Behavioural Science Section / Original Paper
Gerontology 2020;66:149–159
DOI: 10.1159/000502544

Received: April 4, 2019
Accepted: August 7, 2019
Published online: September 12, 2019

Elder Abuse and Social Capital in Older
Adults: The Japan Gerontological
Evaluation Study
Chie Koga a Masamichi Hanazato b Taishi Tsuji b Norimichi Suzuki b
Katsunori Kondo b, c
a Division of Advanced Preventive Medicine, Graduate School of Medicine and Pharmaceutical Sciences,

Chiba, Japan; b Center for Preventive Medical Sciences, Chiba University, Chiba, Japan; c Center for Gerontology andSocial Sciences, National Center for Geriatrics and Gerontology, Aichi, Japan

Keywords
Elder abuse · Prevention · Population-based study · Social
capital · Social cohesion

Abstract
Background: Elder abuse is a serious public health issue
worldwide, but large-scale epidemiologic studies remain
sparse. Although social factors in human relations such associal support and social isolation have been proposed as
the factors related to elder abuse, cognitive social capital has
not been examined. Objective: This study aims to clarify theprevalence of and the factors associated with elder abuse
among independent older adults in Japan. Methods: The
study design is a retrospective observational study. The data
were derived from the Japan Gerontological Evaluation
Study (JAGES). These self-report data were collected from
26,229 people aged 65 years or older living in 28 municipalities in 2013. The types of elder abuse and factors associatedwith them were examined using logistic regression analysis.
Results: The prevalence of elder abuse among the sample
was 12.3% (11.1% in males and 13.3 in females). In the entire
sample, physical, psychological, and financial abuses werereported to be 1.26, 11.12, and 1.45%, respectively. Factors© 2019 The Author(s)Published by S. Karger AG, Baselkarger@karger.com
www.karger.com/ger

This article is licensed under the Creative Commons AttributionNonCommercial-NoDerivatives 4.0 International License (CC BYNC-ND) (http://www.karger.com/Services/OpenAccessLicense).
Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission.

associated with increased odds of experiencing abuse werebeing a woman, living with family members, having poor
self-rated health, and having mild or severe depression. By
contrast, age ≥85 years, being widowed, or unmarried, andhaving a positive view of community trust were associatedwith a lower risk of experiencing abuse. Conclusion: Whileparticular demographic factors and health are associatedwith a greater risk of elder abuse, our findings that trust within the community lessens the risk indicates the importanceof social capital. This should be taken into consideration
when developing population-based strategies to prevent elder abuse.
© 2019 The Author(s)Published by S. Karger AG, Basel

Introduction

The World Health Organization defines elder abuse as“a single, or repeated act, or lack of appropriate action,
occurring within any relationship where there is an expectation of trust, which causes harm or distress to anolder person” [1]. Elder abuse is a serious public healthissue in both high- and low-income countries. About 141
million people are estimated to suffer from elder abuse
Chie Koga
Graduate School of Medicine and Pharmaceutical Sciences
Chiba University
1-8-1 Inohana, Chiba 260-8670 (Japan)
E-Mail chiekoga @ chiba-u.jp

[2]. In the most recently reported data from Japan, there
were 17,078 cases of elder abuse in 1 year [3]. In addition,elder abuse is associated with a number of poor healthoutcomes such as mental health [4, 5], suicide [6] andother negative events [7]. Therefore, establishing countermeasures for preventing elder abuse must be urgently
addressed.
In previous studies, elder abuse has been classified asseveral types: physical, sexual, financial, and emotional/
psychological abuses, and neglect [4, 8, 9]. The issue canbe addressed at the level of the individual (each victim
and perpetrator), relationship, and community [8]. Risk
factors for victims include functional disabilities, poor
physical health, and cognitive impairment. Furthermore,
perpetrators may have issues, such as mental illness, substance abuse, and financial dependency [10]. Risk factors
at the relationship level include victim-perpetrator codependency and marital status. Moreover, geographic location, negative stereotypes of aging, and cultural norms arepotential contributing factors [8]. Most previous studies
have investigated risk factors, such as demographics andhealth, in association with particular types of abuse. An
increasing number of studies have focused on elder abuse
among community-dwelling older people [2, 8]. However, there are few studies using a representative population-based sample. Therefore, there is a need for largescale epidemiological studies. Furthermore, functional
dependency and poor physical health or frailty are strongrisk factors for elder abuse [4, 8, 11], and there is limited
information regarding abuse among physically independent older adults.
Regarding the strategy to prevent elder abuse, social
factors in human relationships, such as social support andsocial isolation, also known as structural social capital,
have been considered [8, 12]. Social capital refers to thenorms, networks, and associations that facilitate actions
in community and can be classified as structural and cognitive social capitals [13]. Structural social capital reflects
the objective nature of social behavior, such as social support. Cognitive social capital reflects a subjective assessment of an individual’s social relationships that affect social engagement in the community [14]. For instance, lowsocial support increases the risk of elder abuse [8]. However, there is also a concept of cognitive social capital
identified regarding the issues of social cohesion. Social
cohesion is a factor associated with health [15, 16] andsubjective well-being [17, 18]. Low levels of social cohesion increase the risk of depression [19]. In addition, elder
abuse is strongly associated with a lack of well-being [20]and depression [21], raising the question as to whether
150

