INTRODUCTION
Elder abuse is
a significant social health problem dating back to ancient times.1
The World Health Organization defines Elder Abuse “as a single or repeated act
or lack of appropriate action within a relationship where there is expectation
of trust. This action causes harm
or distress or is likely to cause harm or distress to an older person who is
above sixty years old.2 The action or
inaction that constitutes elder abuse was unrecognized as abuse until the
development of approaches to address child abuse and domestic
violence in the latter part of the 20th century. Its perception, knowledge and
understanding have progressively improved, though slowly, over the decades.
From being treated covertly as a family affair, it has gained better attention
to the point that it is now considered a problem of public health importance
with legal implications.1,3 A
historical evolution of Elder Abuse that brought the
issue to prominence is necessary here. A British
scientific journal first documented it in 1975, describing it as ‘granny
battering, elder battering’.4 This publication opened up
discussions on Elder Abuse. In 1982, the matter of elder abuse as a crime
gathered medical attention during the ‘First World Assembly on ageing’ in
Vienna, Austria.5 Thereafter, no discussion on ageing is
complete without the welfare of the older persons with Elder Abuse and
maltreatment pointing to inadequate
welfare. The Vienna Assembly provided the groundwork for policies and
programmes on ageing. They outlined the following concerns: health and
nutrition, protection of the elderly, especially from abuse, housing, family
life, social welfare, income and security. Other issues included employment, education
and actions regarding research into the needs of the elderly citizen.5
The United Nations also proclaimed the year 1999 as the international year for
older persons. With the renewed attention on ageing
and the aged, discussions on Elder Abuse became inevitable.
The ‘Second
World Assembly on Ageing’ took place in Madrid, Spain in 2002 and two key
documents were adopted: “A Political Declaration and the Madrid International
Plan of Action on Ageing", in which Governments pledged to show more
commitment towards problems associated with ageing, including elder abuse and
neglect.6 The responsibility for translating and implementing the
International Plan of Action on Ageing was given to the United Nations Regional
Commissions with a mandate for a five-year review. The third five-year
review was in 2018, during which the Economic Commission for Africa (ECA)
announced its most recent progress. Information was obtained through various
methods which consisted of administration of questionnaires to member countries
to ascertain the availability of selected data, document reviews, database
searches, internet searches and case studies. The conclusion was that there was
slight advancement in policy formulation and development on ageing in Africa,
but implementation was slow and unevenly spread within the continent and
regions.7 More so, the paucity of information particularly with
regards to the elderly in Africa makes the tracking of implementation of the
‘Madrid International Plan of Action’’ on ageing very difficult. On June 15
every year, the ‘World Elder Abuse Awareness Day’ is marked to increase
awareness and suggest strategies to surmount this issue.8
In Nigeria, it
is solely the responsibility of family members to care for their elderly
persons.9 Nigeria first showed interest in policy for elderly care
when the Federal Ministry of Health participated in ‘the 1999 Fourth Global
Conference of the International Federation on Ageing in Montreal, Canada.10
Despite this participation, the family is still wholly responsible
for care of their elderly ones. There was
however a minor general statement as regards elderly care in Section 14.2(b) of
the 1999 Constitution of
Nigeria which states ‘that the security and welfare of its people
shall be the primary purpose of the government11 and it promises in
‘Section 16, sub-section 2(d), that suitable and adequate shelter, suitable and
adequate food, reasonable national minimum living wage, old age care,
pensions, and employment,’ as well as sick benefits, will be provided to all
citizens.12 Despite these declarations, Nigeria still lags as there
is no consensus on care and support of the elderly persons of Nigeria. A
situation where care and support are lacking quickly breeds elder abuse and maltreatment. The occurrence of elder abuse
varies among nations and cultures, with high incidence seen in low- and
middle-income countries.13 It occurs in
various forms and degrees ranging from psychological/emotional abuse, physical
abuse, financial abuse, neglect, sexual abuse, theft and even institutional
abuse. Elder abuse is detrimental to the general well-being of any elder. It is
a violation of human rights. The global population of persons aged 60 years and
over continues to rise and has been estimated to reach two billion by the year
2050. Hurme and colleagues have predicted that this demographic shift will lead to more elder abuse and
maltreatment. Factors that increase the likelihood of an elder being abused
include: age, gender, social status, educational background, level of income,
living arrangement, and marital status among others.14 With the
expected increase in the population of the aged in Nigeria and the predicted
rise in Elder Abuse, a survey of elder abuse and maltreatment is timely. This study therefore aimed to determine the prevalence and
pattern of Elder Abuse and Maltreatment in a Peri-urban area of Rivers State, Nigeria.
MATERIALS AND METHODS
Study Area
The study took
place in Akpor kingdom in Obio-Akpor Local Government Area (LGA) of Rivers State,
Nigeria. Traditionally called Akpor
Kingdom, the area is in Obio/Akpor
Local Government area, one of the two LGAs that make up Port Harcourt
metropolis. There are ten communities in Akpor
kingdom, but through multi-stage sampling, five communities were selected. They
are Alakahia, Choba, Rumuekini, Rumuosi and Ozuoba communities. They are part
of a major city
(Port Harcourt) in the Niger Delta - a major centre of economic activity in
Nigeria. The LGA covers 260 square kilometre (km2). There is one tertiary
institution – the University of Port Harcourt, Choba
in the locality of this study.
