@2024 Afarand., IRAN

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ISSN: 1027-1457    Scientific Journal of Forensic Medicine 2018;24(3):219-227

Background
Growth of the elderly population has led to an increase in the prevalence of misbehavior against them which is one of the major problems of social health in today’s societies.
Previous Studies
…[1-9]. It is difficult to determine the true prevalence of elder misbehavior and neglecting them, because the sanitary professions may be faced with problems in determining and reporting its reasons due to denying the extent of the problem in the society and ignoring the elder misbehavior reports (10). Although studies have shown that the type of elder misbehavior may vary in different countries, but its prevalence is in a range of 3.2%-27.5 (11). Danesh and Chang in a study showed that the prevalence of elder misbehavior in California was 2.4-1.8%. Dong reported 0.2%-64 of the elder misbehavior prevalence and its various types in the general population of Chinese (13). Yan and Chan showed the prevalence of elder misbehavior in China by 0.4%-36.1 (14). Studies show that one million elderly people are exposed to misbehavior in the United States every year and more than 25% of them physically injured (15). Manoochehri et al in a research in Tehran showed that 84.8% of the elderly were faced with emotional abuse (16)….[17-24].
Aim(s)
The present research aimed to investigate the relationship between social factors and the prevalence of misbehavior in elderly people covered by the health centers in Kashan city.
Research type
This research is a descriptive-analytical study.
Research society, place and time
The study was carried out on 500 elderly aged over 60 who were covered by the health centers of Kashan city.
Sampling method and number
The subjects were 500 elderly aged over 60, who had health records in the health centers of Kashan city. Considering the previous studies and estimating of elder misbehavior (25), the sample size was determined 334 people based on the Cochran formula at a confidence level of 95%. The numbers of samples were determined 500 people using cluster sampling method, counting the coefficient of 1.5. The inclusion criteria for participation in the study were being more than 60 years old, having Iranian nationality, ability to speak in Persian, absence of mental illness (psychosis), having full consciousness, having ability to communicate and answer to study questions, and inhabiting in Kashan city. The exclusion criteria from the study were the withdrawal of the sample from responding to the questionnaire during the conduct of the work and interview.
Used devices&materials
Data collection was conducted after coordinating with the health-therapy chancellor of Kashan university of medical science and the issuance of a license. In the first stage, the city of Kashan was divided into five areas based on a health map, and 2 health centers were selected from each area, randomly. 10 health centers were selected. In the next stage, after coordination with the selected health centers, the number of older people in each health center was determined. Based on the covered population and gender, quotas were allocated to each health center. Based on the gender and population covered by each health centers, the size of the quota was different. In this stage, some cases were randomly selected from the health records of each center. The subjects were contacted by phone call after coordinating with the health centers, in the absence of mental illness of elderly people according to the statement of the same health center, as well as having the inclusion criteria. After expressing the aims of the research, the elderly were invited to participate in the study. At the time of the meeting, after providing the necessary explanations regarding the study and the application of obtained information, the questionnaire was given to the elderly. The questionnaire was completed individually by respect to privacy for each subject. If the information of the questionnaire was incomplete, the participant was asked to complete the information. The data collecting instrument was a multi-section questionnaire; the first part of the questionnaire included demographic characteristics (age, gender, education, marital status, number of children, living condition of elderly with family, chronic diseases and the ability to walking) and the second part of the questionnaire included information about elder misbehavior within the family. The questionnaire of investigating the elder misbehavior within the family contains 