Examining the severity of disability and vulnerability among older adults and its impact on elder abuse: a cross-sectional study

Abstract

Disability and vulnerability are among the consequences of aging. This stage of life can be associated with the abuse of older adults by others. The present study aimed to examine the severity of disability and vulnerability among older adults and its impact on elder abuse in older adults residing in Jiroft County, southern Iran, in 2024. This descriptive-analytical cross-sectional study was conducted on 385 older adult individuals. The data collection tools included standardized questionnaires on disability, vulnerability, and elder abuse. Data were analyzed using t-test, ANOVA, Pearson correlation coefficient, and multiple linear regression with SPSS version 23 at a significance level 0.05. The mean scores for the severity of disability, vulnerability, and elder abuse among the older adult participants were 98.34 ± 7.56 out of 144, 9.75 ± 3.08 out of 15, and 12.01 ± 3.55 out of 49, respectively, indicating a moderate level of disability, a high level of vulnerability, and a low level of elder abuse. There was a statistically significant positive correlation between elder abuse and the severity of disability (r = 0.821, p < 0.001) as well as vulnerability (r = 0.795, p < 0.001) among older adults. According to the results of multiple linear regression, disability components—including disability in performing activities of daily living, self-care, walking, understanding and communication, lack of self-employment, interaction with others, and participation in social activities—and vulnerability components—including physical, psychological, and social vulnerability—were identified as predictors of elder abuse (P < 0.05). Among the older adult participants, disability was estimated at a moderate level, vulnerability at a high level, and elder abuse at a low level. Based on the results, disability, and vulnerability were identified as predictors of elder abuse, with an increase in these two variables leading to a rise in elder abuse. Therefore, the formulation of supportive policies and their implementation, especially in empowering and promoting self-care among older adults, is recommended. Additionally, attention should be paid to the psychological and social aspects of older adults, and providing a suitable living environment for this age group by all responsible individuals, from family members to municipal authorities, is suggested.

Introduction

Many countries face the aging phenomenon today, as increased life expectancy and decreased birth rates have led to population aging¹. According to reports, the number of older people worldwide will reach about 1.5 billion by 2025 and over 2 billion by 2050². With the growing older adult population, the prevalence of disabilities and vulnerabilities has become a serious public health problem, showing an upward trend³.

Disability is defined as an impairment in daily activities⁴ or the need for assistance with at least one activity of daily living⁵. In old age, various body systems deteriorate, leading to a decline in human abilities⁶. This process results in increased disability and vulnerability, a progressive decline in mobility and memory function, reduced independence, increased dependency of older adults on others, and higher care costs, placing economic pressure on healthcare systems⁷. The level of disability among older adults varies depending on different countries and social systems. A study on the prevalence of disability among older adults showed that the prevalence of physical functional limitations in older Egyptian men was 71%, while in women, it was 88%, whereas, for Tunisian men and women, it was 50% and 76%, respectively⁸. Additionally, the results of some studies indicate that the severity of disability is higher among illiterate older adult’s individuals⁹ and those who have lost their spouses¹⁰. Disability can occur concurrently with certain geriatric syndromes (falls, frailty, cognitive impairment)^11,12 and chronic conditions (hypertension, myocardial infarction, arthritis, diabetes, stroke)^13,14, which underscores the importance of addressing it.

Another consequence of aging is the vulnerability syndrome, which has garnered significant attention in geriatric medicine in recent decades and can have notable effects on the lives of older adults¹⁵. Vulnerability syndrome is an age-related condition more prevalent among older adults, characterized by a decline in physiological reserves and an increased vulnerability to stressors¹⁶. This syndrome is associated with weakness, fatigue, activity intolerance, reduced energy, and unintentional weight loss in more severe cases¹⁵. older adult’s individuals with this syndrome are more likely than others to experience adverse outcomes such as disability, hospitalization, frequent visits to emergency departments, falls, and multiple medical consultations^17,18. Some studies indicate vulnerability is associated with certain demographic factors such as age, gender, education, and marital status^19,20. Vulnerability increases with age¹⁹ and is more frequently reported among older women, those with lower education levels, and unmarried individuals²⁰.

