Bringing elder abuse out of the shadows: a study from the old age homes of Davangere district, Karnataka, India

INTRODUCTION

Ageing of population is a major emerging demographic issue and is an inevitable consequence of the demographic transition experienced by most countries.¹ In 2001, geriatric population was 77 million and it is estimated that in India total number of elderly will rise to 150 million by 2025.² With more elderly people living longer, the households are getting smaller and congested, causing stress in joint and extended families and issues of elder security and well-being are becoming a matter of concern. There is a need to take care of the situation of elderly in terms of social and mental well-being, economic and social security and elder abuse.¹

Elder abuse

Is defined as “elder abuse is 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”. It is important to note that elder abuse in this definition excludes random acts of violence or criminal behaviour against older people”. Elder abuse constitutes of different forms of abuse like neglect, disrespect, verbal abuse, physical abuse, financial abuse, psychological and emotional abuse or even sexual abuse.³

There is growing realization among older persons that they are more often than not being perceived by their children as a burden. The vulnerability and dependence in old age exposes them to elder abuse. This problem of elder abuse silently affects the older person's life, health, dignity, safety, emotional feelings and also violates the human rights of older person.⁴

The older generation that had once been dependent on their children for old age care is now increasingly looking towards old age homes and long-term institutional facilities.There are legal safeguards to older persons in India, one of which is maintenance and welfare of parents and senior citizens Act 2007, in a national survey only 11% knew about it.¹

The Objective of the study was to identify the magnitude and the pattern of elder abuse experienced by the elderly, that made them to join old age home.

METHODS

It is a cross sectional study conducted between January 2012 ^_ December 2012 for 1 year. Davangere district has 6 talukas, with 7 old age homes (OAH) in its jurisdiction. Data was collected from all the residents of the 7 old age homes of Davangere district, Karnataka, India. With this by the end of study we were able to reach a sample of 105 elderly.

Inclusion criteria

All the residents aged 60 years and above in the old age homes.

Exclusion criteria

Individuals who refused to give consent.

Statistical analysis

Data was entered and analyzed using statistical package SPSS Version 17. Results were tabulated in percentages and proportions. Chi square test was applied to test the significance.

A semi structured and pre tested questionnaire was used to interview the residents after modifying to local language. Contents of the questionnaire were explained to the residents and to the head/manager (concerned person) and they were ensured that a total confidentiality will be maintained. The questionnaire included information regarding socio-demographic factors and their social problems. Regarding social problems, the main focus was to obtain the reason for the elderly to join the old age home. The individuals who have experienced elder abuse and ended up in OAH were further interviewed regarding the type of elder abuse and the person involved in the abuse. The below table shows the definitions of various forms of abuse considered in our study.

RESULTS

Out of 105 residents, majority were in the age group of 60 – 69 (young old) accounting for 48%. Females outnumbered the males, 68 (65%) were females and 37 (35%) were males. 64 (61%) of the residents were either widow or widower and 14 (13%) remained unmarried. 101 (96%) residents belonged to Hindu Religion. 48 residents (46%) were illiterates & 30 residents (29%) stopped schooling once they reached primary schooling (Table 2).

*To be read column wise

Major portion of the residents were engaged in unskilled work in their past as their mode of earning (38%). Social security benefits in the form of old age pension/widow pension were available to about 43% of the residents. 71% of the residents were from rural background (Table 3).

Elder abuse, the major reason for the elderly to join old age home

In our study reason given by majority of the residents to join OAH was abuse accounting for 37 (35.2%), and 28 residents (26.7%) joined old age home as they didn’t wanted to be burden on their family members. About 20 residents (19%) had joined because there was nobody to take care of them and 11 residents (10.4%) joined to be cared in a better way. Other reasons given by residents were for companionship 4 (3.8%), due to ill health/ disability 3 (2.9%), to live with self - respect 2 (1.9%) and one individual was forced by relatives to join OAH.

*To be read column wise

Person involved in elder abuse

Daughter in law of the residents was the major person involved in the elder abuse accounting for 45.9% and son was involved in the abuse among 24.3% elderly. Abuse from relatives accounted for 21.6%. Spouse and daughter were reported in about 5.4% and 2.7% cases respectively (Figure 2).

