Violence and abuse are associated with a range of negative outcomes including poor mental health (Golding 1999; McManus et al., 2022; Paulino & Ogonah 2024; Whiting 2023), poor physical health (Brieding et al., 2008; Chandan et al., 2020), and financial and housing insecurity (Chan et al., 2021), to name a few. However, the vast majority of this evidence focuses on children and young people, or adults of working age.
By comparison, the impacts and even the prevalence of violence and abuse against older adults are poorly researched and understood. For instance, the Crime Survey for England and Wales, one of the largest crime surveys with over 30,000 participants, and the source of official statistics on the prevalence of violence, excludes those aged over 74 (Office for National Statistics, 2021), which is still an improvement over the prior limit of 59 up to 2017. This has resulted in a gap in our understanding of the extent, nature, and consequences of exposure to violence and abuse in this age group.
Given that older age is associated with poorer physical health and increased isolation (Hammig 2019), exposure to violence and abuse is likely to exacerbate these issues, thus support needs are likely to be high.
Fadeeva et al., (2024) therefore aimed to estimate the prevalence of past-year violence victimisation in older adults compared with younger adults, identify factors associated with violence in older age, and examine the extent to which violence victimisation was associated with common mental disorder (CMD).
The negative consequences of violence and abuse victimisation is well documented in young people and adults of working age, however its prevalence, associated risk factors, and impacts in older aged adults is under investigated.
Methods
The authors conducted a secondary analysis using data from the 2014 Adult Psychiatric Morbidity Survey (APMS), a nationally representative survey conducted every seven years with approximately 7,500 participants. They sought to compare experiences of violence and common mental disorder in those aged 60 years and over, to those aged 16-59 years.
Participants were asked questions related to past year experiences of violence and abuse from an intimate partner or family member, and/or bullying or serious assault from any type of perpetrator. Participants were also asked questions related to the presence of any of six common mental disorders (CMDs) in the past week including depression, mixed anxiety/depression, generalised anxiety disorder, panic disorder, phobic disorder and obsessive compulsive disorder. Covariates were also assessed, including physical and cognitive impairments; social context, discrimination and caring responsibilities; and demographic and socioeconomic factors.
Weighted descriptive analyses were conducted to provide descriptive profiles, as well as associations between these characteristics, violence experiences and CMD prevalence. Additionally, multivariable regression analyses were run separately for older and younger adults, to examine associations between violence and CMD, adjusting for sociodemographic factors (model 1), sociodemographic factors and loneliness and isolation (model 2), and sociodemographic factors and experience of child abuse (model 3).
Results
The sample comprised 7,054 adults, including 4,484 16–59-year-olds and 2,570 adults aged 60 years and over (within this 67.6% were aged 60-74, and 32.4% were aged 75 and over).
The analysis indicated that 2% (n=52) of those aged 60 years or over had experienced violence in the past year, compared to 9.9% of those aged 16-59 years old. All forms of violence measured were less prevalent in the older age group. In terms of past-year violence, within the older age group, violence from another family member was the least common (0.4%), while the most common form was violence from an intimate partner (1.3%). In terms of lifetime violence, violence from an intimate partner was reported by 13.9% of older adults, and violence and abuse experienced as a child was the most common overall (18.2% of older adults).
Older adults who had experienced violence of any type in the past year, were more likely to be aged 60-74 years (compared to 75 years and over), non-white, socially isolated or lonely, and divorced, separated or widowed, whereas gender, tenure and activities of daily living were not significantly associated with past year violence.
In terms of CMDs, the authors found that older adults who had experienced violence in the past year were more likely to live with a CMD than older adults who had not experienced violence (26.4% versus 10.2%). Regression analyses showed that these odds remained significantly increased even following adjustment for gender, age, ethnic group, marital group, tenure, needing assistance with activities of daily living, being isolated or lonely and childhood abuse (OR= 2.6, 95%CI 1.3 to 5.2).
Past-year violence was experienced by 2.0% of older adults, compared to 9.9% of younger adults. Risk factors included non-white ethnicity, being no longer married, and being socially isolated or lonely.
Conclusions
The authors concluded that, while less likely than younger adults, violence is evident in older adults, and is associated with poor mental health, even when other adversities were controlled for. Violence in this age group was often from an intimate partner, and was more common in non-white populations, indicating ethnic inequalities.
This study suggests that, while less likely than younger adults, violence is evident in older adults, and is associated with poor mental health.
Strengths and limitations
This study addresses a key gap in the literature and in our knowledge; answering an important question about the prevalence and risk factors of violence and abuse in a population often excluded from research. A strength of this study is the use of data from the APMS (Adult Psychiatric Morbidity Survey), which uses a robust, multi-stage, national probability sample. The study also accounts for multiple potential confounders and mediators. Further, the inclusion of violence from strangers as well as partners is a strength.
However, there are several important limitations. Firstly, while it does utilise the most recently available APMS data, the data is now ten years old, and it is possible that the association between violence and CMD has changed in recent years, for instance, as a result of COVID-19 and its associated lockdowns (McNeil et al., 2023; Thiel et al., 2022), or as a result of the cost of living crisis.