The two phenomena of disability and vulnerability discussed earlier can expose older adults to various forms of abuse, such as psychological, physical, and financial abuse, loss of autonomy, rejection, and emotional or financial neglect²¹. The impact of disability and vulnerability on elder abuse has been highlighted in some studies^22–26. Elder abuse is a widespread global issue and a common form of violence against older adults²⁷. According to the World Health Organization’s definition, elder abuse is a single or repeated act, or the failure to act appropriately, that causes harm or distress to an older individual and diminishes their quality of life²¹. Currently, elder abuse is the most hidden form of mistreatment within the aging population²³. This issue encompasses family violence, intergenerational concerns, health, justice, and human rights issues²⁸. Estimates indicate that 4–10% of individuals aged 60 and older are currently being abused by relatives, caregivers, or others²⁹. This phenomenon leads to numerous adverse consequences for older adult’s individuals, including psychological distress and depression³⁰, mortality³¹, hospitalization³², and reduced mental well-being³³.

Given the growing older adult population, the issues of disability and vulnerability among older adults, along with their consequences and elder abuse, are matters that should receive serious attention from high-level policymakers and health program planners in a country. Therefore, examining the severity of disability and vulnerability among older adults, as well as the level of elder abuse, can provide comprehensive information regarding the status of these three variables. Additionally, by being aware of the current situation and providing appropriate information, steps can be taken towards formulating and implementing programs for managing and controlling disability and vulnerability among older adults, as well as preventing elder abuse, ultimately aiming to enhance the quality of life for this age group.

Most studies in this field have focused on the separate examination of each of the three aforementioned variables, with less attention given to the relationships between them. On the other hand, considering the limited research on the impact of the severity of disability and vulnerability among older adults on elder abuse, the present study aimed to examine the severity of disability and vulnerability among older adults’ residents of Jiroft County in southern Iran and their effect on the level of elder abuse in 2024. The findings of this study will not only contribute to expanding knowledge regarding the variables examined in the field of aging but also enhance the awareness of high-level managers and policymakers about elder abuse and the influence of disability and vulnerability on this phenomenon within society. Furthermore, in line with the main objective of this research, the findings could provide a foundation for planning support programs for older adults.

Based on the theoretical framework discussed, the conceptual model of the research is presented in Fig. 1.

Fig. 1.

Conceptual model of the research (created by the researchers).

Figure 1.

Methods

Design and setting

This descriptive-analytical cross-sectional study was conducted in Jiroft County, southern Iran, between September and December 2024.

Participants

The study population consisted of older adults living in Jiroft County in southern Iran. Based on the formula below³⁴ and considering a 5% margin of error, the estimated sample size was 385 individuals.

In the above formula:

Z = 1.96, d = 0.05.

The distribution of questionnaires among the 385 participants was conducted using a multi-stage sampling method. First, based on a geographical map, Jiroft County was divided into five sections: north, south, east, west, and center. Then, the older adult population of each section was determined based on statistics from the older adults covered by the health centers of Jiroft University of Medical Sciences. Subsequently, the required sample size for each section was calculated according to stratified sampling proportional to size. Each section was then divided into several neighborhoods, and the required sample size for each neighborhood was identified using proportional stratified sampling. Finally, a list of streets in each neighborhood was prepared, and the targeted older adult individuals were randomly selected to participate in the study.

The inclusion criteria consisted of voluntary consent, being aged 60 years or older, residency in Jiroft County, and the ability to communicate verbally. According to the WHO, age 60 and above is defined as the threshold for older adults’ status in developing countries³⁵. Since cognitive disorders such as Alzheimer’s, delirium, and major and minor neurocognitive disorders are considered mental disorders that affect cognitive abilities (including learning, memory, perception, and concentration)³⁶, older adult individuals identified through inquiries at health centers as having these conditions were excluded from the study. Additionally, unwillingness to participate in the study was another criterion for exclusion.

Instruments

The data collection tool consisted of a four-part questionnaire. The first section included demographic information (such as age, gender, marital status, education level, and financial adequacy).

The second section consisted of the World Health Organization’s standard disability intensity questionnaire. This questionnaire contains 36 questions and assesses disability in older adults across seven dimensions, including disability in understanding and communicating (6 questions), disability in walking (5 questions), disability in self-care (4 questions), disability in interacting with others (5 questions), disability in performing daily activities (4 questions), lack of self-employment (4 questions), and lack of participation in social activities (8 questions). The scoring scale for this questionnaire is a 5-point Likert scale (with scores ranging from 4 for “not at all” to 0 for “I could not do it at all”). The total score for disability intensity falls within a range of 0 to 144, where a higher score indicates less disability. Accordingly, average scores are classified as follows: 0 to 36 as no disability, 37 to 72 as mild disability, 73 to 108 as moderate disability, and 109 to 144 as severe disability³⁷. The validity and reliability (Cronbach’s alpha coefficient of 0.97) of this questionnaire have been confirmed in the study by Adib-Hajbaghery and Akbari (2009) within the Iranian older adult population³⁸.

