Elder Abuse in a Developing Area in Bolivia

Abstract

In many parts of the world, elder abuse happens almost unnoticed. Until recently, this serious social problem was hidden from public view and was regarded as an essentially private matter. However, there is growing evidence that elder abuse is an important problem of public health and in the society. The objective of this study is to determine the degree of abuse of elder and vulnerable people in the families and communities of Eastern Bolivia. With this end in mind, we conducted a cross-sectional descriptive study with a sample size of 210 60-year-old people coming from different health care areas. Elder Abuse Suspicion Index (EASI) and Yaffe’s Evaluation Form of Social Work were used. An abuse rate of 39% of the older adults was identified. The most common type of abuse observed was psychological abuse (32.4% of cases), followed by neglect (21.9%). Children were identified as triggers of the abuse in 66.7% of cases of abuse. The prevalence of elder abuse was similar to the prevalence of other types of abuse that exist in Bolivia, such as the gender-based abuse. Also, this prevalence is comparable to other developing countries and European countries. The profile of abused older adult is as follows: woman, widow, 70 years old, incomplete primary education, without an occupation, and an average of 4.59 children. The information obtained shows that dysfunctional families have a higher percentage of elder abuse.

Keywords

elder abuse community violence predicting domestic violence domestic violence

Elder abuse has been recognized as more widespread than gender maltreatment or children abuse (Fernández-Alonso & Herrero-Velázquez, 2006). In the First Consensus Conference About Elder Abuse, held in Spain in 1995, elder abuse was defined as

Any act or omission that causes deliberate harm, directed at persons over 65, that is carried out in the family, community or institutional environment, that violates or endangers the psychological or psychical integrity, the autonomy or any other fundamental right of the individual and that can be demonstrated objectively or perceived subjectively. (Kessel et al., 1996, p.368)

From a conceptual point of view, the United Nations defines an elder person as a person above 60 years (World Health Organization [WHO], n.d.). According to Risco et al. (2005), the estimated prevalence of this problem differs according to the study setting and the assessment instruments employed. Moreover, frequently, the older adult does not want to be recognized as an abuse victim for fear of retaliation, confinement in institutions, or simply because he or she prefers to deny a reality that is difficult to accept (Yan, 2014). On the other hand, their relatives or caregivers, who are frequently responsible for the situation, do not reveal these facts for obvious reasons (Fernández-Alonso & Herrero-Velázquez, 2006).

According to Fernández-Alonso and Herrero-Velázquez (2006), the most frequent forms of elder abuse are physical abuse (such as beatings, burns, fractures, improper administration of drugs or toxic substances), psychological abuse (meaning behaviors that cause psychological harm, such as manipulation, intimidation, threats, humiliation, emotional blackmail, contempt, or deprivation of the power of decision), physical neglect (not meet basic needs, such as denial of food, hygienic care, housing, security, and medical treatment), emotional abuse or neglect (denial of affection, isolation, and confinement), economic abuse (hinder the use and control of their money, financial exploitation, and economic blackmail such as removal of material goods or signing under duress on goods), and sexual abuse (any sexual activity made without consent).

Since the “Toronto Declaration on the Global Prevention of Elder Abuse” (WHO, 2002), the importance of the participation of many sectors of society in the prevention of elder abuse has been emphasized. At the same time, the Toronto Declaration encourages all the countries to develop structures to provide, among others, social, health care, legal, and protection services to answer and prevent the problem in an effective way by bringing this situation to the context of Human Rights. The United Nations Fund for Population Activities (UNFPA) and HelpAge International (2012) analyze the current situation of the older adults and examine the progress made after the Second World Assembly on Ageing, which preceded the Toronto Declaration. The report also indicates that 43% of older men and women participating in previous studies were victims of personal violence.

In the Bolivian case, it is worth noting that the context of the older adults is very different from that of Europe. Therefore, we have to take into account the following data: According to the 2012 Housing and Population Census, Bolivia has 10,027,254 inhabitants among whom 8.9% are aged 60 years or older (Instituto Nacional de Estadística, 2013); the average life expectancy is 62 years for men and 67 for women (HelpAge International & Defensoría del Pueblo, 2011), only 16% of people older than 65 years have retirement pension, most of whom are men and live in urban areas (Chumacero, Escobar, & Mendizábal, 2013); and half of the Bolivian elder women (52.2%) live in poverty (Chumacero et al., 2013).

