Questionnaire for assessment of the presence of abuse and for determination of its type according to Meit (2007), who included some diagnostic findings and criteria for every type of abuse - for example:

  1. Physical and verbal abuse by asking the patient whether there is anyone shouting at him/her, calling by obscene words, laughing at him/her, slapping, hitting, pushing, etc.
  2. Financial and medical abuse by asking the patient whether anyone divided his/her money with, theft of money, family forget buying drugs to the patient, or ignored to call the doctor for him/her at time of need, etc.
  3. Emotional and psychological abuse by asking the patient about the presence of habitual verbal aggression, threats, insults, etc.
  4. Negligence by asking about failure to provide the patients with adequate food, clothing, shelter, etc.


Referral to all the above findings or diagnostic criteria was assessed for every type of abuse. The presence of two positive findings ensured the type of abuse occurred, and every type of abuse was considered a shape of negligence.

(d) Furthermore, physical and psychiatric history and examination were performed to detect psychiatric disorder according to DSM-IV (2005).


  Results Top


Studying sociodemographic criteria of the studied group, the result revealed that the majority of the studied groups was between 75 and 84 years of age. More than 50% of them were female patients. About one-third of them were single. About 47% were illiterate followed by 40% of them had basic education. About 86% of them had pension, 50% of them were reported income less than 300 pounds/month, 34% of them were employed and finally more than 53% of them had no health insurance. All the previous served as risk factors for complication.

This study shows that the prevalence of the elderly abuse is 23%: 10% physical and verbal abuse, 16% medical and financial abuse, 11% psychological and emotional abuse and 23% have negligence abuse [Figure 1]. It also shows that there are some associations among the mixed types of abuse: the prevalence of medical and negligence abuse is 30.4%, the prevalence of medical, negligence and financial abuse is 21.7%, the prevalence of physical and financial abuse is 8.6%, the prevalence of the patients who have all types of abuse is 8.6%, about 4% have financial with negligence type followed by 4% have physical, medical and negligence abuse [Figure 2]; [Table 1].
Figure 1:

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Figure 2:

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Table 1: Sociodemographic characteristics of the studied groups

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This study shows that the source of income from previous occupation and health insurance was significantly higher among the groups with good quality of life than in the groups with bad quality of life. Hence, 67% of the studied groups reported good quality of life, whereas 33% of the studied group reported bad quality of life, but there was no significant difference between the group with good quality of life and the group with bad quality of life regarding other demographic criteria [Table 2].
Table 2: Parameters of the quality of life among the studied group

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In this study, the parameters of quality of life such as health perception, house stay due to illness, psychological troubles, independence in activity of daily livings and religious activities were significantly higher among the group with good quality of life than in the group with bad quality of life. It showed also that there was highly statistically significant difference between the quality of life affection and the elderly abuse types [Table 3].
Table 3: Relationship between the quality of life and types of abuse

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This study shows that there was highly statistically significant difference between the old people who had been diagnosed with psychiatric disorders according to DSM-IV and the other group who had not been diagnosed, and the most frequent psychiatric disorders were depressive disorders and the least frequent psychiatric disorders were somatoform and schizophrenic disorders [Table 4].
Table 4: Prevalence of the psychiatric disorders according to DSM-IV among the studied group

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In this study, it revealed that there was highly statistically significant difference between the group with elderly abuse and psychiatric disorders [Table 5].
Table 5: Relationship between abuse and psychiatric disorders

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  Discussion Top


Ageing, for any living, is a biological process that begins with impregnation and ends with death. However, this process may be modified by individual differences including heritage, lifestyle, job, nutritional habits, chronic diseases, personality/mood, how the individual is perceived by the society, his/her entourage and him/herself [10]. As the unique qualities of the elderly, who are being treated as outcasts due to the growing tendency towards nucleus family, cannot be replaced by any other factors, the new generation is growing up without receiving sufficient love and care, and thus the loveless youths inclined to violence are being formed [11].

The result revealed that the majority of the studied groups was between 75 and 84 years of age. More than 50% of them were female patients. About one-third of them were single. About 47% were illiterate followed by 40% of them had basic education. About 86% of them had pension, 50% of them were reported income less than 300 pounds/month, 34% of them were employed and finally more than 53% of them have no health insurance. All the previous served as risk factors for complication [12].

There was no significant difference between the groups with abuse and the group with no abuse regarding the smoking habit. This agrees with the study by National Library of Medicine [13], who stated that the pervasiveness of environmental tobaccos smoke had probably made it difficult to detect an increased risk for smoking-related diseases and psychological disorders in the spouses of smokers [13].

In addition, this study shows that the habit of drinking coffee or tea and lack of physical activity was significantly higher among the groups with abuse than the groups with no abuse. This agrees with the study by National Center on Elder Abuse (NCEA) [14].

