A Nationwide Exploration of Knowledge and Attitudes toward the Abuse of Older Individuals: A Cross-Sectional Study among the General Population of the Republic of Croatia
1
Department of Nursing, University Centre Varaždin, University North, Ul. 104. Brigade 3, 42 000 Varaždin, Croatia
2
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA
3
Department for Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA 98195, USA
*
Author to whom correspondence should be addressed.
Soc. Sci. 2024, 13(9), 467; https://doi.org/10.3390/socsci13090467
Submission received: 6 April 2024
/
Revised: 18 August 2024
/
Accepted: 28 August 2024
/
Published: 4 September 2024
(This article belongs to the Section Social Policy and Welfare)
Abstract
:Understanding the frequency of abuse suffered by older individuals proves challenging when attempting to link it to everyday social issues due to variations in the interpretation and comprehension of this form of mistreatment. This cross-sectional study conducted in May and June of 2023 aimed to investigate the perceptions and attitudes of the general population in the Republic of Croatia regarding the abuse of older individuals. The research included 822 volunteers aged from 18 to 64 who actively engaged in social media. A self-developed, structured questionnaire (based on an exhaustive review of the relevant literature) that underwent a thorough pilot testing phase to confirm clarity, coherence, and respondent comprehension was used to collect the study data. The data analysis included descriptive statistics, chi-square tests for associations between variables, and Mann–Whitney U and Kruskal–Wallis tests to assess the relationships between correct answers and observed indicators, with a significance level set at p < 0.05 (two-tailed). It can be concluded that there was a statistically significant difference in knowledge of possible causes of abuse depending on the age groups of the respondents (p = 0.001) and their present employment within the health or social system (p < 0.001). A prevailing neutral stance was observed among the majority of the surveyed population regarding the attribution of responsibility to older individuals themselves for any mistreatment they face. When confronted with scenarios illustrating abusive behaviour towards older individuals, the participants exhibited nuanced recognition across different forms of abuse, with the exception of financial abuse, where most participants indicated that there was no abuse or possible abuse. These findings underscore the need for enhanced public education initiatives concerning the diverse manifestations of abuse and neglect within the community of older individuals in the Republic of Croatia. Additionally, there is a pressing need for counselling services aimed at fostering a deeper understanding of the unique needs of older individuals and the underlying factors contributing to abusive behaviour. Through such measures, societal awareness and support mechanisms can be fortified, fostering a culture of respect, empathy, and protection for older adults.
1. Introduction
Population aging represents an important demographic challenge facing today’s society, with implications for the healthcare system, social care, the economy, and social structures (Jakovljevic and Ogura 2023). The age of 65 is often viewed as the age limit for older individuals (Shinan-Altman and Werner 2019). According to the UN classification, the Republic of Croatia belongs to the fourth group of European countries where over 10% of the population is over 65 years old, as the proportion of people over 65 years old was 22.3% according to the last census in 2021. This indicates that the trend of the progressive aging of the population continues. The phenomenon of the abuse of older individuals was first introduced in the United Kingdom in 1975 with the term “granny battering” (Schlesinger 1984). Previously, there was little consensus regarding the necessity of distinguishing the abuse of older individuals as a distinct form of violence and abuse with its own risk factors that need to be prevented and addressed. It has mainly been grouped with other forms of abuse, such as domestic violence, and not recognised as a separate form of abuse (Ludvigsson et al. 2022).
The issue of abuse presents challenges when it comes to integrating it into common social concerns due to the varying interpretations of what constitutes abuse and the significant underreporting of cases. Abuse of older individuals is defined as: “intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable older individual by a caregiver or other person who stands in a trust relationship, or failure by a caregiver to satisfy the basic needs or to protect the older individual from harm”. Abuse is not only a problem for those living on the margins of society, but is also found in the immediate environment of all socio-economic and educational groups (Pillemer et al. 2016). Due to their poorer financial situation and weaker financial resources, older individuals are often victims of domestic violence, and violence between adult children within the same family is becoming increasingly common. When it comes to domestic violence, it is important to emphasise that it is not an isolated case, but a complex pattern of behaviour in which violence is an integral part of the relationship dynamic (Lanchimba et al. 2023).
The objective of this study was to investigate the perceptions of the abuse of older individuals among the general population residing in the Republic of Croatia in order to explore various aspects of elder abuse—including understanding the potential factors contributing to abuse, attitudes towards blaming older individuals for their abuse, and responses to scenarios depicting different forms of abuse. We formulated five hypotheses: (1) there is a statistically significant difference in the understanding of potential causes of the abuse of older individuals between male and female participants; (2) age is significantly associated with the understanding of potential causes of the abuse of older individuals, with different age groups demonstrating varying levels of understanding; (3) employment in the health or social sector is significantly associated with accuracy in recognising potential causes of the abuse of older individuals, with differences observed between those employed in these sectors and those who are not; (4) there are statistically significant differences in attitudes towards blaming older individuals for their abuse across different age groups; and (5) participants’ recognition of severe forms of abuse (physical, emotional, sexual, and neglect) versus financial abuse varies significantly, with differences observed across different age groups.
2. Research on Abuse of Older Individuals
Much of the existing research has primarily concentrated on the prevalence of older individuals’ abuse, with limited attention given to older individuals’ personal perceptions of such abuse. It has to be noted that central and eastern European countries usually lack this public acknowledgement of sensitive issues. Most research on the abuse of older individuals has relied on binary outcomes (i.e., occurrence vs. non-occurrence), which tend to simplify the complexity and severity of such abuse by reducing it to a single category of positive cases. This approach is useful for identifying the prevalence rates of the abuse of older individuals and its associated risk factors, however, it oversimplifies the complexity of abuse and offers limited insight into its various dimensions, such as its perceived severity (Burnes et al. 2017; Broady et al. 2024).
