AN INVESTIGATION ON THE EFFECTS OF ABUSE ON THE PSYCHOLOGICAL WELL-BEING OF THE ELDERLY: A CASE OF KIAMBU TOWN, KIAMBU COUNTY, KENYA by Albert M. Karanja A thesis presented to the School of Applied Human Sciences of Daystar University Nairobi, Kenya In partial fulfillment of the requirements for the degree of MASTER OF ARTS In Counseling Psychology October 2023 Daystar University Repository Library Archives Copy ii APPROVAL AN INVESTIGATION ON THE EFFECTS OF ABUSE ON THE PSYCHOLOGICAL WELL BEING OF THE ELDERLY: A CASE OF KIAMBU TOWN, KIAMBU COUNTY, KENYA by Albert M. Karanja 15-2035 In accordance with Daystar University policies, this thesis is accepted in partial fulfillment of the requirements for the Master of Arts degree Sign: Date: ________________________ __________________ Jared Menecha, PhD, 1 st Supervisor _________________________ _________________ Ann Mwiti, PhD, 2 nd Supervisor _______________________ __________________ Jared Menecha, PhD, HOD, Psychology and Counseling ___________________________________ __________________ Kennedy Ongaro, PhD, Dean, School of Applied Human Sciences Daystar University Repository Library Archives Copy iii Copyright © 2023 Albert Karanja Daystar University Repository Library Archives Copy iv DECLARATION AN INVESTIGATION ON THE EFFECTS OF ABUSE ON THE PSYCHOLOGICAL WELL BEING OF THE ELDERLY: A CASE OF KIAMBU TOWN, KIAMBU COUNTY, KENYA. I declare that this thesis is my original work and has not been submitted to any other college or university for academic credit. Signed: ____________________ Date: __________________ Albert M. Karanja 15-2035 Daystar University Repository Library Archives Copy v ACKNOWLEDGEMENT It would not have been possible for me to complete this thesis without the participation and support of various people. I sincerely appreciate the support that they rendered me. Daystar University Repository Library Archives Copy vi TABLE OF CONTENTS APPROVAL……………………………………………………………………………… ii DECLARATION………………………………………………………………………… iv ACKNOWLEDGEMENT………………………………………………………………... v TABLE OF CONTENTS…………………………………………………………………vi LIST OF TABLES………………………………………………………………………viii LIST OF FIGURES……………………………………………………………………... ix LIST OF ABBREVIATIONS AND ACRONYMS……………………………………. x ABSTRACT………………………………………………………………………………xi CHAPTER ONE………………………………………………………………………….. 1 INTRODUCTION………………………………………………………………………... 1 Introduction ..................................................................................................................... 1 Background of the Study ................................................................................................. 1 Statement of the Problem ................................................................................................ 5 Objective of the Study ..................................................................................................... 7 General Objective ............................................................................................................ 7 Specific Objectives .......................................................................................................... 7 Research Questions ......................................................................................................... 7 Justification of the Study ................................................................................................. 8 Significance of the Study ................................................................................................ 8 Assumptions of the Study ............................................................................................... 9 Scope of study ............................................................................................................... 11 Limitations and Delimitations of the Study .................................................................. 11 Definition of Terms ....................................................................................................... 11 Summary ....................................................................................................................... 12 CHAPTER TWO………………………………………………………………………... 13 LITERATURE REVIEW……………………………………………………………….. 13 Introduction ................................................................................................................... 13 Theoretical Framework ................................................................................................. 13 General Literature Review ............................................................................................ 16 Empirical Literature Review ......................................................................................... 19 Conceptual Framework ................................................................................................. 33 Discussion ..................................................................................................................... 34 Summary ....................................................................................................................... 35 CHAPTER THREE……………………………………………………………………... 36 RESEARCH METHODOLOGY……………………………………………………….. 36 Introduction ................................................................................................................... 36 Research Design ............................................................................................................ 36 The Population .............................................................................................................. 36 Target Population .......................................................................................................... 37 Sampling Frame and Sampling Procedure .................................................................... 37 Inclusion and Exclusion Criteria ................................................................................... 38 Data Collection Instruments .......................................................................................... 39 Daystar University Repository Library Archives Copy vii Type of Data .................................................................................................................. 39 Data Collection Procedure............................................................................................. 39 Pilot Test ....................................................................................................................... 40 Data Analysis and Presentation ..................................................................................... 41 Ethical Consideration .................................................................................................... 42 Chapter Summary .......................................................................................................... 43 CHAPTER FOUR………………………………………………………………………. 44 DATA ANALYSIS, PRESENTATION, AND INTERPRETATION OF FINDINGS… 44 Introduction ................................................................................................................... 44 Response Rate ............................................................................................................... 44 Reliability of the Research Instruments ........................................................................ 44 Demographic Characteristics of the Respondents ......................................................... 45 Descriptive Analysis of Study Variables ...................................................................... 49 Psychological Well-being of the Elderly People ........................................................... 49 Emotional Abuse and Psychological Well-Being of the Elderly .................................. 51 Financial Abuse and Psychological Well Being ........................................................... 56 Physical Abuse and Psychological Well Being ............................................................. 59 Coping Strategies among the Elderly Experiencing Emotional, Financial and Physical Abuse ............................................................................................................................. 61 Summary of key Findings ............................................................................................. 66 CHAPTER FIVE………………………………………………………………………... 69 DISCUSSIONS, CONCLUSIONS, AND RECOMMENDATIONS…………………... 69 Introduction ................................................................................................................... 69 Discussion ..................................................................................................................... 69 Conclusions ................................................................................................................... 76 Recommendations ......................................................................................................... 78 Suggestions for Further Research.................................................................................. 80 REFERENCES………………………………………………………………………….. 81 APPENDICES…………………………………………………………………………... 84 Appendix i: Letter of Transmittal……………………………………………………….. 84 Appendix ii: Questionnaire……………………………………………………………… 85 Appendix iv: Ethical Clearance…………………………………………………………. 89 Appendix v: Research Permit…………………………………………………………… 90 Appendix vi: Plagiarism Report………………………………………………………….91 Daystar University Repository Library Archives Copy viii LIST OF TABLES Table 3. 1: Target population……………………………………………………………………37 Table 4. 1: Reliability Test Results…………………………………………………………….. 45 Table 4. 2: Distribution of Respondents by Gender…………………………………………..46 Table 4. 3: Distribution of Respondents by Age-group……………………………………… 47 Table 4. 4: Highest Level of Education………………………………………………………... 48 Table 4. 5: Length of Stay in the Homes for the Aged in Kiambu County………………… 49 Table 4. 6: Psychological Well-being of the Elderly People……………………………….. 50 Table 4. 7: Emotional Abuse and Psychological Well-Being of the Elderly……………… 55 Table 4. 8: Financial Abuse and Psychological Well Being………………………………... 57 Table 4. 9: Physical Abuse and Psychological Well Being…………………………………. 59 Table 4. 10: Coping Strategies among the Elderly…………………………………………... 62 Table 4. 11: Model Summary…………………………………………………………………… 64 Table 4. 12: ANOVA………………………………………………………………………………64 Table 4. 14: Coefficient of Determination…………………………………………………… 65 Daystar University Repository Library Archives Copy ix LIST OF FIGURES Figure 2. 1: Conceptual Framework…………………………………………………………... 34 Figure 4. 1: Experience of Any Form of Abuse………………………………………………. 52 Figure 4. 2: Perpetrators of Abuse against the Elderly in the Homes for the Aged…….. 53 Figure 4. 3: Form of Emotional Abuse Experienced by the Elderly………………………. 54 Figure 4. 4: Distribution of Gifts Brought by Volunteers/ Well-wishers………………….. 58 Figure 4. 