Elder Abuse in South Africa: A Community‐Based Study of Its Prevalence, Perpetrators, and Predictors

Background. Elder abuse is under-researched in low-and middle-income countries (LMICs) where culture and context shape detection and reporting. This study estimated the prevalence, perpetrators and predictors of self-reported elder abuse in South Africa.
Methods. Data were collected in 2021 from 490 households in the STRIDE community-based survey across the Western Cape and Limpopo provinces. Each household included an older adult (≥65 years) and an informant (≥18 years). The adapted EAST assessed physical, emotional, sexual and financial abuse and neglect. Other measures included functional impairment (WHODAS 2.0),
dementia caseness (10/66 algorithm), dementia severity (DSRS), neuropsychiatric symptoms (NPI-Q), social engagement (LSNS-6), and a novel insight into memory impairment variable comparing informant and self-ratings of memory. Logistic regression models examined demographic and health-related predictors of self-reported elder abuse.
Results. One in ten (10.4%) older adults screened positive for abuse, with most perpetrators being either a non-family member where there is a personal relationship, or family member. Financial (78%) and emotional (50%) abuse were dominant, while neglect, physical and sexual abuse were less frequent (<6%). Functional impairment was associated with elder abuse (OR= 1.05, p<0.01). Recall
ability was not associated with reporting abuse, highlighting that cognitive limitations within the present sample did not influence disclosure.
Conclusion. Elder abuse in South Africa is prevalent and closely linked to functional dependence and financial exploitation. This is one of the first studies to examine the relationship between dementia, functional impairment and elder abuse at community level, providing critical evidence to inform
prevention and support strategies in LMICs.