The usual respect and care given to our aging population is now being compromised by a growing incidence of neglect and abuse, where even Time magazine discussed it in an article titled “The Growing Epidemic of Elderly Abuse”, emphasising the surge in cases of abuse of older individuals (driven by factors such as social isolation and financial exploitation, but also inadequate support systems) (Glatter and Papadakos 2024). The article highlighted the effects of the abuse on older individuals, including emotional, physical, and financial harm. It called for more attention to be paid to this issue, emphasising the need for stronger protective measures and greater public awareness to combat this growing crisis (Glatter and Papadakos 2024).
Furthermore, much of the reviewed literature addresses the abuse of older individuals in general terms, rather than focusing specifically on abuse by caregivers. It is crucial to consider this broader context alongside the specific factors related to caregiver abuse. Accurately assessing the prevalence of abuse and neglect among older individuals is challenging, as the literature presents varying estimates (Broady et al. 2024). On a global scale, a meta-analysis found that approximately 16% of adults aged 60 and older who lived at home experienced some form of abuse over a 12-month period. This included psychological abuse (11.6%), financial abuse (6.8%), neglect (4.2%), physical abuse (2.6%), and sexual abuse (0.9%) (Yon et al. 2019).
While caring relationships between caregivers and family members or friends are generally founded on trust and empathy, it is recognised that some caregivers do engage in abuse, neglect, and exploitation. Understanding the risk factors in these situations is crucial for identifying and preventing such abuse (Broady et al. 2024). Earlier research found that, in relation to abuse or neglect, significant risk factors for older individuals include multimorbidity (Alraddadi 2022; Sathya et al. 2022), a low socioeconomic status (Gürsoy and Kara 2020; Sathya et al. 2022; Chen and Chan 2022), previous traumatic event exposure (Acierno et al. 2010; Chen and Chan 2022), depression (Maia et al. 2019; Gürsoy and Kara 2020), and low social support (Acierno et al. 2010; Amstadter et al. 2011).
Abuse within caring relationships has been found to be a broader and more complex phenomenon than previously understood. The characteristics linked to the abuse of older individuals can vary depending on the type of abuse and the specific definition applied (Välimäki et al. 2020; Broady et al. 2024). Overall, the literature has identified several risk and protective factors related to caregivers, care recipients, and broader cultural or systemic issues, many of which are consistent across various international contexts. Some of the reviewed literature suggests the need for valid risk assessment tools to facilitate systematic early screening in caregiving roles and help to identify caregivers and families at a higher risk of abuse (Melchiorre et al. 2017; Broady et al. 2024).
A Cochrane Review on preventing the abuse of older individuals categorised studies into several areas: (1) education; (2) programs to reduce risk factors; (3) policies related to abuse; (4) legislation related to abuse; (5) programs to improve the detection of abuse; (6) programs for elderly victims of abuse; and (7) rehabilitation programs for perpetrators of abuse. However, due to various methodological issues and constraints, the review could not assess whether the interventions were effective in reducing such abuse. Specifically, the effectiveness of education programs in enhancing caregivers’ knowledge about abuse remained unclear because of the low quality of the evidence reviewed (Baker et al. 2016).
3. Materials and Methods
3.1. Study Design
This cross-sectional study conducted in May and June of 2023 aimed to investigate the perceptions of the abuse of older individuals among the Croatian-speaking population residing in the Republic of Croatia and actively engaged in social media. We designed a recruitment strategy with an emphasis on participant autonomy and data confidentiality, while the ethical considerations (including obtaining informed consent) were outlined at the survey’s inception. The inclusion criteria, specifying an age range from 18 to 64, were transparently communicated to potential participants. The robust sample size of 822 individuals, reflective of the general community (and spanning across all counties in the Republic of Croatia), yielded a calculated power of 95% at a confidence level of 95%. The temporal constraints and choice of a cross-sectional methodology in the design of this study were grounded in the practicalities of data collection and resource considerations.
3.2. Instrument and Data Collection
The original and novel survey instrument, developed through an exhaustive review of the relevant literature, underwent a thorough pilot testing phase to ensure clarity, coherence, and respondent comprehension. Beyond socio-demographic variables like gender, age, and education, the questionnaire delved into nuanced aspects of older individuals’ abuse. More specifically, to gauge the participants’ perspectives comprehensively, questions were framed to assess their knowledge about the potential causes of abuse, attitudes towards assigning blame to older individuals, and responses to scenarios contributing to abuse. The incorporation of a 5-point Likert scale, with a rating of 5 indicating “strongly agree” and 1 indicating “strongly disagree”, facilitated nuanced response capture. The further consolidation of responses into three categories (i.e., “agree”, “neutral”, and “disagree”) provided a structured framework for analysis. During this consolidation, we took care to maintain the integrity of the original data by carefully considering how each response level contributed to the overall construct being measured.
In this study, we employed a convenience and purposive sampling approach, the latter with the aim to obtain approximately one-quarter of respondents that were employed in the health or social sector to facilitate comparative analyses. The choice of Google Forms as the data collection platform was informed by its widespread usage, accessibility, and user-friendly interface. The transition to an online format not only facilitated ease of participation, but also allowed for the systematic tracking of responses and a structured data collection process, ensuring that all responses were properly recorded and stored securely. The dissemination of the survey link through Facebook aimed to maximise our outreach and diversify the participant demographics. For transparency purposes, we included a clear and concise participant information sheet within the online form.
To ensure the quality and reliability of the data collected, we implemented several rigorous quality control measures throughout the data collection process. Our survey instrument was developed based on an exhaustive review of the relevant literature and underwent a thorough pilot testing phase to confirm clarity, coherence, and respondent comprehension. This pilot phase allowed us to identify and rectify any ambiguities in the questions, thereby enhancing the reliability of the responses. In addition, we employed systematic monitoring for incomplete or inconsistent responses during the data collection, and any such responses were excluded from the final analysis. Data integrity checks were performed to ensure that the responses were consistent with the inclusion criteria and to identify any potential outliers that could affect the analysis.