On August 26, 2012, the “Elderly Dignity Day” was held in Bolivia, established by the Supreme Court Decree No. 0264 (August 26, 2009). In recent years, there have been significant advances in social protection policies in support of the older adults in Bolivia. Some examples are the 3797 Act, also called the “Dignity Pension,” that offers a universal lifelong pension to the older adults; the 3323 Act on Elder Health Care Insurance; the 1886 Act on Rights and Privileges; and the 369 General Act of the Elderly, aimed at regulating the rights, guarantees, and duties of older adults (HelpAge International & Defensoría del Pueblo, 2011). However, the Social Security Systems have not been efficiently developed yet and the retirement pensions are low, forcing older people to work when they should retire. According to the data provided by Survey Households with Older Persons 2011, 48% of the population older than 65 years are still working (Escobar, Martínez, & Mendizábal, 2013) and 59% of the people older than 60 years live with less than a dollar per day (Larico, 2012). According to Camacho (2012), due to the aforementioned reasons, older people remain, on many occasions, invisible to the society while they are suffering discrimination and violations of their rights by most part of the population and by their own relatives.

Regarding the prevalence of abuse in Bolivia, nearly 4,700 older adults from 17 Bolivian municipalities reported incidents of abuse, according to HelpAge International and the Defensoría del Pueblo (2011). Moreover, Gabriela Montaño, director of the Integral Legal Municipal Services Department of Cochabamba, pointed out that 510 elder abuse complaints were registered during the first half of 2012, 60% of which were caused by psychological violence. In 40% of the cases, the abusers were reported to be the children or relatives of the victims (Camacho, 2012).

In this line, elder abuse is considered an emergent social-health problem within the Bolivian society and it highlights the great importance of the issue nowadays. Therefore, we decided to carry out a study to learn more about the degree of vulnerable elder abuse in the family and community of Bolivia, belonging to a developing country, and compare the results with situation in other neighboring countries and Europe.

Method

Participants

A total of 210 people aged above 60 years who belong to the Health Insurance for Elderly Care of Santa Cruz de la Sierra (Bolivia) were included in the study. The inclusion criterion was to live for 6 months in the current cohabitation situation. The exclusion criterion was to suffer from cognitive disorder.

The references used for sample size calculation are the data from the UNFPA and HelpAge International (2012), in which a sample of 1,300 elder men and women who participated in previous consultations declared that 43% of them are subjected to personal violence. Accepting an alpha error of .95 to a precision of ± .07 units, in a bilateral contrast to an estimated 0.4 ratio, is required in a population-based random sample of 210 subjects, assuming that the population is 1,487,020 subjects. It is estimated to result in a replacement rate of 10%.

The sample was composed of a total of 210 subjects, 57.6% of whom were women, and all of them (women and men) with an average age of 69.35 years (standard deviation [SD] ± 6.904). The most frequent civil status was married (36.2%), followed by widowed (27.1%) and separated or divorced (17.1%). Most of the people interviewed had an incomplete basic education (37.1%), had received a non-formal basic education (18.6%), an incomplete high school/vocational college education (15.2%), or were illiterate (12.9%). A total of 41.4% of the subjects were active workers. Though 99% of the sample had some type of income, only 10.5% reached the official minimum income. Furthermore, 94.8% of the people interviewed had children, with a mean number of 4.82 children (SD ± 2.818). Most of the individuals cohabited permanently with someone (97.1%), either with some of their children (62.4%) or their spouses (45.7%; Table 1).

Table 1.

Sociodemographic Characteristics, Autonomy Test of Activities of Daily Living, and Family APGAR Test of the Older Adults.