Type of abuse

Regarding the type of elder abuse, majority of the residents experienced psychological/emotional abuse (70%) followed by Physical abuse (13%). About 11% felt they were being neglected by their family members. In 6% of the residents, it was the financial abuse that made them to join OAH (Figure 3).

Major person involved in the psychological abuse of the elderly was daughter in law accounting for 14 (54%). Elderly felt neglected the most from the relatives 3 (75%). Son was the major person involved in the physical form of abuse 3 (60%) (Table 4).

*To be read row wise.

*To be read row wise.

Abuse was found more evident among elderly aged 80 years and above and females experienced more abuse than their counter part. Elderly from urban area had experienced more abuse. Abuse was found to be high among widow/ widowers. There was no significant association between abuse and any of these socio demographic factors (Table 5).

DISCUSSION

In our study reason given by majority of the elderly to join OAH was abuse similar finding was noted from a study in old age homes of Kerala where the residents reported “family problems” which is categorised as quarrels with their sons, daughters, relatives, son in law and daughter in law, as the main reason to join OAH accounting for to 41%.⁵ Whereas in a study from old age homes of Chennai, about 11.4% of elders stated that their family members mistreated them.⁶ and a national survey findings say, more than one fifth of the elderly, 23% reportedly experienced abuse nationally.¹ Even though there is variation in the findings, in the recent years elder abuse is very much prevalent in the community which is forming a major reason for elderly to leave home.

In our study daughter in law was the major person involved in the elder abuse followed by the son, this finding is similar to a National survey report on elder abuse in India (2013), nationally the daughter-in-law has been reported as a primary perpetrator of abuse (39%) followed closely by the son (38%).¹ Whereas a study from Kerala, showed majority of the abuse was from son (62.4%), followed by daughter in law (59.2%).⁷ Son as a primary perpetrator (39% was found in another study carried out in Tirunelveli district, Tamil Nadu followed by daughter in 15% of the residents and daughter in law accounted in (7.3%) residents.⁴ Majority of the residents in our study are females and adjustment problem they have faced with their daughter in law might have led them to OAH.

Residents in our study experienced psychological/emotional abuse as a major form of abuse and in a study from old age homes of Tirunelveli district, Tamil Nadu mixed abuse (47%) was the major reason for elderly to join OAH followed by emotional abuse (16.3%), financial abuse (14.3%), neglect (8.3%) & sexual abuse (2.3%).⁴ A study from Kerala reported Nearly half (49%) experienced some form of abuse from their family, among them most common forms stated by the residents were verbal abuse (39%) and neglect (39%) followed by physical abuse (13%) and financial abuse (10%).⁷ This shows the changing value towards the old people among the younger generation.

Limitations of the study

Our study assessed the magnitude and pattern of elder abuse and was not intended to find out the impact of elder abuse. Hence we recommend that further studies looking at impact of elder abuse on health and well-being of the elderly can be taken up.

CONCLUSION

Majority of the residents in our study was formed by females. Illiteracy was found on the higher side and majority of the elderly were from rural background. Elderly are becoming victims of elder abuse, with this regard from our study we conclude that elder abuse formed the major reason for the elderly to join the old age home. Main form of abuse experienced is verbal abuse. In most of the cases, daughter in law was the primary perpetrator.

Recommendations

Elder abuse is widespread and unreported. Hence efforts should be made from the government to sensitize the public regarding the problems of old age and importance of family to act as a unit to tackle the problems of old age. Younger generation should be sensitized and motivated that it’s their responsibility to respect, honour and protect the elderly people. Legal awareness about the rights of the older persons such as “maintainence and welfare of parents and senior citizens act 2007” should be created. More research should be encouraged in the field of geriatrics and elder abuse, so that the elder population, who are regarded as precious assets, will have a better quality of life.

ACKNOWLEDGEMENTS

Authors are thankful to the residents of all the old age homes for their kind participation and also we are grateful to the managers/concerned person of all the old age homes for giving me permission to conduct the study.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee of Banaras Hindu University, India

REFERENCES

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