Violence against the elderly : case description in the city of Aracaju , Sergipe , Brazil

Objective: To describe the cases of violence against the elderly in the city of Aracaju, Sergipe, Brazil. Methods: A descriptive study that analyzed 189 open investigations documents from May 2012 to May 2013, the Department for Assistance to Vulnerable Groups. Results: From the valued investigations in the period, there were 112 investigations (66.3%) related to violence against the elderly. Of these, 70.5% were opened by police reports, predominantly psychological violence (40.2%), at home (96.4%) during the morning (35.7%) and in the northern area of the city, (33.0%). Most were against women (65.2%) aged 60-69 years old (50.9%), retired (73.2%), with primary education (66.1%). The most frequent abusers were their children (54.4%), men (74.1%), with more than 40 years old (50%), unemployed (61.6%), with primary education (62.5%) and using suspicion drug (18.8%) charged in most cases (83.9%). Conclusion: The findings show that violence is associated, due to the overlapping socio-demographic factors and subsidize the need of scientific knowledge on the subject, and improvement of public policies to ensure quality of life of elderly.


INTRODUCTION
The increasing number of elderly people worldwide is due to socioeconomic changes that determined big scientific and technological innovations associated with better living conditions.However, this achievement also generates negative aspects such as violence and abuse increasing 1 .
Population aging is a global reality.In Brazil, it is due to a reflection of increase life expectancy, due to the advancement in health and reduction of birth rate 2 .It is a phenomenon observed by increasing the proportion of older people (60 years old and over) resulting from the fertility decline, the fall in mortality rates and increasing life expectancy 3 .
It occurs at an accelerated rate, leading to changes in social policies and thus becoming a major challenge for Public Health, together with dramatic changes in the structures and family roles, as well as in labor patterns and migration 2 .
The violence was present in human history by a multitude of ways and in different environments.In Brazil, most frequently from the 80's, domestic violence against the elderly became denounced, however, this form of violence is difficult to identify and hidden from public opinion 4 .In the country, there is no idea of the prevalence problem yet.However, the characteristics of the current Brazilian society, such as the serious socioeconomic difficulties for a large segment of the population, prejudice against aging and the cult of youth, known factors favoring the spread of violence, believing that the problem is quite frequent 5 .Violence against the elderly can be classified into physical, sexual, psychological, economic, institutional, abandonment/ neglect and self-neglect 4 .
According to the Department of Assistance to Vulnerable Groups (DAGV) in 2009, only in Aracaju there were 160 investigations of suspected violence against elderly 6 .In the first months of 2010 there were already 64 cases in DAGV 7 .However, it should be noted that violence against elderly citizens are not only physical abuse.The psychological abuse, neglect, abandonment and mistreatment make deep marks as the marks on the body, and it is even worse, since they cannot be erased.
The poor information about the abused and abusers is a delicate situation, especially because the elderly generally do not report suffered physical and sexual abuse, due to the embarrassment and fear of repression by their caregivers, who are often their abusers 8 .
The growing concern with this topic is notorious.In research using Violence and Elderly as keywords, there is an increasing number of articles published on the topic.In database analysis of MedLine, LILACS and SciELO, the results show that between 2000 and 2007 the number of publications covering the topic was only 33, while between 2008 and 2014 this number doubled.Furthermore, studies on violence against elderly corroborate the findings that this issue has risen in recent years 2,9,10 .
Faced with this perspective and considering the new population profile and the relevance of investments in studies on elderly and their vulnerability to violence in order to contribute to development and advancement of public policies that aim to improve the quality of life and dignity of the elderly, this study raises the possibility of promoting interventions in these policies, and to add scientific knowledge in the academic world on this topic.In this context, the study aimed to assess the current situation of violence against the elderly in the city of Aracaju -SE, from official documents generated by the Department for Assistance to Vulnerable Groups.Specifically, it aimed to characterize violence against the elderly, identifying the socio-demographic profile of the victim and his abuser, besides knowing the applied behavior of professional after identification of the elderly, victims of abuse.