5: Medical Assistance Following Physical Abuse………………………………...61 Daystar University Repository Library Archives Copy x LIST OF ABBREVIATIONS AND ACRONYMS DU-ISERC: Daystar University Institutional Scientific Research Committee NACOSTI: National Commission for Science, Technology and Innovation WHO: World Health Organization Daystar University Repository Library Archives Copy xi ABSTRACT The study focused on the escalating issue of elderly abuse within families and society in Kenya, particularly in Kiambu town. It examined emotional, financial, and physical abuse and its effects on the psychological well-being of the elderly. Additionally, the study analyzed how coping strategies moderate the relationship between abuse and the psychological well-being of the elderly. Guided by the disengagement theory and the social exclusion theory, a descriptive cross-sectional research design was employed. The target population consisted of 345 adults aged 65 years and above, with 148 respondents sampled from three homes for the aged in Kiambu town. Data was collected through a questionnaire and analyzed using descriptive statistics in SPSS version 20. The findings revealed alarming rates of abuse experienced by the elderly in these homes. Emotional abuse was prevalent, with caregivers causing stress (66.4%) and subjecting them to mockery (74.6%). Family members were also culprits, often shouting at the elderly (62.7%) among others. The study established that emotional, financial, and physical abuse significantly negatively impacted the psychological well-being of the elderly. Coping strategies primarily involved seeking solace in prayers and seeking help from relatives. The study suggests initiatives for public education and awareness to foster a senior-friendly society in Kiambu County. Additionally, it underscores the urgency of strengthening legal protections for the elderly, paticularly concerning property rights and financial exploitation. This research serves as a call to action to address the pressing issue of elder abuse in the region. Daystar University Repository Library Archives Copy 1 CHAPTER ONE INTRODUCTION Introduction In the evolving landscape of global health and well-being concerns, the state of the elderly, especially in areas such as Kiambu town in Kiambu County, has increasingly come into focus. As the world's senior population continues to grow, the emphasis on their mental and emotional well-being is of paramount importance. The mental and emotional health of this demographic is critical, yet understudied, especially in the context of abuse. Abuse, in its various forms, can have profound implications on the psychological health of older individuals. However, it is also recognized that individual coping strategies may influence the severity of these effects. This chapter introduced the concept of elderly abuse, outlined the study objectives, the significance of the study, scope and limitations of the study. Background of the Study Elder abuse is a widespread issue. Although the phrase "elder abuse" was first used to describe the mistreatment of elderly people in British scientific publications in 1975 under the term "granny battering" (Phelan 2020), it is a global problem (Akpeniba, 2019). According to Mariam et al. (2018), many elderly people around the world experience abuse and violence in significant ways frequently from those who are directly in charge of providing for them. According to Yon et al. (2017), elder abuse is defined as a single, recurring action or a lack of appropriate measures that takes place in trust relationships between older persons and carers that causes elderly people distress, injury, or agony. According to Li et al. (2019), old persons abuse instances are primarily the result of purposeful or inadvertent acts of omission or commission against the elderly. In this situation, omission is typically regarded as neglect. The abuse could be materially-related, financial, Daystar University Repository Library Archives Copy 2 psychologically-related, or physical. No matter how elderly people are mistreated, it typically leads to unwarranted harm, suffering, and pain as well as a decreased quality of life or a violation of their human rights. The phenomenon of elder maltreatment transcends geographic boundaries and cultural contexts, manifesting itself as a severe issue that demands immediate attention and intervention. The World Health Organization's European Region report sheds light on the depth of this crisis, indicating that a staggering 4 million elderly individuals in Europe alone face maltreatment each year. These figures, distressing in their own right, become even more alarming when considered in a broader, global context. In the United States, the situation, though varying in certain aspects, mirrors the gravity of the problem. Data from the National Research Council (2014) reveals that up to 2 million elderly Americans experience abuse, with a significant proportion of these cases involving their trusted caregivers as the perpetrators. This unsettling reality prompts an imperative reevaluation of the systems in place to protect the elderly. The consistency of such high numbers across different regions highlights not only structural inadequacies but also deeply ingrained societal biases and misconceptions about the elderly, underscoring the need for a multifaceted approach to tackle this pervasive issue. In the European milieu, Finland, in particular, offers a compelling and intricate landscape of elder maltreatment. A study by Laurola et al. (2019) elucidates a troubling pattern: both elderly men and women, with an intensified vulnerability among women, are subjected to maltreatment. Disturbingly, the sources of such violence are often those who are intimately connected to them -spouses, offspring, or entrusted caregivers. However, what is disclosed in research might only scratch the surface of the actual prevalence. The cultural fabric of Finland, much like many other societies, could harbor stigmas around admitting familial or caregiver abuses. Such societal pressures or the innate fear of retaliation may dissuade many Daystar University Repository Library Archives Copy 3 victims from voicing their experiences, suggesting that actual incidence rates might be substantially higher than what's currently acknowledged. Shifting focus to the Asian landscape, the situation is marked by vast inconsistencies in reported maltreatment rates. Yan's (2017) synthesis offers a wide-ranging picture, with prevalence rates oscillating from a minuscule 0.22 per 1000 to a shocking 62%. This staggering variation underscores the heterogeneity within the Asian continent. Specifically, South Korea's situation is particularly concerning. Research by Lee et al. (2021) reveals that approximately one in eight elderly individuals have faced some form of maltreatment. The profound fluctuations in prevalence rates across Asia make it essential to dissect regional distinctions. Factors such as traditional familial structures, societal attitudes towards the elderly, the robustness of healthcare systems, and the efficacy of legal mechanisms all play a role. Each country or region’s unique interplay of these factors can potentially offer insights into the observed disparities and guide targeted interventions. Africa's narrative in this discourse is equally disconcerting. The WHO's (2017) study spanning 28 countries revealed that 15.7% of the elderly populace had encountered abuse. A deep dive into Egypt's context by El-Khawaga et al. (2021) sketches a bleak tableau, with negligence reigning highest, trailed by psychological abuse. It is noteworthy that the abuse rates soared among specific demographics, notably females, farmers, illiterates, and those dwelling in solitude. The revelation that elders with chronic ailments, especially those grappling with diabetes and hypertension, were more susceptible to abuse, flags the dire need for targeted interventions. Moreover, Nigeria's predicament, as chronicled by Akpan and Umobong (2018), underscores the gravity of medical neglect, further compounding the already grievous situation. Such findings spotlight the pressing need for Africa to bolster its elder care mechanisms, foster societal awareness, and promulgate stringent regulations. Daystar University Repository Library Archives Copy 4 In developing nations like Kenya, the elderly population is growing more quickly, and it is predicted that by 2030, these nations would together account for 6.3% of the world's population who are 60 years of age or older (WHO, 2015). The number of elderly people is increasing, which raises concerns about their well-being in terms of retirement income security, social support, healthcare, and living conditions. Therefore, it is crucial that the government implements policies that focus on the requirements of senior citizens. In Kenya, how abuse is perceived differs from culture to culture and from society to society. The community's attitudes toward the elderly are driven by either honor or disdain (Henia, 2019). Elderly people are regarded and valued when it is the former; when it is the latter, they are seen as societal burdens that weaken society. Ageism and abuse are facilitated by the negative perception of adults (Lachs & Pillemer, 2017). According to the general consensus, elder abuse is a domestic problem that happens within the family. Evidence, however, shows that elder abuse extends beyond marital violence and involves mistreatment of the elderly by people who have positions of trust in their professions and organizations, such as lawyers, doctors, nurses, police officers, and bank employees. Kiambu County has the largest elderly population which constitutes about 5 percent of the County population (World Health Organization, 2016). Cash Transfer Programmed for the elderly was developed to ensure the welfare of the elderly is well taken care of. The county government has guaranteed protection under the Constitution so they can participate in development activities, personal development, dignity, and respect. Together with the family, the State is also obligated to provide care and reasonable assistance to older persons (Lee et al., 2021). The National Policy for Older Persons and Aging has been put into effect by the government. The policy offers a thorough framework for addressing issues related to older people and aging in development processes, as well as providing information for other sectoral policies. Daystar University Repository Library Archives Copy 5 The Ministry of Labor, Social Security, and Services has created a draft National Plan of Action for implementing the Policy. The ministry has also created a draft Older Person Bill as a framework to fight elder abuse, among other measures. These standards have been designed to control the development of institutions for older people. The initiative makes it possible for the population's most vulnerable segment to achieve basic necessities. The Cash Transfer Program for Older Persons currently gives identified households in each of the 47 counties Ksh2,000 per month. The government allotted Ksh 7.4 billion for older people during the 2015–2016 fiscal year, up from Sh5.9 billion during the previous fiscal year. Although there is an increasing awareness in Kenya of taking care of the old, some are still victims of abuse, neglect, and mistreatment (Henia, 2019). A growing body of literature and research on elder abuse is evidence of a gradual recognition of the problem and of the need for a response in Kiambu County and Kenya at large. Therefore, this study has endeavored to examine the effects of emotional, financial, and physical abuse on the psychological well- being of elderly people in Kiambu County. It has also sought to establish the moderating effect of coping strategies adopted by the elderly in Kiambu County. Statement of the Problem In 2015, it was predicted that 12.3% of the world's population was over 60 years old; by 2050, this number is expected to rise to 2.1 billion, or 21.3% of the world's population (United Nations, 2017). In Egypt, El-Khawaga, Eladawi, and Abdel-Wahab (2021) found that emotional abuse was substantially more common (56.5%) among female elders. Arens, Fierz, and Ziga (2017) noted that despite recent efforts to comprehend the causes and effects of elder abuse, research on the subject is still in its infancy, particularly in retirement facilities. In Kenya, abuse of elderly people within families and society has been on the rise. The old are also denied clothing, not accorded medical care and insurance, they suffer abandonment and isolation, and loneliness, amongst other ills. World Health Organization WHO (2016), Daystar University Repository Library Archives Copy 6 data suggests that 4 to 6 percent of elderly persons suffer from some form of abuse, a large percentage of which goes unreported. According to the 2019 Kenya Population and Housing Census, the number of people aged 60 and above in Kenya is 3.9% of the total population. This translates to