	Frequency (N)	Percentage (%)
Sex
Man	89	42.4
Woman	121	57.6
Civil status
Married	76	36.2
Widowed	57	27.1
Single	23	11.0
Partner	18	8.6
Separated or divorced	36	17.1
Children
Yes	199	94.8
No	11	5.2
Economic income
Yes	208	99.0
No	2	1.0
Education level
Illiterate	27	12.9
Non-formal learning elementary	39	18.6
Incomplete primary	78	37.1
Complete primary	16	7.6
Incomplete secondary	32	15.2
Complete secondary	7	3.3
University	11	5.2
Working activity
Yes	87	41.4
No	123	58.6
Official minimum income
Yes	22	10.5
No	188	89.5
Type of cohabitation
Permanent	204	97.1
Non-permanent	6	2.9
With whom the older person lives (several options are possible)
Single	25	11.9
Children	131	62.4
Partner	96	45.7
Grandchildren	35	16.7
Other family	33	15.7
Caregiver paid	0	0
Other form	3	1.4
Dependence for basic activities of daily living
Severe (21-60 points)	3	1.4
Moderate (61-90 points)	20	9.5
Low (91-99 points)	17	8.1
Independence (100 points)	170	81
Family APGAR Test
Normofunctional (7-10 points)	135	64.3
Dysfunctional mild (3-6 points)	64	30.5
Dysfunctional severe (0-2 points)	11	5.2

Note. APGAR = adaptability, partnership, growth, affection, and resolve.

Materials

The instruments used to measure the variables were as follows: (a) The subjects’ medical records from their respective medical centers. (b) The Elder Abuse Suspicion Index (EASI) of Yaffe, Wolfson, Lithwick, and Weiss (2008) adapted into Spanish by Pérez-Rojo, Izal, Sancho, and the Research Group Trátame Bien (2010; sensitivity index 0.51, specificity index 0.95). Suspicion of abuse exists if there are one or more affirmative responses to the Items 2, 3, 4, 5, 6). (c) The Social Work Evaluation Form (Formulario de Evaluación de Trabajo Social [FETS]) of Yaffé, Lithwick, and Wolfson (2007). This form has 67 questions. Question No. 59 is “Do you think that the patient is being abused?” This question is considered the criterion variable to compare and validate the results from the EASI and it is answered by the interviewer. The FETS was adapted into Spanish by Pérez-Rojo et al. (2010). (d) Mini-Mental State Examination (MMSE) of Folstein, Folstein, and McHugh (1975), adapted and validated into Spanish by Lobo, Saz, Marcos, and the Research Group ZARADEMP (2002; Screening tool for cognitive disorder, highest score, 35 points. It is considered that someone is suffering from a cognitive disorder when the score is below 23 points. It has good validity and reliability with a specificity of 0.82 and a sensitivity of 0.84). (e) Autonomy Test of Activities of Daily Living of Mahoney and Barthel (1965; A scale which values the autonomy of the individual to perform basic and essential activities in his or her daily life, such as eating, bathing, dressing, grooming, moving the wheelchair to bed, climbing stairs, and so forth). Range from 0 to 100. The lower the score is, the higher the degree of dependency and “vice versa.” The levels of autonomy are as follows: independent = 100 points, mildly dependent = 91 to 99 points, moderately dependent = 61 to 90 points, severely dependent = 21 to 60 points, and totally dependent = 0 to 20 points. It was adapted into Spanish by Baztán et al. (1993); its validity is between 0.73 and 0.77 and its reliability is from .88 to .98. (f) Family adaptability, partnership, growth, affection, and resolve (APGAR) Test of Smilkstein (1978). This test contains five Likert-type items to assess the perception of the person on family function. The maximum score is 10 points. It is considered “severe dysfunctional family” from 0 to 3 points, “slightly dysfunctional family” from 4 to 6 points, and “normofunctional family” from 7 to 10 points. It was adapted into Spanish by Bellón, Delgado, Luna del Castillo, and Lardelli (1996) and it has a validity of 0.8 and reliability higher than .75. (g) A questionnaire to measure sociodemographic variables (age, sex, civil status, children, economic income, education level, working activity, and type of cohabitation).