3.3. Data Analysis
Upon the completion of the data collection, the dataset was subjected to analysis using the IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, comprising frequency counts and percentages, were computed to offer a comprehensive overview of the participant responses. The chi-square test (χ2) was employed to examine the associations between categorical variables, providing insights into the potential relationships within the data. Testing the total number of correct answers in relation to the observed indicators was performed using the Mann–Whitney U test and the Kruskal–Wallis test. The reporting of statistical methods and tests adhered to established conventions in research manuscripts, enhancing the study’s transparency and reproducibility. All significance tests were conducted with a two-tailed p-value threshold set at <0.05.
4. Results
4.1. Sociodemographic Characteristics
Table 1 displays the distribution of the participants’ sociodemographic characteristics. A total of 822 individuals from the Republic of Croatia participated in the study. Female participants were the majority, accounting for 58.2% of the total. The age of the participants varied between 18 and 64 years, with an average of 38.1 years. Most participants (57.5%) had secondary school education or lower. The remaining percentage (42.5%) had a college degree or higher education. Within the study sample, 23.4% of the participants were employed in the health or social system.
4.2. Potential Factors Contributing to Abuse of Older Individuals
Table 2 displays the percentages of agreement and disagreement by independent variables (gender, age, and employment in health or social system) for the items regarding knowledge of the potential factors contributing to the abuse of older individuals. The majority of respondents, i.e., 38.8% of them, agreed that older women are more likely to experience abuse and neglect compared to men, while 59.5% agreed that those with mental and physical disabilities are more likely to experience abuse and neglect. Meanwhile, 42.1% of respondents expressed disagreement with the statement that older individuals residing in large families are more exposed to abuse and neglect, while 35.2% of participants agreed that the abuse and neglect of older individuals is more prevalent in families with a low socioeconomic level. Furthermore, a majority of 51.3% agreed that individuals harbouring negative sentiments or thoughts towards older individuals, or those who have encountered unfavourable experiences with them, are more prone to neglect and mistreat them. In total, 52% of respondents agreed that individuals who perceive the responsibility of caring for older individuals as burdensome are more inclined to neglect and abuse them (Table 2).
Given that all the possible causes of the abuse of older individuals mentioned can be deemed accurate in accordance with previous research (Ananias and Strydom 2014; Lachs and Pillemer 2015; Pillemer et al. 2016), statistical testing was conducted to assess the total number of correct responses relating to the independent variables (gender, age, and employment in the health or social system). For these purposes, we used the Mann–Whitney U test and the Kruskal–Wallis test (Table 3). The total number of correct answers had an arithmetic mean of 3.22, with a standard deviation of 1.85. No relationships were found between genders in terms of their understanding of the potential causes of abuse (Mann–Whitney U test = 76,946.500; p = 0.111), meaning our first hypothesis was not confirmed. An association was identified between age groups (Kruskal–Wallis test = 16.516; p = 0.001); correct answers were seen less in older participants, confirming our second hypothesis. Furthermore, a statistically significant correlation was found between participants employed in the health or social sector and those not employed in these fields (Mann–Whitney U-test = 40,227.500; p < 0.001), confirming our third hypothesis. Moreover, participants working in the health and social sectors exhibited greater levels of accuracy in their responses.
4.3. Blaming Older Individuals for Their Abuse
Table 4 presents the percentage and chi-square test results, which indicate the levels of agreement and disagreement among different age groups regarding attitudes towards blaming older individuals for their abuse. A majority of participants, specifically 36.5% of them, expressed their disagreement that nagging and complaining from older individuals might be considered as valid reasons for engaging in abusive behaviour toward them. Meanwhile, 39.4% expressed neutrality and indicated that excessive requests from older individuals may result in abusive behaviour. In total, 37.3% of respondents held the belief that older individuals would be less exposed to abuse if they possessed a better understanding of the challenges faced by younger adults and children. A total of 41.4% of the study participants agreed with the assertion that the occurrence of abuse would decrease if older individuals resided separately or in a nursing facility alongside individuals of their own age. Considering the p-values presented in Table 4, we can say that the fourth hypothesis was confirmed for all the claims (or scenarios), except for the statement “If the older individuals lived in a nursing home with their peers, there would be less abuse”.
4.4. Scenarios Involving Depictions of Various Forms of Abuse of Older Individuals
Table 5 presents the percentage and chi-square test results for different age groups concerning scenarios depicting various forms of abuse of older individuals. For Scenarios 1 and 2, pertaining to financial abuse, most participants, ranging from 59.9 to 64.1%, held the belief that either no abuse was occurring or that there was the potential for abuse. Regarding other scenarios involving other forms of abuse (such as physical, emotional, sexual, and neglect), the majority of participants, ranging from 42.6 to 98.2%, perceived these forms of abuse as more severe—a statistically significant difference according to age groups was found for three scenarios, partly confirming our fifth hypothesis.
5. Discussion
Our study revealed a concerning lack of understanding regarding elder abuse in Croatia, particularly considering the forms of financial exploitation and neglect, emphasising the need for comprehensive education and awareness campaigns to combat this pervasive issue and safeguard the vulnerable population of older individuals. Through an examination of participants’ knowledge and attitudes, we sought to shed light on the factors contributing to the abuse of older individuals, but also explore how mistreatment and abusive behaviours are recognised in different scenarios.