The third section comprised the standard vulnerability questionnaire developed by Gobbens and colleagues (2010)³⁹. This questionnaire includes 15 questions across three physical, psychological, and social domains. The physical domain consists of 8 questions regarding physical health (physical functioning), unintentional weight loss, difficulty walking, balance issues, hearing impairment, visual impairment, reduced or absent hand strength, and physical fatigue. The psychological domain includes four questions related to cognition, depression, neurological symptoms, and coping with problems. The social domain consists of 3 questions concerning living alone, social interactions, and social support. Responses to the questions are provided in a binary format: yes (score of 1) and no (score of 0). The total vulnerability score for older adults ranges from 0 to 15, categorized as low vulnerability (0 to 3.75), moderate vulnerability (3.76 to 7.50), high vulnerability (7.51 to 11.25), and severe vulnerability (11.26 to 15)⁴⁰. The validity and reliability (Cronbach’s alpha coefficient of 0.80) of this questionnaire have been validated in a study by Abdi et al. (2020) within the Iranian older adult population⁴¹.

The fourth section comprised the standard elder abuse questionnaire developed by Jitapunkul and colleagues (1991)⁴². This questionnaire contains 49 questions across eight different dimensions, including caregiver neglect (11 questions), psychological abuse (8 questions), physical abuse (4 questions), financial abuse (6 questions), deprivation of autonomy (10 questions), social exclusion (4 questions), financial neglect (4 questions), and emotional neglect (2 questions). The questions in this instrument feature binary response options: yes (score of 1) and no (score of 0). Based on a total score ranging from 0 to 49, the level of elder abuse is classified as low (0 to 12.25), moderate (12.26 to 24.50), high (24.51 to 36.75), and severe (36.76 to 49)⁴³. The validity and reliability (Cronbach’s alpha coefficient of 0.93) of this questionnaire have been validated in a study by Heravi-Karimooi et al. (2010) within the Iranian older adult population⁴³.

Procedure and statistical analysis

To collect data, one of the researchers (ARY) visited the homes in the selected streets of each neighborhood in the city at various times throughout the week, including morning, afternoon, and evening, to distribute and gather the questionnaires. To ensure ethical considerations were met, participation in the study and completing the questionnaire forms were voluntary and conducted only with the individual’s consent. After informing the participants about the study’s objectives, the confidentiality of their responses was emphasized, and verbal consent was obtained. The questionnaires were then distributed in person among the older adult’s participants and collected on the same day of distribution. The older adult’s individuals completed the questionnaires; however, some requested assistance from the research team (ARY) in filling them out.

The collected data was subsequently entered into IBM SPSS Statistics version 23 (Armonk, NY: IBM Corp) for analysis. To examine the correlation between the variables of disability severity, vulnerability, and the level of elder abuse among the participants, as well as the correlation of these three variables with age, the Pearson correlation coefficient was used. The T-test was employed to assess the differences in the mean scores of the three main research variables based on gender. ANOVA was used to analyze the differences in the mean scores of disability severity, vulnerability, and elder abuse based on marital status, education level, and financial adequacy. Finally, to investigate the simultaneous impact of various dimensions of disability and vulnerability (as the independent variables) on the level of elder abuse (dependent variable) among the study participants, multiple linear regression analysis was utilized. In the regression model, the R-squared shows the percentage of the dependent variable changes the independent variables explain. The value of this index is between zero and one, and if it is more than 0.6, it shows that the independent variables have been able to explain the changes in the dependent variable to a large extent⁴⁴. In addition, one of the presuppositions of multiple linear regression is the absence of collinearity between independent variables. VIF index was used to check for non-alignment. According to statistical logic, if the VIF is greater than 10, then alignment is possible⁴⁵.

Results

The mean age of the older adults in the study was 67.84 ± 5.43 years, with the majority (52.21%) falling within the 60 to 70 age group. Of the participants, 51.69% were female, while the remainder were male. Most respondents had primary education (40.26%), were married (71.69%), and reported low financial adequacy (48.05%). Table 1 illustrates the study’s frequency distribution of the older adults (Table 1).

Table 1.

