Abuse of older Chinese with varying degree of cognitive and physical impairment : examining the roles of caregiver and contextual variables using a structural equation modeling approach

Abstract

Background: This study investigated rates and associated factors for abuse in older Chinese with cognitive and physical impairment by family caregivers in the People’s Republic of China.

Methods: A cross-sectional sample (N = 1,002) was surveyed.

Results: Based on different operational definitions and informants, rates of elder abuse ranged from 9.7 to 51.2% for psychological abuse, 0.8 to 1.2% for physical abuse, 53.6 to 72.5% for caregiver neglect, and 31.4 to 40.8% for financial exploitation. For any abuse subtype, care-recipient reports generated the highest, while caregiver-care-recipient joint reports yielded the lowest rates. Correlation analyses demonstrated a similar set of risk factors for various forms of abuse. Significant association among abuse subtypes suggested plausible co-occurrence of multiple forms of abuse in a given caregiving context. Structural equation modeling (SEM) was performed to evaluate the mediating effect of caregiver burden. SEM results for psychological abuse indicated that caregiver burden had mediating effect on the association between (a) care-recipient NPSs; (b) care-recipient physical impairment; (c) caregiver depression; (d) caregiver suboptimal health status; (e) caregiver perceived familism and psychological abuse. However, the positive association between care-recipient cognitive impairment and psychological abuse was not affected by caregiver burden. SEM results for physical abuse showed that caregiver burden mediated the relationship between (a) care-recipient physical impairment; (b) care-recipient cognitive impairment; (c) care-recipient NPSs; (d) caregiver suboptimal health status; (c) caregiver received informal social support and physical abuse. SEM results for caregiver neglect indicated that caregiver burden mediated the association between (a) care-recipient cognitive impairment; (b) care-recipient physical impairment; (c) caregiver depression; (d) caregiver suboptimal health status; (e) caregiver received informal social support and caregiver neglect. However, the positive relationship between care-recipient NPSs and caregiver neglect was not mediated by caregiver burden. SEM results for financial exploitation showed no association between caregiver burden and financial exploitation, excluding the possibility of caregiver burden as a mediator. However, care-recipient cognitive impairment and NPSs, as well as caregiver suboptimal health status were significantly predictors of financial exploitation.

Conclusion: This study suggested the need of establishing a more clear definition for elder abuse and integrating multiple sources of reports in prevalence estimation. In general, a similar set of associated factors was found for various abuse subtypes. The conceptual model of this study was applicable to all other abuse subtypes examined, excluding financial exploitation. This implied possibly unique process underlying financial exploitation, which warrants further investigation. Cognitive, physical, and neuropsychiatric symptoms of the care-recipients, as well as physical and psychological problems of the caregivers were consistently associated with abuse. Contrary to the author’s presumption that the cultural value of familism would be a family coping resource protective against abuse, it was identified as a risk factor. Conversely, received informal social support had a consistent buffering effect on the risk of various abuse subtypes. Lastly, caregiver burden appeared as a mediator between different associated factors and abuse. This information is useful for reinforcing protective factors while reducing risk factors, so as to intervene existing cases and prevent new cases of elder abuse.