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      The association between elder abuse and childhood adversity: A study of older adults in Malaysia

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          Abstract

          Objectives

          Childhood adversity has been linked with later victimization of young and middle-aged adults, but few studies have shown persistence of this effect among elders, especially outside of North America. This research examined the association between adverse childhood experiences (ACEs) and elder abuse among older adults aged 60 years and over in Malaysia.

          Design

          Cross sectional data were collected via face-to-face interview from June to August 2019.

          Setting

          Eight government community health clinics in Kuala Pilah, a district in Negeri Sembilan state approximately 100km from Malaysian capital city Kuala Lumpur.

          Participants

          Older adults aged 60 years and above (N = 1984; Mean age 69.2, range 60–93 years) attending all eight government health clinics in the district were recruited for a face-to-face interview about health and well-being.

          Measurement

          The Adverse Childhood Experience International Questionnaire (ACE-IQ) and the Revised Conflict Tactics Scale (CTS) were utilized to estimate childhood adversity and elder abuse respectively.

          Results

          Multiple logistic regression analysis revealed a significant relationship between the number of cumulative ACEs and elder abuse. Compared to older adults with no self-reported adversity, those reporting three ACEs (OR 2.67, 95% CI 1.84,3.87) or four or more ACEs (OR 1.7, 95% CI 1.16, 2.48) had higher risk of any elder abuse occurrence since age 60 years. The effect was most prominent for financial and psychological elder abuse. The associations persisted in multivariate logistic regression models after adjusting for sociodemographic and health factors.

          Conclusion

          Early life adversities were significantly associated with victimization of older adults. Social and emotional support to address elder abuse should recognize that, for some men and women, there is a possibility that vulnerability to maltreatment persisted throughout their life course.

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          Most cited references54

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          The brief resilience scale: assessing the ability to bounce back.

          While resilience has been defined as resistance to illness, adaptation, and thriving, the ability to bounce back or recover from stress is closest to its original meaning. Previous resilience measures assess resources that may promote resilience rather than recovery, resistance, adaptation, or thriving. To test a new brief resilience scale. The brief resilience scale (BRS) was created to assess the ability to bounce back or recover from stress. Its psychometric characteristics were examined in four samples, including two student samples and samples with cardiac and chronic pain patients. The BRS was reliable and measured as a unitary construct. It was predictably related to personal characteristics, social relations, coping, and health in all samples. It was negatively related to anxiety, depression, negative affect, and physical symptoms when other resilience measures and optimism, social support, and Type D personality (high negative affect and high social inhibition) were controlled. There were large differences in BRS scores between cardiac patients with and without Type D and women with and without fibromyalgia. The BRS is a reliable means of assessing resilience as the ability to bounce back or recover from stress and may provide unique and important information about people coping with health-related stressors.
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            The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

            A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done.
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              The lifelong effects of early childhood adversity and toxic stress.

              Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. An ecobiodevelopmental framework also underscores the need for new thinking about the focus and boundaries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS One
                plos
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                22 July 2021
                2021
                : 16
                : 7
                : e0254717
                Affiliations
                [1 ] Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
                [2 ] Institute for Community Health Research, Hue University, Hue, Vietnam
                [3 ] Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia
                [4 ] Kuala Pilah District Health Office, Ministry of Health, Kuala Pilah, Malaysia
                Harvard Medical School, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0001-9575-0207
                Article
                PONE-D-21-08892
                10.1371/journal.pone.0254717
                8297753
                34292992
                37c87bc9-90e5-4695-9db8-b1d527f3a45d
                © 2021 Asyraf et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 March 2021
                : 1 July 2021
                Page count
                Figures: 0, Tables: 4, Pages: 14
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100004386, Universiti Malaya;
                Award ID: GC001A/B-14HTM
                Award Recipient :
                Financial Disclosure: This study was funded by Universiti of Malaya Grand Challenge Grant (PEACE) (GC001A/B-14HTM)- URL https://spm.um.edu.my/2018/03/06/jcum-prevent-elderly-abuse-and-neglect-initiative-peace-university-of-malaya/. Choo Wan Yuen and Noran Naqiah Hairi were the principal investigators and led the grant application The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Traumatic Injury Risk Factors
                Child Abuse
                Medicine and Health Sciences
                Public and Occupational Health
                Traumatic Injury Risk Factors
                Child Abuse
                Social Sciences
                Sociology
                Criminology
                Crime
                Child Abuse
                Medicine and Health Sciences
                Pediatrics
                Child Abuse
                People and Places
                Population Groupings
                Age Groups
                Adults
                Elderly
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Substance-Related Disorders
                Substance Abuse
                Medicine and Health Sciences
                Public and Occupational Health
                Substance-Related Disorders
                Substance Abuse
                Biology and Life Sciences
                Psychology
                Behavior
                Drug Abuse
                Social Sciences
                Psychology
                Behavior
                Drug Abuse
                Social Sciences
                Economics
                Finance
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Traumatic Injury Risk Factors
                Violent Crime
                Domestic Violence
                Medicine and Health Sciences
                Public and Occupational Health
                Traumatic Injury Risk Factors
                Violent Crime
                Domestic Violence
                Social Sciences
                Sociology
                Criminology
                Crime
                Violent Crime
                Domestic Violence
                Medicine and Health Sciences
                Pediatrics
                Child Health
                Medicine and Health Sciences
                Public and Occupational Health
                Child Health
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Geriatric Depression
                Medicine and Health Sciences
                Geriatrics
                Geriatric Psychiatry
                Geriatric Depression
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Geriatric Psychiatry
                Geriatric Depression
                Custom metadata
                The dataset used in this study is not available publicly due to local regulations imposed by the Medical Review and Ethics Committee (MREC), Ministry of Health Malaysia. Data could be obtained via written request to the Department of Social and Preventive Medicine University of Malaya, Faculty of Medicine, Level 5, Block I, 50603 Kuala Lumpur, Federal Territory of Kuala Lumpur or email contact@ 123456spm.um.edu.my .

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