Independent variables

Older adult information: age, sex (man/woman), civil status (married/widowed/single/partner/separated or divorced/other), children (yes/no), education level (illiterate, non-formal learning elementary/incomplete primary/complete primary/incomplete secondary/complete secondary/university), working activity (yes/no), economic income (yes/no), official minimum income (yes/no), type of cohabitation (permanent/non-permanent), with whom he lives (single/children/partner/grandchildren/other family/paid caregiver/other), and currently living together. Household composition: number of persons under the household, age, sex (man/woman), civil status (married/widowed/single/partner/separated or divorced/other), working activity (yes/no), economic income (yes/no), and official minimum income (yes/no). Assessment of cognitive disorder (yes/no), Assessment of the degree of dependence (independent, mildly dependent, moderately dependent, severely dependent, and totally dependent), Family APGAR (severe dysfunctional family/slightly dysfunctional family/normofunctional family), and Registered signs of abuse in the medical histories (open answer format).

Dependent variables

EASI questionnaire: Suspicion of abuse (yes/no). FETS questionnaire: Interviewer’s belief about whether it is a case of abuse (yes/no).

Procedure

The design was a cross-sectional descriptive study, developed during October 2014 in the city of Santa Cruz de la Sierra (Bolivia). The interviewer, who made the surveys to the elders, was an independent, health care professional, expert on the subject of study. The elders were recruited through nurses and social workers in health centers. The individuals who accepted to participate in the study were interviewed at home at a later stage. All of them signed the request for consent. The MMSE, the Autonomy Test of Activities of Daily Living, and the Family APGAR Test were checked before the EASI and the FETS questionnaires.

The statistical analysis was carried out using the program PASW Statistic 18. This analysis involved descriptive analysis of the categorical variables through count (n) and proportion (%) calculation; the quantitative variables are calculated through arithmetic mean (M) and SD, comparison of the categorical variable proportions through chi-square tests for contingency tables (in the case of 2 × 2 tables, the chi-square statistic with the Yates correction was used), and when the frequency is < 5, we employed the Fisher test.

In all statistical tests, the “significant” values were those whose confidence level was 95% (p < .05).

The principles established in the Helsinki Declaration relative to the Human Rights and the Biomedicine were respected, as well as the personal data protection.

Results

The sample was composed of a total of 210 older adults of Santa Cruz de la Sierra, none of them had any type of cognitive disorder, and therefore, they were able to finish the interview.

With regard to the Autonomy Test of Activities of Daily Living, 81% of the persons interviewed were independent.

Regarding the Family APGAR, 64.3% of the older adults belonged to normal functional families.

With regard to the information of the main caregiver (a person belonging to the family or environment who provides support or care for the older person when he or she needs it and who also accompanies this older person most of the time), 53% were women with an average age of 54.31 years (SD ± 16.946). Of the caregivers, 69.7% were married. Most of them had some type of income (89.7%) and 73.5% had a paid job. Only 15.8% of the caregivers reached the official minimum salary.

With respect to abuse, in the last year 39% of the interviewed persons had suspicion of abuse according to the EASI questionnaire. About 32.4% of the older adults interviewed were suspicious of psychological abuse, followed by neglect (21.9%), physical abuse (7.1%), and economic abuse (6.7%). A total of 66.7% of the victims identified their children as the abusers, followed by their partners (6.5%), by their brothers (6.5%), by their grandchildren (5.1), by their neighbors (3.3%), and by their daughter- or son-in-law (3.9%).

Regarding the perception of the interviewed people according to the FETS, 6.7% of the older adults thought that they were mistreated by someone close to them in the last year, 20% of the older adults thought it was damaged (intentionally or not) by someone close to them (in 82.9% of cases, this fact had happened in the last year), and 82.4% of the interviewees were satisfied with the help they received from their relatives. Regarding subjects’ emotional state, in 39% of cases sadness was observed, followed by depression (15.2%), fear (14.8%), embarrassment (11%), powerlessness (11%), crying (6.2%), anger (1.4%), and anxiety (1%). Based on objective data such as clothing, dirt, foul smell, and so forth, and perception of older people, according to the FETS, the evaluator believed that 37.1% of respondents were cases of abuse and 2.9% were unsure.

