The aging process is one of the most delicate times of a person's life [1]. The number of individuals in the world who are 60 years of age or older is steadily rising worldwide, and is expected to double, to around 2.1 billion, by the year 2050 [2]. In a response, various governing bodies have instituted aging-in-place policies, resulting in a shift towards home-based care and assigning substantial roles to care partners and home care services [3-5]. However, the connections between older people and their family members have actually suffered greatly as a result of breakthroughs in technology, financial welfare, and family structure [6]. In their advanced age, older adults may be inadequately prepared and/or less inclined to establish new social connections, resulting in disengagement. Family members, contending with conflicting role obligations, often grapple with managing the stress associated with caregiving. This marginalization, coupled with insufficient social support, renders them susceptible to maltreatment and neglect - an issue of global concern that demands prompt attention [7].
Definition, prevalence, risk factors and consequences of older adults’ abuse and neglect
According to the World Health Organization (WHO), older adults’ abuse is defined as "a single or repeated act, or lack of appropriate action, which causes harm or distress to an older person". Abuse on all fronts—physical, sexual, psychological, emotional, financial, and material—as well as neglect and major loss of respect and dignity are all included in this category of violence [8]. Operationally, neglect is defined as “the refusal or failure of responsible caregivers to provide a care dependent older adult with assistance in daily living tasks or essential support such as food, clothing, shelter, health and medical care” [9]. According to data from the WHO [8], one in six older adults aged 60 years and over have experienced abuse at least once in their lives, and the prevalence of abuse among this demographic is rising. Older adults’ abuse in communities is on the rise, according to a systematic review and meta-analysis of 52 studies from 28 different countries [10]. A review by Yon, Mikton, Gassoumis, and Wilber (2017) showed that the overall prevalence of abuse among community-dwelling older persons was 15.7%, and estimated the prevalence of neglect to be 4.2% based on 30 studies conducted in 20 different countries [11].
Due to the world's old population's rapid growth and the societal changes, older adults’ abuse and neglect are becoming a major social issue [12], and a matter of significant concern within the realm of public health, bearing serious implications for social, economic, and health domains [11]. Advanced age, female gender, higher educational status, lower economic status, dependency, loneliness, dementia, social isolation, and a violent family background are risk factors for older adults’ abuse [13, 14]. Ageism against older people and specific cultural norms (e.g., normalization of violence) are community- and societal-level elements that have been connected to older adults’ abuse instances [15]. Furthermore, a previous study showed significant correlations between abuse and the health and resilience of older adults [16]. This study suggested that a lower probability of exposure to abuse among older adults is associated with higher resiliency scores, indicating that as participants become more resilient, they are less likely to experience physical, anxiety, depression, and fatigue issues. Conversely, there is a negative moderate correlation between experience of abuse and health, meaning that as exposure to abuse decreases, the health of older adults improves.
The adverse health outcomes resulting from the mistreatment of older individuals can be particularly serious. This form of abuse has the potential to diminish an individual's functional capacity, increase their dependence, contribute to cognitive impairment, and elevate the risk of malnutrition, polypharmacy, morbidities, or premature death [15, 17]. It raises the likelihood of hospital admission and institutionalization, both of which have a major, detrimental financial impact on health, families, and society at large, encompassing healthcare expenses for medical care and recovery, along with the delivery of support and assistance by the judicial and societal framework [18, 19]. Despite its widespread prevalence and serious consequences on physical and mental health, older adults’ abuse is inadequately reported, and its precise rate remains uncertain [20]. A report from the US Department of Justice asserts that a significantly larger proportion of harassment and inappropriate behavior is perpetrated against senior citizens than is officially documented. Only one out of every 23 incidents are reported to the relevant governing bodies [21]. Discrepancies in the statistical data related to this issue stem from a lack of consensus on the assessment of older adults’ abuse [15].
Measurement of abuse and neglect among older adults
Multiple methodologies are available for evaluating abuse and neglect in older individuals. Presently, there is no universally acknowledged standard for appraising older adults’ abuse. There is an important diversity of legal definitions, a broad spectrum of clinical experiences and scenarios, and a significant overlap between indicators of abuse and disease markers, in addition to the variations in standards across different regions. Consequently, a compelling need exists for further validation testing of the existing assessment tools [22, 23].
