Action plan for tackling violence against older adults in Brazil: analysis of indicators by states

Abstract Objective :to analyze the indicators of the action plan for tackling violence against older adults in Brazil, through temporal and spatial trends. Method: all nine indicators that form the plan were taken from the Sistema de Indicadores de Saúde e Acompanhamento de Políticas do Idoso (the Indicators of Health and Monitoring of Policies for Older Adults System). Time trend analysis was applied by Joinpoint Regression (CI95%), spatial distribution by states and clusters by Ward’s hierarchical agglomerative method, using quadratic Euclidean distance. Results: the study indicated a significant trend of an increase in notifications of cases of violence against older adults, of the hospitalization of older adults because of abuse, of the hospitalization of older adults because of femur fractures, of the mortality rate of older adults because of falls and of the hospitalization of older adults because of falls. Five clusters were formed, with two cluster formations standing out: that of the states of Rondonia, Roraima and Tocantins, because of their high levels of hospitalization and mortality by traffic accidents and high levels of mortality by abuse; and that of the states of Espírito Santo, Goias, Mato Grosso do Sul, Parana, Rio Grande do Sul, Sao Paulo and Sergipe, because of their high levels of hospitalization and mortality by falling and fractures, as well as their high level of violence against older adults. Conclusion :records of violence against older adults are increasing in Brazil, with specific types of violence concentrated in specific regions of the country.

摘要 研究目的：本研究旨在通过时空趋势分析，剖析巴西打击针对老年人暴力行为行动计划的相关指标。研究方法：本研究所纳入的构成该行动计划的全部9项指标，均取自《老年人健康与政策监测指标体系》（Sistema de Indicadores de Saúde e Acompanhamento de Políticas do Idoso）。时间趋势分析采用Joinpoint回归（Joinpoint Regression），置信区间为95%（CI95%）；空间分布分析以各州为分析单元，聚类分析采用沃德（Ward）分层系统聚类法，以二次欧氏距离作为相似度计算依据。研究结果：本研究显示，针对老年人暴力案件报案数、老年人虐待相关住院人次、老年人股骨骨折相关住院人次、老年人跌倒相关死亡率及老年人跌倒相关住院人次均呈现显著上升趋势。本次分析共生成5个聚类簇，其中两类聚类特征尤为突出：其一为朗多尼亚州（Rondônia）、罗赖马州（Roraima）与托坎廷斯州（Tocantins）组成的聚类簇，该区域因交通事故导致的老年人住院与死亡率居高不下，同时虐待相关死亡率亦处于高位；其二为圣埃斯皮里图州（Espírito Santo）、戈亚斯州（Goiás）、南马托格罗索州（Mato Grosso do Sul）、巴拉那州（Paraná）、南里奥格兰德州（Rio Grande do Sul）、圣保罗州（São Paulo）与塞尔希培州（Sergipe）组成的聚类簇，该区域跌倒与骨折相关的老年人住院及死亡率较高，且针对老年人的暴力事件发生率亦处于高位。研究结论：巴西针对老年人的暴力案件记录呈持续上升趋势，且特定类型的暴力行为呈现出区域集中性特征。