49 phrases in 8 subscales of caring neglect, psychological abuse, physical abuse, financial abuse, and negation of authority, rejection, financial and emotional neglects. The instrument has options "yes", "no" and "no case". The scores are in ranging from zero to 100. A higher score indicates a higher rate of symptoms of misbehavior. Thus, 100 score indicates the maximum rate of misbehavior and zero indicates that there is no evidence of misbehavior. The lowest score (zero) is to select the option of "No" and the highest score (100) is to select the option of "yes". The option of "No item" has no score. This instrument has been compiled and validated based on the findings of a qualitative study on the elder misbehavior in Iran, according to the cultural characteristics of Iranian society and it has face validity, content, and constructs validity. Reliability of the questionnaire was 0.99 with Cronbach's alpha (26). Data were analyzed by SPSS 21 software through Chi-square test and logistic regression method. The Kolmogorov-Smirnov test was used to testing the normality of the data distribution.
Findings by Text
Of the 500 elderly participants in this study, 290 people (58.0%) were male and 210 people (42.0%) were female. The average age of the subjects was 72.07±9.03 which the elderly people aged 60-70, had the highest frequency than the others (47.8%). The highest frequency in term of education level related to the illiterate people (61.2%) and the elderly people was literate (38.8%). The majority of elderly people were married (87.4%) and 62.2% of elderly people didn’t have systematic diseases. The prevalence of emotional neglect, caring neglect, financial neglect, the negation of authority, psychological abuse, financial abuse, and physical abuse and rejection were 6.8%, 8.29%, 2.35%, 6.37%, 45.0%, 2.41%, 22.45%, and 16.6% respectively. The score of misbehavior in males was higher than females and it was higher in the age group of 70 and older than the other age groups. Elderly people with 5 children and more obtained higher scores of misbehavior than the others. Elderly widowed, divorced and single had higher levels of misbehavior than the married. As well as the illiterate elderly and elderly with the inability to walk had higher scores of misbehavior. There was a significant relationship between the level of misbehavior and age, gender, education, marital status, number of children, the living condition of elderly with family, chronic diseases and the ability to walking (Table 1). Based on the results of the regression logistic analysis, the variables of age and the number of children had a relationship with misbehavior. There was a significant difference between the age of 80 and older (OR=6.819, CI 95%=2.007-23.172) with the age of 60-70 as well as there was a significant difference between having no children (OR=5.83, CI 95%=1.533-22.175) with having five children and more (p>0.01).
Main comparison to the similar studies
…[25]. The results of the present research showed that widowed and divorced elderly people had faced a higher rate of misbehavior, which is accordance to findings of the previous studies (18, 24, 28). Wu et al showed that elderly people who live alone are exposed to misbehavior more than the others (23). Some studies have reported widowhood as a key factor for the increase in misbehavior risk. In a large study, Pillemer and Suitor in a study showed that husbands are more likely to be sacrificed than women (29). However, Miller and Dodder focused on the harasser and victim couples and found that women are likely to be the main victims. Among the harassers, there is a more likelihood that men commit physical abuse (30)….[31-36].
Suggestions
It is suggested that in the future, studies be planned to assessment the level of misbehavior and effective factors on it in the elderly who live in the sanatorium and nursing homes.
Limitations
One of the limitations of this study was investigating the elderly people living in the home.
Conclusions
Elderly people with higher age, more children, without a spouse, living with a child and having a history of illness and inability to walk are more exposed to misbehavior.
Acknowledgments
I would like to appreciate the health centers which collaborated with the researchers in this study and the elderly people for helping us in conducting this research.
Conflict of interest
There is no conflict of interest.
Ethical Permissions
This study was approved by the research council of Kashan University of Medical Sciences with an ethics code number of 5003.
Funding Sources
There are no funding sources.

