Hom Nath Chalise^1* and Bidhan Raj Paudel²

¹Social Gerontologist, Department of Public health, Nobel College, Sinamangal Kathmandu, Nepal.

²Medical Officer, KaskiSewa Hospital, Pokhara, Kaski, Nepal.

*Corresponding Author: Hom Nath Chalise, Social Gerontologist, Department of Public Health, Nobel College, Sinamangal Kathmandu, Nepal.

Published Date: 02-24-2020

Copyright^©2020 by Chalise HN, et al. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: Aging is a global issue of importance. But, there are not sufficient researches on the abuse of older persons in the least developed country and Nepal is also one such a country.

Objective: This paper tries to explore the situation of abuse of older persons among community-living older persons. 

Methodology: This is a cross-sectional community-based study carried out in the western part of Nepal in 2018. The total sample size for this study was 318 older adults 60 years and above. 

Findings: The age range of respondents was 60 years to 90 years with a mean age of 71.5 (±4.5) years. The majority of the subjects were male (62.5%), married (52%), with some health problems (62.2%) and had some savings for the future (50.1%). This study shows the prevalence of abuse was 50.3% in the last six months. Findings show the most common older person's abuse was disrespect (42.5%), neglect (41.2%), verbal abuse (29.3%), economic abuse (10.2%), emotional abuse (8.1%) and physical abuse (6.9%). Sexual abuse was 0.9%. This study further found being older, being a woman, suffering from disease, not having financial saving and having health problems were significant factors for an elder person's abuse.  

Conclusion: Abuse of older persons is found quite high in Nepal. This study based on a small sample size cannot be generalized to the whole population. There should be an in-depth study using both quantitative and qualitative methods to explore the real situation of elderly abuse and associated factors.

Keywords

Elderly abuse; Abuse of older persons; Elder mistreatment; Financial abuse; Older adults; Nepal

Introduction 

Aging is a lifelong process of growing up and growing old in between conception and death [1]. Globally, an elderly subgroup of the population is the fastest-growing population than any other age group [2,3]. Study shows aging have direct and indirect implications for families, health and economics [4]. However, there is very little research focusing on issues of older adults, particularly in poorer and developing countries [5,6]. So, much research in this field from different countries and cultures will help for the possible policy formation for the quality of life of older adults.

Aging in Nepal is relatively under-researched [2,3,6-10]. Most of the aging research carried out in Nepal is cross-sectional [2,3,9,11] and there is no publicly available National research carried out in this field. Consequently, there is a lack of specific initiatives in poor and developing nations for developing programs and services to enhance the well-being and quality of life of senior persons [12].

World Health Organization [13] defined older person's 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". 

According to WHO (2015) prevalence of abuse of older persons ranged from 2% to 14% in high or middle-income countries [14]. A study by Chalise (2017) shows the prevalence of older person's abuse is quite high in developing and poor countries compared to middle or high-income countries. The study further says, "Victims of abuse of older persons are at increased risk of illness, injury, pain, anxiety, depression, the likelihood of hospitalization, decreased quality of life and death due to neglect and loneliness" [15]. Very little research is carried out focusing on the abuse of older adults of Nepal [2,16-18]. The purpose of this research is to explore the different types of abuse of older persons in a community living senior persons from a poor country Nepal.

Methods and Materials 

This is a cross-sectional research carried out in the western part, Bardia district of Nepal. Approval for this study was carried out from local authorities of concerned area. Participants of this study were community-living elderly of one community of Bardiya chosen conveniently. This village has a mix of populations of different ethnic groups. House to house and face to face interview was carried out for this purpose. Only one elderly was selected from each household generally having the highest age. Inclusion criteria for this study was individual 60 years and above and able to respond with the enumerator. Participation in this study was voluntary. All the participants were well explained about the objective of the study and informed verbal consent was obtained before data collection. Informed verbal consent was used as Nepalese elderly people are not generally comfortable with signing their names due to illiteracy and also considering misutilisation of signature [19,20]. A structured questionnaire was used as a tool for data collection. It took on an average of 25 minutes to complete the interview. Initially, the researcher approached 356 older persons of the community but 347 older persons agreed to participate in the survey and the questionnaire was completed with 318. Like in the previous studies "older person’s abuse was considered if older persons have faced mistreatment/neglect, disrespect in any one of the activities: physical, economic, verbal, emotional, neglect, disrespect and sexual in the last six months" [2,21]. This is a descriptive study. Data were analyzed using frequency and percentage table through SPSS software version 16. A person's correlation coefficient was used to analyze the significant variables related to the abuse of older adults. 