The population
estimate for 2023 was 665,789 people in Obio /Akpor LGA and a calculated average population of 35, 211
people was obtained for each of these communities. Like in most parts of the
country, the people of these communities value longevity. The elderly persons
are involved actively in diverse farming activities
as a means of livelihood. Most still have
the burden to cater for themselves. Akpor is the
heartland of the natives– the Ikwerres.3
Study Design: Descriptive cross-sectional study design
was employed.
Study Population: All persons aged sixty (60) years and above in the selected five
(5) communities in Akpor Kingdom.
Exclusion Criteria: Elderly persons who have cognitive impairment
or are too ill to answer questions.
Sample Size Determination
The sample
size was calculated based on the formula: 
The prevalence we worked with was obtained from a previous study on the
assessment of elder abuse and neglect in Akwa Ibom
State, Southern Nigeria.15 Sample size used was 204 persons above
the age of 60 years.
Sampling Method
Multi-stage
sampling method was used. In the final stage -
in the selected
communities, all the households were visited and elderly persons who satisfied
the inclusion criteria were recruited into the study until the sample size was
reached.
Study tool
A structured
interviewer-administered questionnaire was the study tool. It consisted of
three (3) sections. Section 1: Socio-demographic
characteristics. Section 2: Prevalence and patterns of elder abuse among the respondents
(adapted and reviewed from the WHO/INPEA model in the Spain Report16
of elder abuse in the family); while Section 3 highlighted the areas the
respondents suggested needed improvement in elderly care.
Ethical Considerations
A signed informed
consent was obtained from each respondent (elderly person) after adequate
information. The first page of the administered questionnaire had the request
to obtain informed consent and the signature or thumbprint of the respondent.
Data
Collection Procedure
Community entry and house-to-house surveys of elderly
persons. A brief description of the study to the prospective respondents was
done and informed written consent was obtained, followed by interviewer administration of the questionnaire.
Data
Analysis
Descriptive and inferential summary statistical
tools
were used. The data collected was entered
into Microsoft Excel and analyzed using
Statistical Package for Social Science (SPSS) software. Data obtained from the
study were further summarized into tables and
graphs. Also, the Chi-square (
) non-parametric test of
significance was used to interpret the relationship between selected Socio-demographic
characteristics and patterns of elder abuse.
RESULTS
Table 1:
Socio-demographic characteristics of the respondents
|
Variable n = 204
|
Frequency(n)
|
Percentage (%)
|
|
Age group (years)
60-70
>70
|
168
36
|
82.4
17.6
|
|
|
|
|
|
Sex
Male
Female
|
137
67
|
67.2
32.8
|
|
|
|
|
|
Marital status
Single
Married
Widowed
Separated
or divorced
|
9
147
48
0
|
4.4
72.1
23.5
0.0
|
|
|
|
|
|
Source of income
Pension
Children
Family
members
Properties
Others
|
49
76
3
26
50
|
24
37.3
1.5
12.7
24.5
|
|
|
|
|
|
Residence
Own
Rented
Family
member
|
135
67
2
|
66.2
32.8
1.0
|
|
|
|
|
|
Number of Children
≤3
4-6
>6
|
42
116
46
|
20.6
56.9
22.5
|
|
|
|
|
|
Religion
Christianity
Islam
Traditional
|
185
11
8
|
90.7
5.4
3.9
|
The result showed that there
were more males
137(67.2%); 147(72.1%) were married; 73(35.8%) had primary education; 67(32.8%)
were farmers and 168(82.4%) were ≤70
years.
The table above also shows that the
source of income for most of the respondents 76(37.3%) was from their children;
135(66.18%) owned the home they resided in; 116(56.9%) had between 4-6 children
and 185(90.7%) were Christians.
The abuse and maltreatment of the elderly is a
serious public health challenge due to its significant weighty consequences
such as clinical depression, malnutrition, bed sores, and worsening health
challenges among others.
Our study showed that (71.1%) of the
respondents claimed to have experienced at least one form of abuse. This
prevalence is high but not unusual in a developing country like ours where
overwhelmed family members must take care of the elderly with no external help, no
form of insurance, large families and meagre
resources. Institutionalized homes are also very few and culturally
unacceptable. It is viewed as a taboo to send your elderly ones to
care homes in our country. Based on a meta-analysis, the global average
for elder abuse is about 17%.15,17,18
This study also
revealed that almost three-quarters (72.1%) of elders were married. However,
one-third of the spouses were widows/widowers which differs from the survey by Ekot and colleagues in Akwa Ibom
State, Nigeria15 which showed more widows/widowers.
This study noted that
most of the elders (81.8%) had obtained
formal education. The primary level of education accounted for the most common
level of educational qualification in Akpor kingdom.
