Introduction
The improvement of living conditions and increase in life expectancy have led to the phenomenon of aging in societies [1]. Factors such as changes in social conditions such as urbanization, modernism, changes in traditional values, the conflict between the value system of the old and new generations, and the change in the economic state have caused families to be unable to fulfill their roles and responsibilities towards the elderly. As a result, the elderly may be exposed to the risk of misbehavior by family members [2]. Elder abuse is one of the types of family violence that is considered one of the major social health problems in today’s societies whose incidence rate is increasing rapidly in the last two decades [3]. Due to physiological and anatomical changes caused by aging, chronic diseases, retirement, and reduction of social activities, the elderly are more exposed to abuse by family members [4]. Due to the fact that the elderly are considered as a vulnerable group, and since the elderly population of Gonabad city is increasing, and given the negative impact of abuse on the health and quality of life of the elderly, the present study aims to investigate the prevalence of elder abuse and its related factors in Gonabad, Iran.
Methods
This is an analytical cross-sectional study that was conducted in 2020. The study population consists of all elderly people aged ≥60 years covered by community health centers of Gonabad city. The inclusion criteria were: membership in SIB integrated health system, living in Gonabad city, age 60 years and higher, hearing and speech health, and cognitive health. The exclusion criterion was failure to complete the questionnaire. Using the formula and based on similar studies [5], the minimum sample size was determined 376. Considering the 10% possible dropout, the sample size increased to 405. For sampling, first we considered all community health centers of the city as a cluster. Then, we randomly selected one center. Next, based on the number of elderly people covered by that center, we randomly selected the eligible people. Then, they completed the questionnaires in the community health center.
Results
Of 401 participants, 157(39.2%) were men and 244(60.8%) were women. Most of them were in the age range of 60-74(73.8%) and their Mean±SD age was 68.53±6.75 years. Their mean of the activity of daily living (ADL) score was 13.19±5.52. Their mean of instrumental activities of living (IADL) score was 10.20±3.62. The highest prevalence of abuse was related to care negligence and the lowest prevalence was related to rejection. The educational level (P=0.03), history of hospitalization (P<0.001), sleep quality (P<0.001), income level (P<0.001) and dependency level (P<0.001) had a statistically significant relationship with the prevalence of elder abuse by family members.
Discussion
Despite the great emphasis on respecting the elderly in Iranian culture, mistreatment of the elderly by family members is high in Gonabad city. For reducing the rate of elder abuse by family members, a public mobilization is needed to identify and prevent the situations that can lead to the creation of abuse in the elderly which can improve their quality of life and ensure their physical and mental health. Making the family aware of the mental, physical, emotional and social needs of the elderly, trying to improve the lifestyle of the elderly, including hygiene, nutrition, etc., and their more adaptation with the changes in the society caused by modernity are among the proposed solutions to minimize the occurrence of elder abuse.

Ethical Considerations
Compliance with ethical guidelines
Necessary explanations were given to all participants about the study objectives and the confidentiality of their information, and verbal consent was finally obtained from them. They were free to leave the study at any time. This study was approved by the ethics committee of Gonabad University of Medical Sciences (Code: IR.GMU.REC.1399.097).

Funding
This study was extracted from a research project approved by Gonabad University of Medical Sciences

Authors' contributions
Writing the main text of the article: Fateme Hosseini Moghadam and Maryam Moradi; Statistical analysis: Musa Sajjadi, Nasim Khajovian; Designer and final editor of the article: Elham Nikkhah Bidakhti, Reza Nouri and Musa Sajjadi; Data collection: Reza Nouri, Fatemeh Kamli, Samira Moradi Sengcholi

Conflicts of interest
The authors declare no conflict of interest

Acknowledgements
The authors would like to thank the Social Development and Health Promotion Research Center and Health Deputy of Gonabad University of Medical Sciences and all seniors participated in this study for their cooperation


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