Overall, the majority of published tools were predicated on inadequate construct descriptions (abuse-focused tools) and tests of validity with older adults [24, 25]. Many previously developed scales constituted components of generic older adults’ abuse measurements [25-27]. For instance, the Conflict Tactics Scale was initially designed to assess abuse and neglect in the older population, but it was predominantly appraised with students [28, 29]. The Elder Abuse Instrument (EAI, [30]) and the Elderly Indicators of Abuse (E-IOA, [31]) have not been validated in a sample of community-dwelling older people. In addition, some measures may not encompass all types of abuse, such as the Older Adult Abuse Psychological Measure (OAPAM) [32] and the Older Adult Financial Exploitation Measure (OAFEM) [33]. Another measure recently developed in Japan, i.e. the 36-item Assessment Tool for Domestic Elder Abuse (ATDEA), encompasses different types of domestic abuse among older adults; however, it can be burdensome as a lengthy assessment [34]. Few were culturally and socially tailored instruments to specific older adults (such as the Family Members Mistreatment of Older Adults Screening Questionnaire, for Mexican older adults) [35]. Some tools can be utilized to appraise abuse among older adults either in nursing homes [36] or in acute care settings [37].
It is notable that no antecedent measurement scales tailored to evaluate neglect and abuse within local communities have come to light, and an Arabic version of such a scale remains unidentified. In 2020, Asiamah et al. [38] developed the Neglect and Abuse Scale (NAS). The NAS represents the inaugural endeavor to quantitatively assess instances of neglect and abuse experienced by older adults within their respective communities. The scale is composed of 11 items, each accompanied by three descriptive anchors denoting "not at all" (1), "sometimes" (2), and "always" (3) [38]. The analytical process yielded a bifactorial solution labeling its extracted factors as "neglect and assault" (N&A) and "discrimination and exploitation" (D&E). Factor 1 (D&E) encompasses eight items, each emblematic of diverse forms of abusive behaviors, inclusive of age-based discrimination, cheating, deceit for personal gain, instilling fear and panic, sexual harassment, denial of rights or privileges, stealing or defrauding, and betrayal. Factor 2 (N&A) comprises three items, pertaining to neglect (i.e. the deficiency in ensuring an individual's well-being), verbal abuse/disparaging remarks, and physical battery and assault, (i.e. acts causing bodily harm or injury to older adults). The scale has evinced commendable internal consistency and validity, thus endowing it with utility as a discerning instrument for appraising neglect and abuse experienced by older adults at the community level [38].The NAS has, therefore, a broad scope ensuring it captures the multifaceted nature of older adults’ abuse.
Rationale of the present study
The demographic landscape of Egypt is changing quickly. According to projections, the proportion of seniors (60 and over) in the population would more than double between 2020 and 2050, from 8.4 million, or 8% of the total, to 22 million, or 14% [39]. Despite the traditional collectivist nature of its culture, Egypt is currently witnessing a rise in the prevalence of older adults’ abuse, impacting the perception of nursing care quality among older adults [40]. For instance, a cross-sectional survey found that 43.7% of Egyptian older adults reported experiencing abuse at the hands of family members, with neglect accounting for the majority of cases (42.4%) [41]. Because a high proportion of older adults’ abuse cases remain undetected, it is imperative for healthcare providers and social workers providing at-home care services to have access to validated tools to identify elder abuse, given their apt positioning to recognize instances of abuse. This study addresses older adults’ abuse and neglect within the context of a psychometric analysis of the Arabic version of the scale, directly contributing to the objectives of the UN Decade of Healthy Ageing [42]. The absence of linguistic and culturally equivalent measurement instruments that retain the same meaning and conceptual relevance through the examination of psychometric properties used to measure the prevalence of elder abuse in Arabic-speaking countries has been identified [22, 43, 44]. Validating this neglect and abuse scale for use with Arabic-speaking older adult populations is crucial to ensure its cultural appropriateness, linguistic equivalence, and contextual applicability across the diverse Arab world, where no such measure previously existed. This process can strengthen the scale's utility and adoption for research and clinical practice in Arabic-speaking settings, and can assist researchers and practitioners in better detecting and addressing this important public health issue. In this context, the present study aimed to examine the psychometric properties of a new Arabic translation of the NAS in a sample of Arabic-speaking sample of community older adults from Egypt. It is expected that the two-factor solution will be supported, and that the Arabic NAS will show good reliability and concurrent validity.