As clarified before, elder abuse is a problem that needs additional focus and better education for the people taking care of geriatrics. Elder abuse is a problem occurring in both rich and poor countries and at all levels of society [2]. This problem could aggravate as the speed of population aging worldwide is likely to lead to an increase in its incidence and its prevalence [2].
In Saudi Arabia (72%) of the whole population are between the ages of 15 to 64 years old [9]. This will lead to a significant increase to the number of the elderlies in the next decades.
This study is an attempt to explore the knowledge and attitudes of adult visitors to PHCCs in Al Qatif towards elder abuse. The sample consisted of mainly the young and middle-aged, providing a wide spectrum of ages. The percentage of females and males was almost the same, and is roughly representative of the population of Saudi Arabia. No similar previous study has been conducted in Saudi Arabia as far as we know.
When participants’ family types, environments, and whether or not they lived with an older person were evaluated, it was seen that most of them, (57%), lived in small families with children. Only (43%) of participants lived with an older individual. It is known that there are large demographic differences between developing and developed countries in living situations. According to WHO, Saudi Arabia is considered a semi-developed country. In developed countries, most of the older people live in urban areas, While in developing countries, most of them live in rural areas. If current trends continue, there will be a much larger older population in the future [6]. According to the literature, older individuals who live in large families and have attractive founds are more likely exposed to abuse [6]. Most participants in our research did not agree that older individuals who live in a large family are more likely exposed to abuse and neglect. Therefore, this conflict needs to be addressed in future research.
In previous research, it was shown that (62%) of poor older individuals are exposed to abuse, while only (6%) of the older people from wealthy households are abused [10].
Our study showed that (52.8%) of the participants believed that elder abuse is more common in families with low socio-economic status. A previous study supports the opinions of our study participants. It showed that (62%) of poor older individuals are exposed to abuse, while only (6%) of the older people from wealthy households are abused [10].
A sizable majority (77%) of participants disagreed that the older people would be less likely to suffer violence if they were in a nursing home with their peers, rather than living with their caregivers. There were different findings in this issue from the previous literature. A study suggests that between (4%) and (6%) of older persons have experienced some form of abuse in the home. Also, older persons are at risk of abuse in institutions such as hospitals, nursing homes and other long-term care facilities, but no large-scale measuring studies are available [2]. There are limited numbers of studies about this topic in Saudi Arabia.
The results showed that most participants (90.5%) considered manhandling of older parents/in-laws to be violence/abuse, and (87.7%) considered touching intimate body areas of the older people without their consent to be sexual abuse. A previous research supports the participant opinion [11]. In this research sexual abuse was defined as touching, fondling, intercourse, or any other sexual activity with an older adult when the older adult was unable to understand, unwilling to consent, threatened, or physically forced [11].
Eighty-one percent of participants agreed that caregivers who have negative feelings or thoughts toward or have had bad experiences with the older people are more likely to neglect and abuse them. Also, (78.4%) of participants agreed that caregivers who think of looking after the older people as a burden are more likely to neglect and abuse the. In addition, (99.3%) agreed that it is abuse if the older people are exposed to shouting, insults and ridicule. The opinions of the participants of the survey correspond with the findings from a previous research regarding the features of individuals who practice elder abuse [6]. These individuals have personality issues (such as not being able to control emotions and behaviour), financial or medical problems, marital conflict, unemployment, alcohol or drug addiction, and perceiving violence as a solution [6].
An almost unanimous majority (99.8%) of participants agreed that it is abuse if an older person’s money and goods are stolen, whether obtained by force or deception. Also, (90.7%) agreed that borrowing money from older parents and not returning it is violence. Abuse is the physical, psychological or financial mistreatment of an older person by an individual, who has a relationship with them. As mentioned before financial abuse is considered one type of elder abuse [2]. In a study regarding 204 participants who are 65 years and over in Turkey, it was found that (2.5%) of them met financial abuse [6].
Seventy-five percent of participants agreed that the older people are less likely to be exposed to violence if they understand the problems of their children. A study carried out in the US on the relationship between mothers/fathers and their children is mentioned and evaluated. Young mothers and fathers are especially likely to consult their family regarding raising their children, because they accept their family’s expertise on child education [6]. The study also found that care for the older people is often an obligatory duty and not voluntary. It is stated that owing to the social structure of home care conditions, the primary responsibility for older people care is met by adult children, but abuse and neglect are also engaged in by spouses, other relatives and health care staff [6].