Frequency distribution of the studied older adults (n ₌ 385).

Variable	Category	Frequency (n)	Percentage (%)
Age (years)	60–70	201	52.21
	71–80	135	35.06
	≥ 81	49	12.73
Total	–	385	100
Gender	Male	186	48.31
	Female	199	51.69
Total	–	385	100
Marital status	Single	28	7.28
	Married	276	71.69
	Divorced	30	7.79
	Widowed	51	13.24
Total	–	385	100
Education level	Illiterate	51	13.24
	Can read and write	65	16.89
	Primary	155	40.26
	Diploma	78	20.26
	Bachelor’s and above	36	9.35
Total	–	385	100
Financial sufficiency	Not enough at all	94	24.42
	A little is enough	185	48.05
	Moderately enough	87	22.60
	Completely enough	19	4.93
Total	–	385	100

Based on the results, the mean scores for the severity of disability, vulnerability, and elder abuse among the older adults were calculated as follows: 98.34 ± 7.56 out of 144, 9.75 ± 3.08 out of 15, and 12.01 ± 3.55 out of 49, respectively. These findings indicate a moderate level of disability, a high level of vulnerability, and a low level of elder abuse among older adults (Table 2).

Table 2.

Mean and standard deviation of disability severity, vulnerability, and elder abuse among the studied older adults.

Main variable	Component	Score Range	Mean	Standard Deviation
Disability	Disability in understanding and communication	0–24	15.32	5.27
	Disability in walking	0–20	14.12	7.69
	Disability in self-care	0–16	13.47	7.12
	Disability in interacting with people	0–20	13.63	6.38
	Disability in performing daily living activities	0–16	12.54	5.92
	Lack of self-employment	0–16	13.05	7.16
	Lack of participation in social activities	0–32	16.21	6.43
	Overall disability severity	0-144	98.34	7.56
Vulnerability	Physical	0–8	5.21	2.06
	Psychological	0–4	2.49	1.23
	Social	0–3	2.05	1.54
	Overall vulnerability severity	0–15	9.75	3.08
Elder abuse	Caregiver neglect	0–11	2.57	1.26
	Psychological abuse	0–8	1.65	0.73
	Physical abuse	0–4	0.79	0.12
	Financial abuse	0–6	1.40	0.58
	Deprivation of autonomy	0–10	2.10	1.01
	Social exclusion	0–4	1.18	0.45
	Financial neglect	0–4	1.29	0.39
	Emotional neglect	0–2	1.03	0.68
	Total elder abuse	0–49	12.01	3.55

The findings indicated a statistically significant positive correlation between elder abuse and the severity of disability (r = 0.821, p < 0.001) as well as vulnerability (r = 0.795, p < 0.001) among older adults (Table 3).

Table 3.

Correlation between elder abuse and the severity of disability and vulnerability among the studied older adults.

Row	Research variable	1	2	3
1	Elder abuse	1	–	–
2	Disability	P < 0.001* r = 0.821*	1	–
3	Vulnerability	P < 0.001 r = 0.795	P < 0.001 r = 0.856	1

* r Pearson Correlation Coefficient, P P-Value (Correlation is significant at the 0.05 level).

According to Table 4, the results of the multiple linear regression analysis aimed at determining the impact of various dimensions of disability severity and vulnerability on elder abuse among the participants indicated that the significant variables identified in the model, determined using the Enter method, in order of importance, were: disability in performing daily activities, self-care disability, walking disability, communication and comprehension disability, lack of self-employment, difficulty in interacting with others, and lack of participation in social activities for disability severity; and physical, psychological, and social vulnerability for vulnerability. Additionally, this analysis revealed that the adjusted R² value for the model processed for elder abuse based on the variables of disability severity and vulnerability were 0.83 and 0.79, respectively. This means that 83% and 79% of the variations in the elder abuse scores can be explained by the variables present in the model. Also, given the estimated VIF values ​​in the regression model, the non-collinearity between the independent variables of the model is acceptable.

Table 4.

Influential variables on elder abuse among the studied older adults based on multiple linear regression model.