When analysing knowledge about the potential factors contributing to the abuse of older individuals, a mere 27.7% of participants agreed that older individuals living in a large family are more susceptible to experiencing abuse and neglect. Many believed that larger homes or intergenerational households provide a safe environment, but such households are at risk of unequal power dynamics, which can, consequently, expose older family members to a higher risk of abuse (Lowenstein 2010). In total, 38.8% of respondents agreed that older women are more prone to encountering abuse and neglect. Statistically, older women are significantly more likely to be experience violence from their husbands compared to husbands experiencing abuse from women (Meyer et al. 2020); in general, women are more likely to be victims of partner abuse, and this pattern persists even as they age (Ogresta et al. 2008). Approximately 58 to 59.5% of respondents agreed that older individuals with mental and physical disabilities are at a higher risk of encountering abuse and neglect. Older individuals experiencing physical impairments, incontinence, or difficulty performing personal hygiene might be humiliated by caregivers, usually verbally, while other forms of abuse also occur among people with limitations in performing everyday activities (Post et al. 2010).
When analysing the attitudes regarding assigning blame to older individuals for their mistreatment, it was noted that a significant proportion of participants (26.6 to 39.4%) held a neutral view toward each attitude. The fact that the participants disagreed with the practise of attributing blame to older individuals for their mistreatment does not necessarily imply a positive stance, since, very often, a neutral attitude towards older individuals can also have bad outcomes, particularly in terms of disregarding and neglecting their needs. The term “neutral attitude” is very often indistinguishable for researchers and is also often understood as an indifferent attitude, i.e., a “negative attitude in the passive voice” (Hu and Gasper 2022), and that people, regardless of age, have mixed attitudes towards older individuals. This is because attitudes are multidimensional and individuals can simultaneously hold positive and negative attitudes towards older individuals, depending on the specific domains being examined (Spaccatini et al. 2022). When comparing the viewpoints of the authors Ananias and Strydom (2014) with this study, it is evident that they believe older individuals are often demanding, ungrateful, and difficult, which can lead to aggressive behaviour from care providers. Therefore, the focus of further research should be on the quality of care provided to older individuals with intellectual disabilities, dementia, or other significant impairments in their psychophysical functioning (Ananias and Strydom 2014).
When analysing the participants’ responses regarding the recognition of the abuse of older individuals in various scenarios, it was found that they correctly recognised physical, psychological, neglect, and sexual abuse as forms of abusive behaviour. However, when it came to scenarios involving financial abuse, they perceived them as situations where no abuse was present or where potential misuse could occur. This may relate to a study conducted in the Netherlands which discovered that abuse is predominantly characterised as physical abuse, whereas financial abuse is more cumbersome to identify (Mysyuk et al. 2016). In most cases, many older individuals lack the ability to identify abusive behaviour, meaning they have a limited comprehension of the notion of abuse directed towards them and may overlook some forms of abuse (Killick et al. 2015). Some authors have stated that financial abuse is a greater challenge in terms of detection due to its wide spectrum of possible activities, including embezzlement, signature forgery, abuse of power of attorney, and numerous forms of financial fraud. Moreover, the understanding of what constitutes financial abuse varies across cultures and contexts. The topic of the financial abuse of older individuals is still significantly understudied (Schuessler 2022). The acknowledgment of physical abuse as a predominant manifestation of abuse may be attributed to various circumstances. Bodily abuse manifests in observable bodily indicators, such as bruises or scratches, which are conspicuous and facilitate its identification (Houten et al. 2022).
Our study had several limitations. As our sample was a combination of convenience and purposive sampling, the external validity is constrained by the limitations inherent to such a sample. The non-probabilistic method of sample selection, primarily through one social network, may limit the generalisability of the findings to the broader population. There is also a possibility of response bias and social desirability bias. The reliance on an online platform for data collection may introduce a digital divide, excluding individuals without internet access or those who are less familiar with online surveys, which potentially omits certain demographic groups and influences the results.
6. Conclusions
The elderly population is often viewed as a particularly vulnerable segment of society, susceptible to various forms of abuse due to their perceived fragility and dependence. This issue of elder abuse presents a significant social concern in contemporary society, yet it remains inadequately addressed, made particularly evident by the scant coverage of abuse incidents in Croatia. Despite its prevalence, elder abuse tends to receive minimal attention compared to other social issues, partly due to differing perceptions and understandings of what constitutes abuse. If professionals in the field usually receive training to understand and to recognise different forms of abuse, this is not the case for beneficiaries, the families of older persons, and society in general.
Financial exploitation and neglect, among other forms of mistreatment, are distressingly underreported, exacerbating the problem’s invisibility. Even when cases are brought to light, they often stem from limited-scale studies, failing to capture the full extent of the issue. Consequently, there is a pressing need for heightened awareness and education among individuals in the Republic of Croatia concerning elder abuse and neglect in its various manifestations.
Moreover, there is a demand for comprehensive guidance on recognising the signs of abuse, understanding the needs of older individuals, and identifying the potential factors contributing to abusive behaviour. By addressing these gaps in knowledge and understanding, society can take proactive measures to prevent elder abuse and protect vulnerable individuals. Effective education initiatives and increased public awareness efforts are essential steps toward fostering a culture of respect, empathy, and support for the elderly population, ultimately ensuring their safety and well-being.
To effectively address the issue of abuse in older individuals, social policy should focus on enhancing public awareness through nationwide campaigns, mandating comprehensive training programs for all individuals interacting with older adults, as well as on strengthening reporting mechanisms to ensure cases of abuse are brought to light. We believe our results will contribute to the awareness-raising efforts in the Republic of Croatia. Additionally, developing stronger legal protections, expanding support services for both older adults and caregivers, and also promoting community-based initiatives to reduce social isolation are pivotal steps. Increased research and data collection should inform policy decisions, ensuring that interventions are tailored to the specific needs of older people, ultimately fostering a culture of respect and protection.