METHOD
It is a documentary descriptive study, developed in the Department of Assistance to Vulnerable Groups (DAGV) of Sergipe Civil Police, the only place of the state to assist a specific population, homosexuals, women, children, blacks, disabled, elderly people, among others who often become victims of various types of violence, and who have found constant shelter in DAGV where the service gains strength and specializes daily.
Between 2004-2008, DAGV recorded 14,847 police reports (B.O.); 1,972 detailed terms (corresponding to the legal description of the complaints) with 186 arrests, and 16,000 conciliation hearings.These numbers show the size and the types of problems the department has faced in its daily life, throughout its existence, to defend the rights and protection to the target audience of this study 11 .
The documental study is a type of study that uses ample supply of documents considered primary or raw materials, that is, documents not passing an analytic treatment 12 .
There were 189 investigations evaluated and 112 of these were recorded from elderly from May 2012 to May 2013, and thus analyzed in depth.However, to calculate the frequency of violence against elderly, all investigations were used.
The investigations about victims of abuse aged ≥ 60 years old were included in the research, containing the variables selected for this research.
Data were obtained through the Data Collection Form, consisting of 31 objective questions, including: eight (8) for any act of violence; 10 (ten) for the reporter; Eleven (11) for the reported and; Two (2) relating to the behavior adopted by the professionals of the Department of Assistance to Vulnerable Groups.
Data processing was carried out statistically by simple percentage analysis using Microsoft Excel, checking demographic characteristics of the victims (gender, age, self-reported skin color, educational level, marital status); occurrence characteristics (local repetition of violence, nature of injury); violence and means Violence against elderly people: case description in Aracaju (SE) Aguiar MPC, Leite HA, Dias IM, Mattos MCT, Lima WR of aggression; offender characteristics (gender, type, suspicion of alcohol consumption).
The project was submitted to the Ethics Committee in Research of the Federal University of Sergipe (UFS) approved on November 11, 2013, according to protocol number 19779813.9.0000.5546.The effectiveness of the research was based on Resolution 196/96 of the National Health Council and is assured data confidentiality and integrity of the surveys analyzed in addition to the signing of the confidentiality agreement form.

RESULTS
Table 1 below points out that among the 112 investigations analyzed, 70.5% were opened from Police Reports.Most cases occurred in a residential environment (96.4%), with a slight predominance in the morning shift (35.7%) compared to the afternoon shift (30.4%).The incident occurred 33.0% in the north and 30.4% in the western area of Aracaju city.
Literature reference the types of mistreatment of the elderly in various ways, such as physical abuse: use of physical force to elderly do unwanted things, hurt them, cause them pain, disability or death; psychological abuse: verbal or gestural aggression aiming to terrorize, humiliate, isolate or restrict their freedom of living; financial or materials abuse: improper exploitation or use not consented to equity funds; abandonment: absence or defection of government, institutional or family responsibility in providing help 1 .
In the type of violence used, there is the psychological as the highest rate, with 40.2%, followed by physical + psychological association (14.1%).Adding to the physical violence, either alone or in association, this represented 25.8% of cases, and therefore with the second largest proportion.
From the socio-demographic data of the elderly affected by violence, shown in Table 2 that follows, there is a predominance of females (65.2%) than in men.The most affected age group was between 60-69 years old, with 50.9%, and self-reported skin color predominance as brown, with 58 cases (51.8%).
It was also observed high rate (73.2%) of retired elderly when compared to other occupations.Regarding the marital status of the victims, there was a predominance of practicing violence to widowed, totaling 36.6% of the sample.
In the education, more than half (66.1%) attended elementary school, while only 4.4% have Higher Education.
As shown in the table (Table 3) in the abuser´s profile, there was a higher male rate (74.1%) with predominant age ≥ 40 in 50.0% of cases, and the self-reported skin color predominance to brown (61.6%).
