Economic-financial and patrimonial elder abuse : a documentary study *

2 Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brazil. ABSTRACT Objective: To analyze economic-financial and patrimonial cases of elder abuse, recorded in the specialized police station for security and protection of the elderly of a capital city in the northeast region of Brazil. Method: A cross-sectional study was carried out with data extracted from police reports and inquiries recorded in the abovementioned police station. Descriptive and inferential statistics were carried out by means of Pearson’s chisquare test or Fisher’s exact test, and multivariate logistic regression. Results: The sample was made up of 555 police reports. The data showed that financial abuse presented a prevalence of 58.9%, and that older elderly people (67.9%), men (70.4%), and single (75.0%) presented a higher percentage of financial abuse compared with other types of violence, often occurring in public places, with 3.1 more chances of occurrence than at the elderly’s home. Regarding aggressors, women (73.5%), without suspicion of alcohol use (66.4%), and non-family members committed more financial abuse, evidencing 2.97 more chances of practicing it. Conclusion: In the period studied, financial abuse increased in its magnitude when compared with other types of violence, a fact that justifies researching the theme in order to prevent it.


INTRODUCTION
Important changes have occurred in Brazil in the last century, and a demographic revolution stands out among them.In 1999, the proportion of elderly people in the country was 9.1%.In 2009, they represented 11.3% of the total population, and currently, the contingent is higher than 22 million people, larger than the elderly population of some European countries such as France, England, and Italy (1) .
Population aging in Brazil has been occurring before the country resolving basic issues regarding education, health, employment, and, consequently, income, which may get worse unless they are resolved.Therefore, there are no certainties on how the elderly population will live regarding autonomy, income, and health (2) .Elderly people, despite having a lower income, are more vulnerable to several physical and social conditions, and more exposed to greater violence in societies.
In this respect, national and international publications show that violence is considered a public health problem (3)(4)(5) , highlighting the difficulty of its detention for requiring attention and sensitivity to identify its signs and symptoms.Therefore, the consequence is underreporting and reports with numbers lower than reality (5)(6) .
According to the Toronto Declaration, in 2002, elder abuse was characterized as an action that may be individually or recurrently expressed, or as the lack of an appropriate response when they are in a relationship of trust, leading to harm or suffering to the elderly (7) .
Elder abuse includes physical, psychological, and sexual abuse, abandonment, negligence, self-negligence, and economic-financial and patrimonial abuse.The latter is characterized when other people inappropriately make use of the elderly's financial resources (5) .Brazilian data show that 60% of economic-financial and patrimonial abuse reports from this age group were presented in police stations or in the Brazilian department of justice.In addition, it is worth mentioning that financial abuse reports are often associated with physical and psychological maltreatment, which results in injuries, traumas, or even death (6) .
In this respect, the need for broadening research on elder abuse is of utmost importance, because healthcare services provide these victims with immediate and long-term care, and healthcare professionals must seek strategies to prevent this violence.Therefore, the objective of the present study was to analyze economic-financial and patrimonial cases of elder abuse, recorded in the specialized police station for security and protection of the elderly of a capital city in the northeast region of Brazil, in the years of 2009 to 2013.

Study deSign
This was a cross-sectional study carried out in the specialized police station for security and protection of the elderly of a capital city in the northeast region of Brazil.This government body is associated with the public safety department of this state, established in 2005 according to Complementary Law no.51 of August 23, 2005, with the aim of acting in the prevention and interruption of crimes against elderly people (8) .