Author Contributions
Conceptualization, D.S. and M.N.; methodology, D.S. and M.N.; validation, D.S., M.N. and S.O.; formal analysis, D.S. and T.M.; investigation, D.S.; data curation, D.S., S.O. and M.N.; writing—original draft preparation, D.S. and T.M.; writing—review and editing, D.S., M.N., S.O. and T.M.; supervision, M.N. and T.M. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
This study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of University North (University Centre Varaždin) (234/SSD/2023), approval date is 25 April 2023.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The data presented in this study are available upon reasonable request from the corresponding author. The data are not publicly available due to privacy and ethical reasons.
Conflicts of Interest
The authors declare no conflict of interest.
References
- Acierno, Ron, Melba A. Hernandez, Ananda B. Amstadter, Heidi S. Resnick, Kenneth Steve, Wendy Muzzy, and Dean G. Kilpatrick. 2010. Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study. American Journal of Public Health 100: 292–7. [Google Scholar] [CrossRef] [PubMed]
- Alraddadi, Khulood. 2022. Prevalence and Risk Factors of Elder Mistreatment in Sheltered Homes. Journal of Interpersonal Violence 37: 1588–603. [Google Scholar] [CrossRef] [PubMed]
- Amstadter, Ananda B., Kristyn Zajac, Martha Strachan, Melba A. Hernandez, Dean G. Kilpatrick, and Ron Acierno. 2011. Prevalence and Correlates of Elder Mistreatment in South Carolina: The South Carolina Elder Mistreatment Study. Journal of Interpersonal Violence 26: 2947–72. [Google Scholar] [CrossRef]
- Ananias, Janetta, and Herman Strydom. 2014. Factors contributing to elder abuse and neglect in the informal caregiving setting. Social Work/Maatskaplike Werk 50: 268–84. [Google Scholar] [CrossRef]
- Baker, Philip R. A., Daniel P. Francis, Noran N. Hairi, Sajaratulnisah Othman, and Wan Yuen Choo. 2016. Interventions for preventing abuse in the elderly. The Cochrane Database of Systematic Reviews 2016: CD010321. [Google Scholar] [CrossRef]
- Broady, Timothy, Catherine Thomson, Ilan Katz, and Sarah Judd-Lam. 2024. Literature Review on the Abuse, Neglect, and Exploitation of Adults with Disability and Older People by Carers. Sydney: UNSW Social Policy Research. [Google Scholar] [CrossRef]
- Burnes, David, Karl Pillemer, and Mark S. Lachs. 2017. Elder Abuse Severity: A Critical but Understudied Dimension of Victimization for Clinicians and Researchers. The Gerontologist 57: 745–56. [Google Scholar] [CrossRef]
- Chen, Mengtong, and Ko Ling Chan. 2022. Elder Abuse and Neglect in China: Prevalence, Co-occurrence, and Intergenerational Risk Factors. Journal of Interpersonal Violence 37: 9839–62. [Google Scholar] [CrossRef] [PubMed]
- Glatter, Robert, and Peter J. Papadakos. 2024. The Growing Epidemic of Elderly Abuse. Time Magazine. Available online: https://time.com/6973333/elderly-abuse-epidemic-essay/ (accessed on 14 August 2024).
- Gürsoy, Melike Y., and Fatih Kara. 2020. Prevalence of violence against older adults and associated factors in Çanakkale, Turkey: A cross-sectional study. Geriatrics & Gerontology International 20: 66–71. [Google Scholar]
- Houten, Miriam E., Lilian C. M. Vloet, Thomas Pelgrim, Udo J. L. Reijnders, and Sivera A. A. Berben. 2022. Types, characteristics and anatomic location of physical signs in elder abuse: A systematic review. European Geriatric Medicine 13: 53–85. [Google Scholar] [CrossRef]
- Hu, Danfei, and Karen Gasper. 2022. Examining the Link Between Neutral and Ambivalent Attitudes: Their Association and their Co-Occurrence. Social Cognition 40: 1–28. [Google Scholar] [CrossRef]
- Jakovljevic, Mihajlo, and Seiritsu Ogura. 2023. Global Population Aging—Health Care, Social and Economic Consequences, Volume II. Frontiers in Public Health 11: 1184950. [Google Scholar] [CrossRef] [PubMed]
- Killick, Campbell, Brian J. Taylor, Emer Begley, Janet Carter Anand, and Marita O’Brien. 2015. Older people’s conceptualization of abuse: A systematic review. Journal of Elder Abuse & Neglect 27: 100–20. [Google Scholar]
- Lachs, Mark S., and Karl A. Pillemer. 2015. Elder Abuse. The New England Journal of Medicine 373: 1947–56. [Google Scholar] [CrossRef] [PubMed]
