Prevalence of elder abuse among community-dwelling older adults in South Asia: a systematic review and meta-analysis.

backgroundElder abuse is an escalating global concern, jeopardizing public health and human rights while hindering the pursuit of healthy aging. In South Asia, socio-cultural complexities, including patriarchal norms, family-centric caregiving practices, and inadequate institutional support systems exacerbate the problem. Despite global attention, region-specific evidence from South Asia remains limited. This systematic review and meta-analysis estimated the prevalence of community-based elder abuse and sub-types among community-dwelling older adults (≥ 60 years) in South Asia and explored gender differences in abuse experiences.

methodsA comprehensive search across six databases and grey literature identified 1,088 studies. We included studies reporting elder abuse in family or community settings among older adults (≥ 60 years) living in one of the eight South Asian countries: Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Data was extracted using Covidence, and quality assessment was performed using the modified Newcastle-Ottawa Scale. Meta-analyses employed random-effects models, with heterogeneity assessed using the I² statistic.

resultsAfter data extraction, 33 studies were included, representing five countries: Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Most studies were from India (n = 21) and Nepal (n = 7). The pooled prevalence was 31.83% (95% confidence interval [CI]: 25.06-39.47); prediction interval [PI]: 6.06%-77.16%) and should be interpreted with considerable caution given extreme statistical heterogeneity (I²=99.6%, τ²=0.91). Significant inter-country variability was observed [India (25.81%, I²=99.6%, τ²=1.00), Nepal (49.84%, I²=90%, τ²=0.12), and Sri Lanka (30.57%, I²=99.2%, τ²=0.38)]. Gender differences were evident, with women experiencing higher abuse (prevalence = 33.04%, 95%CI: 23.76-43.87) compared to men (prevalence = 24.33%, 95%CI: 17.26-33.13). Subtype analysis identified caregiver neglect and psychological abuse (both around 20%) as the most prevalent forms, disproportionately affecting women.

conclusionsLimited research on elder abuse in South Asia emphasizes the need for comprehensive studies targeting both country-specific and regional contexts. This study highlights common problem of elder abuse in South Asia, particularly among women, and suggests the need for culturally sensitive and community-based interventions to address elder abuse, promote eldercare, and protect vulnerable populations in the region. Findings from five SAARC countries may not apply to Afghanistan, Bhutan, or the Maldives, where eligible studies on elder abuse were not identified.

trial registrationPROSPERO (registration number: CRD42024512991).