approximately 1,855,000 older adults in Kenya, based on the total population of 47,558,296 reported in the same census. In the Kenyan economy, structural inequalities have often been the cause among the general population of low wages, high unemployment, poor health services, lack of educational opportunities and discrimination against old people all of which have tended to make the elderly poorer and more vulnerable (Henia, 2019). Elderly people in Kiambu County are a vulnerable group faced with several challenges including emotional, financial, and physical abuse, poverty, and health insecurity. The Older Person Cash Transfer (OPCT) Program introduced in 2006 to improve the livelihoods of older persons, does not benefit most Elderly people in Kiambu County. Although there is an increasing awareness in Kiambu County of taking care of the elderly, some are still victims of abuse, neglect, and mistreatment. The Constitution of Kenya emphasizes the rights and dignity of the elderly people. However, Kenya's commitment to the care and protection of elderly people is yet to be realized. Muli (2019) found evidence of physical, psychological, financial, and sexual abuse and neglect of the elderly in Machakos County, Kenya. According to studies conducted locally, not much has been done to examine how elder mistreatment affects their psychological health in Kiambu Town, Kiambu County. By investigating the impact of emotional, financial, and physical abuse on the psychological well-being of elderly persons in Kiambu Town, this study aimed to close this research gap. Daystar University Repository Library Archives Copy 7 Objective of the Study General Objective To investigate the effects of abuse on the psychological well-being among the elderly in Kiambu town, Kiambu county, Kenya and the moderating effect of coping strategies on their relationship. Specific Objectives i. To investigate the effects of emotional abuse on the psychological well-being of the elderly in Kiambu town, Kiambu County Kenya. ii. To analyze the effects of financial abuse on the psychological well-being of the elderly in Kiambu town, Kiambu county, Kenya. iii. To assess the effects of Physical abuse on the psychological well-being among the elderly in Kiambu town, Kiambu county, Kenya. iv. To determine the moderating effect of coping strategies on the relationship between abuse and psychological well-being of the elderly in Kiambu town, Kiambu county, Kenya. Research Questions i. What are the effects of Emotional abuse on the psychological well-being of the elderly, in Kiambu town, Kiambu county Kenya? ii. What effect does financial abuse have on the psychological well-being among the elderly in Kiambu town, Kiambu county Kenya? iii. What are the effects of physical abuse on the psychological well-being of the elderly in Kiambu town, Kiambu county Kenya? iv. Do coping strategies have moderating effects on the relationship between abuse and psychological well-being of the elderly in Kiambu town, Kiambu county, Kenya? Daystar University Repository Library Archives Copy 8 Justification of the Study The escalating concerns about the well-being of the elderly, particularly in developing countries like Kenya, necessitated an in-depth exploration of the factors affecting this demographic. Kiambu County, noted for its sizable elderly population, serves as an illustrative microcosm for investigating elder abuse, a phenomenon linked to significant psychological consequences. While global studies have provided insights into the prevalence and impact of elder abuse, the subject remains understudied in the Kenyan context, especially concerning the interplay between abuse types and psychological well-being. The study aimed at bridging this research gap by specifically focusing on Kiambu Town in Kiambu County, Kenya. Given that existing governmental policies and social programs, such as the Older Person Cash Transfer (OPCT) Program, have not fully alleviated the vulnerabilities faced by the elderly, a nuanced understanding of how different forms of abuse; emotional, financial, and physical impact psychological well-being is crucial. Significance of the Study The findings of this study presented significant implications for a wide range of stakeholders, from governmental agencies to individual community members in Kiambu town, Kiambu county, and Kenya broadly. For governmental and non-governmental entities, particularly those advocating for human rights and specifically focused on preventing elderly abuse, these findings underscore the magnitude and urgency of the issue. Policy makers in these domains are urged to prioritize and bolster their efforts, directing resources and strategic interventions towards curbing this pervasive form of abuse. In particular, the results serve as an empirical foundation for drafting policies and regulations aimed at protecting the elderly from various forms of maltreatment. Social workers and counselors, who play a critical role in reshaping societal perceptions and attitudes, can harness the data and insights from this study to construct impactful awareness Daystar University Repository Library Archives Copy 9 campaigns. By understanding the specific nature and prevalence of abuse against the elderly, these professionals can tailor their outreach programs, workshops, and counseling sessions more effectively, fostering a society that recognizes, condemns, and combats such abuse. Furthermore, the broader community and individuals should be cognizant of the revealed prevalence of emotional, financial, and physical abuse inflicted on their elderly counterparts. This awareness is pivotal in nurturing a community where every member actively works to identify, prevent, and report any form of elder abuse. Additionally, healthcare providers, who often serve as the frontline in detecting signs of maltreatment, should assimilate this knowledge, enhancing their capacity to discern potential cases of elder abuse and consequently initiate requisite support mechanisms. The research also unveied community-specific strategies and traditional methods that have been employed to address elderly abuse. Recognizing and analyzing these methods can be instrumental for policy makers and intervention specialists, enabling them to align their approaches with community values, ensuring both cultural sensitivity and effectiveness. From an academic perspective, the findings from this research augment the current literature on elder abuse, enriching the scholarly discourse on its manifestations, implications, and potential mitigation strategies. By establishing a nuanced understanding of the prevalence and nuances of emotional, financial, and physical abuse of the elderly, this study becomes an invaluable asset for subsequent researchers. It not only paves the way for future in-depth investigations but also facilitates the formulation of hypotheses and research questions for upcoming studies in the realm of elderly welfare and protection. Assumptions of the Study The foundational premise of this study rested on several critical assumptions, each pivotal in shaping the direction and outcomes of the research. Primarily, it was taken as a given that the Daystar University Repository Library Archives Copy 10 honesty of the respondents was unwavering. In other words, the study proceeded under the belief that the data collected would be untainted by biases or intentional distortions, thus ensuring that the responses were both genuine and dependable. Moreover, the research leaned heavily on the representational adequacy of the sample chosen. It was assumed that the subset of elderly individuals aged 65 years and above, residing in Kiambu town, Kiambu County, mirrored the broader demographic, socioeconomic, and experiential characteristics of the entire older population in that region. This assumption was vital to ensure the external validity of the findings, enabling the extrapolation of results from the sample to the larger community. Further deepening the layers of assumption was the belief that respondents had a clear understanding and awareness of the different facets of abuse; emotional, financial, and physical endured by the elderly in their locality. This pre- existing awareness was considered crucial as it ensured that the participants were not only well-informed but also more likely to engage thoughtfully with the research questions. Additionally, the study was underpinned by the assumption that respondents were not bound by any contractual or non-disclosure obligations that might deter them from discussing topics related to abuse, especially if these topics had personal or professional implications. This allowed for a more open, uninhibited dialogue, fostering a richer depth of insight. Lastly, was the trust in the veracity of the respondents' narratives. The study assumed that each participant, while engaging with the research instruments, did so with a commitment to truthfulness. This trust was essential to ensuring the credibility and reliability of the research findings, ensuring that the data accurately reflected the realities of the elderly population in Kiambu town, Kiambu County. Daystar University Repository Library Archives Copy 11 Scope of study The scope of the study was limited to elderly people in Kiambu town, aged above 65 years. According to Kiambu town, elderly homes data (2017), there were 247 adults aged 65 and above years. The researchers administered questionnaires and conducted informal interviews with elderly people in Kiambu town. The study focused on three homes for the aged in Kiambu town. These included Nyumba ya Wazee, AKINIITA Foundation and Harrison House Retirement Home. The study focused on abuse, the independent variable (as measured by emotional, financial, and physical abuse), coping strategies, the moderating variable and psychological well-being, the dependent variable. Limitations and Delimitations of the Study The researcher was confronted with the challenge of accessing adequate studies done in the developing world with suitable information that suits the Kenyan scenario. The researcher was faced with the difficulty of respondents who were not willing to participate in the research. To overcome these, the researcher assured the sampled respondents of the confidentiality of the information collected and no names were divulged in the final report. Definition of Terms Elderly people: The elderly people are persons aged 65 years in Kiambu County who reside in 3 homes for the aged in Kiambu town. Emotional abuse: This is abuse experienced by the elderly in Kiambu county characterized by a person subjecting, or exposing, another person to behavior that may result in psychological trauma. Financial abuse: This is abuse experienced by elderly in Kiambu county that entails the illegal or unauthorized use of their property, money, pension book, or other valuables in Kiambu county. Daystar University Repository Library Archives Copy 12 Physical abuse: This is abuse experienced by the elderly in Kiambu county that entails the use of force or violence that causes them bodily harm, injury, pain, or impairment. Summary Chapter one introduced the study. The chapter underscored the existing problem in elderly care. The issue of elderly abuse is introduced as a problem that ought to be addressed hence providing notification for conducting this research. The objectives of the study are clearly laid out in this chapter with the aim of developing recommendations that can ensure that the elderly are cared for and treated well in Kiambu County. The following chapter provides in depth review to existing literature with reference to elderly abuse. Daystar University Repository Library Archives Copy 13 CHAPTER TWO LITERATURE REVIEW Introduction This chapter started with the theoretical foundation on which the study was anchored. The chapter also covered a review of extant literature as guided by the specific objectives. A conceptual framework was also covered in