In the degree of kinship, there was in little more than half of the events (54.5%), the children of the victims as abusers protagonists, representing 61 cases.It is noteworthy that the vast majority (71.4%) of abuses were committed by relatives, and only 4.4% practiced by caregivers without blood relationship.In 61.6% of cases, the abuser's occupation was classified as "other", 100% of those referred to as unemployed.The number of single accounted for 57.1% of the total.Among the reported 62.5% attended elementary school.The data contained in surveys did not indicate completion of the level of education.
Regarding the behavior of DAGV after initiation of the investigation and analysis of materiality of the facts, the results show that 83.9% of the investigations opened obtained the indictment of the reported as a process development, and 16.1% were filed.
Violence against elderly people: case description in Aracaju (SE) Aguiar MPC, Leite HA, Dias IM, Mattos MCT, Lima WR

DISCUSSION
Among the 189 opened investigations of DAGV between May 2012 and May 2013 there were 112 cases examined involving elderly victims.There were 77 cases excluded regarding abuse against other vulnerable groups (blacks, homosexuals and physically disabled) as well as those related to the population below 60 years old.
In this way, the cases of violence practiced exclusively in elderly people were approximately 60% of the cases.Authors point out that, while in the data sources are scarce, meaningless and unreliable; it is difficult to estimate the violence in numbers 11 .Furthermore, the signs and symptoms related to prevalent diseases in the elderly confuse or even overlap the various forms of abuse manifestation 13 .Nevertheless, studies show the importance of using statistical data generated from official bodies, to foster public policies, as well as a situational diagnosis of the event 14 .
Data from the National Research by Household Sampling (PNAD) published by IBGE 15 show that the resident elderly population in Sergipe totals 185,957, that is 9.0% of the Violence against elderly people: case description in Aracaju (SE) Aguiar MPC, Leite HA, Dias IM, Mattos MCT, Lima WR population.Of this total, 51,950 elderly are in Aracaju, equivalent to 9.9% of the population of Aracaju.These data analysis show that 0.3% of Aracaju elderly population sought DAGV service to denounce the violence suffered between 2012 and 2013.However, the magnitude of this phenomenon cannot be expressed by the prevalence.
The finding of high percentage of violence against the elderly in relation to other groups prone to abuse, show that the elderly are a group of vulnerable people, conflicting power relations and violence, especially when in cases of disability and disrespect between generations.
From the investigations analyzed, more than two thirds of the total were opened from police reports and more by the elderly himself.The SAVE-IDOSO, Notice of Legal System for Violence, Abuse and Exploitation of the Elderly, is an initiative of the Secretary of State for Education of Sergipe and has the use of a reporting document completed by health professionals to detect violence.That document has not relevant percentage in the study.This finding may indicate that these professionals, while providing direct and continuous assistance to the elderly, are not familiar with the recognition or even the approach to be taken from the abuse of identification.Regarding the time the violence occurred, no studies were found that worked this variable.
The finding relating to the prevalence of violence in their home supports recent research where violence is expressed most prevalent at home -where is deposited the cozy character of belief, loving and protective of external violence 1,10 .On the other hand, intra-family relationship comes together, as a generator of conflicts that expose the elderly to the risk of a character of violence veiled by the members, thus with high underreporting 10 .
The result observed that the occurrence of violence was more relevant in the northern part of Aracaju city, area with a population of low to medium income 7 , is justified under study which reveals that a life of poverty involves risk factors that may facilitate family disconnection process 13 , noting that economic needs threaten the family unit, enhancing the appearance of conflicts.Nevertheless, there is the exception that cannot be restricted the violence to areas defined by poverty.It is a phenomenon that transcends the stratification boundaries, covered or not by the government.
With regard to types of violence, the psychological was most prevalent, with about half of the cases, considering both genders.This result corroborates other studies, which show that, at home, psychological violence is seen as the first major incidence 2,14 .
Our findings point to various forms of association between the types of violence found, and the ways in which happen in isolation.This exchange took place between all modes of abuse, double or triple combination between them.In this analysis, physical violence, when added in their isolated and associated form, is second in prevalence.