Gerontology 2020;66:149–159
DOI: 10.1159/000502544

social cohesion should be investigated with respect toabuse in this population. Examining the relationship between abuse and social capital, including cognitive social
capital, may eventually contribute to strategies that prevent elder abuse, particularly those that go beyond theconventional approach at the individual or relationshiplevel. Such research may provide evidence to support a
population-based prevention strategy, lowering the riskin the entire population by supporting healthy social behavior [22]. In Japan, wherein aging is occurring more
rapidly than elsewhere in the world [23], such population-based research is urgently needed. Therefore, theaims of the present study are to clarify the distribution ofeach type of elder abuse among independent older­Japanese adults and investigate associations with sociodemographic, health, and social capital factors.

Materials and Methods
Population and Settings
We used cross-sectional data from the Japan Gerontological
Evaluation Study (JAGES), a population-based study of independent older adults aged ≥65 years who did not have physical or cognitive disabilities [23, 24] and not eligible for receiving public longterm care insurance benefits. In this retrospective observational
study, we used JAGES data from 2013, which were collected
through a mail survey from 131,245 people living in 30 municipalities across Japan. The municipalities included urban, suburban, and rural communities in 12 prefectures from the northernmost to the southernmost prefectures in Japan. Although the­JAGES respondents were not randomly selected, the data covereda wide range and size of community populations. For the present
study, we randomly selected one-fifth of the JAGES participants
including data from 26,229 individuals (Fig. 1).
Measurements
Elder Abuse
Elder abuse was measured using a questionnaire. Questionnaire designs were the collective effort of several researchers (including social epidemiologists and social workers). There is no
standard judgment for elder abuse. Therefore, it is also difficult toclarify the criteria for judging what kind of behavior, how many,
how often, or how long abandonment is considered elder abuse. It
is required to make decisions from multiple angles, such as whether the rights of the older adults are protected, and whether loss of
their life, health, or lifestyle is predicted. In this study, questionnaires were designed to identify specific actions that older adults
have endured, such as being hit, harm to their self-esteem, andtaking of their savings/pension benefits to confirm the presence orabsence of elder abuse. Three questions were asked to identify
physical abuse, psychological abuse, and financial abuse. For physical abuse, participants were asked “In the past year, did you everexperience physical violence from your family, such as being hit,
kicked, having objects thrown at you, or being shut in a room.” For
psychological abuse, there were asked “In the past year, did you

Koga/Hanazato/Tsuji/Suzuki/Kondo

Baseline survey enrollment (2013):
n = 193,694 (selected from 30 municipalities)

Total respondents:
n = 137,736 (response rate: 71.1%)(1/5 of the participants were randomly selected)
lack of information about elder abusen = 110,211
Participants randomly selected one-fifth:
n = 27,525
Invalid ID number, sex, and/or age: n = 1,296
Total participants analyzed
n = 26,229

Fig. 1. Flow chart of study participant enrollment.

ever experience an act by your family that harmed your self-esteem, such as verbal abuse, cutting remarks, or being ignored forlong periods.” Answers to both questions were on a scale ranging
from 1 (never), 2 (once or twice), 3 (occasionally), or 4 (frequently). Those who answered 1 were considered nonabused, while
those giving any answer from 2 to 4 were considered abused. For
financial abuse, participants were asked “Do any of your family
members take or use your savings or pension benefits without yourconsent?” The answer was either yes or no, with the former categorized as abused and the latter as nonabused. The data were analyzed for 4 categories, namely physical abuse, psychological abuse,financial abuse, and any abuse regardless of type.