this chapter. Theoretical Framework This section examined the theories that the study was anchored to in accordance with the independent and dependent variables. The study was guided by the following theories: disengagement theory, and the social exclusion theory. Disengagement Theory The disengagement theory, introduced by Cumming and Henry in 1961, posits a perspective on aging that has been both embraced and critiqued by the academic community. Central to this theory is the idea that as individuals age, they experience a natural and mutual withdrawal from societal interactions. According to the tenets of the theory, such a withdrawal or disengagement is not only inevitable but also deemed appropriate and natural for older adults. Over time, several iterations of the disengagement theory have emerged, with variations like moral-disengagement being documented (Adelakun, & Obue, 2020). An essential component of this theory is the concept of age-grading. This suggests that as older adults transition to phases of retirement and reduced societal roles, the younger generation steps in to assume roles that require specific skills or knowledge. Consequently, the focus of older individuals tends to shift from pursuing societal influence and power to seeking personal contentment and enjoyment. Daystar University Repository Library Archives Copy 14 However, the disengagement theory is not without its critics. A notable point of contention is the theory's largely linear perspective, which does not account for the multifaceted nature of individual experiences as one ages. As posited by Andrew (1995), the theory largely glosses over instances where society might expect or even demand continued engagement from aging individuals due to their significant contributions. Furthermore, the theory harbors inherent assumptions about societal roles, particularly in the context of family structures. It presumes a conventional two-parent family model comprising a father and a mother, thereby sidelining alternate family constructs such as single-parent households or same-gender partnerships. Such assumptions reveal an inherent gender bias, which can be problematic given the diverse familial structures in contemporary societies. In the context of elder abuse, the disengagement theory offers valuable insights. Specifically, it sheds light on the societal dynamics that might render older adults more susceptible to mistreatment. As per the theory's framework, the very process of disengagement, while natural, could inadvertently lead to older individuals being perceived as less valuable or relevant. Such societal perceptions, coupled with the changing roles and power dynamics as younger individuals assume prominent positions, could enhance the vulnerability of the elderly, making them potential targets for abuse (Vardhan, 2022). Therefore, understanding the implications of the disengagement theory is crucial for policymakers and caregivers alike, ensuring that the dignity and worth of older adults are upheld, irrespective of societal shifts and evolving dynamics. Social Exclusion Theory John Briggs (1994) introduced the Social Exclusion theory, providing a comprehensive lens into understanding powerlessness in contemporary society. At its core, this theory transcends mere material deprivation. It encapsulates a multifaceted framework of exclusionary experiences, encompassing inadequate social participation, the deficiency of cultural and Daystar University Repository Library Archives Copy 15 educational resources, restricted access to essential services, and an overarching lack of empowerment. This conceptual framework was conceived to provide a holistic understanding of power dynamics, rather than merely highlighting its resultant outcomes. Four primary dimensions characterize social exclusion: restricted access to social rights, material deprivation, constrained social participation, and a discernible lack of normative integration (Burholt et al., 2020). The manifestation of social exclusion arises from a confluence of individual or group-centric risk factors such as age, gender, and race. Furthermore, larger societal shifts, ranging from economic developments, technological advancements, evolving social norms, to legislative decisions and broader societal policies, all intersect to orchestrate these exclusionary practices. Intricacies of businesses, administrative bodies, and even societal behaviors further compound this dynamic (Phelan, 2020). Interestingly, Phelan (2020) posits that social exclusion exerts a more profound influence on poverty and socio-economic mobility than mere geographical or spatial analyses might suggest. This exclusionary process, in many instances, is both a precursor and a resultant consequence of poverty. Expounding on this, Burholt et al. (2020) note that social exclusion embodies a web of multifarious, often overlapping disadvantages, effectively capturing the intrinsic relationship between individuals and societal structures, thereby spotlighting the structural roots of such disadvantages. In the context of elderly populations, the relevance of the Social Exclusion theory becomes even more pronounced. Often, the elderly are sidelined, leading to their portrayal as marginalized members within societal structures. Such marginalization is not only indicative of material deprivations but spans the gamut from insufficient social engagement, limited cultural and educational enrichment, to restricted access to essential services, and a pervasive feeling of powerlessness. Burholt et al. (2020) articulate that the elderly's exclusion is Daystar University Repository Library Archives Copy 16 emblematic of their reduced capacity to attain societal well-being standards and partake in customary societal activities. Hence, the Social Exclusion theory underscores not only the resultant deprivations but the intricate processes of disempowerment and alienation that lead to such outcomes. General Literature Review Psychological Well-being Among the Elderly In the contemporary, rapidly-evolving landscape, discussions on mental health are experiencing a transformation, centering the significance of psychological well-being. Traditional narratives on mental health primarily focused on the absence of mental afflictions. However, current perspectives adopt a holistic approach, positing that genuine mental health encompasses not only the absence of disorders but also the presence and nurturing of psychological well-being (Ryan & Desi, 2018). This evolution in understanding mirrors a wider societal recognition of mental health's complexity, shaped by a myriad of internal and external factors. Delving into the nuances of psychological well-being reveals two crucial yet distinct dimensions: hedonic and eudaimonic well-being. The hedonic perspective, deeply embedded in age-old philosophical discussions on happiness and pleasure, holds prominence in contemporary psychological discourse. It revolves around the equilibrium of positive emotions and life contentment. To elucidate, hedonic well-being reflects the happiness stemming from lived experiences and the overarching satisfaction with one's life trajectory. Research, such as the insights offered by Carruthers and Hood (2020), indicates that consistent positive emotions and a fulfilling life perspective are indicative of heightened hedonic well-being. In contrast, eudemonic well-being navigates the profound depths of philosophical discourse. Beyond the transient nature of happiness, it emphasizes deriving profound meaning and Daystar University Repository Library Archives Copy 17 direction from existence (Ryan & Desi, 2018). Central to this dimension are themes of personal evolution, realization of latent potential, and deep-seated alignment with intrinsic values and aspirations. This perspective presents a comprehensive, purpose-driven viewpoint, emphasizing the significance of life's voyage over ephemeral joys. A salient point in understanding psychological well-being is recognizing its fluid nature. It is not an immutable state; rather, it is a spectrum influenced by daily events, interactions, and surroundings. Contrary to prevailing notions, resilience does not equate to imperviousness. Even the most robust psychological frameworks can be assailed under sustained adverse conditions. While transient adversities might bolster psychological fortitude, enduring stressors, especially in professional settings, can incrementally diminish psychological well- being. Prolonged, unchecked stress has repercussions beyond the psychological realm, manifesting as tangible health issues such as cardiovascular diseases, diabetes, and compromised immunity, as elucidated by Chandola (2018). Focusing on the elderly population, it becomes evident that their mental health paradigm is intricately woven with their cultural, societal, and personal narratives. The elderly, bearing lifetimes of experiences and wisdom, merit care and consideration that celebrates their unique journeys and individualities. However, challenges persist, notably in the form of elder abuse, casting somber overtones on their later years. Grasping the intricate cultural dynamics and subtleties associated with elder abuse and its psychological aftermath is of paramount importance (Ryan & Desi, 2018). As global communities’ endeavor to provide for their aging demographics, the convergence of cultural comprehension and psychological well-being is instrumental in ensuring dignified, respectful, and fulfilling lives for the elderly. Abuse among the Elderly Berkowsky (2020) underscores that emotional abuse, although often less visible than its physical counterpart, is equally insidious. This form of abuse subjects’ individuals to Daystar University Repository Library Archives Copy 18 behaviors that can lead to significant psychological trauma, such as anxiety, chronic depression, and post-traumatic stress disorder. At its core, emotional abuse manifests in power imbalances, evident in various situations like bullying, workplace abuse, and particularly through manipulative tactics like gaslighting. It is imperative to understand that the goal of emotional abuse, like physical abuse, is control. The distinction lies in the means: emotional abusers exploit emotions as their primary weapon. This can occur at any life stage, be it in childhood, adolescence, or adulthood (Simmons et al., 2022). The ramifications of such abuse are far-reaching, impacting relationships profoundly. The absence of physical scars does not negate the severity or authenticity of emotional abuse, which is recognized as a genuine concern or even a crime in several jurisdictions. Delving into financial abuse, Atim et al. (2023) illuminate the subtleties of this exploitation. It encompasses unauthorized or illicit utilization of another's finances, assets, or valuables. Tactics range from fraudulently obtaining power of attorney to manipulating wills, culminating in the victim's financial deprivation or even eviction. This form of abuse is not only about theft; it is a manipulative strategy to maintain power and control in a relationship. In many abusive scenarios, particularly in physically abusive ones, financial control becomes the tether that keeps the victim entrapped. The elderly are especially susceptible. As Lee et al. (2021) note, elder financial abuse arises from perceptions of them as easy targets, especially if they are dependent or display cognitive impairments. Such abuse is further exacerbated by perceived lenient penalties and inadequate protective systems (Henia, 2019). Physical abuse is the overt use of force causing injury, pain, or impairment. It encompasses acts like battery, assault, or any unwarranted restraint. Elder physical abuse, as highlighted by Atim et al. (2023), is particularly concerning given the context of elder maltreatment – abuse or neglect experienced by individuals aged 60 and above. Elderly residents in nursing homes or assisted living facilities