Results

Description of study population

Table 1 shows a description of the study population. The mean age of the subjects was 71.5 (±4.5) years and age ranged from 60 to 90 years. The majority of the subjects were male (60.5%) and married (59.5%). A further living arrangement shows, 88.4% of adults were living with their son, 6.3% spouse only and 5.3% with others. 60% of respondents were literate, fifty percent of adults had some savings for their future, 62% had some health problems and 19.8% of older adults were involved in income-generating activities (Table 1).

Table 1: Description of study population according to demographic and socio and health variables. 

This study shows 50.3% of community-living older adults had some problem of elder abuse (Table 2) in the last six months. Major subtypes of older person abuse were disrespect (42.4%), followed by neglect (41.2%), verbal abuse (29.3%), economic abuse (10.1%), emotional abuse (8.2%) and physical abuse (6.9%). Sexual abuse was found among 0.9% and mostly in women.

Table 2: Types of older persons abuse.

Spearman's correlation test (Table 3) shows that older persons abuse increases with age (p=0.257), men have lower elder abuse (p=-0.240), widow/widower have higher abuse (p=0.312), illiterate have higher elderly abuse (p=0.172), personal saving decreases the abuse (p=-0.182) and having some health problem increases (p=-0.382) abuse in older adults.

Table 3: Elder abuse according to demographic and socio and health variables.

Discussion

Nepal is in a stage of demographic transition [22]. Due to fertility decline and improvement in mortality in older ages in the past decade has made the proportion of elderly to increase rapidly [8]. Since fertility is further declining in this decade [22], the elderly population is expected to increase rapidly in the coming days also. Moreover, with continuing advancements in medical science, longevity continues to increase and the population of older age groups is projected to increase at even faster rates. This study is trying to explore the abuse of older persons in the community living elderly from the western part of Nepal. We expect such research will be helpful for the policy implication for healthy and happy longevity.

This descriptive study shows most (88.4%) of the seniors in Nepal live with their children. But, this study found one half (50.3%) of the older adults were suffering from at least one type of older person abuse or mistreatment in the last six months. A past study from Nepal shows elderly abuse varies from 26% to 61.7% [2,18,23]. A similar study carries out in the eastern part of Nepal found elderly abuse was 47.4% [2]. The present finding is slightly higher than this finding. This prevalence of elderly abuse in Nepal is quite high when compared with the developed country where it is generally less than 15% [11]. On the other hand, if we look at the situation of other nearby developing countries older person's abuse is also high. A study from Thai shows 50% of elders living with family members were abused [24]. Similarly, one South Indian study shows approximately 60% of the older adults experienced either some forms of abuse [25]. African study also shows more than 60% of seniors experienced abuse of older persons [26].This variation on abuse of older person estimate maybe due to variations in operational definitions, as well as details of actions or cultural differences while considering the abuse of older persons. [2,15,27].

Regarding the different subtypes of elder abuse, this study found very common abuse of older persons were disrespect (42.5%), neglect (41.2%), verbal abuse (29.3%), economic abuse (10.2%), emotional abuse (8.1%) and physical abuse (6.9%). This finding is similar to one previous study from Nepal [2]. But a study from developed country shows prevalence of different subtypes of elder mistreatment: 11.6% (8.1-16.3) for psychological mistreatment, 6.8% (5.0-9.2) for financial mistreatment, 4.2% (2.1-8.1) for neglect, 2.6% (1.6-4.4) for physical mistreatment, and 0.9% (0.6-1.4) for sexual mistreatment [28]. An Indian study also found neglect (39.1%), verbal abuse (39%), physical abuse (12.7%) and financial abuse (10%) most commonly reported elder abuse [25].

This study further found significant factors associated with elder abuse were higher the age, being female, being widow/widower, illiterate, not have financial saving and poor health. These findings are consistent with many other studies. Indian study also shows women, widows, oldest age groups and physically immobile are more vulnerable to abuse than others [25]. Other studies also support those older persons having some chronic disease have higher elder abuse [28,29].

This study shows the situation of abuse of older persons from a least developed country- Nepal. The findings of this study should be understood carefully based on some limitations of this study. Some of the limitations of this study are explained here. First, Due to the cross-sectional nature of the study causality cannot be assumed. Second, respondents were selected conveniently and each volunteer participant was their control. Third, the data collection method was a face-to-face interview and there may be some leading question biases. Fourth, there may be some biases through respondents while reporting elderly abuse. Fifth, as this study is carried out in a small geographical area, findings cannot be generalized to whole population of the country. 

Conclusion

The prevalence of elderly abuse is quite higher in the community living elderly in Nepal. This study based on a small sample size cannot be generalized to the whole population. A further in-depth study is needed to know the real situation of elderly abuse in Nepal.

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