Abstract
The study determined the role of health factors to the prediction of self neglect among older Malaysians. This paper utilizes a sub sample of 480 older persons from a cross sectional study entitled "Perception, Awareness and risk factors o elder abuse." The study was conducted in the state of Perak, Malacca, Kelantan and Selangor which represent four zones in Peninsular Malaysia. Data was collected in January to May 2008 through face- to- face interviews using in structured questionnaires. Respondents were asked whether they ever experience about at age 50 years and above. The experience of self neglect was measured by7 items with pre-determined response categories of (1) Yes, (2) No and (3) Not applicable. The items were developed by the research team, based on base literature. Among the 480 subjects included in the analysis, 221(46%) corroborated cases of self-neglect occurred. The result showed the possibility of Self neglect among depressed elderly people who are more than double those who are not depressed. Effect of Disability on Self neglect is significant; So that the elderly people who have a higher disability, their chance Self neglect more than one time elderly people whom their disability is less. Elderly people living in the society who occurrence geriatric depression and/or disability may possibly be real at risk for the increase of self-neglect and may become candidates for intervention.
Key words: Health factors, Self-Neglect, Elderly, Malaysia
Introduction
The full impact of an aging population will hit Malaysia in 2035, where 17% of the total population is projected as senior citizens. With a rapidly growing elderly population, the incidence of elder self neglect can be expected to increase (Aizan. T, 2007) and for a variety of reasons the abuse and neglect of older adults continues to critically impact its victims' quality of life. The prevalence of the abuse of older adults is rapidly increasing.
Population aging is one of humanity greatest triumphs. It is also of our greatest challenges. One of these problems can be elder self neglect. Elder self neglect can be defined as situations in which there is no perpetrator and neglect is the result of the older person refusing care (NCPEA, 2010).
Poor health status factors increase the risk of elder abuse and self neglect that weaken function and create care needs that go in excess of and /or will exceed their caregiver ability to meet them.
There is contentious data to support weakness of elder people's poor health to be a risk factor for elder self neglect (Karl A. Pillemer, 2007). Current studies have failed to show direct association between health condition and neglect, even while it had been implicit that defenselessness itself was a risk factor for abuse. Physical and mental harm however show to participate a not direct role in elder self neglect, decreasing seniors' ability to protect them or to escape, thus increasing vulnerability (Monique I Sellas, 2009). Health factors in this study that assessed include Geriatric depression, Disability, chronic disease and health perceived factors.
Dong X (2008) suggest that depression is a significant risk factor associated with elder abuse and self neglect among Chinese elderly. In another study clinically significant depressive symptoms and cognitive impairment predicted abuse in an epidemiological sample of community-dwelling elderly residents. Depressive symptoms and cognitive impairment were independent predictors and also contributed to multivariate models that took into account broader social and medical contexts (Robert C. Abrams, 2002). Self-neglect is often associated with mental health problems, including substance abuse, dementia, and depression (NCPEA, 2010). There is not knowledge about relationship Geriatric depression and self neglect among Malaysian.
Decline in physical function was associated with increased risk of reported elder abuse and greater self-neglect severity in community-dwelling population (Dong, x. 2010). There are limitations to the study. Ideally, the relationship between elder maltreatment and deficits in individual and community resources needs to be examined in a prevalence study of a representative sample of older adults. Since the reported cases are estimated to be only a fraction of the elder maltreatment victims, the representativeness of such a sample may be limited. Dyer and colleagues (2007) conducted a cross-sectional chart review of nearly 460 cases of elder self-neglect referred by social services agency and found that 76.3% of the cases had abnormal levels of physical performance testing. In another recent study, Naik and colleagues (2008) examined 100 community subjects reported to social services agency for elder self-neglect and found that impairment in instrumental ADL was significantly associated with elder self-neglect. However, the authors did not find a statistically significant cross-sectional association between impairment in physical performance testing and elder self-neglect (p = .49), (Dong, Mendes de Leon, et al, 2009).
