Vilar-Compte Mireya, Gaitán-Rossi Pablo
EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Mexico City, Mexico.
Front Psychiatry. 2018 Dec 18;9:599. doi: 10.3389/fpsyt.2018.00599. eCollection 2018.
Elder abuse is a common phenomenon with important effects on the health and well-being of older adults. There are important gaps in elder abuse measurement, as it is usually reported as the absence or presence of elder abuse, disregarding its severity and frequency. Identify different ways of measuring severity and frequency of elder abuse and assess whether different experiences of severity and frequency suggest syndemic relationships. Through a sample of 534 non-institutionalized Mexican older women, we assessed how severity (i.e., number of abusive experiences and number of types of abuses) and frequency (i.e., if abusive experiences had happened few or many times) correlate among them. For each of these measures we estimated a multinomial model to examine associations with social support, functional impairments, socioeconomic status, food insecurity, depression, and comorbidities, while controlling for key socio-demographic variables. 30.5% of the older women reported psychological abuse, 8.2% financial exploitation, 5.1% caregiver neglect, 3.5% physical abuse, and 1.2% sexual abuse. In terms of frequency, 77.8% of the women self-reported having never been abused or only once in the last 12 months, whereas 13.1% reported abusive experiences repeating few times, and 9.9% repeating many times. In terms of severity, 66.7% of the older women had not been abused, 22.3% had suffered one type of abuse, and 11.1% two or more. Similarly, 15.0% reported one abusive experience, 8.1% two, and 10.3% three or more abusive events during the last 12 months. Severity measures showed similar associations: social support and high socioeconomic level as protective factors among those with less severe abuse, whereas increased depression, food insecurity and functional impairments were associated with more severe experiences of elder abuse. Frequency followed a different pattern, depressive symptoms were significantly associated with those with few experiences (compared to those with none or once), while functional impairments were associated with many experiences of elder abuse. It is relevant to assess elder abuse through its severity and frequency as inter-individual variability and the complexity of the experience shows different determinants suggesting a syndemic approach. This has important clinical and policy implications.
老年人虐待是一种常见现象，对老年人的健康和幸福有着重要影响。老年人虐待的衡量存在重大差距，因为它通常被报告为是否存在老年人虐待，而忽略了其严重程度和频率。确定衡量老年人虐待严重程度和频率的不同方法，并评估严重程度和频率的不同经历是否表明存在共病关系。通过对534名非机构化的墨西哥老年女性进行抽样，我们评估了严重程度（即虐待经历的数量和虐待类型的数量）和频率（即虐待经历发生的次数少或多）之间的相关性。对于这些衡量指标中的每一个，我们估计了一个多项模型，以检验与社会支持、功能障碍、社会经济地位、粮食不安全、抑郁和合并症之间的关联，同时控制关键的社会人口学变量。30.5%的老年女性报告遭受过心理虐待，8.2%遭受过经济剥削，5.1%遭受过照顾者忽视，3.5%遭受过身体虐待，1.2%遭受过性虐待。在频率方面，77.8%的女性自我报告在过去12个月中从未遭受过虐待或仅遭受过一次虐待，而13.1%报告虐待经历重复了几次，9.9%报告重复了多次。在严重程度方面，66.7%的老年女性未遭受过虐待，22.3%遭受过一种类型的虐待，11.1%遭受过两种或更多种虐待。同样，15.0%的女性报告在过去12个月中有一次虐待经历，8.1%报告有两次，10.3%报告有三次或更多次虐待事件。严重程度衡量指标显示出类似的关联：社会支持和高社会经济水平是虐待程度较轻者的保护因素，而抑郁、粮食不安全和功能障碍的增加与老年人虐待的更严重经历相关。频率则呈现出不同的模式，抑郁症状与经历较少的人显著相关（与没有经历或仅经历一次的人相比），而功能障碍与多次老年人虐待经历相关。通过严重程度和频率来评估老年人虐待是很有必要的，因为个体间的差异和经历的复杂性表明不同的决定因素，这表明需要采用共病方法。这具有重要的临床和政策意义。