- Lanchimba, Cintya, Juan Pablo Díaz-Sánchez, and Franklin Velasco. 2023. Exploring factors influencing domestic violence: A comprehensive study on intrafamily dynamics. Frontiers in Psychiatry 14: 1243558. [Google Scholar] [CrossRef]
- Lowenstein, Ariela. 2010. Caregiving and Elder Abuse and Neglect—Developing a New Conceptual Perspective. Ageing International 35: 215–27. [Google Scholar] [CrossRef]
- Ludvigsson, Mikael, Nicolina Wiklund, Katarina Swahnberg, and Johanna Simmons. 2022. Experiences of elder abuse: A qualitative study among victims in Sweden. BMC Geriatrics 22: 256–68. [Google Scholar] [CrossRef]
- Maia, Paulo H. S., Efigênia Ferreira E. Ferreira, Elza Machado de Melo, and Andréa Maria Duarte Vargas. 2019. Occurrence of violence in the elderly and its associated factors. Revista Brasileira De Enfermagem 72: 64–70. [Google Scholar] [CrossRef]
- Melchiorre, Maria G., Mirko Di Rosa, Francesco Barbabella, Norma Barbini, Fabrizia Lattanzio, and Carlos Chiatti. 2017. Validation of the Italian Version of the Caregiver Abuse Screen among Family Caregivers of Older People with Alzheimer’s Disease. BioMed Research International 2017: 3458372. [Google Scholar] [CrossRef]
- Meyer, Sarah R., Molly E. Lasater, and Claudia García-Moreno. 2020. Violence against older women: A systematic review of qualitative literature. PLoS ONE 15: e0239560. [Google Scholar] [CrossRef]
- Mysyuk, Yuliya, Rudi G. J. Westendorp, and Jolanda Lindenberg. 2016. Older persons’ definitions and explanations of elder abuse in the Netherlands. Journal of Elder Abuse & Neglect 28: 95–113. [Google Scholar]
- Ogresta, Jelena, Silvia Rusac, and Marina Ajduković. 2008. Exposure of the elderly to violence in the family. Revija Za Socijalnu Politiku 15: 3–22. [Google Scholar]
- Pillemer, Karl, David Burnes, Catherine Riffin, and Mark S. Lachs. 2016. Global Situation, Risk Factors, and Prevention Strategies. The Gerontologist 56: 194–205. [Google Scholar] [CrossRef] [PubMed]
- Post, Lori, Connie Page, Thomas Conner, Artem Prokhorov, Yu Fang, and Brian J. Biroscak. 2010. Elder Abuse in Long-Term Care: Types, Patterns, and Risk Factors. Research on Aging 32: 323–48. [Google Scholar] [CrossRef]
- Sathya, Thennavan, Rangasamy Nagarajan, and Y. Selvamani. 2022. Multimorbidity as a Risk Factor of Elder Abuse/Mistreatment in India: A Cross-Sectional Study. Journal of Interpersonal Violence 37: 9191–213. [Google Scholar] [CrossRef] [PubMed]
- Schlesinger, Rachel A. 1984. Granny bashing: An Introduction to the Problem. Canadian Woman Studies/Les Cahiers De La Femme 5: 57–59. [Google Scholar]
- Schuessler, Zohreh. 2022. Nurses’ Role in Identifying Elder Financial Abuse. Journal of Continuing Education in Nursing 53: 30–34. [Google Scholar] [CrossRef]
- Shinan-Altman, Shiri, and Perla Werner. 2019. Subjective Age and Its Correlates Among Middle-Aged and Older Adults. International Journal of Aging & Human Development 88: 3–21. [Google Scholar]
- Spaccatini, Federica, Ilaria Giovannelli, and Maria Giuseppina Pacilli. 2022. “You are stealing our present”: Younger people’s ageism towards older people predicts attitude towards age-based COVID-19 restriction measures. The Journal of Social Issues 78: 769–89. [Google Scholar] [CrossRef]
- Välimäki, Tarja, Anna Mäki-Petäjä-Leinonen, and Mojtaba Vaismoradi. 2020. Abuse in the caregiving relationship between older people with memory disorders and family caregivers: A systematic review. Journal of Advanced Nursing 76: 1977–87. [Google Scholar] [CrossRef]
- Yon, Yongjie, Maria Ramiro-Gonzalez, Christopher R. Mikton, Manfred Huber, and Dinesh Sethi. 2019. The prevalence of elder abuse in institutional settings: A systematic review and meta-analysis. European Journal of Public Health 29: 58–67. [Google Scholar] [CrossRef]
Table 1.
Distribution of participants in the study by their sociodemographic characteristics.
| Number | Percent | |
|---|---|---|
| Gender | ||
| Female | 478 | 58.2 |
| Male | 344 | 41.8 |
| Age | ||
| 18–30 yrs | 265 | 32.2 |
| 31–40 yrs | 220 | 26.8 |
| 41–50 yrs | 186 | 22.6 |
| 51–64 yrs | 151 | 18.4 |
| Education level | ||
| Elementary | 7 | 0.9 |
| High school | 465 | 56.6 |
| Bachelor/Master | 332 | 40.3 |
| Postgraduate | 18 | 2.2 |
| Employed in the field of health/social system | ||
| Yes | 192 | 23.4 |
| No | 630 | 76.6 |
| Total | 822 | 100 |
Table 2.
Understanding the potential factors contributing to abuse of older individuals.
