‘No More Shame’ in disclosing and responding to violence and abuse of older women


In 2018, the World Health Organization (WHO) estimated that one in three women globally have suffered either physical and/or sexual violence from both intimate partners or non-partners in their lifetimes, with the majority perpetrated by intimate partners.1

In May 2020 the United Nations called for collective action to urgently address what they dubbed ‘the Shadow Pandemic’, drawing attention to intensified violence against women of all ages – particularly domestic violence – since the beginning of the COVID-19 pandemic.2

This dire situation has undoubtedly worsened with figures released in late April 2024 showing an almost 30% spike in the rate of Australian women killed by intimate partners and that around half of all women murdered in the 2023-24 financial year were killed by former or current intimate partners.3

Women and girls of all ages are too often victims of violence and abuse of all kinds. Older women, and especially women with disabilities, however, are often forgotten victims.4

Elder abuse can be a form of domestic or family violence and around 15% of older Australians living in the community experience elder abuse with one in six adults over 65 affected each year.5

Defined as ‘a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person’,6 elder abuse is a significant and devastating cause of physical, mental, and emotional harm.

Elder abuse can be financial, physical, psychological, sexual, and negligent.6 It diminishes quality of life and increases mortality risk by 40%.7 Elder abuse is associated with depression, anxiety, fear, and suicide,6 as well as falls and incontinence.8

While there is some variation between studies, a recent systematic review supports Australian prevalence statistics indicating that women are more vulnerable to elder abuse of any form compared to men.9 Perpetrators of elder abuse are more likely to be men, often adult sons, partners, or friends.5

As pervasive sexist attitudes and behaviours, both overt and covert, perpetuate violence against women and girls of all ages, the abuse of older women highlights the intersection and compounding impacts of sexism and ageism, as ageism is one of the core drivers of elder abuse.7

Ageism perpetuates harmful beliefs that older people are burdens on society due to misconceptions of inherent frailty, cognitive deficiency, helplessness, and weakness – misconceptions that promote the tolerance of elder abuse.10 Sexist and ageist attitudes are not only ‘out there’ in the community, but also present and harmful among health providers.11

As in the community, ageism and sexism in the health and aged care sector cannot be tolerated as this adversely impacts the ability for people who experience, or are at risk of, elder abuse to access timely, effective, and appropriate help. Isolation and stigma are also commonly felt by older women who are subjected to violence and elder abuse, which compounds difficulties in accessing supportive services and information.12

Just as being a woman is likely to increase a person’s risk of experiencing violence and abuse, other social and cultural determinants of health are also known to compound this risk.

Older people from culturally and linguistically diverse backgrounds, First Nations Peoples, people who are gender and sexually diverse, women living in non-urban areas, and with experience of homelessness are at greater risk of abuse and encounter many difficulties accessing support and assistance.13,14 These factors are likely to be compounding, increasing the risk of experiencing elder abuse.

While Australian governments have begun to take notice of the national and arguably global emergency of violence against women, stronger and more focussed action and greater funding is urgently required. Within the actions that governments and other stakeholders must take, a focus on violence and abuse experienced by older people who identify as female must not be overlooked.

Since 2021, the Australian Nursing and Midwifery Federation (ANMF) has collaborated with a team led by Professor Bianca Brijnath from the National Ageing Research Institute (NARI) and several collaborating researchers and groups on a Medical Research Future Fund project (the No More Shame study).

Our project aims to address the stigma of elder abuse that underlies the ongoing lack of detection and underreporting in healthcare settings by enhancing healthcare providers’ ability to recognise, respond, and refer suspected cases of elder abuse. The intervention implemented by the project is a co-designed training program for health providers who work with older people in subacute hospitals. It is hoped that the study will detect significant and measurable improvements in participating health providers’ knowledge and management of elder abuse and ageist attitudes; hospitals’ detection and multidisciplinary responses to elder abuse; and older people’s sense of safety, quality of life, and mental health.

Ultimately, empathy, respect and putting older people at the centre is critical to stopping this pernicious problem in our communities. While the No More Shame study does not exclusively focus on violence and elder abuse experienced by those who identify as female, it is an important contribution to knowledge in this space and will ideally underpin future work aiming to raise awareness and reduce ageism amongst those working with older people in other settings and the community more broadly, thus reducing the shame and stigma  felt by those with lived experience of  elder abuse.

