The effects of caregiver coping strategies and familism on the association between increased caregiving stressors and domestic abuse against older Chinese with cognitive and physical impairments : a two-year longitudinal study

Abstract

Background: As population aging continues to grow more prevalent worldwide, elder abuse has become a top concern for governments in many nations. With its negative effect on individual health, families, and society as a whole, elder abuse has evolved into a significant social problem the underlying causes of which demand urgent attention from researchers, social welfare agencies, healthcare providers, policy makers, as well as the general public. Methods: this is a longitudinal survey. At baseline, 1,002 dyads of older Chinese with cognitive and physical impairment and their family caregivers were consecutively recruited from three major public hospitals in Guangdong Province of the PRC. The family caregivers were asked to report frequencies of elder abuse and severities of external caregiving stressors (care recipient cognitive impairment, neuropsychiatric symptoms (NPSs), and impairment in instrumental activities of daily living (IADL impairment)). At the Two-Year follow-up, data were collected on the deterioration in external caregiving stressors, caregiver coping strategies, cultural value of familism, and elder abuse. An integrated theoretical framework adapted from useful and relevant concepts from existing theories on elder abuse guided the present empirical analysis. Using Structural Equation Modeling (SEM) and hierarchical regression analysis, the mediation effect and moderation effect of caregiver dysfunctional coping on the association between deterioration in external caregiving stressors and elder abuse were examined. Changes in the rate and pattern of elder abuse were estimated using descriptive analysis. Results: 959 dyads completed the follow-up study (attrition rate =4.3%). The effect of deterioration in care recipient NPSs on psychological abuse, physical abuse, and caregiver neglect at follow-up was fully mediated by caregiver dysfunctional coping. Additionally, the effect of deterioration in care recipient cognitive impairment on psychological abuse and caregiver neglect was partially mediated by caregiver dysfunctional coping. Caregiver dysfunctional coping was also found to be a partial II mediator of the association between deterioration in care recipient IADL impairment and physical abuse, as well as the relationship between deterioration in care recipient NPSs and financial exploitation. Additionally, familism was found to moderate the relationship between care recipient deterioration in NPSs and psychological abuse, the relationship between care recipient deterioration in IADL impairment and physical abuse, the relationship between care recipient deterioration in NPSs and caregiver neglect, as well as the relationship between care recipient deterioration in NPSs and financial exploitation and the association between care recipient deterioration in cognitive impairment and financial exploitation. Conclusion: this study provides an integrated, cultural-specific, and multidimensional theoretical framework to guide elder abuse research. Methodologically, this study establishes tentative sequences among risk factors, potential mediator and moderator, and elder abuse. Compared to cross-sectional research, this study identifies associations that are more reliable and similar to the causal associations that are only attainable from studies with experimental design. Practically, findings from this study provide important information to guide the development of culturally and contextually specific prevention and intervention programs for elder abuse.