receiving it, to (3) needing and receiving nursing care or assistance.
Self-rated health was measured by asking “How is your current
health status?” Answer choices were (1) excellent, (2) good, (3) fair,and (4) poor. We used the 15-item Geriatric Depression Scale, defining mild depression as >5 points and severe depression as >10
points [28].
Social Capital
We examined 2 constructs of social capital, structural and cognitive. Structural social capital was measured by assessing social
support, i.e., mutual assistance available among people around theparticipants [29]. The 4 variables we measured were receiving andproviding emotional support, and receiving or providing instrumental support. Questions on emotional support were “Do you
have someone who listens to your concerns and complaints?” and“Do you listen to someone’s concerns and complaints?” Those on
instrumental support were “Do you have someone who looks after
you when you are sick and confined to bed for a few days?” and“Do you look after someone when he/she is sick and confined to
bed for a few days?” Social cohesion as an indicator of cognitivesocial capital was measured by 3 questions about the area whereparticipants lived. Community trust was measured by asking “Do
you think people living in your area can be trusted in general?”Norms of reciprocity were measured by asking “Do you think people living in your area try to help others in most situations?” Lastly, community attachment was measured by asking “How attached
are you to the area where you live?” Responses to each range from
1 to 5: very (1); moderately (2); neutral (3); slightly (4); or not at all(5). Participants answering 1 or 2 were categorized as having social
cohesion, those answering 4 or 5 as having no social cohesion, andthose answering 3 as neutral.
Statistical Analysis
We conducted a descriptive analysis and summarized the characteristics of the participants. The numbers and percentages bygender for each variable were reported. Because the number ofvariables in this analysis contains missing data, we performed multiple imputation. In total, 20 multiple imputed data sets which included all measurement variables using the multivariate normal
imputation method under a “missing at random” assumption werecreated, and the estimated parameters were combined using Rubin’s combination methods. Logistic regression analysis was performed after multiple imputation to investigate associations between demographic, health, and social factors, and each type ofelder abuse. Three models of analysis were used. Model 1 included
all demographic factors and health status except depression. In
model 2, depression was added to the variables in model 1. Model
3 included all the variables in model 2 in addition to social cohesion. Stata 15/IC (StataCorp, College Station, TX, USA) was used
for all statistical analysis.

Sociodemographics and Health Status
According to previous studies, we included basic demographic
information, including sex, age (65–69, 70–74, 75–79, 80–84,
or ≥85 years), education level (≤9 or ≥10 years), equivalent income(low, middle, or high), marital status (married, widowed, separated, unmarried, or other), living arrangement (living alone, withfamily members, or other facility), and self-reported socioeconomic status (low, low-middle, high-middle, or high) [25–27]. We
used 3 questions to measure health status, necessity of daily support, and used self-rated health and depression. Although participants in the JAGES dataset are independent and not eligible forreceiving public long-term care, there might be some older adults
who need assistance. The questionnaire was designed to distinguish participants who need assistance for daily life. Basic activities
of daily living (ADLs) consist of self-care tasks such as bathing,showering, personal hygiene, and grooming, dressing, toilet hygiene, transferring, and self-feeding. Therefore, their needs fornursing care were asked using several concrete ADL examples. For
necessity of daily support, participants were asked “Do you regularly receive nursing care or assistance for walking, bathing, and/or using a toilet?” Answers ranged from (1) no need for nursing
care or assistance, (2) nursing care or assistance needed but not

Sample Characteristics and Prevalence of Elder Abuse
The characteristics of 26,229 participants as per sex
and statistical significance using the χ2 test are shown in
Table 1. Physical, psychological, and financial abuse

Elder Abuse and Social Capital in Older
AdultsGerontology 2020;66:149–159
DOI: 10.1159/000502544

Results

151

Table 1. Characteristics of the study participants (n = 26,229)

Sociodemographic factors
Age group, n (%)
65–69 years
70–74 years
75–79 years
80–84 years≥85 years
Education level, n (%)≤9 years≥10 years
Missing
Equivalent income, n (%)
Low (≤199)
Mid (200–399)
High (≥400)
Missing
Marital status, n (%)
MarriedWidowedSeparated
Unmarried
OthersMissing
Living arrangement, n (%)
Living alone
With family members
Other facilities
Missing
Health status
Necessity of daily support, n (%)
Unnecessary
Necessary
Missing
Self-rated health, n (%)
Very good
Good
Fair
Bad
Missing
Geriatric Depression Scale, n (%)
NormalMild depression
Severe depression
Missing
Social support
Received emotional support, n (%)
Yes
NoProvided emotional support, n (%)
Yes
No
Received instrumental support, n (%)
Yes
No

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Gerontology 2020;66:149–159
DOI: 10.1159/000502544

Total(n = 26,229)

Male(n = 12,085)

Female(n = 14,144)

7,276 (27.7)
7,794 (29.7)
5,874 (22.4)
3,605 (13.7)
1,680 (6.4)

3,486 (28.8)
3,577 (29.6)
2,682 (22.2)
1,634 (13.5)
706 (5.8)

3,790 (26.8)
4,217 (29.8)
3,192 (22.6)
1,971 (13.9)
974 (6.9)

10,858 (41.4)
14,789 (56.4)
582 (2.2)

4,643 (38.4)
7,248 (60.0)
194 (1.6)

6,215 (43.9)
7,541 (53.3)
388 (2.7)

10,914 (41.6)
7,895 (30.1)
2,192 (8.4)
5,228 (19.9)

5,132 (42.5)
4,084 (33.8)
1,132 (9.4)
1,732 (14.4)

5,782 (40.9)
3,811 (26.9)
1,060 (7.5)
3,491 (24.7)

18,347 (69.9)
5,504 (21.0)
887 (3.4)557 (2.1)
223 (0.9)771 (2.9)

10,218 (84.6)
936 (7.7)
322 (2.7)
249 (2.1)
122 (1.0)
238 (2.0)

8,129 (57.5)
4,568 (32.3)
565 (4.0)308 (2.2)
101 (0.7)473 (3.3)