Variable				Unstandardized coefficients		Standardized coefficientβ	P-value*	Statistics VIF
				B*	Std. error*
Elder abuse	Severity of disability	–	Constant	4.517	1.603	–	0.001	–
		X1	Disability in performing daily living activities	0.856	0.195	0.847	< 0.001	1.256
		X2	Disability in self-care	0.845	0.188	0.838	< 0.001	1.223
		X3	Disability in walking	0.840	0.184	0.833	< 0.001	1.022
		X4	Disability in understanding and communication	0.838	0.179	0.826	< 0.001	1.304
		X5	Lack of self-employment	0.824	0.171	0.812	< 0.001	1.101
		X6	Disability in interacting with people	0.815	0.165	0.807	< 0.001	1.227
		X7	Lack of participation in social activities	0.809	0.158	0.794	< 0.001	1.324
	Vulnerability	–	Constant	3.709	1.116	–	0.001	–
		X8	Physical	0.801	0.185	0.794	< 0.001	1.123
		X9	Psychological	0.789	0.173	0.781	< 0.001	1.322
		X10	Social	0.779	0.168	0.767	< 0.001	1.112

* P-value Correlation is significant at the 0.05 level, B Unstandardized coefficients, Std. Error Standard Error.

Based on the multiple linear regression analysis, the linear equation for elder abuse among the studied older adult individuals was derived as follows:

Y: Elder Abuse Score.

x_{1,2,3,4,5,6,7}: Components of Disability Severity.

X_8,9,10: Components of Vulnerability (Table 4).

According to the findings of the study, the mean score of disability severity among older adults significantly varied based on the variables of age (p = 0.001), gender (p = 0.02), marital status (p = 0.04), education level (p = 0.005), and financial adequacy (p = 0.03). Specifically, the mean score of disability severity increased with age. Additionally, the mean score of disability severity was higher among older adult men (98.86 ± 6.61 out of 144), divorced individuals (99.52 ± 6.57 out of 144), illiterate individuals (100.16 ± 7.47 out of 144), and those lacking financial adequacy (99.42 ± 7.63 out of 144) compared to others.

Additionally, the mean score of vulnerability among the older adult participants significantly differed based on the variables of age (p = 0.002), gender (p = 0.03), marital status (p = 0.002), education level (p = 0.003), and financial adequacy (p = 0.02). Specifically, the mean score of vulnerability increased with age. Furthermore, the mean score of disability severity was higher among older adult men (10.04 ± 2.42 out of 15), divorced individuals (11.07 ± 2.55 out of 15), illiterate individuals (10.81 ± 2.81 out of 15), and those lacking financial adequacy (10.29 ± 2.71 out of 15) compared to others.

Finally, the mean score of elder abuse among the older adult participants varied based on the variables of age (p = 0.03), marital status (p = 0.01), education level (p = 0.02), and financial adequacy (p = 0.004). Specifically, the mean score of elder abuse increased with age. Additionally, the mean score of elder abuse was higher among divorced older adult individuals (13.42 ± 4.61 out of 49), illiterate individuals (13.15 ± 4.19 out of 49), and those lacking financial adequacy (13.37 ± 3.92 out of 49) compared to others (Table 5).

Table 5.

Relationship between elder abuse, severity of disability, and vulnerability with demographic variables of the studied nurses.

Variables	Category	Severity of disability		Vulnerability		Elder Abuse
		Mean ± SD (out of 144)	P-value	Mean ± SD (out of 15)	P-value	Mean ± SD (out of 49)	P-value
Age (year)	60–70	97.24 ± 6.55	0.001	9.14 ± 2.87	0.002	11.67 ± 3.79	0.03
	71–80	98.56 ± 7.42		9.76 ± 3.18		11.84 ± 4.65
	≥ 81	99.22 ± 7.33		10.35 ± 2.65		12.52 ± 4.43
Gender	Male	98.86 ± 6.61	0.02	10.04 ± 2.42	0.03	12.68 ± 4.52	0.06
	Female	97.82 ± 7.09		9.46 ± 3.31		11.34 ± 4.32
Marital status	Single	98.48 ± 7.25	0.04	9.32 ± 3.17	0.002	11.55 ± 4.44	0.01
	Married	96.73 ± 7.43		8.41 ± 3.29		10.43 ± 4.19
	Divorced	99.52 ± 6.57		11.07 ± 2.55		13.42 ± 4.61
	Death of wife	98.61 ± 7.36		10.20 ± 2.64		12.64 ± 3.82
Education level	Illiterate	100.16 ± 7.47	0.005	10.81 ± 2.81	0.003	13.15 ± 4.19	0.02
	Reading and writing	99.26 ± 7.38		10.73 ± 2.73		13.09 ± 4.67
	Elementary	98.48 ± 7.26		9.45 ± 3.47		12.35 ± 3.72
	Diploma	97.57 ± 6.59		9.36 ± 3.36		11.97 ± 4.31
	Bachelor and above	96.23 ± 7.14		8.40 ± 3.19		9.49 ± 4.53
Financial adequacy	Not enough at all	99.42 ± 7.63	0.03	10.29 ± 2.71	0.02	13.37 ± 3.92	0.004
	A little is enough	99.36 ± 6.78		10.11 ± 3.28		12.64 ± 4.56
	Moderately enough	97.59 ± 7.42		9.83 ± 2.45		11.51 ± 4.45
	It is quite enough	96.99 ± 7.59		8.77 ± 3.32		10.52 ± 4.38