Method
This study was cross-sectional and method of the research is a kind of survey research. It would be done with designing questions about elder self neglect and effective associated factors. Then, their completion with total population and ontological and etiology of elder self neglect would be considered. Firstly, in addition to presentation of images from economic, social and population of old age, structure of elder self neglect and also the most important effective factors on occurrence of such incident on the basis of theoretical approaches of research would be recognized and determined. Total population of this research consists of people older than 60 years of age who were inhabitants of urban and rural areas. Areas in four provinces of Malaysia including Kelantan, Melaka, Perak, and Selangor would be included. In fact, the present research is a part of a large project called" Influential factors on abuse experience among older Malaysia" in Malaysia. That project was performed in the above mentioned four provinces.
Four provinces will be considered on the basis of profile of provided households by gerontology UPM institute and with cooperation of department of Malaysia statistic in year of 2000. Sample size of this research equals to 480 people.
Meanwhile in this research for selection of old people as total population, 5 criteria which are mentioned below have been used as circle of inclusion and exclusion: Being Malaysia citizen, No problem in hearing, not being senile, not having mental illnesses and being permanent resident in enumeration block area.
Therefore each of these samples among these age groups in four related provinces that are present during completion of questionnaire in stage of field operations in their own houses constitute sample of the study.
Of course, completion of questionnaires would be done by trained team of research assistants and in the form of participatory and face to face interview with respondents.
Since total population of this research consists of urban and rural old people in four central provinces, therefore selection sample also would be done among old people of the same provinces. On the other hand, as it was mentioned earlier, this research is a part of a larger project titled that has been performed in four considered provinces. Total sample size of the large project was 1300 people.
Validity of measurement tools emphasizes on this point that whether concept and questions related to measurement tools (questionnaire) evaluates the same concepts and topic that is considerable in research or not. In this research, measurement of rate of validity measurement tool would be done through method of concepts validity (face method). It means that in this method questionnaire would be assigned after primary collection with supervisor and few numbers of expert people and researchers. After feedback and performance of their comments in questionnaire and its improvement of questionnaire, validity would be measured.
Also in this research in order to evaluate reliability of tool measurements that confirms the repetition and general liability of questionnaire and this point that if questionnaire is repeated in the same circumstances/similar consequences will be obtained or not. The method of Kronbach alpha would be used for this aim. In this method, the rate of consistency on the basis of scale or index which is considerable will be evaluated. After collection of completed questionnaires in this stage, rate of Cronbach alpha scales and indices of questionnaire would be calculated after improvement of questionnaire, and correctness of method for expression of items/elimination of extra items, and adding necessary items, final questionnaire of research will be provided and among selected statistical sample from total population will be completed. Results showed that overall reliability of the instrument was cronbachs Alpha, 0.611. Alpha of 0.507 is noted for self neglect, and geriatric depression Alpha was 0.642
After data collection from survey method, they entered to SPSS software and then on the basis of research objectives and hypotheses would be analyzed and processed in next stage research findings in two section of descriptive and inferential would be exhibited.
In descriptive findings section, the way of distribution and arrangement of variables would be explained and exhibition of research findings in the form of one dimensional table with in kinds of indices of tendency measurement (mode, median and mean) and tendency to dispersion (variance, standard deviation, kurtosis, skewness) would be done.
Sector of the analytical and inferential finding is related to discussion of research hypotheses test. In this section, regarding the scale and level of data measurement and also identity of hypotheses, different kinds of parametric and nonparametric statistical tests of which are suitable for hypotheses test would be applied. The most important parametric statistical tests are including t-test with two independent samples/ correlation of Pearson and non parametric statistical tests also including chi-square which is multi dimensional independence and association measurement multi variate regression would be applied. Finally, influential rate of variables would be determined with logistic regression.
Result
Baseline descriptive data for these subjects are summarized in Table 1. Overall, the subjects were elderly, female (50.8), Muslim (81%), and single (67.3% Never married, Divorced/Separated, Widowed), 53.8 percent of respondents residing in the city.
In this research, evaluate Self neglect among respondents, using the seven questions that the study results showed that 43 / 3 percentage of respondents at least one time was Self neglect. Of 480 cases interviewed, 266 (55.4%) individuals, were found to have had depressed. Of the elderly, 22.5% (n=108) had likely depressive symptoms, 32.9 %( n=158) had possible depressive and 44.6% were none depressed. Geriatric depression was higher in women (59.5%) than in men (52.7%).