3,625 (13.8)
20,855 (79.5)
405 (1.5)
1,344 (5.1)

1,052 (8.7)
10,292 (85.2)
204 (1.7)
537 (4.4)

2,573 (18.2)
10,563 (74.7)
201 (1.4)
807 (5.7)

24,271 (92.5)
888 (3.4)
1,070 (4.1)

11,268 (93.2)
383 (3.2)
434 (3.6)

13,003 (91.9)505 (3.6)
636 (4.5)

3,082 (11.8)
17,602 (67.1)
3,995 (15.2)
668 (2.5)882 (3.4)

1,462 (12.1)
7,958 (65.9)
1,989 (16.5)
337 (2.8)339 (2.8)

1,620 (11.5)
9,644 (68.2)
2,006 (14.2)
331 (2.3)
543 (3.8)

15,914 (60.7)
4,241 (16.2)
1,403 (5.3)
4,671 (17.8)

7,609 (63.0)
2,136 (17.7)
713 (5.9)
1,627 (13.5)

8,305 (58.7)
2,105 (14.9)
690 (4.9)
3,044 (21.5)

24,062 (91.7)
2,167 (8.3)

10,701 (88.5)
1,384 (11.5)

13,361 (94.5)
783 (5.5)

23,206 (88.5)
3,023 (11.5)

10,492 (86.8)
1,593 (13.2)

12,714 (89.9)
1,430 (10.1)

24,225 (92.4)
2,004 (7.6)

11,228 (92.9)
857 (7.1)

12,997 (91.9)
1,147 (8.1)

Koga/Hanazato/Tsuji/Suzuki/Kondo

Table 1 (continued)

Provided instrumental support, n (%)
Yes
NoSocial cohesion
Community trust, n (%)
Trust
Neither
Do not trust
Missing
Norm of reciprocity, n (%)
YesNeither
No
Missing
Community attachment, n (%)
YesNeither
No
Missing

Total(n = 26,229)

Male(n = 12,085)

Female(n = 14,144)

19,689 (75.1)
6,540 (24.9)

9,238 (76.4)
2,847 (23.6)

10,451 (73.9)
3,693 (26.1)

17,592 (67.1)
6,864 (26.2)
1,094 (4.2)
679 (2.6)

8,379 (69.3)
2,980 (24.7)
469 (3.9)257 (2.1)

9,213 (65.1)
3,884 (27.5)
625 (4.4)422 (3.0)

13,244 (50.5)
9,494 (36.2)
2,493 (9.5)
998 (3.8)

6,206 (51.4)
4,379 (36.2)
1,175 (9.7)
325 (2.7)

7,038 (49.8)
5,115 (36.2)
1,318 (9.3)
673 (4.8)

20,202 (77.0)
4,024 (15.3)
1,357 (5.2)
646 (2.5)

9,422 (78.0)
1,807 (15.0)
621 (5.1)
235 (1.9)

10,780 (76.2)
2,217 (15.7)
736 (5.2)
411 (2.9)

Association between Sociodemographic Factors and
Health Status, Social Factors, and Elder Abuse
Results of models 1 and 2 from logistic regression analysis are shown in online supplementary Tables 1 and 2 (forall online suppl. material, see www.karger.com/
doi/10.1159/000502544). Model 3 is shown in Table 2, including the number of people who experienced abuse, OR,
and 95% CI for the outcomes and covariates. With models

1 and 2, we investigated the effect of depression, which is aknown strong risk factor. Between the results of models 1
and 2, the OR of poor self-rated health reduced from 2.82
(95% CI 2.21–3.59) to 1.47 (1.14–1.89). Between the resultsof models 2 and 3, the OR of mild depression decreased
from 2.19 (2.00–2.40) to 2.10 (1.91–2.31), and the OR of
severe depression decreased from 4.06 (3.57–4.63) to 3.66
(3.19–4.19). In model 3, women were 2.77 (2.15–3.56)
times, living with family members was 2.70 (1.55–4.71)
times, need for daily support was 1.66 (1.05–2.62) times,
mild depression was 2.35 (1.77–3.12) times, and severe depression was 5.07 (3.62–7.11) times higher than being
physically abused in each reference group. However, those
aged 85 years or older were 0.48 (0.24–0.98) times, widowed were 0.44 (0.30–0.64) times, receiving instrumental
support was 0.57 (0.39–0.85) times, and having trust in thecommunity was 0.54 (0.33–0.88) times lower to be physically abused than their respective reference groups. Moreover, women were 1.61 (1.24–1.75) times, living with family members was 2.67 (2.18–3.28) times, having poor selfrated health was 1.61 (1.24–2.10) times, mild depression
was 2.16 (1.96–2.39) times, and severe depression was 3.79
(3.29–4.36) times higher to be psychologically abused thantheir respective reference groups. In contrast, those aged
85 years or older were 0.73 (0.60–0.89) times, widowed were0.65 (0.57–0.74) times, separated were 0.76 (0.59–0.99)
times, unmarried were 0.72 (0.53–0.98) times, receiving