The prevalence of the affection with psychiatric symptoms was 70.6% in the group with elderly abuse and 29.4% in the group with no abuse, and the whole prevalence of diagnostic psychiatric disorders was 12% (66.7% of them in the group with elderly abuse and 33.3% of them in the no abuse group) [15]. Hence, there was highly statistically significant difference of psychiatric symptoms and disorders among the groups with abuse than the group with no abuse. This agrees with the study by Unwin et al. [16] who found that, in their study on the health status and psychological well-being of the old age affected highly with mistreatment of the elders, the prevalence of the psychiatric disorders increased with the increased prevalence of elderly abuse [17].


  Conclusion and recommendation Top


Referral to the questionnaire, which consider any type of elderly abuse as a shape of negligence, the prevalence of elderly abuse among the studied persons was 23%, physical and verbal abuse was 10%, psychological and emotional abuse was 11%, financial and medical abuse was 16% and negligence was 23%. Hence, this study recommend to:

Increase the awareness about elder abuse problems and try to reduce the stigma among families, elder persons and the community.

Development of practice guidelines and standards of care for elderly to achieve, maintain and advance good quality health services. These guidelines should be clearly written and regularly communicated to all health service providers by references manuals, posters, checklist and other job aids.


  Acknowledgements Top


The authors thank all geriatrics and workers at the health unit who agreed to participate in the study, despite of their exhaustion.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.Campas. Cairo Demographic Center Population Projection in Egypt, 2002. Available at: http://www.un.org.eg/linkClick.aspx?Fileticket=oOc7rFNbj8%3D&tabid=54&mid=439.  Back to cited text no. 1
    
2. American Academy of Family Physicians. Intervention and treatment strategies for elder abuse. Am Fam Physician 2005; 72 :896-898.  Back to cited text no. 2
    
3. American Psychological Association (APA). Elder abuse and neglect (2010). In search for solutions. Available at: http://www.apa.org/pi/aging/resources/guides/elder-abuse.aspx.  Back to cited text no. 3
    
4. Besdine RW, Fulmer TT, Grossberg GT. MH Beers, TV Jones, M Berkwits. Psychiatric disorders. The Merck manual of geriatrics. Merck Sharp & Dohme 2000.  Back to cited text no. 4
    
5. Buzgov R, Ivanova K. Nursing ethics, elder abuse and mistreatment in residential settings. Vol 16. Sage Publications; 2009;110-127.  Back to cited text no. 5
    
6. Desai AK, Grossberg GT. Pathy J, Sinclair AJ, editors. Geriatric psychiatry. Principles and practice of geriatric medicine. John Wiley & Sons; 2006.  Back to cited text no. 6
    
7. DiGiovanna A. Hartford JA, editor. Biological perspectives. Human aging. 2nd ed. McGraw-Hill; 2000.  Back to cited text no. 7
    
8. Evans P. The verbal abuse site (1999). Available at: http://www.verbalabuse.com/page3/page3.html.  Back to cited text no. 8
    
9. Gallo JJ. Jeannette E, Matheny SC, Lewis EL, editors. Healthy aging & assessing older adults. Current family medicine. The McGraw-Hill Companies; 2007.  Back to cited text no. 9
    
10.Hashem AE. Care for the elderly nationally in Egypt (strategy and action plan until 2015). World Health Organisation Regional Office of the Eastern Mediterranean; 2007.  Back to cited text no. 10
    
11.Clipp EC, Steinhauser KECK Cassel, et al., editor. Psychosocial influences on health in later life. Geriatric medicine an evidence-based approach. Vol. 6. 4th ed. New York, Berlin, Heidelberg: Springer-Verlag; 2003.  Back to cited text no. 11
    
12.Alagiakrishnan K, Blanchette P. Delirium. eMedicine, 2010. Available at: http://emedicine.medscape.com/article/288890-overview.  Back to cited text no. 12
    
13.National Library of Medicine. The Islamic Medical Manuscript Collection (2003). Available at: http://www.nlm.nih.gov/pubs/nlmnews/janmar03/58n1newsline.pdf.  Back to cited text no. 13
    
14.National Center on Elder Abuse (NCEA). 2007. Available at: http://wwwncea.aoa.gov/ncearoot/Main_Site/FAQ/Basics/Types_Of_Abuse.aspx.  Back to cited text no. 14
    
15.Rao G. Jeannette E, Matheny SC, Lewis EL, editors. Movement disorders Current family medicine. McGraw-Hill Companies; 2007.  Back to cited text no. 15
    
16.Unwin BK, Porvaznik M, Spoelhof GD. Nursing homes (2010). Available at: http://www.ncbi.nlm.nih.gov/pubmed/20507046.  Back to cited text no. 16
    
17.Kaplan Sadock AJ. Comprehensive diagnosis of clinical psychiatry. 4th ed. Lippincott Williams & Wilkins; 2005.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
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