Only adults living in a residential household were included in the APMS, excluding those living in temporary housing, sleeping rough, or, notably, those living in care homes or other communal or institutional care settings, which, as reported elsewhere, are at a high risk of violence (Yon et al., 2019). The latter is a large and relevant population, and this exclusion likely biases the sample, with those living independently or with family more likely to be healthy and less isolated than older adults living in care homes (Office for National Statistics 2023; Victor 2012).
Relatedly, the response rate for the survey was only 57%, potentially further biasing the population. Selection bias means that those who chose to take part in the survey may be different from those who chose not to. For instance, those with more severe health issues (who, as the authors note, are also more likely to experience violence in their lifetime), may be less likely to take part in a survey.
The APMS is a cross-sectional survey, therefore this study is unable to establish causality. Indeed, the authors note that longitudinal studies are necessary to explore causal relationships between violence and health.
The experience of violence and abuse, particularly in the past year, is very sensitive and the topic is highly stigmatised, especially among older people. There is therefore a possibility of underreporting due to lack of processing time, stigma, shame or fear of disbelief.
Finally, the APMS, for which questions relating to violence are based on the Conflicts Tactics Scale (Straus 2017), does not capture all forms of violence. Coercive control is a recognised form of violence and abuse characterised by patterns of behaviour that are intended to exert control or power over someone and has been a criminal offence since 2015. However, it is not measured in the AMPS in any way, potentially resulting in an underestimation of the prevalence of violence.
There are many limitations in this research, which may mean that violence against older people has been underreported by this study.
Implications
- Evidence suggests that older adults are exposed to violence and abuse, therefore future studies and surveys should look to include this population.
- Service providers should also strive to identify this population and provide tailored support.
- The impact of violence on mental health should be considered when supporting older adults who have experienced violence and abuse.
Service providers should screen older adults for experiences of violence and provide tailored support to this group of people.
Statement of interests
None.
Links
Primary paper
Fadeeva, A., Hashemi, L., Cooper, C., Stewart, R., & McManus, S. (2024). Violence against older people and associations with mental health: A national probability sample survey of the general population in England. Journal of affective disorders, 363, 1-7.
Other references
Breiding, M. J., Black, M. C., & Ryan, G. W. (2008). Chronic disease and health risk behaviors associated with intimate partner violence—18 US states/territories, 2005. Annals of epidemiology, 18(7), 538-544.
Chan, C. S., Sarvet, A. L., Basu, A., Koenen, K., & Keyes, K. M. (2021). Associations of intimate partner violence and financial adversity with familial homelessness in pregnant and postpartum women: A 7-year prospective study of the ALSPAC cohort. PLoS One, 16(1), e0245507.
Chandan, J. S., Thomas, T., Bradbury‐Jones, C., Taylor, J., Bandyopadhyay, S., & Nirantharakumar, K. (2020). Risk of cardiometabolic disease and all‐cause mortality in female survivors of domestic abuse. Journal of the American Heart Association, 9(4), e014580.
Elkin, M. (2021). Domestic abuse victim characteristics, England and Wales: Year ending March 2021. Office for National Statistics, 1-10.
Golding, J. M. (1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of family violence, 14, 99-132.Hämmig, O. (2019). Health risks associated with social isolation in general and in young, middle and old age. PloS one, 14(7), e0219663.
McManus, S., Walby, S., Barbosa, E. C., Appleby, L., Brugha, T., Bebbington, P. E., … & Knipe, D. (2022). Intimate partner violence, suicidality, and self-harm: a probability sample survey of the general population in England. The Lancet Psychiatry, 9(7), 574-583.
McNeil, A., Hicks, L., Yalcinoz-Ucan, B., & Browne, D. T. (2023). Prevalence & correlates of intimate partner violence during COVID-19: A rapid review. Journal of Family Violence, 38(2), 241-261.
Office for National Statistics. (2023). Older people living in care homes in 2021 and changes since 2011. Characteristics of the population aged 65 years and over living in a care home in 2021 including health, disability, ethnicity, and main language, and changes since 2011.
Paulino, A. & Ogonah, M. (2024). Mental illness is linked to being a victim and/or perpetrator of violence: time to face up to some inconvenient truths? The Mental Elf.
Straus, M. A. (2017). Measuring intrafamily conflict and violence: The conflict tactics (CT) scales. In Physical violence in American families (pp. 29-48). Routledge.
Thiel, F., Büechl, V. C., Rehberg, F., Mojahed, A., Daniels, J. K., Schellong, J., & Garthus-Niegel, S. (2022). Changes in prevalence and severity of domestic violence during the COVID-19 pandemic: A systematic review. Frontiers in psychiatry, 13, 874183.
Victor, C. R. (2012). Loneliness in care homes: a neglected area of research?. Aging health, 8(6), 637-646.
Whiting, D. (2023) Mental disorder and homicide: are rates and sentencing patterns changing? The Mental Elf.
Yon, Y., Ramiro-Gonzalez, M., Mikton, C. R., Huber, M., & Sethi, D. (2019). The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis. European journal of public health, 29(1), 58-67.