The results show next to the second stage, the variables considered, four variables Geriatric Depression, Disability, Location and Religion statistically significant effect on the self neglect among elder Malaysian. In addition, the amount of influence on these four variables self neglect Geriatric Depression, Location, Disability and Religion were the most effect on over Self neglect had had. Influence the quality of each of these variables is also shaped so that:
geriatric Depression on the possibility of Self neglect among depressed elderly people who are more than double those who are not depressed (Exp (B) =2/485)
Effect of disability on Self neglect is significant. So that the elderly people who have a higher disability, their chance Self neglect more than one time (1/147) elderly people whom their disability is less. Chronic diseases and self perceived were not significant risk factors associated with elder abuse experienced among Malaysian.
Discussion
Table 1 Baseline socio demographic of subjects in a study self neglect
Variable
Categories
F
%
Gender
Male
236
49/2
Female
244
50/8
Total
-
480
100
Age
65 years and lower
198
41/2
66 to 75 years
197
41
76 years and higher
85
17/7
Total
-
480
100
Marital
Single (Never married, Divorced/Separated, Widowed)
323
67/3
Married
157
32/7
Total
-
480
100
State
Selangor
117
24/4
Melaka
116
24/2
Perak
106
22/1
Kelantan
141
29/4
Total
-
280
100
Education
Literate
315
65/6
Illiterate
165
34/4
Total
-
480
100
A caregiver to older person
Yes
29
6
No
451
94
Total
-
480
100
Location of residence
Urban
222
46/2
Rural
258
53/8
Total
-
480
100
Religion
Muslim
389
81
Non-Muslim
91
19
Total
-
480
100
Race
Malazian
367
76/5
Non-Mayazian
113
23/5
Total
-
480
100
Employment status
Employed
82
17/1
Unemployed
398
82/9
Total
-
480
100
Income
Low
140
29/2
Medium
214
44/6
High
88
18/3
Not response
38
7/9
Total
-
480
100
:
Relation of socio demographic and health factors with self neglect among older Malaysian 2 Table
Independent variables
Scale
Association
Selfneglect
Socioeconomic factors
Employment status
Nominal
Phi
X2= 0.384
V= 0.028
P= 0.310
Income
Interval
Eta
X2= 54.096
V= 0.336
P= 0.432
Education
Nominal
Phi
X2= 0.009
V= 0.004
P= 0.499
Health status
factors
Self perceived health
Ordinal
Cramer's V
X2= 0.751
V= 0.040
P= 0.861
Chronic disease
Nominal
Phi
X2= 3.320
V= 0.042
P= 0.083
Geriatric Depression
Nominal
Phi
X2= 26.412
V= 0.235
P= 0.000
Disability
Interval
Eta
X2= 20.654
V= 0.207
P= 0.037
Background factors
Gender
Nominal
Phi
X2= 1.539
V= 0.125
P= 0.057
Location
Nominal
Phi
X2= 10.097
V= 0.145
P= 0.001
Age
Interval
Eta
X2= 37.059
V= 0.278
P= 0.287
Race
Nominal
Phi
X2= 1.194
V= 0.050
P= 0.162
Marital
Nominal
Phi
X2= 1.372
V= 0.053
P= 0.142
Religion
Nominal
Phi
X2= 2.381
V= 0.070
P= 0.077
B
S.E.
Wald
df
Sig.
Exp(B)
Step 1a
GDS
.980
.193
25.815
1
.000
2.665
Constant
-.830
.149
31.144
1
.000
.436
Step 2b
GDS
.970
.195
24.808
1
.000
2.638
Location
.577
.193
8.958
1
.003
1.780
Constant
-1.716
.337
25.939
1
.000
.180
Step 3c
GDS
.901
.197
20.873
1
.000
2.463
Disability
.131
.052
6.496
1
.011
1.140
Location
.572
.194
8.695
1
.003
1.773
Constant
-2.673
.510
27.431
1
.000
.069
Step 4d
GDS
.910
.199
20.975
1
.000
2.485
Disability
.137
.052
7.012
1
.008
1.147
relegion
-.641
.256
6.280
1
.012
.527
Location
.692
.202
11.689
1
.001
1.998
Constant
-2.387
.521
20.990
1
.000
.092
