Abstract
BackgroundWith an increasing number of older adults in low- and middle-income countries (LMIC), the burden of multimorbidity and functional dependence is on the rise. At the same time, a higher prevalence of elder abuse is observed in these populations. There is scarce evidence on the interplay between elder abuse and multimorbidity with no reports from LMIC settings yet. Present study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India.MethodsThe data for this study was collected as a part of our AHSETS study comprising of 725 older adults residing in rural Odisha, India. Multimorbidity was assessed by the MAQ PC tool while Hwalek-Sengstock elder abuse screening test (HS-EAST) was used to assess the risk of elder abuse. Functional dependence was measured by the Lawton IADL questionnaire. We used ordinal logistic regression models to identify the correlates of elder abuse and test for mediation by functional dependence.ResultsAround 48.8 % (95 % CI:45.13–52.53 %) older adults had multimorbidity while 33.8 % (95 % CI:30.35–37.35 %) had some form of dependence. Out of 725, 56.6 % (CI 52.85–60.19 %) were found to be at low-risk elder abuse and 15.9 % (CI 13.27–18.72 %) being at high-risk. The prevalence of higher risk of elder abuse was greater among females, non-literates, widowed persons, those not currently working and those belonging to lower socio-economic strata. The risk of elder abuse was significantly associated with multimorbidity (AOR = 1.68; 95 %CI: 1.11–2.57) and functional dependence (AOR = 2.08; 95 %CI: 1.41–3.06). Additionally, we found a partial mediation mechanism of functional dependency between the pathway of multimorbidity and elder abuse.ConclusionsElder abuse and multimorbidity are emerging as issues of significant concern among rural elderly in Odisha, India. Multimorbidity and functional dependence are associated with significantly higher odds of elder abuse among rural older adults. Further, we report the role of functional dependence as a partial mediator between multimorbidity and elder abuse. Therefore, potential interventions on reducing the economic, physical and care dependence among multimorbid patients may reduce the risk of elder abuse.
Highlights
The global geriatric population is predicted to double from 11.5 % to 2015 to 22 % in 2050, with 80 % of them in the low and middle-income countries (LMICs), like India, where the majority live in rural communities [1, 2]
We approached a total of 784 eligible households and with a non-response rate of 7.5 %, a total of 725 rural elderly people participated in the AHSETS study
We did not find any significant difference in risk of elder abuse among different age groups
Summary
The global geriatric population is predicted to double from 11.5 % to 2015 to 22 % in 2050, with 80 % of them in the low and middle-income countries (LMICs), like India, where the majority live in rural communities [1, 2]. Elder abuse is a growing, complex, and significant problem among these rural communities with multiple physical, social, cultural, economic and psychological dimensions. The prevalence of elder abuse varies across the globe which ranges from over 40 % in high-income countries to 13 %-28 % in LMICs [6]. Recent studies have reported the prevalence of elder abuse among rural populations to be as high as 50 % [7]. With an increasing number of older adults in low- and middle-income countries (LMIC), the burden of multimorbidity and functional dependence is on the rise. There is scarce evidence on the interplay between elder abuse and multimorbidity with no reports from LMIC settings yet. Present study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India
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