Sample
The study sample was made up of 555 police reports and inquiries recorded in the specialized police station from January 2009 to December 2013.Police reports and inquiries regarding the elderly residing in the abovementioned capital city from both genders were selected, and those regarding elderly victims of violence living in other cities in the country were excluded.

data collection
The data, which covered the period from January 2009 to December 2013, were collected in 2015 by means of a form with information regarding the elderly, aggressors, and place of occurrence.This information was extracted from police reports and testimonies of the elderly victims and their aggressors, component parts of the police inquiries consulted.However, it is worth mentioning that, in some cases, the aggressors were not identified.
The dependent variable of the study was the occurrence of economic-financial and patrimonial abuse.The independent variables regarding the elderly were gender, age, marital status, education level, and the elderly's condition at the time of their presentation at the police station.The elderly were categorized into younger elderly (60 to 79 years) and older elderly (80 years and older) (9) .With regard to their aggressors, the variables were gender, age, marital status, education level, degree of kindred, and suspicion of alcohol or drug use.Regarding the occurrence, date, and place of aggression were checked.

data analySiS and treatment
The data collected were coded into a Microsoft Excel spreadsheet, in double entry format for checking of errors, and were later transferred to the Statistical Package for the Social Sciences 19 software -SPSS 19.
The prevalence of economic-financial and patrimonial abuse was calculated through the division of all elderly people who suffered it by the total number of elderly victims of violence, including financial and patrimonial abuse.
The data regarding the elderly and aggressors were submitted to descriptive analyses, and measures of central tendency (mean, median), dispersion (standard deviation), and cross-checking among the variables were carried out with the purpose of examining the existence of possible associations, by means of Pearson's chi-square test or Fisher's exact test.The variables that presented p-value lower than 0.20 in the bivariate analysis were selected to compose the multivariate logistic regression model, which were introduced one by one with the use of the Stepwise Forward method.The criterion for null hypothesis rejection was p<0.05.

ethical aSpectS
Authorization from the specialized police station was requested for the development of the present study.The research was submitted to the research ethics committee of the Universidade Federal do Piauí and was authorized under protocol number 890,533/2014.

RESULTS
Among the 555 police reports recorded in the specialized police station for security and protection to the elderly, 327 (58.9%) corresponded to economic-financial and patrimonial abuse.The victims' age ranged from 60 to 99 years old, with a mean of 71.3 (SD=8.2) and median of 70.In Table 1, the data show that, of the total violence recorded in the DSPI, financial abuse was higher than other types of violence, and the highest percentages were among older elderly people (67.9%), men (70.4%), single (75.0%), with complete or incomplete higher education (78.6%).Following the same analysis, the largest number of cases occurred in the urban area (59.0%), with a higher percentage in public places (92%), and most of the elderly were accompanied during their reports (60.3%).However, it is worth mentioning that in many cases, financial abuse occurred simultaneously with other types of violence: 202 (61.8%) cases of psychological abuse, 36 (11%) cases of physical abuse, 21 (6.4%) cases of negligence, 10 (3.1%) cases of abandonment, and two (0.6%) cases of sexual abuse.In addition, a statistically significant association (p<0.001) was found among the different types of violence that occurred simultaneously with the financial, psychological, and physical abuse.
The aggressors' age ranged from 16 to 69 years old, with a mean of 34.6 (SD=10.1)and median of 34.Table 2 shows that financial abuse is mostly perpetrated by women (73.5%), widowed (66.7%), with complete and incomplete higher education (64.0%).In addition, a higher percentage of this specific type of violence was found when the aggressors did not present a record of suspicion of alcohol (66.4%) or drug use (60.0%), and were non-family members (86.5%).It is worth mentioning that values regarding the aggressors differ from the total elderly victims, since in many cases, there was no information about the aggressors, especially in the records regarding financial abuse.It is important to observe that an increase was recorded in the period from 2009 to 2011 (35% and 61%, respectively), followed by a decrease in 2012 (58%), and a subsequent increase in 2013 (67%).
Table 3 presents factors associated with the occurrence of economic-financial and patrimonial abuse.The result of the bivariate analysis (Table 1) showed a statistically significant association between suffering this type of violence and the elderly's gender (p<0.001),education level (p=0.025), and place of occurrence (p<0.001).Regarding the characteristics of the aggressors involved in financial abuse, a significant association was found among the variables gender (p<0.001),suspicion of alcohol use (p<0.001), and family aggressor (p<0.001)(Table 2).The variables elderly's age (p=0.072),marital status (p=0.087), and aggressors' education level (p=0.120) were also submitted to multivariate analysis, because they met the inclusion criterion established (p<0.20).
Therefore, in the final multivariate model, the predictors of financial abuse were public places, non-family aggressors, nonalcohol use by the aggressors, and being women.Regarding the sociodemographic variables of the elderly victims of economicfinancial and patrimonial abuse, only being an older elderly person presented an association in the final model.

