Is multimorbidity associated with risk of elder abuse? Findings from the AHSETS study

Abstract

Background 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. 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. Methods The 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. Results Around 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. Conclusions Elder 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.

Multimorbidity and its associated risk factors among older adults in India

“…Recent studies have revealed that there exist significant associations between obesity [ 28 ] and loneliness [ 29 ] accompanied by multimorbidity in India. Another recent study has investigated in Odisha that multimorbidity increases the odds of older adults' abuse [ 30 ]. There are very few studies on multimorbidity prevalence and its associated risk factors among older adults in India.…”

Epidemiology and impact of chronic disease multimorbidity in India: a systematic review and meta-analysis

“…We observed 60.5% (n=23) of the included studies were based on primary data 5 , 17 , 19 , 20 , 22 , 25 - 29 , 32 - 35 , 37 , 39 - 43 , 45 - 48 whereas 39.5% were from secondary data analysis of nationally representative samples such as Longitudinal Ageing Study in India (LASI) wave-0 (n=1), 18 Study on Global Ageing and Adult Health (SAGE) wave-0 15 (n=1), SAGE wave-1 16 , 21 , 24 , 36 , 44 (n=5), LASI wave-1 32 , 35 (n=2), Building Knowledge Base on Population Aging in India (BKPAI) 38 (n=1), India Human Development Survey (IHDS-II) 31 (n=1) and -United Nations Population Fund (UNFDPA) 23 (n=1). Fifteen studies were from Odisha 5 , 17 , 19 , 25 , 26 , 28 , 32 - 34 , 39 , 40 , 42 , 45 , 47 , 48 ; 12 studies 16 , 18 , 21 , 23 , 24 ,…”

“…Fifteen studies were from Odisha 5 , 17 , 19 , 25 , 26 , 28 , 32 - 34 , 39 , 40 , 42 , 45 , 47 , 48 ; 12 studies 16 , 18 , 21 , 23 , 24 , 30 , 31 , 36 , 38 , 44 , 46 , 49 represented pan India and eight studies were from other states of India. 20 , 22 , 27 , 29 , 35 , 37 , 41 , 43 Eleven studies 5 , 19 , 25 , 26 , 28 , 32 , 33 , 34 , 39 , 43 , 47 were conducted in hospital/primary care (study conducted among patients attending hospitals/primary care) setting while 24 were from the community based set up (data collected by visiting household through face to face interviews) 16 - 18 , 20 ...…”

Elder abuse, depression, anxiety, and stress in community‐dwelling older adults

“…In this study, some variables and types of abuse were found to be significantly related. In the studies conducted in the literature, education level, 31,32 employment status, 14 health perception, 33 presence of psychiatric illness, 12,34 dependency in activities of daily living, 30,34,35 and low mental status 30,34 were among the factors associated with abuse.…”