ANALYSIS OF INTERPERSONAL AND SELF-INFLICTED VIOLENCE IN OLDER ADULTS

to identify the prevalence of interpersonal and self-inflicted violence in older adults in the state of Espírito Santo and its association with victim and aggression characteristics.

Method:

this is a cross-sectional study with data on notifications of elder abuse registered in the state of Espírito Santo, Brazil between 2011 and 2018 in the Notifiable Diseases Information System (SINAN). Violence nature (interpersonal or self-inflicted) and victim and aggression characteristics were assessed. Multivariate analysis was conducted using Poisson regression with robust variance. The association was presented by Prevalence Ratio (PR) and 95% Confidence Interval (95%CI).

Results:

the prevalence of interpersonal violence was 85.0% (95%CI: 83.3-86.5), and of self-inflicted violence was 15.0% (95%CI: 13.5-16.7). Interpersonal elder abuse was associated with higher prevalence in female victims, aged 80 years or older, black/brown and without disability/disorder, with repetition history, with suspected use of alcohol, outside the residence, in urban areas and motivated by intolerances. On the other hand, self-inflicted violence among older adults was more prevalent in male victims, aged 60 to 69 years, white, with disabilities/disorders, when aggression occurred at home, without repetition history, without suspicion of alcohol use, in rural areas and without intolerance.

Conclusion:

Victim and aggression characteristics influence the occurrence of interpersonal and self-inflicted violence in older adults.

DESCRIPTORS:
Violence; Elder abuse; Mandatory reporting; Epidemiological monitoring; Health information systems

Variables	N	%
Sex
Male	757	39.4
Female	1167	60.6
Older adults’ age
60 to 69 years	1048	54.5
70 to 79 years	529	27.5
80 years and older	347	18.0
Skin color
White	781	45.6
Black/brown	932	54.4
Education (years of study)
0 to 4 years	702	60.9
5 to 8 years	180	15.6
9 years and older	270	23.5
Marital status
With a partner	889	56.4
Without a partner	689	43.6
Disability/disorder
Yes	393	24.6
No	1201	75.4
Repetition history
Yes	923	58.0
No	669	42.0
Suspected alcohol use
Yes	486	39.9
No	731	60.1
Occurred at their homes
Yes	1445	83.5
No	285	16.5
Occurrence shift
Morning/afternoon	705	59.0
Night/dawn	490	41.0
Occurrence area
Urban	1562	86.5
Rural	244	13.5
Motivated by intolerance
Yes	414	37.2
No	699	62.8
Referrals
Yes	1541	83.3
No	310	16.7
Aggressor’s age
0-19 years	39	4.0
20-59 years	763	79.0
60 years and older	164	17.0
Aggressor’s sex
Male	924	63.6
Female	350	24.1
Both sexes	178	12.3
Relationship with the victim
Child	604	47.2
Partner	256	20.0
Other family member	238	18.6
Unknown	181	14.2
Number of people involved
One	1069	69.8
Two and more	462	30.2

Variables	Interpersonal violence				Self-inflicted violence
	n=1635				n=289
	n	%	95%CI*	p-value	n	%	95%CI	p-value
Sex
Male	629	83.1	80.2 - 85.6	0.062	128	16.9	14.3 - 19.7	0.062
Female	1006	86.2	84.1 - 99.1	0.062	161	13.8	11.9 - 15.9	0.062
Older adults’ age
60 to 69 years	840	80.2	77.6 - 82.4	<0.001	208	19.8	17.5 - 22.4	< 0.001
70 to 79 years	471	89.0	86.1 - 91.4		58	11.0	8.6 - 13.9
80 years and older	324	93.4	90.2 - 95.6		23	6.6	4.4 - 9.8
Skin color
White	645	82.6	79.8 - 85.1	<0.001	136	17.4	14.9 - 20.2	< 0.001
Black/brown	827	88.7	86.5 - 90.6	<0.001	105	11.3	9.4 - 13.5	< 0.001
Education (years of study)
0 to 4 years	598	85.2	82.3 - 87.6	0.905	104	14.8	12.4 - 17.6	0.905
5 to 8 years	151	83.9	77.8 - 88.6		29	16.1	11.1 - 22.2
9 years and older	230	85.2	80.4 - 88.9		40	14.8	11.0 - 19.6
Marital status
With a partner	777	87.4	85.0 - 89.4	0.020	112	12.6	10.6 - 14.9	0.020
Without a partner	571	83.2	80.2 - 85.8	0.020	115	16.8	14.1 - 19.7	0.020
Disability/disorder
Yes	1062	88.4	71.9 - 80.3	<0.001	139	11.6	19.7 - 28.1	< 0.001
No	300	76.3	86.5 - 90.1	<0.001	93	23.7	9.9 - 13.5	< 0.001
Repetition history
Yes	820	88.8	86.6 - 90.7	<0.001	146	11.2	9.3 - 13.3	< 0.001
No	523	78.2	74.9 - 81.1	<0.001	103	21.8	18.8 - 25.1	< 0.001
Suspected alcohol use
Yes	442	91.0	88.0 - 93.2	<0.001	44	9.0	6.8 - 11.9	< 0.001
No	561	76.7	73.5 - 79.7	<0.001	170	23.3	20.3 - 26.5	< 0.001
Occurred at their homes
Yes	1201	83.1	81.1 - 84.9	<0.001	244	16.9	15.0 - 18.9	< 0.001
No	263	92.3	88.5 - 94.9	<0.001	22	7.7	5.1 - 11.4	< 0.001
Occurrence shift
Morning/afternoon	596	84.5	81.7 - 87.0	0.510	109	15.5	13.0 - 18.3	0.510
Night/dawn	421	85.9	82.5 - 88.7	0.510	69	14.1	11.2 - 17.4	0.510
Occurrence area
Urban	1337	85.6	83.8 - 87.2	0.048	225	14.4	12.7 - 16.2	0.048
Rural	197	80.7	75.3 - 85.2	0.048	47	19.3	14.8 - 24.7	0.048
Motivated by intolerance
Yes	401	96.9	94.7 - 98.2	<0.001	13	3.1	1.8 - 5.3	< 0.001
No	464	66.4	62.8 - 69.8	<0.001	235	33.6	30.2 - 37.2	< 0.001
Referrals
Yes	1.336	86.7	84.9 - 88.3	<0.001	205	13.3	11.7 - 15.1	< 0.001
No	234	75.5	70.4 - 79.9	<0.001	76	24.5	20.0 - 29.6	< 0.001