| Gender | Age | Working in Health or Social System | Total | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Women | Men | 18–30 yrs | 31–40 yrs | 41–50 yrs | 51–64 yrs | Yes | No | ||||
| Older women are more likely to experience abuse and neglect | Agree | 39.3 | 38.1 | 39.2 | 38.2 | 42.5 | 34.4 | 55.2 | 33.8 | 319 | 38.8 |
| Disagree | 35.6 | 35.5 | 31.7 | 37.7 | 32.8 | 42.4 | 26.6 | 38.3 | 292 | 35.5 | |
| Neutral | 25.1 | 26.4 | 29.1 | 24.1 | 24.7 | 23.2 | 18.2 | 27.9 | 211 | 25.7 | |
| Older individuals with physical disabilities are vulnerable to abuse and neglect | Agree | 63.2 | 50.9 | 62.6 | 61.4 | 60.3 | 42.4 | 80.8 | 51.1 | 477 | 58.0 |
| Disagree | 14.6 | 22.9 | 18.5 | 13.6 | 13.4 | 29.8 | 8.3 | 21.1 | 149 | 17.7 | |
| Neutral | 22.2 | 26.2 | 18.9 | 25.0 | 26.3 | 27.8 | 10.9 | 27.8 | 196 | 24.3 | |
| Older individuals with intellectual disabilities are more likely to be exposed to abuse and neglect | Agree | 64.4 | 52.6 | 57.0 | 65.5 | 59.2 | 55.6 | 71.9 | 55.7 | 489 | 59.5 |
| Disagree | 8.4 | 16.3 | 15.1 | 8.1 | 9.1 | 13.9 | 7.3 | 13.0 | 96 | 11.7 | |
| Neutral | 27.2 | 31.1 | 27.9 | 26.4 | 31.7 | 30.5 | 20.8 | 31.3 | 237 | 28.8 | |
| Older individuals living in large families are more likely to be exposed to abuse and neglect | Agree | 22.6 | 34.3 | 24.6 | 25.9 | 33.3 | 28.5 | 27.1 | 27.7 | 226 | 27.5 |
| Disagree | 44.1 | 39.2 | 42.6 | 43.6 | 38.2 | 43.0 | 46.9 | 40.6 | 346 | 42.1 | |
| Neutral | 33.3 | 26.5 | 32.8 | 30.5 | 28.5 | 28.5 | 26.0 | 31.7 | 250 | 30.4 | |
| Instances of abuse and neglect of older individuals are more prevalent within families of lower socioeconomic class | Agree | 33.5 | 37.5 | 37.7 | 33.2 | 37.6 | 30.5 | 49.5 | 30.8 | 289 | 35.2 |
| Disagree | 34.9 | 34.3 | 31.7 | 34.1 | 37.1 | 37.7 | 30.2 | 36.0 | 285 | 34.6 | |
| Neutral | 31.6 | 28.2 | 30.6 | 32.7 | 25.3 | 31.8 | 20.3 | 33.2 | 248 | 30.2 | |
| Individuals harbouring negative emotions, thoughts, and bad experiences with older individuals are more likely to neglect and abuse them | Agree | 53.8 | 47.9 | 50.2 | 55.0 | 56.5 | 42.4 | 54.2 | 50.5 | 422 | 51.3 |
| Disagree | 14.8 | 23.3 | 21.5 | 11.8 | 18.2 | 21.8 | 21.8 | 17.3 | 151 | 18.4 | |
| Neutral | 31.4 | 28.8 | 28.3 | 33.2 | 25.3 | 35.8 | 24.0 | 32.2 | 249 | 30.3 | |
| People who perceive the responsibility of caring for the older individuals burdensome are more likely to neglect and abuse them | Agree | 53.1 | 50.3 | 51.7 | 55.5 | 60.2 | 37.1 | 69.3 | 46.7 | 427 | 52.0 |
| Disagree | 19.9 | 24.1 | 22.6 | 20.9 | 14.5 | 29.8 | 11.4 | 24.7 | 178 | 21.6 | |
| Neutral | 27.0 | 25.6 | 25.7 | 23.6 | 25.3 | 33.1 | 19.3 | 28.6 | 217 | 26.4 | |
Table 3.
Testing the relationships between independent variables (gender, age, work in the health or social system) and knowledge about potential causes of abuse of older individuals.
Table 3.
Testing the relationships between independent variables (gender, age, work in the health or social system) and knowledge about potential causes of abuse of older individuals.
| N | Mean Rank | Test | p | |
|---|---|---|---|---|
| Gender | U: 76,946.500 | 0.111 | ||
| Female | 478 | 422.52 | ||
| Male | 344 | 396.18 | ||
| Age | H: 16.516 | 0.001 * | ||
| 18–30 yrs | 265 | 412.69 | ||
| 31–40 yrs | 220 | 427.28 | ||
| 41–50 yrs | 186 | 444.35 | ||
| 51–64 yrs | 151 | 345.96 | ||
| Work in the field of health or social system | U: 40,227.500 | <0.001 * | ||
| Yes | 192 | 516.98 | ||
| No | 630 | 379.35 |
Note. N = number; U = Mann–Whitney U-test; H = Kruskal–Wallis test; * denotes statistical significance (p < 0.05).
Table 4.
Attitudes towards blaming older individuals for their abuse.
| Age | Total | χ2 | df | p | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 18–30 yrs | 31–40 yrs | 41–50 yrs | 51–64 yrs | |||||||
| Older individuals often complain and nag, which leads to abusive behaviour | Agree | 26.1 | 35.0 | 35.5 | 25.9 | 251 | 30.5 | 29,779 | 12 | 0.003 * |
| Disagree | 40.3 | 33.2 | 31.2 | 41.0 | 300 | 36.5 | ||||
| Neutral | 33.6 | 31.8 | 33.3 | 33.1 | 271 | 33.0 | ||||
| Older individuals are demanding, which leads to abusive behaviour from those in their household | Agree | 21.5 | 27.3 | 25.8 | 34.4 | 217 | 26.4 | 29,679 | 12 | 0.003 * |
| Disagree | 41.5 | 30.0 | 32.8 | 29.2 | 281 | 34.2 | ||||
| Neutral | 37.0 | 42.7 | 41.4 | 36.4 | 324 | 39.4 | ||||
| Older individuals are less likely to be exposed to abuse if they understand their children’s problems | Agree | 28.6 | 40.0 | 38.7 | 47.0 | 307 | 37.3 | 24,057 | 12 | 0.020 * |
| Disagree | 39.3 | 31.8 | 33.9 | 29.8 | 282 | 34.3 | ||||
| Neutral | 32.1 | 28.2 | 27.4 | 23.2 | 233 | 28.4 | ||||
| If older and younger individuals lived separately, there would be no abuse | Agree | 31.4 | 48.7 | 48.9 | 39.0 | 340 | 41.4 | 28,483 | 12 | 0.005 * |
| Disagree | 37.7 | 29.0 | 25.8 | 33.8 | 263 | 32.0 | ||||
| Neutral | 30.9 | 22.3 | 25.3 | 27.2 | 219 | 26.6 | ||||
| If the older individuals lived in a nursing home with their peers, there would be less abuse | Agree | 43.0 | 43.6 | 48.4 | 46.4 | 370 | 45.0 | 15,231 | 12 | 0.229 |
| Disagree | 29.5 | 29.1 | 23.6 | 31.1 | 233 | 28.3 | ||||
| Neutral | 27.5 | 27.3 | 28.0 | 22.5 | 219 | 26.7 | ||||
Note. χ2 = chi-square test; df = degrees of freedom; * denotes statistical significance (p < 0.05).
