1. Introduction
As the aging population is growing [1], factors such as the evolution of the family role, the current crisis, and the pressure of modern life have weakened the social base of the older people and have increased the incidence of abuse by family members towards the elderly. This abuse can be manifested in various forms, such as overlooking elderlies’ physical and psychological needs, their financial exploiting, disregarding elderly rights, and even beatings or humiliation by family members [2]. As it is necessary to identify elder abuse prevalence to design multiple interventions, to inform authorities and decision-makers of the severity of the problem, and to support for the elderly, we conducted this study to investigate the prevalence of domestic abuse towards older people referred to health centers in West Tehran area.

2. Materials and Methods
In this descriptive-analytical study with a cross-sectional design, we recruited 312 older people referred to 18 hospitals and 34 health centers in regions 9, 21, 18, and 22 of Tehran between November 2017 and February 2018, using simple random sampling method (7 samples from each setting). The inclusion criteria included having age >60 years, being resident at home (not in the nursing home), having no memory impairment disorders (such as dementia, Alzheimer disease, or Parkinson disease) and hearing loss, being conscious when answering questions, and having the willingness to participate in the study. We explained the research objectives and confidentiality of information to the participants. For surveying participants, we used the Iranian Domestic Elder Abuse Questionnaire developed by Heravi Karimoei et al. [1].
It has 49 items and 9 subscales of care neglect (11 items), psychological abuse (8 items), physical abuse (4 items), financial abuse (6 items), sexual abuse (2 items), authority deprivation (10 items), rejection (4 items), financial neglect (4 items), and emotional neglect (2 items) . These items are answered by “Yes”, “No”, and “No relevance”. The total score ranges from 0 to 100; a higher score indicates a higher level of abuse, and 0 indicates no abuse [1]. The collected data were analyzed by SPSS V. 21, using The independent t-test.
3. Results
The Mean±SD age of the participants was 67.93±6.44 years. Most of the participants were women (55 of 312). Moreover, 10.9% of them were under treatment for depression; 26.6% were living alone, and the spouse of 35.9% them was not alive. About 79.2% needed care, and 25% were illiterate. Also, 67.2% had high school diploma, and 7.8% had a university education. The findings showed that 77.9% of the samples had experienced abuse at the onset of old age. Only 22.2% of them had not experienced any abuse by family members. The highest frequencies of domestic abuse were care neglect (58.3%), psychological abuse (56.4%), and emotional neglect (50.3%). 
The older people reported complaints about various abuses they had experienced. About 25.6% complained of leaving them in following the dietary regime (despite their financial capability). Also, 25% suffered from receiving no assistance for movement, or leaving them (23.7%) alone in their outdoor jobs (like shopping and paying bills). Some (23.4%) complained of leaving their housework, such as cleaning or repairs. Besides, some (31.3%) complained of blaming them for no reason, or not caring about their personality, knowledge, ability, and experience (26.6%), yelling at them (25.3%). Finally, 39.4% suffered from not receiving enough attention or not being visited or called (41.3%). The least domestic abuse experienced by the samples was related to sexual abuse (3.2%), rejection (9.3%), and physical abuse (16.3%). Table 1 presents the Mean±SD age of the dimensions of domestic elderly abuse. The results of the independent t-test showed that the older people, who needed a caregiver (t=4.30, df=130.03, P=0.001), lost their spouse (t=-2.76, df=307, P=0.006), were under treatment for depression (t=2.60, df=33.36, P=0.014), had higher overall score of domestic abuse.
 
4. Conclusion
The findings showed that 77.9% of the older people had experienced at least one type of abuse. Being depressed, needing for a caregiver, and being widow/widowed were the risk factors that increase domestic elderly abuse. Health workers, by screening for the elderly at risk of domestic abuse, need to inform them about the dimensions of domestic abuse and their rights as an injured person. Teaching the methods of preventing elder abuse and educating families in this regard can be a useful step. Finally, we suggest that the proper statutory laws be adapted and executed, supportive institutions be established to provide counseling based on the type of abuse and conditions, a referral network be created between different specialties, and community support services be provided to support and alleviate the suffering of the abused older people.
Ethical Considerations
Compliance with ethical guidelines
This study received its ethical approval (Code:IR.IUMS.REC.No. 1396.9416368013) from the Research Ethics Committee of Iran University of Medical Sciences.
Funding
The present paper was extracted from the MSc. thesis of first Author, Marzieh Rohani, in Department of MPH (Master of Public Health), School of Health, Iran University of Medical Sciences.
Authors' contributions
Conceptualization, design, analysis, and initial draft preparation by Marzieh Rohani and Tahereh Dehdari; data collection by Marzieh Rohani, Maryam Hosseinyrad, and Mahrokh Alaei Janat-Makan; final draft preparation by all authors; supervision by Tahereh Dehdari.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgments
This study was ethically approved by the Iran University of Medical Sciences.

 

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