DISCUSSION
The prevalence of financial abuse was 58.9% when compared with other types of violence, a result close to that found in one study carried out in Portugal (3) , and considered high when compared with national and international studies (10)(11)(12) .
The sociodemographic profile of the elderly victims of economic-financial and patrimonial abuse found in the present study, when compared with other types of violence, was characterized by older elderly men (Table 1).This type of violence was also described in 47.5% of the victims analyzed in Portugal (3) from 2011 to 2013.However, one study carried out in the United States that compared cases of financial and physical abuse and the judicial dynamics involved, showed that the victims who suffered financial abuse had a mean age of 82.2 years.However, they were mostly women (67.7%) (13) .
In Brazil, one study carried out from 2003 to 2007 in the Brazilian Federal District that described the profile of elderly people who suffered violence, showed a propensity of aggression cases against elderly men (14) , a fact found in the present study, probably because men are usually responsible for the financial system and due to their independence in resolving this issue.Consequently, it is believed that elderly men may be more exposed to the suffering of this type of violence.
The single elderly presented a higher prevalence (75%) of being victims of financial abuse, corroborating one study carried out in the state of Porto Alegre (11) , where most elderly people who suffered violence belonged to the category without a partner.However, this result was different from that found in one study carried out with elderly victims of violence in Portugal (3) , where the category married represented more than half of the victims.
The present study showed that the largest absolute number of elderly people who suffered financial abuse had complete or incomplete elementary school, in addition to showing a high percentage of elderly people with complete or incomplete higher education among victims of financial abuse (78.6%), when compared with other types of violence (Table 1).However, one study carried out in India (15) showed that elderly people who had attended school for at least eight years had fewer chances of suffering violence.
Therefore, financial abuse occurs simultaneously with other types of violence, especially psychological abuse.This phenomenon is often manifested in a cumulative way, and is more intense, spread, and present in the Brazilian society than shown in statistics, perhaps for being a phenomenon of a difficult diagnosis, especially because feelings of guilt and shame of the elderly abused are added to the fear of retaliation of the aggressors or those who neglect them (6) .
In the present study, among the characteristics of the aggressors who perpetrated financial abuse when compared with other types of violence, the highest prevalence was of women (73.5%), with complete or incomplete higher education (64.0%), without suspicion of alcohol (66.0%) or drug use (60.0%) at the time of the aggression, and non-family members (86.5%) (Table 2).
Regarding aggressors' gender and marital status, when analyzing the occurrences of financial abuse with no comparison with other types of violence, results showed that they were mostly men.In this respect, one study carried out by means of notifications of elder abuse in Brazil, with financial abuse among them, also showed that most aggressors were men (16) .
When analyzing the occurrence of financial abuse in comparison with other types of violence, non-family aggressors presented a high percentage (86.5%).This situation is characterized by the significant number of cases that occur in public places, such as banks and credit agencies for retired people.This datum corroborates those of the previously mentioned study (16) , which, when comparing the elderly's gender with the aggressors' characteristics, shows that elderly men are more abused by strangers.
In addition, financial abuse and negligence were mentioned as the second most prevalent cause in one study carried out with 87 Canadian elderly people, mostly perpetrated by family members with different education levels, from elementary school to those with college degree, despite the low number.Another topic mentioned by the elderly in the abovementioned study is that they suffered financial abuse by the government, with low retirements and pensions, which are insufficient for their daily expenses (17) .
When examining the occurrence of financial abuse in absolute numbers of this study, a higher number of family aggressors was found, which is in line with one study carried out with Australian elderly people (18) , where the perpetrators of financial abuse in most cases were family members.The fact of the elderly being abused by a family member at their own home represented an important complication, contributing to the emergence of emotional, social, physical, and cognitive problems (11) .However, in the present study, when financial abuse was compared with other types of violence, a higher percentage of non-family aggressors was found.
In Brazil, among the main family situations, there are the elderly who live with their children and grandchildren (19) , which leads to an incompatibility of values and financial difficulties.With the increase in life expectancy in the last years, this configuration has become more common, which generates conflicts between the elderly and other family members, as well as economic-financial and patrimonial abuse to the elderly by their family members.