Discussion

The findings of this study indicated that the severity of disability among the older adult participants was at a moderate level. According to the study by Arsang-Jang et al. (2018), 7% of older adults experienced moderate disability⁴⁶. Some results from the study by Adib Hajbagheri (2008) showed that the older adult participants were at a relatively acceptable level of disability and had relatively good health⁴⁷. According to the results of the study by Adib-Hajbaghery and Akbari (2009), the average disability score among older adults was at a low level³⁸. The study’s results by Shahbazi et al. (2008) also indicated that the average disability scores of older adults were high⁴⁸. Thus, the results of the aforementioned studies are inconsistent with this section of the current research findings. This inconsistency may be attributed to differences in the research population and the measurement tools used to assess the level of disability among older adults.

Disabilities affect various aspects of the lives of older adults and have personal, social, and economic consequences that impact the individual, their family, other involved persons, and even society as a whole⁴⁹. Aging is accompanied by a decline in physical and mental abilities, an increase in chronic illnesses, the simultaneous use of multiple medications, retirement, reduced income, depression, and the loss of loved ones—all of which contribute to a decreased ability to communicate and comprehend, to move and get around, to carry out self-care activities, to adapt and live with others, to manage household and occupational tasks, and to participate in society⁵⁰. In addition, factors such as the age and gender composition of the population and the healthcare system can play a role in the prevalence of disability among the older adults⁴⁶. Given that the rate of older adult population growth in Iran has increased from about 1.7% to over 3% in the past two decades, it is expected that the number of individuals with disabilities will rise shortly³⁸. In Spain, the prevalence of severe and very severe disability among individuals over 80 years of age has been reported at 17% and 9%, respectively⁵¹. Moreover, the overall prevalence of disability in Spain and the Netherlands has been estimated at 49.8% and 52.4%, respectively⁵². The rate of disability varies across countries and social systems. A study on the prevalence of disability among older adults found that the rate of physical functional limitations among Egyptian older adults was 71% in men and 88% in women, while in Tunisia, the same limitations were reported at 50% for men and 76% for women⁸.

To explain this part of the study’s findings, it can be stated that the older adult’s participants likely experienced difficulties in understanding, communicating, and interacting with others, and they did not perform well in self-care without the presence of others. Furthermore, they have not been very successful in their daily activities, such as walking, and ultimately, they lack the necessary physical capabilities to carry out occupational, familial, and social activities.

The results of the present study also indicated a high level of vulnerability among the older adult’s participants. This finding is consistent with the results of studies by Asadi et al. (2021)⁵³ and Jafarian Yazdi (2021)⁴⁰. The results of the study by Saeidimehr et al. (2021) indicated that 14.3% of older adults were vulnerable, and 25.7% were at risk of vulnerability⁵⁴. Additionally, Amrahi Tabieh et al. (2020) showed that 30.3% of older adults were vulnerable⁵⁵. In other countries, the prevalence of vulnerability among the older adults living in the community is reported to be 22.5% in South Asia (India, Sri Lanka), 24.6% in Western Asia (Saudi Arabia, Turkey), 11.3% in Southeast Asia (Indonesia, Malaysia, Singapore, Thailand, Vietnam), and 7.8% in East Asia (China, Japan)⁵⁶. The vulnerability prevalence greatly depends on the studied population and the operational definitions used in the reported studies⁵⁴. The economic and social conditions of the participants in the study, their lifestyle, and the level of access of older adults to healthcare services may also influence the prevalence of vulnerability⁴⁰.