Table 5.
Scenarios involving depictions of various forms of abuse of older individuals.
| Age | Total | χ2 | df | p | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 18–30 yrs | 31–40 yrs | 41–50 yrs | 51–64 yrs | |||||||
| Anticipating her older father’s tendency to sign documents without reviewing them, the financially burdened adult daughter requests her father to sign a form authorising her access to his bank account | No or possible abuse | 56.6 | 70.4 | 72.5 | 57.6 | 527 | 64.1 | 38,381 | 12 | <0.001 * |
| Abuse | 18.1 | 8.2 | 9.1 | 13.9 | 104 | 12.7 | ||||
| More serious form of abuse | 25.3 | 21.4 | 18.4 | 28.5 | 191 | 23.2 | ||||
| The adult daughter frequently visits to check on her older and frail mother. On each occasion she visits, she takes a favourite thing without her mother’s consent | No or possible abuse | 54.7 | 63.1 | 62.9 | 60.2 | 492 | 59.9 | 18,619 | 12 | 0.098 |
| Abuse | 23.4 | 19.1 | 21.0 | 13.9 | 164 | 20.0 | ||||
| More serious form of abuse | 21.9 | 17.8 | 16.1 | 25.9 | 166 | 20.1 | ||||
| The older mother of an adult son suffering from dementia constantly interferes in family activities; so, the son chooses to administer extra sleeping medication to her, allowing the family to enjoy watching a film undisturbed | No or possible abuse | 15.1 | 16.4 | 22.6 | 17.2 | 144 | 17.5 | 37,818 | 12 | <0.001 * |
| Abuse | 36.6 | 49.5 | 48.4 | 35.8 | 350 | 42.6 | ||||
| More serious form of abuse | 48.3 | 34.1 | 29.0 | 47.0 | 328 | 39.9 | ||||
| An older mother lives with her daughter’s family, and although contributing the majority of her pension towards expenses, the family fails to supply her with adequate clothing and food | No or possible abuse | 26.8 | 35.0 | 38.7 | 31.1 | 267 | 32.5 | 46,940 | 12 | <0.001 * |
| Abuse | 20.8 | 22.7 | 26.9 | 10.6 | 171 | 20.8 | ||||
| More serious form of abuse | 52.4 | 42.4 | 34.4 | 58.3 | 384 | 46.7 | ||||
| The adult son insists that the older father modify his will. Upon the father’s refusal, the son threatens him: “I’ll put you in a nursing home if you don’t do what you’re told.” | No or possible abuse | 22.3 | 25.0 | 28.5 | 27.1 | 208 | 25.3 | 32,676 | 12 | 0.001 * |
| Abuse | 20.4 | 22.3 | 28.0 | 12.6 | 174 | 21.2 | ||||
| More serious form of abuse | 57.3 | 52.7 | 43.5 | 60.3 | 440 | 53.5 | ||||
| During mealtime, the adult son frequently strikes his older father, who has dementia, on the arms and hands in a way that causes noticeable bruises | No or possible abuse | 0 | 0 | 0 | 0.7 | 1 | 0.1 | 13,154 | 9 | 0.156 |
| Abuse | 3.8 | 2.3 | 0.5 | 3.3 | 21 | 2.6 | ||||
| More serious form of abuse | 96.2 | 97.7 | 99.5 | 96.0 | 800 | 97.3 | ||||
| The daughter is frustrated with her bedridden mother, who frequently wets the bed and has to constantly change clothes/bedding. Consequently, the daughter resorts to aggressively hitting her mother each time this occurs | No or possible abuse | 0 | 0.5 | 0 | 0.7 | 2 | 0.2 | 13,293 | 12 | 0.348 |
| Abuse | 2.6 | 0.9 | 0.5 | 2.0 | 13 | 1.6 | ||||
| More serious form of abuse | 97.4 | 98.6 | 99.5 | 97.3 | 807 | 98.2 | ||||
| The adult son visits his mother’s nursing home and discovers her in a state of tears. He discovers that that the caretaker engaged in inappropriate physical contact while she was bathing | No or possible abuse | 0.4 | 0 | 0 | 0.7 | 2 | 0.2 | 10,502 | 9 | 0.311 |
| Abuse | 3.8 | 2.3 | 1.6 | 4.6 | 25 | 3.0 | ||||
| More serious form of abuse | 95.8 | 97.7 | 98.4 | 94.7 | 795 | 96.8 | ||||
Note. χ2 = chi-square test; df = degrees of freedom; * denotes statistical significance (p < 0.05).
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
MDPI and ACS Style
Skupnjak, D.; Neuberg, M.; Obranić, S.; Meštrović, T. A Nationwide Exploration of Knowledge and Attitudes toward the Abuse of Older Individuals: A Cross-Sectional Study among the General Population of the Republic of Croatia. Soc. Sci. 2024, 13, 467. https://doi.org/10.3390/socsci13090467
AMA Style
Skupnjak D, Neuberg M, Obranić S, Meštrović T. A Nationwide Exploration of Knowledge and Attitudes toward the Abuse of Older Individuals: A Cross-Sectional Study among the General Population of the Republic of Croatia. Social Sciences. 2024; 13(9):467. https://doi.org/10.3390/socsci13090467
Chicago/Turabian StyleSkupnjak, Dino, Marijana Neuberg, Sonja Obranić, and Tomislav Meštrović. 2024. "A Nationwide Exploration of Knowledge and Attitudes toward the Abuse of Older Individuals: A Cross-Sectional Study among the General Population of the Republic of Croatia" Social Sciences 13, no. 9: 467. https://doi.org/10.3390/socsci13090467
Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.
