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      Mortality of elder financial and psychological abuse victims in rural Malaysia: a prospective cohort study

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          Abstract

          Objectives

          To determine the longitudinal impact of elder financial and psychological abuse on risk of death among older Malaysians.

          Design

          7-year prospective cohort study. Baseline data were collected in late 2013 and respondents were followed up in June 2020.

          Setting

          Kuala Pilah, Negeri Sembilan, Malaysia.

          Participants

          1927 community-dwelling older adults aged 60 or older randomly sampled from the national census. Individuals with severe cognitive impairment were excluded.

          Outcome measure

          Mortality data were provided by the Malaysian National Registration Department and linked to respondents’ national identification numbers. Kaplan-Meier curves and Cox regression were used to examine victims’ survival periods and the impact of abuse on risk of death.

          Results

          Overall, 450 respondents (23.4%) died after 7 years. Among financial and psychological abuse victims, death percentage was 25.8% compared with 23.3% among those who did not experience these types of abuse. Kaplan-Meier curves showed shorter survival among abuse victims, but Cox regression found no significant impact of financial and psychological abuse on mortality risk (HR 1.05, 95% CI 0.78 to 1.41). Among all the variables studied, only cognitive impairment led to higher mortality risk (HR 1.32, 95% CI 1.03 to 1.69).

          Conclusion

          Our findings contradict prior empirical studies that supported the link between elder abuse and neglect (EAN) and mortality, even though we focused on two abuse subtypes. Results in this study are more in line with the recently emerging evidence that showed no association between EAN and mortality.

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          Most cited references42

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          How stress influences the immune response.

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            The short form of the Geriatric Depression Scale: a comparison with the 30-item form.

            The Geriatric Depression Scale (GDS) exists in both short and long forms. The original 30-item form of the GDS has been shown to be an effective screening test for depression in a variety of settings. However, its utility in patients with dementia of the Alzheimer type (DAT) is questionable. The short, 15-item version of the GDS was developed primarily for brevity and, in particular, for use in populations such as the medically ill or those with dementia, where the longer form might be burdensome. How well this short form works in these populations, however, is largely undetermined. In this paper, the sensitivity and specificity of the 15- and 30-item GDS are compared in a group of patients who were either cognitively intact or had mild DAT. The findings suggest that the short version of the GDS, like its longer predecessor, is an effective screening tool in the cognitively intact. However, in a population of subjects with mild DAT, it does not appear to retain its validity.
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              Stress, depression, the immune system, and cancer.

              The links between the psychological and physiological features of cancer risk and progression have been studied through psychoneuroimmunology. The persistent activation of the hypothalamic-pituitary-adrenal (HPA) axis in the chronic stress response and in depression probably impairs the immune response and contributes to the development and progression of some types of cancer. Here, we overview the evidence that various cellular and molecular immunological factors are compromised in chronic stress and depression and discuss the clinical implications of these factors in the initiation and progression of cancer. The consecutive stages of the multistep immune reactions are either inhibited or enhanced as a result of previous or parallel stress experiences, depending on the type and intensity of the stressor and on the animal species, strain, sex, or age. In general, both stressors and depression are associated with the decreased cytotoxic T-cell and natural-killer-cell activities that affect processes such as immune surveillance of tumours, and with the events that modulate development and accumulation of somatic mutations and genomic instability. A better understanding of the bidirectional communication between the neuroendocrine and immune systems could contribute to new clinical and treatment strategies.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2022
                19 July 2022
                : 12
                : 7
                Affiliations
                [1 ]departmentDepartment of Public Health Medicine , Universiti Teknologi MARA , Sungai Buloh, Malaysia
                [2 ]departmentDepartment of Social and Preventive Medicine , University of Malaya , Kuala Lumpur, Malaysia
                [3 ]departmentCentre for Epidemiology and Evidence-Based Practice , University of Malaya , Kuala Lumpur, Malaysia
                [4 ]departmentSocial Wellbeing Research Centre , University of Malaya , Kuala Lumpur, Malaysia
                [5 ]departmentFaculty of Law , Multimedia University , Melaka, Malaysia
                [6 ]Agensi Kaunseling dan Pengurusan Kredit , Kuala Lumpur, Malaysia
                [7 ]departmentFamily Health Development Division , Ministry of Health , Putrajaya, Malaysia
                [8 ]Ministry of Health , Putrajaya, Malaysia
                [9 ]Negeri Sembilan State Health Department , Seremban, Malaysia
                [10 ]departmentDepartment of Primary Care Medicine , University of Malaya , Kuala Lumpur, Malaysia
                Author notes
                [Correspondence to ] Wan Yuen Choo; ccwy@ 123456ummc.edu.my
                Article
                bmjopen-2022-061412
                10.1136/bmjopen-2022-061412
                9301796
                fb18ba83-0190-4680-857b-8965e55dbd11
                © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                Product
                Funding
                Funded by: Agensi Kaunseling & Pengurusan Kredit (AKPK);
                Award ID: GA023-2021
                Funded by: University of Malaya/Ministry of Higher Education (UM/MOHE) High Impact Research Grant;
                Award ID: E000010-20001
                Funded by: University of Malaya Grant Challenge;
                Award ID: GC001-14HTM
                Categories
                Public Health
                1506
                1724
                Original research
                Custom metadata
                unlocked

                Medicine
                public health,preventive medicine,geriatric medicine
                Medicine
                public health, preventive medicine, geriatric medicine

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