Elder Abuse and Social Capital in Older
AdultsGerontology 2020;66:149–159
DOI: 10.1159/000502544­ ccurred in 0.7, 9.6, and 2.1% of male participants, ando1.7, 12.4, and 0.9% of female participants, respectively. Of
those who experienced any type of abuse in the preceding
year, 1,341 (11.1%) were male, and 1,887 (13.3%) werefemale. A total 12,085 were male, and more than half were
under 74 years old; 56.4% of participants had an education level of 10 years or longer, 41.6% were low in equivalent income, 69.9% were married, and 79.5% were livingwith family members. A total of 3.4% participants needed
daily support, 67.1% of participants had good self-rated
health, 16.2% of participants had mild depression, and5.3% of participants had severe depression. Regarding social support, 91.7% received emotional support, 88.5%
provided emotional support, 92.4% received instrumental support, and 75.1% provided instrumental support. Of
the participants, 67.1% trust their community, 50.5% had
the norm of reciprocity, and 77.0% were attached to theircommunity.

153

154

Gerontology 2020;66:149–159
DOI: 10.1159/000502544

Koga/Hanazato/Tsuji/Suzuki/Kondo
1.00
2.35
5.07

121
77
66

27
304

Social support
Receiving emotional suport
No, n = 2,167
Yes, n = 24,062

1.00
1.14

1.00
1.37
1.38
1.22

20
203
75
17

1.00
0.44
0.58
0.83

263
36
8
6

1.00
1.66

1.00
0.81
0.94

158
71
20

290
27

1.00
0.85

166
152

1.00
2.70
2.89

1.00
1.19
1.01
1.13
0.48

88
115
73
46
9

18
277
8

1.00
2.77

90
241

Living arrangement
Living alone, n = 3,625
With family members, n = 20,855
Other facilities, n = 405
Necessity of daily support
Unnecessary, n = 24,271
Necessary, n = 888
Self-rated health
Very good, n = 3,082
Good, n = 17,602
Fair, n = 3,995
Bad, n = 668
Geriatric Depression Scale
Normal, n = 15,914
Mild depression, n = 4,241
Severe depression, n = 1,403

Male, n = 12,085
Female, n = 14,144
Age group
65–69 years, n = 7,276
70–74 years, n = 7,794
75–79 years, n = 5,874
80–84 years, n = 3,605≥85 years, n = 1,680
Education level≤9 years, n = 10,858≥10 years, n = 14,789
Equivalent income
Low (≤199), n = 10,914
Mid (200–399), n = 7,895
High (≥400), n = 2,192
Marital status
Married, n = 18,347
Widowed, n = 5,504
Separated, n = 887
Unmarried, n = 557