When considering these aspects regarding the aggressors, it is important to mention that abuse may assume different forms and situations, being impossible to quantify it due to its underreporting.The belief that family members are the greatest aggressors of the elderly must be demystified, because although they are in charge of the elderly's care, there is a lack of support from government bodies for its accomplishment.Therefore, investing in public policies for the protection of the elderly in the private and public context is necessary (6) .
With regard to the type of violence practiced against the elderly, a growth trend in financial abuse compared with other types of violence was found in the period studied (Figure 1).This finding corroborated other studies carried out in the area (3,20) and reflected structural changes that have occurred in the family nucleus and society.It is worth mentioning the vulnerability of this social segment.The literature highlights the concern of gerontologists, especially with older elderly people, due to the increase in the incidence of morbidities and reduction in these individuals' autonomy (1) .
In this respect, the accelerated population aging observed in Brazil demands a society for all ages, not only privileging elderly people, but also benefiting other generations.However, in spite of the existence of government policies in the country, such as the Statute of the Elderly and the National Commitment for Active Aging, there is a lack of actions ensuring their rights, such as the strengthening of report mechanisms for violation of human rights, assurance of sensitization movements of the society concerning aging and the most common types of violence in this period of life, investment in the quality of long-term institutions for the elderly, and training of human resources to provide care to this population (6) .
The multivariate model showed that family aggressors have 62% fewer chances of committing financial abuse against the elderly, with a significant association (p=0.010)(Table 3).However, one study carried out with Australian elderly people showed that most financial abuses were practiced by family members.The following risk factors were mentioned for the occurrence of this type of violence: a strong sense of ownership of the older person; reduced cognitive capacity; dependence on a family member's care; use of alcohol and other drugs by family members; and lack of knowledge of the elderly regarding their rights (18,21) .
In spite of the high number of violence occurrences at home, as found in the study carried out in Porto Alegre (11) , the present study showed that, when analyzing financial abuse in comparison with other types of violence, occurrences at public places presented a significant association (p=0.020)with 3.1 more chances of occurrence in comparison with occurrences at home (95% CI: 1.93-8.01).Private places were considered a protective factor when compared with other types of violence that occurred at home; however, this association was not significant.For this reason, the variable type of place remained in the final model, because the category public place presented a greater chance of being significant (Table 3).
In the literature (22) , different forms through which financial abuse occurs in practice were found, and, in addition to being associated with other types of violence, the places of occurrence are especially banks, healthcare plan agencies, and stores.Elderly people are also victims of embezzlers, who take advantage of the mental and physical vulnerability of this population, in addition to being victims of robbery and theft of credit cards.
Based on the logistic regression, aggressors with no suspicion of alcohol use presented 2.97 more chances of committing financial abuse (Table 3).This implies that, in order to practice financial abuse, aggressors must be focused and lucid, so they are able to achieve their objectives efficiently.The literature shows the types of violence associated with suspicion of alcohol use by aggressors, as follows: physical violence, sexual abuse, and negligence (16) .
Regarding the aggressors' gender, association with the occurrence of financial abuse was found (p=0.014),demonstrating that men have 51% fewer chances of committing this type of violence (Table 3).
In the present study, the results showed that younger elderly people presented 44% fewer chances of being victims of financial abuse, and older elderly people presented more chances of suffering financial abuse (67.9%) (Table 3).In one study carried out in the district of Breña, in Peru (4) with elderly people residing in the community, where researchers studied prevalence, types of violence and their association with sociodemographic variables, and presence of depressive symptoms, the logistic regression model showed that, regarding age, 81.1% of the cases of violence occurred with older elderly people.
However, one study carried out in Los Angeles (12) , when analyzing the elderly's characteristics regarding the abuse suffered, showed that younger elderly people were associated with an increase in financial abuse risk.
In the evaluation of the present study, its limitation was the lack of complete data from the police reports and inquiries concerning some variables, especially those associated with the aggressors, which became an obstacle in their characterization.In addition, there was a lack of specific studies regarding economic-financial and patrimonial abuse against the elderly in the scientific literature, especially those concerning aggressors' data.
Elderly people require attention from the several sectors of society, especially healthcare professionals, considering that this population is more vulnerable.International data (23) evidenced the need for sensitizing nurses, physicians, and social workers towards the recognition of financial abuse against the elderly, showing them that financial abuse may occur simultaneously with other types of violence, such as psychological and physical abuse, so they are able to research and prevent them, intervening in the protection of elderly people.

