Unravelling the web of neglect in elderly cancer care in South India: A grounded theory approach

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Background and objectives Elder neglect, characterised by unmet care needs, social isolation, and emotional distress, has been consistently reported in epidemiological studies, yet it continues to be insufficiently acknowledged as a major public health concern in India. Existing frameworks inadequately explain how factors interact to produce neglect and abandonment. This study aimed to explore the circumstances leading to neglect among elderly cancer patients in Puducherry and Tamil Nadu. Methods A qualitative grounded theory design was used. Data were collected through five in-depth interviews, six key informant interviews, and 156 narrative accounts from 52 patient–caregiver–community triads using the SENILE-C tool. Transcribed interviews were analysed through open, axial, and selective coding using constant comparative methods, supported by theoretical sampling, member checking, and multi-coder triangulation. Theory triangulation with the theory of planned behaviour, Maslow’s hierarchy, broken windows theory, and the interplay theory helped contextualise how neglect develops and escalates. Results Neglect emerges as a dynamic, progressive process that begins with subtle lapses in care and can escalate to overt abandonment. Vulnerability was shaped by individual factors (self-neglect, emotional distress, functional decline), family-level pressures (caregiver burnout, economic strain, substance use, exploitation), and community influences (stigma, discrimination, weak social support, limited palliative care). The interplay theory showed how combined pressures across these domains can push families beyond their coping threshold, leading to worsening neglect. Interpretation and conclusions The study highlights neglect as a cumulative, socially reinforced process requiring multi-level interventions. Strengthening caregiver support, addressing financial and social barriers, and expanding community-based palliative care services may help prevent escalation of neglect and improve outcomes for elderly cancer patients.