This did not tally with a similar study in south-south Nigeria.15
The proportion of respondents who had
worked or were working for the government was 30.4%. This result agrees with
the urban nature of our study area where government jobs are readily available.
The results of this study indicates that most
of the elders (80.9%) were still actively involved in
one occupation or another for survival, thereby
further highlighting some form of inadequate financial care by
their family and the lack of social security from the state.19
According to the
results of this study, the sources of income for elders ranged from
support from their children (37.3%) to that from extended family members
(1.5%). Estate rents and sales gave 12.7% while some income (24%) came from
pension receipts and 24.5% from business proceeds. This observation conforms to
our culture and agrees with what obtains in reality in our locality.
Almost two-fifths of the elders (38.7%)
had their children as caregivers while (18.6%) had caregivers who were not
related to them. Females made up about two-thirds of the total caregivers for
the 204 respondents (63.2%). This conforms to findings from previous
studies
which stated that care for elderly persons rests mainly on their children20,21.
In most Nigerian cultures, care of parents is
seen as a filial responsibility and a family obligation. Most
of the elders (66.2%) owned and
lived in their own houses. This may be because most of the respondents are
indigenous to the place where this study was carried out.
In identifying the pattern of elder
abuse and maltreatment, we observed neglect to be the the most common form of abuse followed by emotional
abuse. Neglect of healthcare was pinpointed as the most
prevalent. This
finding aligns with a similar study in another locality in South-South Nigeria.18
Physical abuse, financial abuse and neglect among respondents were noted among
respondents. This agrees with other studies that had been carried out in
Nigeria which showed in decreasing order the prevalence of abuse as
psychological/emotional, neglect, financial,
physical abuse and sexual abuse the least common.15,19,21. The outcome
of our study revealed that the prevalence of restriction and physical assault
was found to be low. This low prevalence of restriction is anticipated in an
environment like that of this study population where some elders still go out
to fend for themselves and their family members because of poor welfare
services from the government and society. And also the inability of their
children to give the expected support due to the high unemployment rate in
Nigeria. We also live communally so daily interactions with neighbors is the
norm. Physical
assault/beating was low relative to the other forms of abuse because the dread
of being cursed by the elderly person restrains people from such acts as an
elder’s curse is feared in our
local culture.
One-third of the abused elders had
experienced financial abuse, particularly in the form of their money being
stolen and other financial misappropriations, including
price inflation.
From the results of this study, prevalence
of neglect
of elders was high.
This
high value may be because most of the care for the elderly occurred within the
family and the caregivers were majorly family members. Due to the competing
family demands, they tend to ignore the basic living needs of the elderly and
perhaps some wrong cultural beliefs that they have lived
their lives and need to expend less energy on them. The neglect of health
care needs was most significant as 28.4% of respondents claimed to be victims.
The misinterpretation of elderly persons’ illnesses as merely due to senility
and a preference to spend resources on younger persons rather than to seek
treatment for the aged may explain this. The combination of poverty,
the busy schedule of children as they seek their daily bread and the long time spent
to obtain health care services in our locality also
contribute to the cause of health care neglect. Also, the fact that healthcare
negligence is not conspicuous makes the perpetrators feel a bit secure. This
high level of healthcare negligence is contrary to what is obtained in
developed countries where there is strong and effective
healthcare insurance for all ages and special health
aides for the elderly.22
Poor hygiene was the least form of
neglect (11.8%). This may be because of the location of our study which is in
an urban area with better amenities like water and sanitation. Neglect in the
form of inadequate clothing was also low (16.2%) but may be as a result of
their less involvement in social activities so their available clothes would
suffice.
This study showed that neglect
and emotional
abuse were the most common forms of elder
abuse in Akpor kingdom. This agrees with the studies
of Ekot, Asogwa and Dong X.23,24,25
Dong et al and Teaster et al in their respective
studies
observed that neglect was the most common type of elder abuse.25,26
The hardly-recognized, easily-ignored nature of neglect may explain its
predominance.
The study also showed a low prevalence
of sexual abuse towards elders (4.4%). This agrees with the studies by Acierno et al, and Mowlam et al.27,28
This low prevalence of such acts may be due to the fact
that it is seen
as a taboo attract a lot of
ancestral curses in our local tradition.
Conclusion:
There is a high prevalence of elder abuse with Neglect
and emotional
abuse being the most common form of elder abuse in our locality. Steps need to
be taken to reduce all forms of abuse and maltreatment of our elderly persons.
There is an urgent need for a public campaign against elder abuse. Health
education on the impact of various forms of elder abuse, and the implementation
of appropriate sanctions against acts of abuse
towards the elderly should be made a priority
health and social policy by the government. Provision of the
necessities of life for the elderly by the family, community and government
should be an integral part of our way of life.
Acknowledgement:
We thank all participants who volunteered to be
studied. We are grateful to Mr Oghenerukewe Tebu who carried out the
analysis.
Competing interest: The authors
declare that they have no competing interests
Funding: None
Authors’
contribution
Conceptualization: GO, CI, INO
Data analysis: GO. Drafting of the manuscript:
INO, GO.
Review and editing of manuscript: INO, GO, CI
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