Vulnerability leads to an increased risk of adverse outcomes such as functional decline, repeated hospitalizations, and death, which in turn results in higher healthcare system costs⁵⁷. Vulnerability is a distinct process but is directly associated with disability, disease, and comorbid conditions⁵⁸. It contributes to increased disability, comorbidities, residence in long-term care facilities, falls, fractures, hospitalizations, reduced independence, polypharmacy, and mortality⁵⁹. If vulnerability persists and becomes widespread, it will have significant consequences for older adult’s individual and social lives⁶⁰. Given the high prevalence of vulnerability in the present study and considering that vulnerability is a predictable and preventable process, identifying individuals at risk of vulnerability (or pre-vulnerability) requires special interventions and targeted planning to control and reduce its prevalence in older adults⁵⁴.

The results of the present study indicated that the level of elder abuse is low. Cass (2008) stated in his study that inappropriate behavior, elder abuse, inequality, discrimination, deprivation, and adverse conditions threaten the dignity of older adult patients⁶¹. According to findings from the research conducted by Ghasemi et al. (2020)⁶², Molaei et al. (2017)⁶³, Nori et al. (2014)⁶⁴, Hosseini et al. (2016)⁶⁵, Nassiri et al. (2016)⁶⁶, and Heravi Karimoei et al. (2012)⁶⁷, elder abuse has a high prevalence in Iran. The results of all the aforementioned studies are inconsistent with this section of the present research findings. Differences in study methods, varying definitions and concepts of elder abuse, the use of different and sometimes inappropriate tools, challenges related to collecting valid data, and some influencing factors on this phenomenon—including social and cultural factors—have contributed to the discrepancies in the results and also created barriers to scientifically comparing the findings. The low level of elder abuse in this study indicates that older adult individuals have experienced less mistreatment, which may be attributed to the strong cultural emphasis on respecting and honoring older adults in the southern regions of Iran.

Elder abuse in Iran has not received sufficient attention due to various factors, including cultural issues, and there are still no accurate statistics on the prevalence of elder abuse or the characteristics of the victims and perpetrators⁶⁸. This is partly because no official authority in Iran is specifically responsible for addressing the situation of the older adults. However, given the different dimensions of elder abuse and the components of each, it can be stated that many older adults have experienced some form of mistreatment—at least in one aspect—by their caregivers or those around them⁶⁹. It is important to note that traditions and religious beliefs in Iran, which remain deeply rooted in people’s lives despite the country’s gradual move toward modernity, play a significant role in maintaining respect and value for older adults. Considering this cultural context, alongside the growing older adult population on the one hand and, on the other hand, the increasing difficulty of life circumstances and child-rearing—as well as the financial and psychological pressures faced by families that may lead to mistreatment of the older adults —it is essential to adopt preventive measures. These measures should aim to stop violence against the older adults before it becomes a tragic social phenomenon and, more broadly, should focus on prevention, protection, and promotion of well-being in this area⁷⁰.

Based on another part of the findings of this research, a positive and significant correlation was observed between the severity of disability in older adults and the level of elder abuse. This means that as the severity of disability among older adults increased, so did the incidence of elder abuse. Furthermore, the severity of disability among older adults and its dimensions—including difficulties in understanding and communication, walking, self-care, interaction with others, daily activities, occupational activities, and social and family activities—were identified as predictors of elder abuse. However, given the cross-sectional design of the study, the observed relationships do not allow for causal inferences. In line with this section of the current study’s findings, part of the results from the study by Vaidyanathan et al. (2018) indicated a positive and significant correlation between elder abuse and disability²². Additionally, a study conducted by Yan et al. (2011) in Hong Kong identified the number of days of caregiving for older adults as a predictive factor for elder abuse⁷⁰. Sathya and Premkumar (2020) found a significant relationship between disability in older adults and elder abuse. In addition, a strong association was identified between functional ability and experiences of abuse among the older adults⁷¹. Previous studies have shown that health-related factors such as disability, dementia, and chronic illnesses are associated with elder abuse^72,73. Earlier research has also indicated that disability in older age is linked to long-term care needs, dependency on caregivers, and higher healthcare costs. These factors, in turn, may increase the likelihood of elder abuse by caregivers and family members^74,75.

To explain this section of the research findings, it can be stated that older adult individuals facing physical and mental disabilities, chronic illnesses, loneliness, social isolation, and a lack of adequate social support experience increased dependence and the need for care, which consequently leads to a higher incidence of elder abuse⁷⁶. older adult individuals who are unable to communicate and interact with others are likely to receive less attention from those around them due to this aspect of their disability, leading to neglect, which is a form of elder abuse. Additionally, seniors who are unable to engage in work activities may experience financial abuse due to the lack of support for their living and health expenses from their caregivers. Moreover, older adult individuals who struggle with social and familial activities may gradually suffer from psychological harm and depression, which in turn can lead to psychosomatic issues over time.