are especially vulnerable due to their dependent status and the Daystar University Repository Library Archives Copy 19 nature of these institutions. Perpetrators can range from caregivers and medical professionals to acquaintances and even family members. The maltreatment of elderly residents in nursing homes has only recently gained widespread recognition, despite its grave implications. The aftermath of such abuse often casts long shadows over the victims, affecting them for their remaining years. To counter this, a collective effort is required: the elderly themselves, medical professionals, caregivers, and families must collaborate to combat the prevalence of abuse in care institutions (Danyoh, Dampson, & Dzakadzie, 2018). Empirical Literature Review Emotional Abuse and Psychological Well-Being of the Elderly The frustration and worry of the caregiver or resident's family members frequently signal the start of emotional abuse. Taking care of an older senior can be difficult, especially if there are health issues. Even if the relationship might not have been abusive at first, sustained stress can make caregivers impatient. Yelling at patients, making fun of them, downplaying their problems, and using insulting language are all signs of emotional abuse (El-Khawaga, Eladawi, & Abdel-Wahab, 2021). On the other hand, it can also entail making threatening gestures, keeping the patient away from friends and relatives, and ignoring them. Li et al. (2019) pointed out that the effects of emotional abuse can also have a negative impact on one's physical health. Patients may ignore or injure themselves. From refusing to participate in bathing or grooming to purposefully causing harm through hair pulling or self-cutting, behaviors can range widely. Additionally, nervous habits like scratching can unintentionally result in self- harm. Complications from degrading elderly individuals in nursing homes can take many different forms (Yon et al., 2017). One of the most prevalent types of emotional abuse involves using verbal threats to control patients (Li et al., 2019). Mood swings, anxiety, Daystar University Repository Library Archives Copy 20 melancholy, bewilderment, and a host of other behaviors are brought on by emotional abuse. Verbal remarks and neglect are just two examples of emotional abuse. During this time of abuse, elderly victims tend to remain silent out of concern that speaking up would cause further harm. Alraddadi, (2022) systematic review serves as a comprehensive lens into the broader impacts of elder abuse on psychological well-being. By identifying depression, anxiety, and post- traumatic disorder as the most common aftermaths, the study highlights the profound ramifications elder abuse has on its victims. The fact that abused elderly individuals consistently reported heightened psychological distress when compared to their non-abused counterparts is a clear testament to the severity of this issue. The nuanced finding that the distress level varies based on the abuse's nature and frequency provides a roadmap for professionals to identify and offer targeted therapeutic interventions. The findings from the study accentuate the alarming psychological toll of elder abuse. With mental health already being a taboo topic in many societies, elderly victims might suffer in silence, exacerbating their trauma. It is crucial for healthcare providers, caregivers, and policymakers to be equipped with the knowledge and tools to address this. The study's emphasis on the varying distress levels also showcases the importance of customized care. Not all victims have the same experiences or reactions; hence, a one-size-fits-all approach might not be effective. The study conducted by El-Khawaga et al. (2021) investigated the prevalence, types, risk factors, and lifestyle aspects related to the abuse of rural elders in Mansoura Districts, Dakahlia, Egypt. Among the various forms of elder abuse studied, emotional abuse emerged as a significant concern. The study revealed that negligence was the most frequent form of abuse reported (40%), followed by emotional abuse (30.5%). The research also noted that emotional abuse was significantly higher among female elders (56.5%). These findings underscore the importance of public education and policy initiatives to address emotional Daystar University Repository Library Archives Copy 21 abuse of the elderly, particularly in rural areas where the prevalence of abuse may be higher. The study was located in Egypt while the current study was situated in Kenya. A study by Li et al. (2019) utilized a population-based epidemiological design, involving face-to-face in-home interviews and mortality data collection over four years. In Li et al. 's (2019) study, the methodology employed was robust, aiming at obtaining a well-rounded view of the conditions faced by the elderly in China. The depth and duration of the study added a layer of authenticity to the findings, highlighting their significance. It is crucial to note the specific cultural and socio-economic dynamics of China when interpreting these findings, as these factors might significantly influence the nature and prevalence of elder abuse. The researchers collected data from Chinese elderly persons aged 60 years and above. The study revealed that the likelihood of psychological abuse on elders increases with stressful work environments and aggressive residents labeled as wrong residents. Moreover, the findings revealed that emotional mistreatment and caregiver neglect were associated with greater mortality risk. The findings indicated that emotional abuse among the elderly negatively affects their psychological well-being. However, the study was based in China, hence cannot be used to make generalizations in a similar study conducted in developing countries and in particular, Kenya. Akpeniba (2019), looked at the abuse of the elderly by formal caregivers in nursing homes through a systematic review of underlying factors. The systematic review method, coupled with the qualitative content analysis, offered a holistic view of the current state of elderly care in such institutions. It is also essential to recognize the constraints of relying solely on published articles, as there might be instances of abuse that are undocumented or underreported. To achieve this, ten (10) articles were selected from two main databases) and reviewed based on a set criterion. A qualitative content analysis was then applied to the analysis of the result. Findings from the study indicate that about 11% to 29.1 % of residents Daystar University Repository Library Archives Copy 22 have reported having been a victim of at least one form of elder abuse within the past year in an institutional setting. The commonest form of elderly abuse in nursing homes was identified to be neglect and emotional/psychological abuse. The study was based on empirical data while the current research was based on primary data. The research by Dong et al., (2018) presents an unsettling scenario for the elderly population in India, showcasing how elder abuse detrimentally affects their mental health. This is especially concerning given the traditional importance of elderly individuals in Indian culture. The study underscores the importance of considering the nuances of abuse, emphasizing that the frequency and multifaceted nature of abuse significantly amplify the mental health challenges, particularly in older women. These findings necessitate focused interventions tailored to the Indian socio-cultural context, aiming to prevent elder abuse and provide necessary mental health support. The study presents a predicament faced by the elderly in India that stands out as an urgent concern, more so given the nation's veneration for its older citizens. It is crucial to delve into why such a gap exists between cultural reverence and the lived reality of many seniors. Furthermore, the heightened vulnerability of older women indicates that interventions need to adopt a gendered perspective, understanding the unique societal pressures and challenges faced by elderly women in India. Evandrou et al. (2017) study offers a slightly different perspective compared to conventional research. The lack of a significant connection between physical mistreatment and anxiety symptoms offers new avenues for investigation. This result could be due to various reasons: perhaps the resilience levels of individuals in sheltered homes, the possibility that emotional abuse has a deeper and more profound impact, or even cultural perceptions surrounding physical versus emotional harm. Regardless, the significant link between emotional Daystar University Repository Library Archives Copy 23 mistreatment and anxiety symptoms is a critical point of concern, underscoring the importance of recognizing and addressing emotional and psychological harm. According to Yon et al.'s (2017) systematic review and meta-analysis of elder abuse prevalence in community settings, the pooled prevalence estimates for psychological abuse, including emotional abuse, was 11.6%. Emotional abuse was identified as the most prevalent subtype of abuse across various studies, with a prevalence rate of 63.4% among older adults. The study established that emotional abuse relates to verbal or nonverbal behaviors which contribute to the infliction of mental pain, anguish, distress, or fear. This form of abuse inflicts emotional pain and trauma on older individuals. The study was however based on secondary data which is prone to bias; to address this limitation, the current study will collect both primary and secondary data. Yon et al.'s (2017) research was instrumental in presenting a holistic view of elder abuse in community settings by combining numerous studies. The staggering prevalence of emotional abuse underscores the urgency of addressing this issue in communities globally. Understanding the nuances and manifestations of this form of abuse can provide vital insights for interventions and policy implementations. Collecting a mix of primary and secondary data is indeed a commendable approach, ensuring a well-rounded perspective and offsetting the inherent biases present in secondary data sources. Financial Abuse and Psychological Well Being Financial exploitation and material exploitation are other names for financial maltreatment. According to Yunus et al. (2019), financial abuse for the elderly refers to the improper or illegal use of another person's money, assets, or property. Due to their potential increased susceptibility to fraud, elderly persons may be in a particularly susceptible position to become victims of financial abuse. Residents frequently aren't informed when financial abuse involving their money or possessions is taking place. Daystar University Repository Library Archives Copy 24 Any suspected abuse should be looked into as soon as possible if family members or other close friends have any suspicions. Elder financial abuse can be brought on by a variety of things, including excessive alcohol use, fraud, and theft. Those who care for old people might take action by bringing them to nursing facilities to stop financial abuse of the elderly. To take swift action when suspicions are raised, family members and friends should educate themselves on the warning signs of financial abuse (Dong, 2017). Major financial decisions should, if feasible, be shared among numerous people. This creates a system of "checks and balances" that helps prevent abuse by one person. In compelling research undertaken by Atim et al. (2023) on the associated factors of elderly abuse within Uganda, primary data were sourced directly from elderly individuals stationed at referral hospitals across the nation. A significant revelation from this study was the heightened susceptibility of individuals aged over 80 years to financial abuse. The underlying factors for this susceptibility range from the heightened risk of neurocognitive disorders and increased functional dependence to