Sex0.69–1.89

1.77–3.12
3.62–7.11

0.87–2.17
0.82–2.31
0.60–2.48

1.05–2.62

1.55–4.71
1.54–5.43

0.30–0.64
0.27–1.23
0.36–1.90

0.61–1.08
0.59–1.50

0.68–1.07

0.89–1.58
0.73–1.39
0.77–1.66
0.24–0.98

2.15–3.56

247
2,669

1,339
699
355

211
1,872
622
117

2,676
131

132
2,589
46

2,339
400
70
31

1,228
883
239

1,187
1,662

918
919
638
308
133

1,159
1,757

1.00
0.86

1.00
2.16
3.79

1.00
1.36
1.59
1.61

1.00
0.98

1.00
2.67
2.38

1.00
0.65
0.76
0.72

1.00
1.06
1.12

1.00
1.08

1.00
0.97
0.91
0.77
0.73

1.00
1.61

OR

0.72–1.03

1.96–2.39
3.29–4.36

1.17–1.58
1.34–1.89
1.24–2.10

0.80–1.21

2.18–3.28
1.86–3.05

0.57–0.74
0.59–0.99
0.53–0.98

0.96–1.16
0.97–1.30

0.99–1.17

0.88–1.07
0.82–1.02
0.67–0.89
0.60–0.89

1.48–1.75

95% CIn

95% CIn
OR

Psychological abuse

Physical abuse

46
335

171
85
52

40
223
85
12

336
20

38
314
11

290
50
11
6

181
96
20

179
189

97
112
103
42
27

255
126

n

1.00
0.92

1.00
1.67
2.90

1.00
0.85
0.99
0.66

1.00
1.16

1.00
1.27
1.20

1.00
0.81
0.83
0.81

1.00
0.75
0.56

1.00
0.89

1.00
1.05
1.24
0.80
1.16

1.00
0.45

OR

Financial abuse

0.61–1.39

1.29–2.17
2.06–4.07

0.60–1.20
0.66–1.50
0.33–1.33

0.71–1.89

0.81–1.98
0.68–2.10

0.56–1.17
0.42–1.64
0.37–1.78

0.58–0.96
0.35–0.89

0.72–1.10

0.80–1.39
0.93–1.65
0.55–1.18
0.73–1.82

0.35–0.56

95% CI

277
2,951

1,488
761
387

244
2,033
684
122

2,946
152

167
2,839
57

2,559
451
79
38

1,371
955
253

1,339
1,812

997
1,003
730
342
156

1,341
1,887

n

1.00
0.89

1.00
2.10
3.66

1.00
1.29
1.54
1.44

1.00
1.03

1.00
2.51
2.27

1.00
0.67
0.78
0.78

1.00
1.02
1.05

1.00
1.05

1.00
0.97
0.95
0.76
0.76

1.00
1.47

OR

Any types of abuse

0.75–1.06

1.91–2.31
3.19–4.19

1.12–1.49
1.31–1.82
1.11–1.85

0.85–1.25

2.08–3.03
1.80–2.85

0.59–0.76
0.61–0.99
0.59–1.03

0.93–1.11
0.91–1.21

0.97–1.14

0.88–1.06
0.85–1.05
0.66–0.87
0.63–0.91

1.36–1.59

95% CI

Table 2. OR with 95% CI for the association between elder abuse and sociodemographic factors, health status, and social factors among older Japanese adults (n = 26,229)

Elder Abuse and Social Capital in Older
AdultsGerontology 2020;66:149–159
DOI: 10.1159/000502544

155

1.00
0.92
1.13
1.00
0.85
0.80

53
122
146
38
69
215

1.00
1.18

72
259

1.00
0.65
0.54

1.00
0.57

41
290

36
109
179

1.00
1.13

38
293

0.55–1.33
0.52–1.25

0.62–1.36
0.74–1.73

0.41–1.03
0.33–0.88

0.88–1.59

0.39–0.85

0.73–1.75

222
580
2,065

375
1,151
1,315

188
914
1,767

635
2,281

213
2,703

329
2,587

1.00
1.00
0.94

1.00
0.94
0.91

1.00
0.84
0.74

1.00
0.99

1.00
0.83

1.00
1.00

OR

0.84–1.20
0.79–1.12

0.81–1.08
0.78–1.06

0.68–1.02
0.60–0.91

0.89–1.10

0.70–0.98

0.86–1.17

95% CIn

95% CIn
OR

Psychological abuse

Physical abuse

Model 3 includes all variables of models 1 and 2 plus social capital.

Social cohesion
Community trust
No trust, n = 1,094
Neither, n = 6,864
Trust, n = 17,592
Norm of reciprocity
No, n = 2,493
Neither, n = 9,494
Yes, n = 13,244
Community attachment
No, n = 1,357
Neither, n = 4,024
Yes, n = 20,202

Provided emotional support
No, n = 3,023
Yes, n = 23,206
Receiving instrumental support
No, n = 2,004
Yes, n = 24,225
Provided instrumental support
No, n = 6,540
Yes, n = 19,689

Table 2 (continued)

23
73
274

43
144
179

21
107
244

100
281

32
349

59
332

n

1.00
1.26
1.18

1.00
1.04
1.03

1.00
0.88
0.95

1.00
0.96

1.00
1.10

1.00
0.91

OR

Financial abuse

0.77–2.08
0.72–1.92

0.71–1.53
0.68–1.54

0.52–1.49
0.55–1.64

0.74–1.24

0.71–1.71

0.63–1.32

95% CI

245
28
2,294

411
1,260
1,466

205
995
1,972

715
2,513

239
2,989

374
2,854

n

1.00
0.99
0.93

1.00
0.93
0.91

1.00
0.85
0.77

1.00
1.00

1.00
0.85

1.00
0.98

OR

Any types of abuse

0.83–1.18
0.79–1.11

0.81–1.07
0.79–1.06

0.70–1.03
0.63–0.94

0.90–1.11

0.72–1.00

0.85–1.13

95% CIinstrumental support was 0.83 (0.70–0.98) times, and having trust in the community was 0.74 (0.60–0.91) times lower to be psychologically abused than each reference group.
Conversely, women were 0.45 (0.35–0.56) times lower toexperience financial abuse. In addition, mild depression
was 1.67 (1.29–2.17) times and severe depression 2.90
(2.06–4.07) times higher to be financially abused than theirrespective reference groups. Lastly, women were1.47 (1.36–1.59) times, living with family members was
2.51 (2.08–3.03) times, self-rated poor health was 1.44
(1.11–1.85) times, mild depression was 2.10 (1.91–2.31)
times, and severe depression was 3.66 (3.19–4.19) times
higher to receive any type of abuse. Moreover, those
aged 85 years and older were 0.76 (0.63–0.91) times, widowed were 0.67 (0.59–0.76) times, separated were 0.78
(0.61–0.99) times, receiving instrumental support was
0.85 (0.72–1.00) times, and having a good level of community trust was 0.77 (0.63–0.94) times lower to experience
any type of abuse.
Discussion/Conclusion

