The vulnerability to being abused among the elderly is one of the most critical issues in the geriatric health because of its long- term consequences [1]. According to the World Health Organization,“Elder abuse is a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” [2]. The abuse can be in the form of verbal, psychological, physical, financial, neglect or sexual. It can lead to serious physical injuries and long-term psychological consequences [3]. The lack of formal education among older people in India further complicates the situation [4]. Decreased functional ability and consequent dependence on others is also a contributing factor for elderly abuse. After the age of 60, people get retired from their active work and spend time socialising with other senior citizens. But due to COVID-19, physical distancing and ban on social gatherings have deprived elderly of these interactions which make them prone to mood and anxiety issues [5]. They are not able to share their worries with friends/relatives; thus, a feeling of loneliness seems to surface. Also, older people have limited knowledge and access to technology which has now become a requirement for availing essential services during this pandemic and that adds a layer to an already existing problem of elderly abuse [6]. 

The situation of alarm generated by Covid-19 has turned into a crisis with unprecedented implications throughout the world [7]. The loss of jobs due to the pandemic on one hand while the poor social security measures in lower middle-income countries (LMIC) including India itself has not only adversely affected the nation’s economy at macro level, but it has also proven to be an anathema at the micro level too. The fear of being unable to be sustained financially has also made an impact on the mental health of the people. Older adults are the segment    of     the     population  most   vulnerable in this pandemic, largely due to their weaker immune systems and higher likelihood of having a chronic condition such as heart disease, diabetes, lung disease and cancer, thus leading to social isolation [8].              

This study was conducted to estimate the prevalence of vulnerability of the elderly to abuse during the COVID 19 pandemic time in district Kangra, Himachal Pradesh.

This observational study was conducted (September to December 2020) in a block area of District Kangra. There are nearly 2500 households which comprises a population of nearly 12,500 people, of which the number of elderly persons, aged above 60 years, is approximately 2500. 

Taking an estimated prevalence of elderly abuse to be 15% from a previous study, and assuming precision of 5% and power of 80%, the estimated sample size was 187. Further assuming a 10% non-response rate the final required sample size was 206. From a list of all persons above the age of 60 years, potential participants were selected using a computer-generated random number list. Contact was made through phone. Attempt to connect was made twice before calling the next number on list.

A semi structured validated questionnaire was use to collect data on demographic and socio-economic variables. Additionally, Vulnerability to Abuse Screening Scale (VASS) [9], was used to collect data on vulnerability to abuse. VASS comprises of 12 items, with “yes” and “no” responses, which evaluate emotional, psychological, and verbal abuse in the hand of family members. VASS total score of>4 was considered as an indicator of presence of abuse.

Data was testedfor normalcy using Kolmogorov-Smirnov normality test (p<0.001) and there was a strong evidence against the normalcy of the data. We describe the quantitative variables as median and inter-quartile range for non-normally distributed data, whereas qualitative variables were expressed as frequencies and proportions and chi square test was used. The data was analysed using SPSS software version 24.0.

The recruiting process stopped when the sample size was achieved. The demographic characteristics of the participants are presented in Table 1. The median age of the study participants was 67 (Interquartile range: 10) years, ranging from 60 years through 97 years. Approximately two-third of the study participants were males (65%), three-fifth of the participants were married (60.7%) and nearly half of the participants were living in a joint family (51%). A majority of the participants were illiterate (35%) while nearly 28% and 29% of them had attended up to middle-school and primary-school respectively. Almost 60% of the participants had some kind of jobs as either skilled, semi-skilled or unskilled workers while the rest were unemployed, retired or home-makers. Overall, 75% of the study participants had some kind of comorbidity, 31.1% participants had hypertension alone, 25.7% had type two diabetes mellitus,18.9% of the participants had both hypertension and diabetes mellitus, and the rest (24.3%) had no comorbidity. About 12% of the study 

Table 1: Demographic Profile of The Study Participants (N=206)

Table 2: Abuse and Loneliness scores of the study participants (N=206)

participants were living alone, almost one-fourth of the participants were living away from the family.

Table 2 illustrates the score obtained from VASS scale that was used to assess the vulnerability to abuse, among the study participants. The proportion of participants who had scored more than four on the VASS tool was found to be 13.1%.

In our study, the prevalence of elder abuse was found to be 13.1%.In our study, sixty-two percent of total study participants belonged to age group of 60–70 years and median age is 67 years. This finding is very much similar to the study conducted by Pritish K et al. [10] in urban settlement colony of Delhi where author recruited 125 elderly participants. In this study, majority of the participants were males, but this gender distribution is not similar in the study conducted by Pritish K et al in Delhi and Ramalingam A et al. [11] where 243 elderly individuals studied in which 63% were women. 

In present study, more than fifty percent participants were married and were living in joint families. More than one third of the study participants were illiterate but higher level of illiteracy among elderly has been reported by Pritish K et al. It was found that about 12% of the study participants were living alone and almost one-fourth of the participants were living away from the family. The pattern of living arrangement is almost similar in a study conducted by Pritish K et al in urban settlement of Delhi. 

Almost two third of the study participants in present study living with co-morbidities such as hypertension, Diabetes Mellitus, which was similar to the 60% reported among older adults aged≥60 years among 9852 older adultsfrom seven selected Indian states [12].

In our study, the prevalence of abuse is present in all elderly age groups which is contrary to the study conducted by Gaikwad et al. [13] in rural area of Karnataka among 127 elderly persons in a community where abuse was found more in the age group of 65-70 years and in> 75 years of age group and also in a study conducted by Pritish et al in urban resettlement colony of Delhi where abuse was more common in higher age group, that is, >70 years.

Prevalence of abuse was found to be 13.1% in our study population. Based on our findings, we conclude that the elderly is highly susceptible to abuse and most likely to feel lonely especially when they have been socially isolated during this time of pandemic. Hence, we strongly recommend that they should be treated with utmost care and love especially during the pandemic time when they are more vulnerable to abuse.

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