With respect to the profile of the older adults in cases of suspected abuse, 62.2% were women, with an average age of 69.96 years (SD ± 6.48). The most common marital status was widow (36.6%). The most common level of studies of this group was incomplete primary education (42.7%). Regarding labor activity, 59.8% had no job activity and 92.7% did not reach the official minimum income. Furthermore, 91.5% had children with an average of 4.59 (SD ± 3.06). The most common coexistence was with children (57.3%), with an average of 19.07 years (SD ± 14.72). They had an average score on the MMSE of 30.34 points (SD ± 3.97), an average score of 95.18 for activities of daily living (SD ± 10.58), being the most independent (72%), moderate dependence (15.9%), or low dependence (8.5%). The Family APGAR score was 5.72 points (SD ± 2.36), 47.6% belong to normal functioning families, followed by mild (40.2%) and dysfunctional (12.2%).

With the data presented, we can say that the profile of abused older adult is as follows: woman, widow, 70 years old, incomplete primary education, without an occupation, and an average of 4.59 children (in Table 2 the profile of older people with suspicion of abuse is compared with that of persons without suspicion of abuse).

Table 2.

Comparison of Demographic Characteristics, the Autonomy Test of Activities of Daily Living, and the Family APGAR in Suspicion of Abuse of Older Adult Versus No Suspicion of Abuse of Older Adult.

	Suspicion of Abuse		No Suspicion of Abuse
	Frequency (N)	Percentage (%)	Frequency (N)	Percentage (%)
Sex
Man	31	37.8	58	45.3
Woman	51	62.2	70	54.7
Civil status
Married	15	18.3	61	47.4
Widowed	30	36.6	27	21.2
Single	13	15.9	10	7.8
Partner	7	8.5	11	8.6
Separated or divorced	17	20.7	19	15
Children
Yes	75	91.5	124	96.9
No	7	8.5	4	3.1
Economic income
Yes	82	100	126	98.4
No	0	0	2	1.6
Education level
Illiterate	15	18.3	12	9.4
Non-formal learning elementary	14	17.1	25	19.5
Incomplete primary	35	42.7	43	33.6
Complete primary	3	3.7	13	10.2
Incomplete secondary	7	8.5	25	19.5
Complete secondary	3	3.7	4	3.1
University	5	6.1	6	4.7
Working activity
Yes	33	40.2	54	42.2
No	49	59.8	74	57.8
Official minimum income
Yes	6	7.3	16	12.5
No	76	92.7	112	87.5
Type of cohabitation
Permanent	80	97.6	124	96.9
Non-permanent	2	2.4	4	3.1
With whom the older person lives (several options are possible)
Single	13	15.9	12	9.4
Children	47	57.3	84	65.6
Partner	24	29.3	72	56.3
Grandchildren	35	42.7	62	48.4
Other family	20	24.4	13	10.2
Caregiver paid	0	0	0	0
Other form	2	2.4	1	0.8
Dependence for basic activities of daily living
Severe (21-60 points)	3	3.6	0	0
Moderate (61-90 points)	13	15.9	7	5.5
Low (91-99 points)	7	8.5	10	7.8
Independence (100 points)	59	72	111	86.7
Family APGAR test
Normofunctional (7-10 points)	39	47.6	96	75
Dysfunctional mild (3-6 points)	33	40.2	31	24.2
Dysfunctional severe (0-2 points)	10	12.2	1	0.8

Note. APGAR = adaptability, partnership, growth, affection and resolve.

We found significant differences when comparing the degree of dependency for Autonomy Test of Activities of Daily Living with suspicion of abuse (p = .008); people with greater dependence (severe and moderate) suffer more abuse. Also, we found significant differences when comparing the suspicion of abuse with regard to marital status (p = .001); older people who are married suffer less abuse.

Last but not least, it is worth noting that we found significant differences when comparing the suspicion of abuse in the EASI with the score obtained in the Family APGAR (p < .001). Those who present suspicion of abuse obtain an average score of 5.72 (SD ± 2.364) in the Family APGAR, while those who have no suspicion of abuse in the EASI get an average score of 7.58 (SD ± 1.947).

Discussion

The data obtained in this study highlight the prevalence of elder abuse in the family practice and community of Santa Cruz de la Sierra (Bolivia), a developing country. To our knowledge, there is no other study that quantifies or determines prevalence of elder abuse in this line. So far, the only information available regarding this subject is in newspaper articles (Camacho, 2012) and the report elaborated by HelpAge International and Defensoría del Pueblo (2011). Therefore, the results of the present study are of great value for the planning of interventions promoting preventive measures.