At the time of violence, drug use by the abuser was found in 18.8% of cases, all practiced by males.Studies show that at least half of the abusers had some type of substance dependency 16 .The abuses carried out by individuals on suspicion of drug use reached more females, a finding confirmed by similar research 3 .
From the results about the profile of abused elderly, it could be noted a prevalence of females over males in a ratio of 1.87, corroborating the findings of several studies with similar methodological analysis 1,2,3,5 .According to a research, there are differences in estimates of violence as the place of occurrence and at home, the main victims are the female 12 .Authors argue that there is greater vulnerability of the elderly woman to violence, in particular those who have suffered domestic violence in adulthood, this fact exerts a greater influence on the occurrence of mistreatment that the risk of failure due to longer life expectancy 10 .
The age range with the highest prevalence among 60-69 years old, confirms recent studies 9,11 , that younger elderly have greater functional autonomy, greater knowledge regarding their rights and ways and means to get them, thus, more conducive to denounce, thereby increasing the denounce rate in this age group.Older elderly could find a problem, due to physical barriers and health complications, remaining confined to the home environment.Although the predominance of brown color, in this study, ethnicity was not considered relevant as a factor associated with violence, given that Brazil is a country of intense miscegenation.Moreover, ethnicity currently is a self-declared characteristic, so the association between the prevalence of elderly abused be brown may be the result of this hegemony, not a purposely most affected group.
The high rate of retired elderly is associated with the highest prevalence of elderly aged 60-69 years old, age group where most of them have already acquired that right.In this fact, some of these elderly people, for staying longer at home and usually do not having conditions to perform activities of daily living alone, may be more susceptible to misunderstanding reactions from their caregivers.
Despite higher prevalence of widowed elderly, the findings indicate a close percentage between them and married.Thus, the sample can reveal the fact of having or not fixed partner does not exert great influence on the involvement of the elderly by violence.The analyzed percentage contradict the literature, which shows that the main victims are those with partner and that spouses are in second place as abusers in domestic context 9 .
As for the level of education, it was found that as the level of education increase, the number of assaults decrease.It is assumed that elderly people with less education can express greater reliance in daily activities or even financial and imposed power relations between the dyad caregiver-elderly.Authors state that the elderly with less education level should not be considered Violence against elderly people: case description in Aracaju (SE) Aguiar MPC, Leite HA, Dias IM, Mattos MCT, Lima WR more favorable of violence 2 .In contrast to the results, the authors found that the occurrence of violence was more common among older people with higher education 17 .
The results found about the abusers´ profile corroborates studies that reveal the children of the victims as the main abusers 1 .In Brazil, from the 626 notifications of violence against elderly patients in a reference health services, 338 were victims of their own children, in their home 9 .
In this study, there were differences in the distribution of abusers by gender of the victim: women were more abused by their children, followed by interaction of people and to a lesser by the spouses.Men were also more abused by their children, but followed in equal proportion by nephews, spouses or caregivers and, finally, by people around them.In contrast to the results, a similar study showed that children and partners more often abused women than men and these, in turn, were victims of strangers and their friendship circle in greater proportion than observed among elderly 3 .
Among the analyzed studies, few specify the abuser´s profile.Although, authors state that most of them live a dependent relationship with the elderly in a hostile family environment, where a previous history of aggression and drug abuse is present 1 .In this context, the analysis of the results adds that these abusers are predominantly single with incomplete elementary school and unemployed.It is believed that the lack of occupation and fixed partner are allied to the low level of education as factors that perpetuate the coexistence of these individuals with the elderly, under one roof, still adding to the frustration that can lead to socio-demographic profile, favoring conflicting power relations and collection between these generations.
Although the vast majority of investigations have evolved to the indictment reported abuser, the filed investigations were by the following reasons: lack of materiality criminal offense and sufficient written evidence; lack of cogent evidence able to prove materiality of criminal acts and to support the indictment of the suspect; and lack of interest in pursuing the victim made.Authors state that another quite frequently filing reason is on improving the situation of violence or mistreatment of the elderly 16 , which may be one of the reasons why victims do not show interest in pursuing the indictment process.
