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

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.

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.

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.

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.