The prevalence of elder abuse is similar to other types of abuse that exist in Bolivia. In this line, we can compare the present results with those of the study of Meekers, Pallin, and Hutchinson (2013), which shows that 47% of women have experienced some kind of abuse in the past year. Moreover, the elder abuse prevalence is similar to other developing countries in South America. In Brazil, according to the study of Duque, Leal, Marques, Eskinazi, and Duque (2012), 20.8% of respondents reported experiencing at least one type of violence in their home environment. In Chile, according to Terra (2013), one out of five older adults has been the victim of some kind of abuse and, according to the National Service for older adults, allegations of aggression against older adults increased by 132% between 2010 and 2011. In Peru, the newspaper ANDINA (“50% de adultos mayores en,” 2009) informed on June 15, 2013, that 50% of older adults suffer some kind of abuse at the hands of their relatives.

However, the prevalence of elder abuse in the present study of Bolivia is similar to that found in developed European countries: In Portugal, which is one of the European countries with the highest number of older adults (PORDATA, 2014), in July 2011 the Daily News (“Portugal na lista negra,” 2011) published that “The Federacion de Institutciones de la Tercera Edad (FITI) warned today that 39.4 per cent of elders are victims of domestic violence in Portugal, according to the data recently released by the World Health Bank.” In Spain, however, it is estimated that the elder abuse’s prevalence in family practice is between 3% and 12% in the case of people older than 60 years (Moya & Barbero, 2005), similar to other countries, such as Turkey, where the study of Ergin et al. (2012) reported that 14.2% of the older adults had experienced some type of abuse in the family and community environment.

The figures of abuse in Bolivia are similar to the results of the report of UNFPA and HelpAge International (2012), with a sample of 1,300 older adults from around the world, wherein 43% of them declared that they were subjected to personal violence.

The fact that the percentage of abuse suspicion is higher in women in Bolivia may be due to the predominant patriarchal conception (HelpAge International & Defensoría del Pueblo, 2011) that subordinate women to men and therefore make them likely to be abused. In the study population, 99% of older adults receive some kind of income, most of them thanks to the non-contributory pension scheme or “Dignity Pension” (universal benefits granted to people older than 60 years; a quantity of 250 Bs [US$ 35.92] from May 2013). According to Escobar et al. (2013), about 91% of older adults living in Bolivia benefit from the “Dignity Pension.” Therefore, most of the older adults’ income is limited to the “Dignity Pension,” which does not even cover their basic needs. As a consequence, most of the older adults in Bolivia live in poverty and have become a vulnerable population sector (Escobar et al., 2013; HelpAge International & Defensoría del Pueblo, 2011). In our study, although significant differences were not found, there was a higher percentage of older adults who did not reach the official minimum income in the group of older adults with suspected abuse (92.7%), in comparation with the group that had not suspected abuse (87.5%). In this way, it could be said that poverty can be considered a risk factor to suffer abuse (Rueda et al., 2008).

The obtained results show that the lower the score in the family APGAR test, the higher the probability of elder abuse. These results agree with those of study of Tuesca and Borda (2003) in Colombia, which establishes a relation between dysfunctional families and women physical abuse.

Most of the elder abuse is carried out by their close relatives such as their children (66.7%) and partners (6.5%). These figures concur with most of the results provided by previous research in other countries such as the study of Fernández-Alonso and Herrero-Velázquez (2006) which reported that in several countries (United States, Canada, United kingdom . . . ) the aggressors were the victims’ partners in 66% of cases, while in the rest of the cases, the aggressors were the victims’ children.

Most of the elder abuse is psychological, which coincides with the observed literature as, for example, the study in Portugal of Ramos (2012), which estimated psychological abuse in 73.4% of cases of abuse of older adults, or the results of the report of Camacho (2012) in the newspaper Los Tiempos in the district of Cochabamba (Bolivia), in which it was reported that of the 510 complaints of mistreatment of older adults, 60% was for psychological abuse.