Fifty-five percent of participants agreed that placement of the older people in a nursing home was neglect, while (27%) disagreed, and the remaining (18%) were neutral regarding this matter. Similar findings was identified in a previous study in Turkey. In that study, most of the participants thought that placing the older people in nursing home is an elderly neglect [6]. Those thoughts could be originated from an Islamic perspective or a cultural one. Both Turkey and Saudi Arabia share the same Islamic values and share a similar culture, however no study conducted was done in Saudi Arabia regarding this point.
There was nearly unanimous (99%) agreement that violence such as beating, slapping, kicking, biting or throwing objects is abuse. This agrees with the American Psychological Association consideration of physical abuse as one of the types of elder abuse [2].
Most of participants agreed with the statement that “Using swear words is considered to be elder abuse because it is uncommon in the culture”. A previous study in North America observed that women and older people reported suffering verbal abuse more frequently [12]. We could not find a study in Saudi Arabia regarding this point.
Nearly all participants (96%) agreed that abandonment of the older people is considered neglect. The opinions of participants match the opinions of participants in another study in Turkey. In that study, most of the participants think that abandoning the older people is elderly neglect [6].
(43.3%) of participants agreed that “İt is neglect if the elderly’s health needs aren’t met or are not met in a timely fashion, while (43%) of participants agreed that it is neglect if the older people live in homes which have unsuitable conditions. A previous study supports matches participant opinions. It mentioned that both caregivers/families and the older people need support related to care. When this support was not timely or adequate, elder abuse and neglect have occurred [6].
Almost all of our participants (96%) agreed that it is abuse to act as if older people relatives don’t exist, imprison them in their room/home and exclude them from society. A previous study in Turkey goes with the participant thought. The study mentions that older people between 70 and 75 years, woman who are divorced, living alone, being isolated and having some chronic diseases are exposed to abuse mostly [6].
Most of the participants disagreed with the statement that “If older individuals can’t meet their own hygiene, nutrition and housing requirements, it means that they are neglecting themselves”. In previous researches it was found that it is very common for the older people to have decreased physical and mental ability and to need care [6].
In our study, most of the participants (98.1%) agreed with the statement that it is their individual responsibility to report elder abuse and neglect if they witness any, and (98.1%) of them also considered elder abuse and neglect to be a criminal act and believed that they have a responsibility to prevent it. Similarly, in a study in Turkey (89%) of participants believed that elder abuse and neglect is a social problem and they have professional and individual responsibilities to prevent it [6].
The majority of our participants, (73.7%), believed that older women are more exposed to abuse and neglect than men, and there was no significant difference between female and male participants in their opinion regarding this. A study in Thailand found that women were approximately five times more likely to have been abused than men [1], The results of our survey matches the study in Thailand.
Most of our participants (84.4%) agreed that older individuals who have mental disability are exposed to abuse and neglect more often. Similarly, (81,4%) of participants agreed that older individuals who have physical disabilities or are bedridden are more often exposed to abuse and neglect. A recent study found that individuals with less functional and cognitive impairment might present more disruptive behaviour and greater interaction with the caregiver, which could be associated with a higher risk of abuse [12]. Similarly, the study found that when the caregiver reported aggressive behaviour inflicted by the care recipient, the risk of all types of abuse increased; nevertheless, such aggressive situations occurred less frequently when the dependency was total [12]. The findings in our survey go in line with the study results.
Our study is the first research in Saudi Arabia that identified the attitudes and awareness toward elder abuse in the Saudi community, the participant in our study responded positive when asked if they had a responsibility to prevent and report elder abuse. One of the possible reasons of this view among those in our study group might be the rapid cultural and geodemographic changes in Saudi Arabia due to people moving from rural to urban area, which lead to enhancements in their education, including education about elder abuse. A further research is needed to examine this conclusion.
As an intervention and prevention measurements to reduce the incidence of elder abuse we could suggest that we include the elderlies in the community festivals and events so that they don’t become isolated from the social life, we could also use a special annual day for the elderlies were both the younger generation and the elders can participate in. As for education the public, school programs can be used to educate the young from early life about this matter also using campaigns] [13].
Our research was focused on the attitude and the knowledge of the age group from 18 to 59 years old we could suggest a specific research for the elderlies and their own attitude regarding this matter. Also, one of the findings of our research was that most of the participants believed that females get abused more than the males. This assertion needs to be investigated to find the motives.
Limitations
There were some limitations in the study. First we didn’t include the older population in the samples and there weren’t any previous studies about the attitude of the older Saudi population about this matter. This might be due to the difficulty to collect a large sample from the older population who visits the PHCCs, in Saudi Arabia people who are older than 65 years old represents only 3.2% of the whole population [14].
The second limitation was that we only conducted this study in the eastern province of Saudi Arabia. This was due to the large size of the kingdom of Saudi Arabia which will take a large amount of resources and time to include other regions.