Association between domestic abuse and violence against older adults and frailty, depression, and nutritional status in an urban Brazilian setting

Objective:
To investigate the association between the risk of violence against older adults and factors such as frailty, depressive symptoms, and nutritional status in a population receiving care in Primary Health Care (PHC).
Methods:
This was an observational, cross-sectional, and quantitative study conducted between June 2023 and March 2024 in the municipalities of Santa Cruz and Macaíba, Rio Grande do Norte, Brazil. The study included 323 older adults (≥ 60 years old) registered in the PHC system. Data collection utilized validated instruments, including the Hurt, Insult, Threaten, Scream - Elder Abuse Screening Test (H-S/EAST) to assess violence risk, the Conflict Tactics Scales Form R (CTS-1) for classifying violence situations, the Edmonton Frailty Scale (EFS) for frailty, the Geriatric Depression Scale (GDS-15) for depressive symptoms, and the Mini Nutritional Assessment (MNA) for nutritional status. Statistical analyses included descriptive statistics, chi-square tests, Mann-Whitney U tests, Spearman correlations, and binary logistic regression.
Results:
Among participants, 46.1% were at risk of violence. Absence of verbal aggression, adequate social support, emotional independence, and better functionality were protective factors against violence. Advanced frailty (OR = 2.43), depressive symptoms (OR = 2.49), and malnutrition (OR = 1.52) were significantly associated with the risk of abuse. Logistic regression identified mood (R² = 0.19) and depressive symptoms (R² = 0.19) as the main predictors of violence.
Conclusion:
A significant association was found between the risk of abuse and multidimensional factors, particularly a history of violent situations, frailty, and depressive symptoms.

研究目标：探讨接受基层医疗（Primary Health Care, PHC）照护的老年人群中，针对老年人的暴力风险与衰弱、抑郁症状、营养状况等因素的关联。
方法：本研究为观察性横断面定量研究，于2023年6月至2024年3月在巴西北里约格兰德州圣克鲁斯市与马卡伊巴市开展。研究纳入了323名注册于基层医疗系统的老年受试者（年龄≥60岁）。数据采集采用经过验证的评估工具：包括用于评估暴力风险的伤害、侮辱、威胁、呵斥-老年人虐待筛查量表（Hurt, Insult, Threaten, Scream - Elder Abuse Screening Test, H-S/EAST）、用于分类暴力情形的冲突策略量表R版（Conflict Tactics Scales Form R, CTS-1）、用于评估衰弱状况的埃德蒙顿衰弱量表（Edmonton Frailty Scale, EFS）、用于测评抑郁症状的老年抑郁量表简版（Geriatric Depression Scale, GDS-15）以及用于评估营养状况的微型营养评定法（Mini Nutritional Assessment, MNA）。统计学分析方法涵盖描述性统计、卡方检验、曼-惠特尼U检验、斯皮尔曼相关分析以及二元逻辑回归分析。
结果：纳入的受试者中，46.1%存在暴力风险。无言语攻击行为、充足的社会支持、情绪独立性以及更佳的功能状态为对抗暴力的保护因素。重度衰弱（比值比OR=2.43）、抑郁症状（比值比OR=2.49）与营养不良（比值比OR=1.52）均与虐待风险存在显著关联。逻辑回归分析显示，情绪状态（决定系数R²=0.19）与抑郁症状（决定系数R²=0.19）是暴力风险的主要预测因子。
结论：虐待风险与多维度因素存在显著关联，尤其是暴力情形史、衰弱状况以及抑郁症状。