Variables	Unadjusted analysis			Adjusted analysis
Variables	PR*	95% CI^†	p-value	PR	95%CI	p-value
Sex
Male	1.0		0.068	1.0		< 0.001
Female	1.04	1.00-1.08	0.068	1.06	1.01-1.10	< 0.001
Older adults’ age
60 to 69 years	1.0		< 0.001	1.0		< 0.001
70 to 79 years	1.11	1.07-1.16		1.10	1.05-1.15
80 years and older	1.17	1.12-1.21		1.17	1.12-1.22
Skin color
White	1.0		< 0.001	1.0		0.001
Black/brown	1.07	1.03-1.12	< 0.001	1.07	1.03-1.12	0.001
Marital status
With a partner	1.05	1.01-1.10	0.022	1.03	0.99-1.08	0.179
Without a partner	1.0		0.022	1.0		0.179
Disability/disorder
Yes	1.0		< 0.001	1.0		< 0.001
No	1.16	1.09-1.23	< 0.001	1.16	1.09-1.23	< 0.001
Repetition history
Yes	1.14	1.09-1.19	< 0.001	1.27	1.15-1.40	< 0.001
No	1.0		< 0.001	1.0		< 0.001
Suspected alcohol use
Yes	1.19	1.13-1.24	< 0.001	1.20	1.11-1.29	< 0.001
No	1.0		< 0.001	1.0		< 0.001
Occurred at their homes
Yes	1.0		< 0.001	1.0		< 0.001
No	1.11	1.07-1.16	< 0.001	1.25	1.12-1.40	< 0.001
Occurrence area
Urban	1.06	0.99-1.13	0.076	1.16	1.09-1.34	0.035
Rural	1.0		0.076	1.0		0.035
Motivated by intolerance
Yes	1.46	1.38-1.54	< 0.001	1.35	1.26-1.45	< 0.001
No	1.0		< 0.001	1.0		< 0.001
Referral
Yes	1.15	1.08-1.23	< 0.001	1.22	1.07-1.38	< 0.001
No	1.0		< 0.001	1.0		< 0.001

Variables	Unadjusted analysis			Adjusted analysis
Variables	PR*	95% CI†	p-value	PR	95%CI	p-value
Sex
Male	1.03	1.00-1.06	0.065	1.04	1.01-1.08	0.008
Female	1.0			1.0
Older adults’ age
60 to 69 years	1.12	1.09-1.16	< 0.001	1.13	1.09-1.17	< 0.001
70 to 79 years	1.04	1.01-1.08		1.05	1.01-1.09
80 years and older	1.0			1.0
Skin color
White	1.06	1.02-1.09	< 0.001	1.05	1.02-1.09	0.001
Black/brown	1.0			1.0
Marital status
With a partner	1.0		0.021	1.0		0.171
Without a partner	1.04	1.01-1.07		1.02	0.99-1.06
Disability/disorder
Yes	1.11	1.07-1.15	< 0.001	1.11	1.07-1.15	< 0.001
No	1.0			1.0
Repetition history
Yes	1.0		< 0.001	1.0		< 0.001
No	1.10	1.06-1.13		1.14	1.09-1.20
Suspected alcohol use
Yes	1.0		< 0.001	1.0		< 0.001
No	1.13	1.09-1.17		1.12	1.07-1.18
Occurred at their homes
Yes	1.09	1.05-1.12	< 0.001	1.14	1.07-1.22	< 0.001
No	1.0			1.0
Occurrence area
Urban	1.0		0.065	1.0		0.031
Rural	1.04	1.00-1.09		1.08	1.01-1.16
Motivated by intolerance
Yes	1.0		< 0.001	1.0		< 0.001
No	1.30	1.26-1.34		1.21	1.17-1.26
Referral
Yes	1.0		< 0.001	1.0		< 0.001
No	1.10	1.06-1.15		1.10	1.04-1.17

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Gracielle Pampolim graciellepampolim@hotmail.com