This information is an impulse to study the influence of the psychological abuse on the health of the victim, and the interaction of this kind of abuse with other types, as the psychological abuse may be the first visible manifestation of elder abuse.

About the study limitations, it is worth mentioning that the EASI is not designed to detect abuse cases, but to identify “abuse suspicion” cases. We have solved this limitation by using the evaluation form of the FETS questionnaire to contrast the results of both instruments; in both questionnaires the same result of abuse cases were obtained. Therefore, the abuse suspicion can be confirmed. At the same time, the validity of the EASI test as an instrument to identify abuse cases in family and community practice is reinforced.

The percentage of abuse evidences the need of further investigations on prevalence of elder abuse and its consequences on the health of the victims in developing countries. In this line, we recommend to develop future investigations that include, in the abuse suspicion cases, in-depth interviews (qualitative perspective) with the older adults and the main caregivers to know the problem from all sides.

Despite limitations, the authors think that the results of the present research can contribute to raise awareness of this problem and identify possible cases of elder abuse; the identification of the violence will lead to the implementation of interventions to solve the problem. It is necessary to develop and implement training programs for health professionals to improve the skills to identify and treat elderly victims of abuse, potential abusers, and others involved. It would also be necessary to develop protocols in Bolivia and new lines of research to delve more accurately into the causes of abuse.

Finally, taking into account the existence of similar data on elder abuse in developed and developing countries, we can safely assume that there is only one profile of abused elderly in spite of the cultural diversity of the different regions of the world.

Regarding the elder abuse profile, it is necessary to start working in the school and in the family from childhood to prevent people from suffering this kind of violence.

Conclusion

As a conclusion, this study has managed to gauge the elder abuse in Santa Cruz de la Sierra (Bolivia), belonging to a developing country in which there is no valid data over the prevalence of such abuse. The profile of abused older adult is as follows: woman, widow, 70 years old, incomplete primary education, without an occupation, and an average of 4.59 children. The information obtained shows that psychological abuse and neglect are the most common types of elder abuse and that dysfunctional families have a higher percentage of elder abuse. The data of abuse found are comparable with developed and developing countries.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Juan Manuel Carmona-Torres has a master’s degree in research. Currently, he is a PhD student at the University of Córdoba under the supervision of professor Mª Aurora Rodríguez-Borrego. His main research area is about vulnerability in the older adults, especially in the study of the elderly abuse in the family and community environment in several countries (Spain, Portugal, and Bolivia).

Pablo Jesús López-Soto has a master’s degree in research. At present, he is a PhD student at the University of Córdoba under the supervision of professor Mª Aurora Rodríguez-Borrego. His main research area is the fragility and vulnerability of older adults focusing on the falls.

Ana Isabel Coimbra-Roca is a social worker in “Proyecto Hombres Nuevos. Hospital Virgen de la Milagrosa,” a non-profit organization. She works with older adults from a social perspective and has extensive experience.

Ruth Mary Gálvez-Rioja is a professor at the Autonomous University Gabriel René Moreno. She is responsible for the departmental program of public and reproductive health in Santa Cruz de la Sierra, Bolivia.

Thomas Goergen is a professor at the German Police University. He is head of the Department of Criminology and Crime Prevention. A psychologist, he is an expert in the area of elder abuse and neglect in professional family care and he has published many peer-reviewed articles in this area.

Mª Aurora Rodríguez-Borrego is a professor at the University of Cordoba, and leader of the GA-2 group “Comprehensive Nursing Care, Multidisciplinary Perspective” in the Maimonides Institute for Biomedical Research of Córdoba (IMIBIC). An anthropologist, she has published several peer-reviewed articles and has public-funded projects studying various aspects of violence and vulnerability in general.

References

50% de adultos mayores en el Perú sufre maltrato por parte de familiares, estiman [50% of older adults in Peru suffer abused by family members, estimate]. (2009, June 15). ANDINA. Retrieved from http://www.andina.com.pe/agencia/noticia-50-adultos-mayores-el-peru-sufre-maltrato-parte-familiares-estiman-238173.aspx

Baztán

J. J.

Pérez del Molino

Alarcón

San Cristóbal

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