Whatever the type of abuse, it will certainly result in unnecessary suffering, injury or pain, loss or violation of human rights and reduced quality of life of the elderly 13 .Paying attention to this, Brazilian studies confirm that elderly people with bad history of mistreatment have a higher prevalence of dementia, depression and rheumatologic problems than those who were not victimized 13 .That is, violence against the elderly becomes a public health problem, due to the magnitude of its consequences.
Even the care of the elderly is primarily delegated to the family, there is a mismatch between their responsibilities, the state and society, should not that be the only alternative for the care of the elderly.The Federal Constitution, the National Policy for the Elderly and the Elderly Statute in this scenario appear as contributions to be provided by the state and guaranteed by the exercise of the whole society.
Authors point out that several areas of knowledge have study the issue of mistreatment of the elderly in a domestic environment 3 .It is apparent that the issue of violence has been gaining strength between recent research and the formulation of more effective public policies in ensuring the rights of that age group, particularly in the area of health and safety.However, despite recent advances in research on the subject, authors confirm that there is still great delay in the society regarding the guaranteeing of rights for elderly, since the policies that currently protect this population still far away from the practices adopted in public and private services of elderly care 3 .Much of the mistreated or abused elderly do not report their abuser for different reasons, including for not realizing the phenomenon as aggression or violence, and are silent for fear of incriminating their relatives 18 .
The difficulties and hidden reasons that prevent the victim to carry out the complaint to abuse, being of any kind or intensity, add to the lack of knowledge and thus effectiveness by professionals of the agencies responsible for providing on health and safety of the elderly.
It is noteworthy that in this study there were limitations on the characterization of the fact, as well as the old profile abused and the abuser, arising from the demarcation of the information in the investigations analyzed.Information such as degree of injury, recurrence of violence, the number of people living at home, comorbidities and need for daily life activities are not covered by DAGV.Thus, there were not present in the study.Nevertheless, the assessment of the results allowed tracing of a profile of the victims and their abusers that supports the latest research on the topic.
The size of the problem that prevails pragmatic interventions are carried out, both in the clinical area and in the social context.This requires public health policies and actions that express a greater commitment to ethics and the defense of human rights, including all age groups, without disregarding the margins of society 10 .The context of poverty, unemployment and critical social situation linked to the profile of the victims and their own abusers require social support policy interventions for the elderly and their caregivers, including providing information on care to be provided.Such measures are of fundamental importance for the reduction of violence against this vulnerable group 1 .
Despite recent advances in research on the topic, authors confirm that there is still great delay in society in relation to guarantee security for the elderly, since the policies that currently protect this population still far from the practices in services public and private elderly care 14 .
Violence against elderly people: case description in Aracaju (SE) Aguiar MPC, Leite HA, Dias IM, Mattos MCT, Lima WR

CONCLUSION
The evaluation of the results allowed the characterization of the act of violence and tracing the profile of the victims and their abusers that supports the latest research on the topic.The findings show that women retired are the most commonly abused in their homes by their children more than 40 years old and who are unemployed.They had only elementary school, under suspicion of drug use and have been charged in most cases.Furthermore, this study shows that despite the prevalence of psychological violence, this occurs associated, due to the overlapping of socio-demographic factors.
It is suggested from the data found that, for a more precise definition of the problem and therefore to the improvement of public policies covering the protection and promotion of health of the elderly, further studies covering data collection with other individuals who live with the elderly in their home environment.
It is imperative to discuss new promotional strategies and protection to this population, involving professionals from different areas and requiring effective mobilization of government and civil society.In the clinical area, health professionals who provide ongoing care to these individuals can support a data source on detection of abuse signs, and allow the qualitative and quantitative evaluation of the reporting of violence.

Table 1 .
Frequency of characterization of violence data assited in DAGV -Aracaju, October 2013

Table 2 .
Socio-demographic profile of elderly affected by violence.Aracaju, October 2013