an inability to adeptly manage finances. The older demographic also manifested tendencies of neglecting to seek financial aid, making uninformed financial choices, or becoming victims of deceitful financial schemes. Yet, a pertinent gap in the research was its lack of focus on the correlation between financial abuse and the psychological well-being of the elderly-a primary aim of the current exploration. In Johnson et al. (2022) review, which probed the ramifications of economic abuse on survivors of intimate partner violence, notable findings emerged that are critical for comprehending the nexus between economic abuse and its multifaceted consequences. It was revealed that victims of economic abuse often grapple with debilitating financial repercussions, heightened material constraints, and considerable economic adversities. Furthermore, the mental health implications were stark. A significant proportion of survivors exhibited deteriorated self-esteem, compromised psychosocial well-being, and pronounced Daystar University Repository Library Archives Copy 25 psychological distress symptoms. Interestingly, the age of the victims showcased varying intensities of psychological repercussions. Women aged between 66-86 displayed elevated probabilities of encountering mild to intense psychological symptoms. In contrast, the younger age bracket, 16-49, demonstrated a heightened susceptibility to severe psychological adversities. This age-centric manifestation of psychological effects underscores the need for age-specific interventions and support systems. The Department of Onlyice's (2022) literature review provided valuable insights into elder abuse, specifically in the Canadian context. Notably, financial exploitation and emotional maltreatment were identified as the predominant abuse forms experienced by seniors. A staggering 20 to 40 percent of reported elder abuse cases were marred by financial exploitation, further emphasizing the magnitude of this issue. Some distinctive factors predisposing seniors to financial deceit by unfamiliar individuals encompassed possession of property, reluctance to seek counsel prior to financial commitments, and cognitive challenges. However, the report failed to elaborate on the intricate relationship between these factors and the psychological well-being of the elderly, an aspect that the current study seeks to elucidate. The World Health Organization's (2022) documentation offered a holistic view of elder abuse and its manifold repercussions. Older individuals, irrespective of their residential circumstances, whether in their homes, a relative's residence, assisted living establishments, or nursing homes, remain susceptible to various forms of abuse. Financial mistreatment, a prevalent form of elder abuse, is manifested through a myriad of deceptive practices ranging from unauthorized financial transactions, misuse of credit facilities, to illicit alterations in vital legal documents like wills. However, while the WHO's data provides a comprehensive overview of elder abuse forms, it remains somewhat cursory in its examination of the interplay between financial abuse and its consequent psychological effects. There is a Daystar University Repository Library Archives Copy 26 palpable need to delve deeper into the causal relationship between these financial exploitations and their immediate and long-term psychological effects on the elderly, an avenue the current research seeks to traverse. Echoing similar concerns, Wamara et al. (2021) embarked on a study centered on the dimensions of elder abuse within Uganda, directing a special focus towards financial abuse. Their findings unveiled an alarming rate of elderly abuse, with financial maltreatment being a recurring theme, as reported by a significant portion of the study's participants. A possible catalyst for this trend, as hypothesized by the study, is Uganda's overwhelming poverty rates, potentially driving the financial exploitation of either economically stable or reliant senior citizens. This research accentuates the need for a more nuanced understanding of the socioeconomic aspects enveloping elderly individuals, urging the incorporation of facets such as familial income and its sources. This would facilitate a deeper comprehension of the dynamics of financial abuse plaguing the elderly demographic within Uganda. However, it is pertinent to note that while Wamara's study was rooted in Uganda, the present research is anchored within the Kenyan context. Further broadening the research horizon, Dong's (2017) empirical review spotlighted the intricacies of elderly abuse. The research revealed that financial exploitation, predominantly orchestrated by kin or trusted individuals, was notably prevalent amongst minority groups. Common manipulative behaviors such as commandeering finances, illicit appropriation of money, and signature forgery emerged as prominent themes. The repercussions of such actions are profound, encompassing monetary losses, social estrangement, and deteriorating health outcomes. This research underscores the urgent imperative for holistic strategies encompassing education, prevention, and interventions to shield the elderly from potential financial exploitation. Dong's approach was rooted in an empirical review, whereas the current study harnesses primary data sourced from Kiambu County. Daystar University Repository Library Archives Copy 27 Lachs and Pillemer (2017), in their systematic review of U.S. studies, highlighted that an estimated 5.6% of senior citizens within broader communities encountered financial exploitation. The manifestations of such financial abuses typically encompass control over financial assets, illicit monetary acquisitions, and exploitation. Recognizing the unique nature of financial abuse as a distinct sub-category within elderly abuse is crucial. The ramifications of financial exploitation are profound, translating to monetary depletions, heightened social isolation, and compromised psychological well-being amongst the elderly demographic. Lachs and Pillemer's research conclusively indicated that financial exploitation exerts a detrimental psychological impact on the elderly's well-being. However, their research terrain was the U.S., whereas the present study aims to capture the Kenyan landscape. Physical Abuse and Psychological Well Being Physical abuse is the use of physical force or violence that causes bodily harm, injury, pain, or impairment to the victim (Yunus et al., 2019). This can include battery, assault, or any inappropriate use of restraint between two people. Physical abuse can occur at any age and may be repetitive or a singular incident. Physical abuse is the use of force intentionally to hurt a victim. According to Berkowsky (2020), elder physical abuse may come from a caregiver, an acquaintance, a nurse, a doctor, a family member, or any other person the elderly patient has contact with. On the other hand, Myhre et al. (2020), elderly self-neglect is the result of the elderly patient's actions. Elder maltreatment is the infliction of abusive behavior by another person. Without a clear definition of elder maltreatment, and indicators of elder abuse, elderly patients are at risk of enduring harm that goes unnoticed. Family members of elderly patients in a nursing home or assisted living facility can help prevent elder physical abuse. By visiting often, paying attention to social or behavioral patterns, and keeping an eye on the elderly patient's health conditions, the risk of elder physical abuse is Daystar University Repository Library Archives Copy 28 significantly minimized. Talk to the elderly patient, listen to his or her concerns, and pay attention to any medicine the patient may be taking (Myhre et al., 2020). Berkowsky's (2020) research presented an insightful investigation into the implications of elder mistreatment, notably physical abuse, on the psychological well-being of senior American citizens. It was distinctly observed that instances of physical abuse were directly correlated with diminished feelings of environmental mastery among the elderly. This reduction was not only confined to a decreased sense of control over their environment; it extended to facets of psychological well-being such as life satisfaction, positive emotional experiences, and a compelling sense of life purpose. Such findings reinforce the necessity for healthcare practitioners and related professionals to maintain a heightened alertness in identifying the signs and potential precursors of elder mistreatment. This pertains especially to manifestations of physical abuse, necessitating timely and effective interventions. While Berkowsky's research provides invaluable insights, it is essential to note that the geographical scope of this study—focused on the U.S.-limits its direct applicability to distinct cultural and social contexts, like that of developing nations, including Kenya. Myhre et al. 's (2020) exploration took a qualitative approach, engaging in focus group discussions with 28 leaders from nursing homes, holding pivotal roles as care managers. The study delineated physical abuse as deliberate actions meant to inflict pain or injury on vulnerable senior individuals or the denial of their fundamental necessities. Notably, the research highlighted that such abuse, when perpetrated by family members, is often insidiously concealed, making its detection a challenge. Among the interpersonal dynamics within nursing homes, physical abuse emerged as the gravest form of resident-to-resident hostility, often culminating in evident harm and psychological distress. The ramifications of such abuse were palpably negative, with affected elderly individuals exhibiting deteriorated psychological states. However, the exclusive reliance on qualitative data by Myhre et al. Daystar University Repository Library Archives Copy 29 potentially limits the comprehensiveness of their findings. In contrast, the current research endeavors to harness both qualitative and quantitative research methodologies, aiming to garner a more holistic understanding of the issue. Yunus et al. (2019) systematic review, delved deep into the multifaceted impact of elder abuse and neglect, with a pronounced focus on physical abuse. Their analysis underscored the detrimental health consequences linked to elder mistreatment, encompassing physical injuries, functional incapacitation, and heightened mortality risks. Physical abuse emerged as a predominant catalyst for unfavorable health outcomes, triggering consequences such as prolonged hospital stays and disabilities. Afflicted elderly individuals reported elevated stress levels attributed directly to physical abuse. Other reported repercussions included urinary incontinence and sleep disturbances, particularly when subjected to both physical and psychological abuse. The review accentuated the imperative for expansive prospective studies, especially in middle-income and low-income regions, to cultivate a more nuanced comprehension of elder abuse and neglect's ramifications. In alignment with this recommendation, the present study embarked on an exploratory journey, seeking to unravel the intricate relationship between physical abuse and the psychological well-being of the elderly populace in Kiambu County, Kenya. Diving deeper into the psychosocial aftermath of elder abuse, Dong et al., (2018) offers an intriguing perspective. It suggests that while physical health detriments are tangible and more immediate, the corrosion of psychological well-being might be even more grievous and long- standing. The aftermath of such victimization, in terms of psychological distress, potentially lingers, underscoring the pervasive nature of its impacts. However, the review ushers in an intriguing paradigm shift; it purports that psychological distress might not only be a byproduct but could very well be a precursor, amplifying the susceptibility to elder abuse. This cyclical causality warrants a deeper