CONCLUSION
The present study showed that the elderly who suffered economic-financial and patrimonial abuse, when compared with other types of violence, were older, single, men, with complete or incomplete higher education.Financial abuse presented a high prevalence and mostly occurred in public places, which had 3.10 more chances of being the occurrence place.
Although men have presented a higher number in the analysis of all types of violence, when investigating financial violence in comparison with other types of violence, it was found that most aggressors were non-family members, and women were those who most perpetrated this type of violence.One of the hypotheses for this type of violence was the close relationship of these women with the elderly men.In addition, it is worth mentioning that the aggressors did not show suspicion of alcohol use and presented a significant association, with 2.97 more chances of occurrence.
In addition, an increase in financial abuse in comparison with other types of violence in the years studied was observed, justifying the relevance of this study and encouraging further research on the theme.
Therefore, as previously mentioned, financial abuse against the elderly may occur simultaneously with other types of violence, and healthcare professionals, especially nurses, must be able to recognize the different types of violence, with the purpose of planning guiding strategies to the elderly and their families for its prevention.

Figure 1 -
Figure 1 -Elder abuse recorded in the specialized police station for security and protection to the elderly according to the year of occurrence recorded in the police report -Teresina, Piauí, Brazil, 2009-2013.

Figure 1
Figure1shows that, in the period from 2009 to 2013, economic-financial and patrimonial abuse presented an increase in its magnitude when compared with other types of violence.It is important to observe that an increase was recorded in the period from 2009 to 2011 (35% and 61%, respectively), followed by a decrease in 2012 (58%), and a subsequent increase in 2013 (67%).Table3presents factors associated with the occurrence of economic-financial and patrimonial abuse.The result of the bivariate analysis (Table1) showed a statistically significant association between suffering this type of violence and the elderly's gender (p<0.001),education level (p=0.025), and place of occurrence (p<0.001).Regarding the characteristics of the

Table 1 -
Sociodemographic characteristics of the elderly victims of economic-financial and patrimonial abuse, and place of occurrence recorded in the specialized police station for security and protection to the elderly -Teresina,Piauí, Brazil, 2009-2013.
a Pearson's chi-square test; b Fisher's exact test

Table 2 -
Sociodemographic characteristics of the aggressors involved in economic-financial and patrimonial abuse, recorded in the specialized police station for security and protection to the elderly -Teresina,Piauí, Brazil, 2009-2013.
a Pearson's chi-square test; b Fisher's exact test

Table 3 -
Odds ratio and respective confidence interval of 95% for associations between the occurrence of economic-financial and patrimonial abuse and sociodemographic variables of the elderly, aggressors, and place of occurrence -Teresina,Piauí, Brazil, 2009-2013.