In this study, we examined the prevalence of self-reported elder abuse among independent older adults inJapan. The results of the present study suggest that participants who were women, aged < 75 years, married,needed daily support, and had low level of self-rated
health, severe depression, and low level of community
trust were more likely to experience elder abuse. To thebest of our knowledge, this is the largest epidemiologic
study of the prevalence of elder abuse and its association
with social cohesion based on a representative population
sample. The prevalence of elder abuse among independent older Japanese was 12.3% (11.1% in males and 13.3%
in females), similar to the of 15.7% in other countries­according to a systematic review [2]. They reported prevalence estimates of 2.6% (1.6–4.4) for physical, 11.6%(8.1–16.3) for psychological, and 6.8% (5.0–9.2) for financial abuses [2]. Our findings of the relative frequencies were similar, with psychological abuse being the mostcommon, followed by financial abuse, and physical abuse
was the least common. The rate of psychological abuse in
our study was considerably higher than that (4.6%) reported in a study from the US [30].
Relationship between Sociodemographic
Characteristics and Elder Abuse
We found that women were more often subjected tophysical and psychological abuse than men. Although
156

Gerontology 2020;66:149–159
DOI: 10.1159/000502544

women are generally more likely to be abused than men,
there may be gender differences depending on the type ofabuse [4, 27, 31]. Our finding of a higher prevalence offinancial abuse among men was similar to that in a K­ oreanstudy, although they also noted more emotional abuse
among men than women [32]. In Japan, the cultural norm
is for women to do the housekeeping. Prior to the introduction of coeducation in home economics in 1973,
physical education, technology, and home economics
were gender-specific curricula in Japanese school education. Such education might therefore influence the perceptions of gender roles among older adults. In 1979, theUnited Nations adopted the Convention on the Elimination of all Forms of Discrimination against Women,
which was formally approved by the Japanese government [33]. However, the older adults in our study grew
up in an era when women were responsible for the housekeeping and therefore management of the family budget.
Under such circumstances, older men might have felt
short of funds and unable to access their money.
The age range posing a greater risk of abuse has varied
in different studies [4, 8]. However, living with family
members is strongly associated with physical and psychological abuses because the perpetrators are often family
members. This may explain why being widowed or unmarried and living alone reduces the risk of abuse [34].
Intervention may be more difficult for families that havean abusive relationship, but it is still important to beaware of situations wherein an individual is at risk of elder
abuse by completely assessing the risk factors. Our findings in regard to sociodemographic factors confirm theresults of other studies.
Relationship between Health Status and Elder Abuse
As reported in other studies, we found that participants who experienced elder abuse tended to report poor
health [8]. Poor overall health and worsening health in
the preceding year are associated with elder abuse [25].
Our participants who needed assistance in daily living
were at a higher risk than others, similar to that reported
in another study, indicating that functional dependency
or poor physical health are risk factors for being abused[8]. In addition, caregivers who are responsible for daily
support and frequently in contact with the individuals
they care for are susceptible to fatigue and stress [35].
Furthermore, the prevalence of abuse will increase as
their physical functions continue to decline and they require greater levels of support [36]. In the present study,
our target population included older adults who were noteligible to receive public long-term care insurance beneKoga/Hanazato/Tsuji/Suzuki/Kondo

fits. Our findings indicate that abuse affects communitydwelling older adults who still are functioning fairly well.
Moreover, this study demonstrated a positive association between elder abuse and poor self-rated status. Participants whose self-rated health is fair or bad tend to experience elder abuse. According to a previous study, there
was a positive correlation between poor self-rated healthand elder abuse [30].
Moreover, mild or severe depression was a risk factor
for abuse among the participants. A previous study reported that older adults who lacked psychological resources were more likely to report abuse than those withgreater psychosocial reserves [20]. Depression is one of
the main risk factors of elder abuse [26]. Participants who
were abused in the present study were abused by the family members. When abuse occurs within what is normally considered a high-trust relationship, the relationshipmight be destroyed, and it may lead to fear of future encounters with people who should be trustworthy. This
fear adds to the psychological stress in older adults. The
association between depression and abuse could be bidirectional. First, it is possible that individuals who are already depressed may be mistreated. In contrast, being
abused may also be a cause of depression. In model 2,
depression was added, and OR of receiving any type ofabuse was 2.19 (95% CI 2.00–2.40) times in mild depressives and 4.06 (3.57–4.63) times higher than those who
did not have any depression. However, after we added thevariables social capital in model 3, OR of depression
slightly decreased to 2.10 (1.91–2.31) in mild depression
and 3.66 (3.19–4.19) in severe depression, indicating thatsocial capital is associated with depression. Although further studies are necessary, previous studies have shownthat there is an association between social capital andmental health [37, 38].

