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

IntroductionCommensurate with demographic and lifestyle transition, increasing magnitude of multimorbidity is common among older adults in low- and middle-income countries (LMIC). At the same time the rising prevalence of elder abuse is concurrently observed in these populations. However, little is known about the elder abuse in the context of multimorbidity with no reports on their interplay from LMIC settings. This study examined the association of multimorbidity with the risk of elder abuse and its correlates in a rural elderly population of Odisha, India. MethodsThe data was collected as a part of our ASHETS study encompassing 725 older adults residing in rural Odisha, India. Multimorbidity was assessed by previously validated MAQ PC tool. Hwalek-Sengstock elder abuse screening test (HS-EAST) was used to assess the risk of elder abuse. Care dependence was measured by Katz index questionnaire. We performed ordinal logistic regression models to identify the correlates of elder abuse. ResultsAround 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 care 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 risk of elder abuse was significantly associated with multimorbidity (AOR=1.88; 95%CI: 1.54-2.21), economic dependence (AOR=1.62; 95%CI: 1.25-1.99) and functional dependence (AOR=1.86; 95%CI: 1.42-2.29). Staying alone (AOR= 1.75; 95%CI: 1.13-2.38) and lower socio-economic status (AOR=2.96; 95%CI: 2.09-3.84) were two other significant correlates. ConclusionsOlder adults with multimorbidity are at 1.88 times higher risk of elder abuse compared to their non-multimorbid counterparts. Both economic and functional dependence are associated with an increase in elder abuse. This suggests the mediating role of care dependence in the pathway to elder abuse in multimorbidity. Future geriatric multimorbidity assessment studies should consider screening for care dependence as well as elder abuse while designing integrated care models.