Ultimately, the results indicated a positive and significant correlation between the level of vulnerability in older adult individuals and elder abuse. This means that as the level of vulnerability in older adult individuals increased, the incidence of their abuse also may rose. Additionally, the level of vulnerability and its dimensions—including physical, psychological, and social vulnerability—can be considered as predictors of elder abuse. However, given the design of this study, caution should be exercised in generalizing the results of this section. According to Dong et al.‘s (2014) findings, as the older adult’s vulnerability increases, the incidence of elder abuse also rises²³. The results of the study by Nemati-Vakilabad and colleagues (2023) showed a significant association between elder abuse and chronic illness. Moreover, in that study, the most prevalent forms of elder abuse were emotional neglect and psychological abuse, while the least reported were rejection and physical abuse⁷⁷. Rahimzadehsani and colleagues (2023) also reported in part of their findings that chronic illness, as a form of vulnerability, significantly predicts the occurrence of elder abuse⁷⁶. Evidence indicates that elder abuse typically occurs among individuals with cognitive impairments and physical dysfunction, and cognitive and functional decline is associated with an increased risk of elder abuse^24–26. In explaining this section of the findings, it appears that older adult individuals who are physically, psychologically, and socially vulnerable often lack adequate and effective social support. This deficiency can further exacerbate the individual’s vulnerability and lead to an increase in mistreatment against them⁷⁸.

In Iran, one of the main reasons for the high prevalence of elder abuse is the passive and indifferent attitude toward older adults, which has led to their exclusion from normal social activities⁷⁷. Older individuals with higher levels of physical frailty are more likely to experience greater psychological vulnerability and, in turn, are at increased risk of being abused by their family members⁷⁹.

Conclusion

The vulnerability of older adults can increase their risk of being abused by others. In other words, the more vulnerable older adults are, the more likely they are to be subjected to abuse. As people age, their capacities in various domains decline, which in itself creates conditions that may lead to elder abuse. That is, older adults who are more vulnerable and less capable are at greater risk of being mistreated or exploited by others.

Therefore, it is recommended that society be made more aware through both general and targeted education aimed at preventing all forms of elder abuse—from early adulthood to old age. It is also suggested that previous policies be revised to strengthen legal and institutional protections for older adults and that new policies and laws be formulated to prevent and reduce any abuse toward the older adults. Failure to take elder abuse seriously at the policymaking level can have significant negative consequences for society—socially, psychologically, and politically.

Intervention measures to reduce older adult individuals abuse are also recommended. These include public and family education and awareness regarding abuse, the formation of specialized teams to monitor the condition of vulnerable and incapacitated older adults, and community-based interventions such as law enforcement teams, death review teams, and victim advocacy programs involving medical professionals. Additional measures include screening and identifying potential abuse through the recognition of risk and protective factors and underlying causes related to violence, promoting research on elder abuse—particularly in regions with high incidence rates—and building a foundational knowledge base on the issue. Other suggested actions include the development, implementation, and evaluation of interventions, involving legal representatives and advocates, utilizing support and counseling systems, coordinating policies to reduce elder abuse, intervening to prevent caregiver abuse in nursing homes, and implementing preventive interventions led by healthcare professionals.

Limitation

Like many studies, this research faced certain limitations. Methodologically, the current study was conducted quantitatively, which may have overlooked some aspects of the research. Additionally, conducting the study as a cross-sectional analysis is another limitation that restricts determining causal relationships. Also, given that the sample examined in this study is restricted to a specific geographical area, caution should be exercised in generalizing the results. Therefore, conducting longitudinal and mixed-method studies in this area could help broaden the findings of this study.

Author contributions

SHB designed the study and prepared the initial draft. ARY contributed to data collection and data analysis. PA, JB, and MV have supervised the whole study and finalized the article. All authors have read and approved the manuscript.

Data availability

Whilst identifying/confidential older adult data should not be published within the manuscript, the datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This study is approved by the ethical committee of Jiroft University of Medical Sciences with the number of IR.JMU.REC.1400.024. Informed consent was obtained from all participants. All the methods were performed in accordance with the relevant guidelines and regulations.

Competing interests

The authors declare no competing interests.