exploration, potentially presenting a critical gap. Daystar University Repository Library Archives Copy 30 The review rightly accentuates the need for future empirical endeavors to navigate this dual role of psychological well-being, both as a consequence and a precursor, thereby providing more granular insights into these interrelations. Transitioning to a study by Mouton et al. (2017), the spotlight is on the tragic interplay between abuse and depression, particularly among postmenopausal women. With abused women being up to three times more predisposed to depression, the study offers a bleak perspective. Beyond the immediate psychological afflictions, abuse seemingly gnaws at the very scaffolds that insulate against depressive episodes, notably social support and self- esteem. Thus, abuse, in essence, does not only inflict immediate pain but erodes the very protective barriers, rendering the individual more susceptible to depressive disorders. The study's emphasis on interventions to curb abuse, thereby attenuating the onset of depression in postmenopausal women, is commendable. Yet, the broader extrapolation to the larger elderly demographic, encompassing both genders, would be invaluable, signifying an area our current research intends to explore further. Elder abuse remains a pressing and multidimensional issue that continues to undermine the dignity and overall well-being of the elderly. As illuminated by Illie et al. (2017), physical violence stands out as a conspicuous manifestation of elder abuse. It directly impinges on the individual, rendering its identification relatively straightforward. Beyond the tangible ramifications, the study delves into the profound psychological repercussions of such abuse. It elucidates a compelling association between elder abuse and deteriorating mental health outcomes, an association that remains resilient even in the face of other confounding factors. Alarmingly, the research underscores that iterative abuse instances or exposure to a multiplicity of abuse forms exacerbates the vulnerability of older women to disorders like depression and anxiety. Despite its profound insights, the study could have further expanded Daystar University Repository Library Archives Copy 31 on the holistic well-being of the elderly, encompassing both physical and psychological dimensions. Coping Strategies among the Elderly Experiencing Emotional, Financial and Physical Abuse Coping strategies, inherently, oscillate between the positive and negative realms. While some might bring momentary solace, they often spiral into detrimental habits. For instance, while an individual might find transient comfort in seclusion, extended spells in bed, or indulging in unhealthy dietary choices, these can invariably exacerbate physical and emotional health. The onus is to discern and promote coping mechanisms that holistically uplift the quality of life, steering clear from strategies that merely swap one issue for another. The intricate landscape of coping mechanisms adopted by elderly individuals facing abuse has garnered notable attention in recent research. A qualitative investigation delineated by Simmons, Wiklund, and Ludvigsson (2022) delves deep into this realm, spotlighting the lived experiences of elderly Swedes. What emerges from this study is a nuanced tapestry of coping techniques, from the tangible—such as seeking social and professional aid—to cognitive maneuvers, notably reframing and acceptance. The coping mechanisms, it is inferred, are not randomly selected but rather deeply intertwined with the individual's personal matrix of age, gender, and past abuse experiences. A critical gap, however, persists in this study: While it sheds light on the coping mechanisms, the underlying triggers or conditions propelling the elderly towards specific coping strategies remain underexplored. Supplementing this narrative, the World Health Organization's (2022) report paints a broader picture, emphasizing the profound repercussions of elderly abuse—ranging from physiological and cognitive impacts to financial and social fallout. The WHO's recommendations exhort a multi-pronged approach. While urging victims to reach out for help, it simultaneously calls for an upskilling of healthcare providers to ensure early detection and intervention. The WHO's clarion call for community-driven initiatives underscores the Daystar University Repository Library Archives Copy 32 collective responsibility in safeguarding the elderly. Yet, a discernible void emerges: While the guidelines provide a broad framework, they lack granularity in terms of implementing and monitoring such programs. The current research endeavors to bridge these gaps, striving for a more holistic understanding of the plight and resilience of the elderly. Meanwhile, Simmons et al. 's (2022) exploration, centered on the Swedish elderly populace, presents a nuanced perspective on coping mechanisms employed post abusive encounters. Grounded in qualitative interviews, the study unfolds the myriad coping strategies, from seeking solace in friends and professionals to the potent allure of self-reliance. However, an underlying thread of shame and societal stigma enveloped many respondents, curbing their outreach for assistance. Those championing self-reliance echoed sentiments of empowerment and control. Notably, while the study underscores the crucial need to comprehend the coping arsenal of the elderly amidst adversity, it refrains from delving into the multifaceted abuse forms encountered by the elderly. This remains a critical avenue for further exploration and an aspect our research intends to cover. Delving into the realm of elderly coping, a study by Danyah et al. (2018) casts light on the stark contrast between coping mechanisms of seniors manifesting symptoms of depression and their mentally robust counterparts. The findings are compelling. Seniors who lean on adaptive strategies depict marked reductions in feelings of loneliness and depression, while those resorting to maladaptive tactics witness heightened mental health challenges. However, the study does not fully account for the broader socio-cultural determinants that might influence the adoption of these coping strategies, creating a lacuna that our research aims to address. In yet another study by Danyah et al. (2018), the focus shifts to the domestic space, illuminating the coping responses of the elderly confronted with home-based abusive episodes. The survey, which encompassed a commendable sample size, unraveled an Daystar University Repository Library Archives Copy 33 unsettling revelation psychological abuse reigned supreme amidst self-reported abuse types. A fascinating finding was the spiritual recourse many elderly individuals sought, resorting to prayers to navigate the tribulations inflicted by caregivers. This devout coping mechanism, however, is geographically and culturally entrenched, with this study rooted in the Ghanaian context. Drawing parallels or extrapolating these findings to the Kenyan scenario, the backdrop of the current study, demands caution. It underscores the need for culturally sensitive research, illuminating indigenous coping strategies, and their efficacy in disparate cultural settings. Further enriching this discourse, a comprehensive review by Moose et al. (2016) casts its net wider, examining how the elderly grapple with an array of negative life events spanning health challenges, interpersonal strife, and fiscal quandaries. The findings underscore a multifaceted coping arsenal-encompassing problem-centric, emotion-centric, and meaning- centric strategies. What becomes evident is that a one-size-fits-all approach to coping is elusive. The efficacy of these strategies oscillates based on the nature of the stressor and the unique makeup of the individual. However, a glaring lacuna in this review is the absence of a cross-cultural lens. Conceptual Framework The conceptual framework is a diagrammatic presentation of variables in the study. The framework illustrates the interrelationship between dependent and independent variables. The independent variables for the study are emotional, financial, and physical abuse. The dependent variable of the study is the psychological well-being of the elderly in Kiambu County. Daystar University Repository Library Archives Copy 34 Figure 2. 1: Conceptual Framework Discussion Figure 2.1 delineates the relationships between multiple variables, offering insights into how specific factors might influence the psychological well-being of the elderly. At its core, this framework highlights the intricate interplay between independent variables, coping strategies, and the resultant dependent variable, which is the psychological well-being of the elderly. The independent variables are categorized into three distinct yet interconnected types of abuses: emotional, financial, and physical. Emotional abuse encompasses facets like frustration, desertion, and neglect. These elements signify the psychological and emotional distresses that elderly individuals might endure, ranging from feelings of abandonment to more overt instances of emotional maltreatment. Emotional abuse Frustration Desertion Neglect Financial Abuse Denial Misrepresentation Theft Physical Abuse Burns Scratches Bullying Psychological Well-Being of the elderly Autonomy Self-acceptance Personal growth Purpose in life Independent variables Dependent variable Coping Strategies Engagement Disengagement Daystar University Repository Library Archives Copy 35 Financial abuse, on the other hand, details transgressions related to monetary matters. It encapsulates acts such as denial, misrepresentation, and theft, pinpointing how elder individuals may be exploited financially. These acts can range from outright stealing of funds to more covert means like deceiving or withholding financial entitlements. The third category of independent variables pertains to physical abuse, shedding light on tangible harm inflicted upon elderly individuals. This includes but is not limited to bums, scratches, and instances of bullying. These indicators signify the physical adversities the elderly might confront, with consequences that are both immediate and long-lasting. While the independent variables elucidate potential adversities, the framework introduces coping strategies as intermediary factors. Coping strategies, such as engagement and disengagement, represent the mechanisms through which elderly individuals respond to and navigate the abuses. Engagement might entail active efforts to address or confront adversities, while disengagement could involve withdrawal or avoidance tactics. The culmination of the framework is the dependent variable: the psychological well-being of the elderly. This is a multifaceted construct, encompassing elements like autonomy, self-acceptance, personal growth, and purpose in life. Essentially, it portrays the mental and emotional states of elderly individuals, positing that their well-being is intrinsically linked to the types of abuses they encounter and the coping strategies they employ. Summary Chapter two focused on the literature review of the study. It covered the information and findings made by different scholars on topics related to psychological wellbeing of the elderly, abuse among the elderly (emotional, financial, physical) and the coping mechanisms adopted by the elderly who experience abuse. Based on the literature provided, it was observed that elderly abuse is a common phenomenon from different parts of the world, Daystar University Repository Library Archives Copy 36 hence necessitating research. The following chapter covers the methodology that was used to conduct this study. Daystar University Repository Library Archives Copy 37 CHAPTER THREE RESEARCH METHODOLOGY Introduction This chapter provided a discussion of the outline of the research methodology that was used in this study. It focused on the research design, population, sample and sampling