As with social support, participants who reported
positively on community trust were less likely to bephysically or psychologically abused than those who did
not trust their community. However, the other factors
related to cognitive social capital, i.e., norms of reciprocity and community attachment, were not significantly
associated with elder abuse in this population. A previous study reported that higher levels of social support
were associated with a lower incidence of elder abuse[12]. Individuals with community trust may have greater
opportunities to share their problems or sympathize
each other, which may emotionally help victims. Because
there are differences in community formation and cultures among regions, it is possible that the method ofcommunity development to improve trust will be different. However, this study has shown an association between elder abuse and the emotions of trust that people
universally have across cultures, and this may increase
the evidence to control and reduce elder abuse. An association between elder abuse and social support at theindividual level has been explored; however, the relationship with social cohesion, i.e., cognitive social capital has
not. Social capital is increasingly being investigated inrelationship with health and health behavior [40]. Ourcross-sectional study found that social support and social
cohesion were associated with a lower incidence of elder
abuse.

Relationship between Social Capital and Elder Abuse
Participants who received a particular type of social
support, i.e., instrumental support, were less likely to suffer physical and psychological abuses, similar to the resultsof a population-based sample adjusted for the need fordaily support and another previous study that reported theassociation between elder mistreatment and social support [30, 39]. Interestingly, we found no significant association between elder abuse and receiving or providing
emotional support or providing instrumental support. Social support is a key factor in abuse prevention and recovery; however, further studies focusing on the mechanismof how social support affects elder abuse are needed because multiple pathways have been reported [39].

Strengths and Limitations
One of the strengths of our study is that it is the first
to investigate the relationship between elder abuse andsocial capital in a population-based representative sample. Understanding not only sociodemographic but alsosocial capital factors related to elder abuse is crucial forestablishing population-based prevention of this serious
health problem. In addition, it is one of the largest epidemiologic studies to investigate factors specifically associated with different types of abuse. There are, however, several limitations to our research. First, the use ofquestionnaires to collect data may be subject to recall
bias. Another limitation is that we used a self-reported
questionnaire which has not been validated; therefore,
its validity in accurately measuring elder abuse should
be investigated in future studies. The cross-sectional
study design does not permit inference of underlying
relationships; therefore, further studies, such as longitudinal studies, are necessary. In addition, because thiswas not a multilevel analysis, further investigations regarding distinguishing factors at individual and community levels are needed. Finally, we excluded subjects

Elder Abuse and Social Capital in Older
AdultsGerontology 2020;66:149–159
DOI: 10.1159/000502544

157

with marked dysfunction in ADL and those on public
long-term care insurance benefits; therefore, these data
do not include random samples as well as national representative samples. However, some without public benefits might still have had considerable difficulty with
ADL and perhaps could not complete this survey. Because it is known that the abuse rate is higher amongpeople with poor ability to manage ADL, the actual incidence of abuse cases is expected to be higher. Further
research should take such limitations into consideration. Despite the limitations, however, this study suggests areas that may be an important perspective of possibility for preventing elder abuse.
In conclusion, elder abuse is prevalent among independent older adults in Japan. While confirming the findings of others that certain demographic factors and poor
health are associated with an increased risk of abuse, we
also found that people who trust others in their community were less likely to be abused. Although further clarification of causation at both individual and community
levels is needed, this study suggests that enriching social
capital could make an important contribution to a population-based strategy to reduce the incidence of elder
abuse.

Statement of Ethics
The JAGES protocol was reviewed and approved by the Ethics
Committee on Research of Human Subjects at the Nihon Fukushi
University (approval No. 10-05) and the Ethics Committee at the
Chiba University Faculty of Medicine (approval No. 2493).

Disclosure Statement
The authors have no conflicts of interest to declare.

Funding Sources
This study was supported by the MEXT (Ministry of Education,
Culture, Sports, Science and Technology-Japan)-supported Program for the Strategic Research Foundation at Private Universities(20092013), JSPS (Japan Society for the Promotion of Science) KAKENHI (grant Nos. JP22330172, JP22390400, JP23243070,
JP23590786, JP23790710, JP24390469, JP24530698, JP24683018,
JP25253052, JP25870573, JP25870881, and 19K04785), Health Labor Science Research Grants (H22-Choju-Shitei-008, H24-Junkanki [Seishu]-Ippan-007, H24Chikyukibo-Ippan-009, H24-Choju-Wakate-009, H25-Kenki-Wakate-015, H26-Irryo-Shitei003[Fukkou], H25-Choju-Ippan-003, and H26-Choju-Ippan-006)
from the Ministry of Health, Labor and Welfare, Japan, the Research and Development Grants for Longevity Science from AMED
(Japan Agency for Medical Research and Development), a grantfrom the National Center for Geriatrics and Gerontology, Japan(24-17, 24-23), and a JST-OPERA program grant (JPMJOP1831).

Acknowledgment
This study used data from JAGES, conducted by the Nihon Fukushi University Center for Well-Being and Society, for their research projects. We are extremely grateful to all study participants
for the use of their personal data. We would like to express our
deepest gratitude to everyone who participated and cooperated in
the surveys.

Author Contributions
C.K.: conceived the design, analyzed the data, performed theliterature review, and wrote the first draft of the article. T.T. andK.K.: collected the data. M.H., T.T., N.S., and K.K.: revised the firstdraft. All authors approved the final version of the manuscript.

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