References

1.         World Health Organization (WHO). Violence Against Women Prevalence Estimates, 2018 [Internet]. Geneva (CH) WHO. 2021 [Cited 3 May 2024]. Available: https://www.who.int/publications/i/item/9789240022256

2.         United Nations (UN). The Shadow Pandemic: Violence against women during COVID-19. United Nations Women [Internet]. New York (USA). 2020 [Cited 3 May 2024]. Available: https://www.unwomen.org/en/news/in-focus/in-focus-gender-equality-in-covid-19-response/violence-against-women-during-covid-19

3.         Australian Institute of Criminology. Australia sees a rise in female intimate partner homicide in new research report [Internet]. Canberra (AU) Australian Government. 2024 [Cited 3 May 2024]. Available: https://www.aic.gov.au/media-centre/news/australia-sees-rise-female-intimate-partner-homicide-new-research-report

4.         World Health Organization (WHO). WHO calls for greater attention to violence against women with disabilities and older women [Internet]. Geneva (CH) WHO. 2024 [Cited 3 May 2024]. Available: https://www.who.int/news/item/27-03-2024-who-calls-for-greater-attention-to-violence-against-women-with-disabilities-and-older-women

5.         Qu L, Kaspiew R, Carson R, Roopani D, et al. National Elder Abuse Prevalence Study: Final Report. Melbourne (AU): Australian Institute of Family Studies. 2021.

6.         The second shadow pandemic: elder abuse. The Lancet Healthy Longevity. The Lancet Healthy Longevity, Volume 2, Issue 6, e301

7.         Dong X, Simon M, De Leon CM, Fulmer T, et al. Elder self-neglect and abuse and mortality risk in a community-dwelling population. Jama. 2009 Aug 5;302(5):517-26.

8.         Ostaszkiewicz J. A conceptual model of the risk of elder abuse posed by incontinence and care dependence. International Journal of Older People Nursing. 2018 Jun;13(2):e12182.

9.         Yon, Y., Mikton, C., Gassoumis, Z. D., & Wilber, K. H. (2019). The Prevalence of Self-Reported Elder Abuse Among Older Women in Community Settings: A Systematic Review and Meta-Analysis. Trauma, Violence, & Abuse, 20(2), 245-259.

10.       Phelan A, Ayalon L. The intersection of ageism and elder abuse. In: Phelan A, editor. Advances in Elder Abuse Research: Practice, Legislation and Policy [e-book]. Switzerland: Springer Cham; 2020 [cited 2024 May 3]:11-22. Available: https://link.springer.com/book/10.1007/978-3-030-25093-5

11.      Gallo V. Ageism in nursing education: A review of the literature. Teaching and Learning in Nursing. 2019 Jul 1;14(3):208-15.

12.      Dow, B., Gahan, L., Gaffy, E. et al. Barriers to Disclosing Elder Abuse and Taking Action in Australia. J Fam Viol 35, 853–861 (2020). https://doi.org/10.1007/s10896-019-00084-w

13.      MacNeil A, Burnes D. Bridging the Gap between Homelessness in Older Adulthood and Elder Abuse: Considerations for an Age-Friendly Shelter System. J Aging Soc Policy. 2022 May 4;34(3):391-400.

14.       Kaspiew R, Carson R, Dow B, Qu L, et al. Elder abuse national research – strengthening the evidence base: research definition background paper. [Internet] Canberra (AU): Commonwealth of Australia; 2019 [cited 2024 May 3]. Available: https://apo.org.au/node/261971

Authors

Associate Professor Micah DJ Peters is the Director of the ANMF National Policy Research Unit (Federal Office) based in the Rosemary Bryant AO Research Centre, Clinical and Health Sciences, University of South Australia.

Dr Marina Cavuoto is a Clinical Neuropsychologist, Senior Research Fellow and Manager of the No More Shame trial at the National Ageing Research Institute, and adjunct Senior Research Fellow at the Turner Institute of Brain and Mental Health, Monash University.

Ms Simona Markusevska is a Research Assistant working on the No More Shame trial at the National Ageing Research Institute.

Professor Bianca Brijnath is the Director of the Social Gerontology Division at the National Ageing Research Institute, Adjunct Professor at the University of Melbourne and the University of Western Australia, and she leads the No More Shame study.

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