techniques, instruments for data collection and procedures, pilot tests and data processing as well as data analysis methods to be used in this study. Research Design According to Gravetter and Forzano (2018), a research design is a general blueprint for the collection, measurement and analysis of data, with the central goal of solving the research problem. The study employed a descriptive cross-sectional research design. Descriptive research entails observing and characterizing variables in their unaltered natural condition. A descriptive research design provides a thorough understanding of a particular phenomenon. A descriptive design was adopted to explain the effects of abuse on the psychological well- being of the elderly. In particular, the design provided an in-depth description of abuse (as measured by emotional abuse, financial abuse and physical abuse), coping strategies and psychological well-being of the elderly. The Population Population refers to the entire group of people, events or things of interest that the researcher wishes to investigate. A study population can be defined as the entire collection of cases or units from which the researcher wishes to draw conclusions. According to Bell, Bryman, and Harley (2022), a population is a well-defined or set of people, services, elements, and events, groups of things or households that are being investigated. The population of this study was the elderly persons in Kiambu County aged 65 years and above. The study focused on 3 Daystar University Repository Library Archives Copy 38 homes for the aged in Kiambu town, Kiambu county, these include: Nyumba ya Wazee, AKINIITA Foundation and Harrison House Retirement Home Target Population The target population for the study was elderly persons in Kiambu County aged 65 years and above. The study targeted 237 elderly persons who live in three selected homes for the aged in Kiambu town. The distribution of the target population based on gender, and homes for the aged is presented on Table 3.1 Table 3. 1: Target population Homes Male Female Total Nyumba ya Wazee 56 61 117 AKINIITA Foundation 24 15 39 Harrison House Retirement Home 33 48 81 Total 113 124 237 Sampling Frame and Sampling Procedure Sampling refers to the systematic selection of a limited number of elements out of a theoretically specified population of elements. A sample design is a strategy used to select study participants or respondents. Simple random sampling was used to select the sample for the study. This ensured that the participants were sampled randomly, hence limiting any opportunity for bias. The sample size was determined by using Krejcie and Morgan's method of determination of a sample size for a given population size. Where: n = required sample size. Daystar University Repository Library Archives Copy 39 = the table value of chi-square for 1 degree of freedom at the desired confidence level (3.841). N = the population size. P = the population proportion (assumed to be .50 since this would provide the maximum Sample size). d = the degree of accuracy (the margin of error) expressed as a proportion (.05). n = 3.841 * 237 * 0.5 * (1- 0.5)/0.05 2 (237-1) + 3.841* 0.5 (1-0.5) n= 227.5793/(0.59+0.9603) n=227.5793/1.55025 n=148 By using Krejcie and Morgan's method of determination of a sample size the eventual sample size obtained was composed of 148 respondents. According to the Central limit theorem, if the sample size is large enough (N > 30), the data follows a normal distribution curve, (Gilbert & Churchill, 2001). Inclusion and Exclusion Criteria Inclusion Criteria The inclusion criteria of the target population included elderly persons in Kiambu County aged 65 years (both male and female). Moreover, only elderly persons living in either one of these three homes for the aged (Nymba ya wazee, AKINIITA Foundation and Harrison House Retirement Home) were sampled for the study. Daystar University Repository Library Archives Copy 40 Exclusion Criteria Persons below 65 years in Kiambu County were not sampled for the study. Additionally, elderly persons aged 65 years and above but not living in Nyumba ya wazee, AKINIITA Foundation or Harrison House Retirement Home were not sampled for the study. Data Collection Instruments Primary data was collected using a structured questionnaire. According to Bell, Bryman, and Harley (2022), the use of structured questions on the questionnaire allows for uniformity of responses to questions. The structured questions were used to conserve time and money as well as to facilitate easier analysis as they are in immediate usable form; while the unstructured questions were used to encourage the respondent to give an in-depth and felt response without feeling held back in revealing any information. The questionnaire was composed of two sections, section A was composed of demographic information while section B consisted of prevalence of emotional, financial, and physical abuse. The researcher sought the help of assistants in distributing the questionnaires. The assistants were qualified counselors and were trained in the data collection process. Type of Data The structured questionnaire collected quantitative data. This is the data that is presented in numerical form. The quantitative data facilitated descriptive data analysis that helped in describing the abuse of elderly persons in Kiambu County. Data Collection Procedure The methodology for data collection involved an active and hands-on approach spearheaded by the primary researcher, supported by two capable assistants. This team-based strategy not only ensured the efficiency and timeliness of data collection but also maintained a rigorous standard of quality throughout the process. Prior to embarking on the data collection journey, the assistants underwent a comprehensive orientation session conducted by the researcher. Daystar University Repository Library Archives Copy 41 During this session, they were apprised of the specific protocols and procedures to be adhered to, ensuring that each respondent's experience was consistent. Central to this process was the emphasis on maintaining the confidentiality of the participants, a pivotal aspect that reinforced the credibility and ethical standards of the research. Recognizing the potential challenges and vulnerabilities associated with the elderly demographic, the research process was designed to be as accommodating as possible. Instead of relying on the conventional drop-and-pick technique for distributing questionnaires, a more involved approach was adopted. This decision was influenced by concerns that elderly respondents might either inadvertently overlook the task of filling out the forms or encounter difficulties in comprehending and answering specific queries due to age-related factors. To circumvent these challenges, upon distributing the questionnaires, the researcher and assistants remained available. This presence allowed respondents to seek clarifications and ensured that they had the requisite support to complete the questionnaires comfortably and comprehensively. Pilot Test A pilot test is conducted to test the validity of the questionnaire and it is carried out with the help of research assistants. The main reasons for the pilot study are to identify any potential deficiencies, omissions and errors in the questionnaire and eliminate them before it is used to collect the actual data. A pilot study was conducted where 38 elderly people were picked from Thogoto Home for the aged. The test-retest method was used to test for the reliability of the instrument. Reliability Bell et al. (2022) noted that reliability is a measure of the degree to which a research instrument yields consistent results after repeated trials. Reliability refers to the consistency Daystar University Repository Library Archives Copy 42 of the research and the extent to which studies can be replicated. To ensure a high degree of reliability of instruments in this study, the researcher personally collected the data and only in a few cases where assistance was sought from well-trained and motivated research assistants. Cronbach's Alpha was used in this study to assess the instrument's reliability. According to Cooper and Schindler (2011), the alpha coefficient varies from 0 to 1, with values of 0.7 and above indicating a reliable instrument. Validity Vakili, and Jahangiri (2018), define content validity as a measure of the degree to which data collected using a certain instrument represent a specific domain of indicators or content of a particular subject. Validity shows whether the items measure what they are designed to measure. The researcher used content validity to examine whether the instruments answered the research questions. Content validity of an instrument is improved through expert judgment. Content validity refers to whether an instrument provides adequate coverage of a topic. The study ensured that all the study variables are well covered in the study instruments to ensure content validity. Data Analysis and Presentation According to Bell et al. (2022) , data analysis involves several closely related operations which are performed to summarize the collected data and organize them in such a manner that they answer the research questions. The operations include editing, coding, classifying, and tabulating. It also entails categorizing, ordering, manipulating and summarizing data, to find answers to the research questions. Before the actual analysis of data using SPSS, data was cleaned, edited, checked for accuracy, and coded. These processes are essential to ensure that the collected data is systematically organized in a manner that facilitates analysis. Daystar University Repository Library Archives Copy 43 The research yielded both quantitative data which was analyzed using descriptive statistics (measures of central tendency, and measures of variations) with the help of Statistical Package for Social Sciences (SPSS) version 20 to achieve the objectives of the study. Further, a multiple regression model was used to show the relationship between the independent and the dependent variables. The regression model is presented below. Y = β0 + β1X1 + β2X2 + β3X3 + ε Y= Psychological wellbeing among the elderly X1= Emotional abuse X2= Financial abuse X3= Physical abuse β1 – β3 = Regression Coefficients ε is the random error term that accounts for all other factors that affect the psychological wellbeing among the elderly in Kiambu town, Kiambu County but are not included in the model. To determine whether there is a significant difference between the research variables, the one-Way ANOVA test was used to measure the significance level of variance. The findings were presented using tables, frequencies, and percentages. Ethical Consideration The study exercised utmost caution while administering the data collection instruments to the respondents to ensure their rights and privacy is upheld. A data collection permit was acquired from NACOSTI and Daystar University. Before the actual administration of the instruments, an introduction on the aim and the purpose of the study was made to the respondents in the language they best understood. A transmittal letter was attached by the researcher to each questionnaire. Daystar University Repository Library Archives Copy 44 The study also sought the consent of the respondents before they are provided with all the requirements of the study. To ensure confidentiality, the respondents' names did not appear on the questionnaire. Furthermore, no respondent was forced into the exercise at any level, their consent was sought first. The participation in the study was on a voluntary basis, no money or incentive was offered to the respondents to answer the research questions. The respondents were informed that they are allowed no refusal to take part in the study in case they feel uncomfortable. The study findings were presented without any manipulation or influence by the researcher in any way. Chapter Summary Chapter thr