TABLES and CHARTS

Show attach file Background
Growth of the elderly population has led to an increase in the prevalence of misbehavior against them which is one of the major problems of social health in today’s societies.
Previous Studies
…[1-9]. It is difficult to determine the true prevalence of elder misbehavior and neglecting them, because the sanitary professions may be faced with problems in determining and reporting its reasons due to denying the extent of the problem in the society and ignoring the elder misbehavior reports (10). Although studies have shown that the type of elder misbehavior may vary in different countries, but its prevalence is in a range of 3.2%-27.5 (11). Danesh and Chang in a study showed that the prevalence of elder misbehavior in California was 2.4-1.8%. Dong reported 0.2%-64 of the elder misbehavior prevalence and its various types in the general population of Chinese (13). Yan and Chan showed the prevalence of elder misbehavior in China by 0.4%-36.1 (14). Studies show that one million elderly people are exposed to misbehavior in the United States every year and more than 25% of them physically injured (15). Manoochehri et al in a research in Tehran showed that 84.8% of the elderly were faced with emotional abuse (16)….[17-24].
Aim(s)
The present research aimed to investigate the relationship between social factors and the prevalence of misbehavior in elderly people covered by the health centers in Kashan city.
Research type
This research is a descriptive-analytical study.
Research society, place and time
The study was carried out on 500 elderly aged over 60 who were covered by the health centers of Kashan city.
Sampling method and number
The subjects were 500 elderly aged over 60, who had health records in the health centers of Kashan city. Considering the previous studies and estimating of elder misbehavior (25), the sample size was determined 334 people based on the Cochran formula at a confidence level of 95%. The numbers of samples were determined 500 people using cluster sampling method, counting the coefficient of 1.5. The inclusion criteria for participation in the study were being more than 60 years old, having Iranian nationality, ability to speak in Persian, absence of mental illness (psychosis), having full consciousness, having ability to communicate and answer to study questions, and inhabiting in Kashan city. The exclusion criteria from the study were the withdrawal of the sample from responding to the questionnaire during the conduct of the work and interview.
Used devices&materials
Data collection was conducted after coordinating with the health-therapy chancellor of Kashan university of medical science and the issuance of a license. In the first stage, the city of Kashan was divided into five areas based on a health map, and 2 health centers were selected from each area, randomly. 10 health centers were selected. In the next stage, after coordination with the selected health centers, the number of older people in each health center was determined. Based on the covered population and gender, quotas were allocated to each health center. Based on the gender and population covered by each health centers, the size of the quota was different. In this stage, some cases were randomly selected from the health records of each center. The subjects were contacted by phone call after coordinating with the health centers, in the absence of mental illness of elderly people according to the statement of the same health center, as well as having the inclusion criteria. After expressing the aims of the research, the elderly were invited to participate in the study. At the time of the meeting, after providing the necessary explanations regarding the study and the application of obtained information, the questionnaire was given to the elderly. The questionnaire was completed individually by respect to privacy for each subject. If the information of the questionnaire was incomplete, the participant was asked to complete the information. The data collecting instrument was a multi-section questionnaire; the first part of the questionnaire included demographic characteristics (age, gender, education, marital status, number of children, living condition of elderly with family, chronic diseases and the ability to walking) and the second part of the questionnaire included information about elder misbehavior within the family. The questionnaire of investigating the elder misbehavior within the family contains 49 phrases in 8 subscales of caring neglect, psychological abuse, physical abuse, financial abuse, and negation of authority, rejection, financial and emotional neglects. The instrument has options "yes", "no" and "no case". The scores are in ranging from zero to 100. A higher score indicates a higher rate of symptoms of misbehavior. Thus, 100 score indicates the maximum rate of misbehavior and zero indicates that there is no evidence of misbehavior. The lowest score (zero) is to select the option of "No" and the highest score (100) is to select the option of "yes". The option of "No item" has no score. This instrument has been compiled and validated based on the findings of a qualitative study on the elder misbehavior in Iran, according to the cultural characteristics of Iranian society and it has face validity, content, and constructs validity. Reliability of the questionnaire was 0.99 with Cronbach's alpha (26). Data were analyzed by SPSS 21 software through Chi-square test and logistic regression method. The Kolmogorov-Smirnov test was used to testing the normality of the data distribution.
Findings by Text
Of the 500 elderly participants in this study, 290 people (58.0%) were male and 210 people (42.0%) were female. The average age of the subjects was 72.07±9.03 which the elderly people aged 60-70, had the highest frequency than the others (47.8%). The highest frequency in term of education level related to the illiterate people (61.2%) and the elderly people was literate (38.8%). The majority of elderly people were married (87.4%) and 62.2% of elderly people didn’t have systematic diseases. The prevalence of emotional neglect, caring neglect, financial neglect, the negation of authority, psychological abuse, financial abuse, and physical abuse and rejection were 6.8%, 8.29%, 2.35%, 6.37%, 45.0%, 2.41%, 22.45%, and 16.6% respectively. The score of misbehavior in males was higher than females and it was higher in the age group of 70 and older than the other age groups. Elderly people with 5 children and more obtained higher scores of misbehavior than the others. Elderly widowed, divorced and single had higher levels of misbehavior than the married. As well as the illiterate elderly and elderly with the inability to walk had higher scores of misbehavior. There was a significant relationship between the level of misbehavior and age, gender, education, marital status, number of children, the living condition of elderly with family, chronic diseases and the ability to walking (Table 1). Based on the results of the regression logistic analysis, the variables of age and the number of children had a relationship with misbehavior. There was a significant difference between the age of 80 and older (OR=6.819, CI 95%=2.007-23.172) with the age of 60-70 as well as there was a significant difference between having no children (OR=5.83, CI 95%=1.533-22.175) with having five children and more (p>0.01).
Main comparison to the similar studies
…[25]. The results of the present research showed that widowed and divorced elderly people had faced a higher rate of misbehavior, which is accordance to findings of the previous studies (18, 24, 28). Wu et al showed that elderly people who live alone are exposed to misbehavior more than the others (23). Some studies have reported widowhood as a key factor for the increase in misbehavior risk. In a large study, Pillemer and Suitor in a study showed that husbands are more likely to be sacrificed than women (29). However, Miller and Dodder focused on the harasser and victim couples and found that women are likely to be the main victims. Among the harassers, there is a more likelihood that men commit physical abuse (30)….[31-36].
Suggestions
It is suggested that in the future, studies be planned to assessment the level of misbehavior and effective factors on it in the elderly who live in the sanatorium and nursing homes.
Limitations
One of the limitations of this study was investigating the elderly people living in the home.
Conclusions
Elderly people with higher age, more children, without a spouse, living with a child and having a history of illness and inability to walk are more exposed to misbehavior.
Acknowledgments
I would like to appreciate the health centers which collaborated with the researchers in this study and the elderly people for helping us in conducting this research.
Conflict of interest
There is no conflict of interest.
Ethical Permissions
This study was approved by the research council of Kashan University of Medical Sciences with an ethics code number of 5003.
Funding Sources
There are no funding sources.

TABLES and CHARTS

Show attach file