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Abuse of power: A look into domestic violence among older people

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With a landmark study under way on domestic violence among older people, Louise Hunt investigates abuse that has long been overlooked

Domestic violence is already a hidden and complex issue but for older people there is an even greater danger that their abuse will go unnoticed.

This concern has prompted nursing lecturers Julie McGarry and Christine Simpson at the University of Nottingham
to conduct the first exploratory study on the issue. The aim is to clarify how health professionals – nurses in particular – can better support older women who have experienced domestic abuse.

Ms McGarry, who is the lead investigator says the study is important because older women’s experiences of domestic violence tend to be subsumed into the broader headline of elder abuse. As a result there is a lack of guidance on this type of domestic violence, with current RCN guidelines covering younger women and children.

‘The research is about recognising that domestic violence in later life is an issue and this will help to generate knowledge on how domestic abuse victims are being treated by health professionals,’ explains Ms McGarry.

Although men also experience domestic violence, the majority of cases involve women. The 12-month Nottingham project is working with a national charity to interview around 40 older women who have experienced such abuse.

One of the barriers to understanding how best to tackle domestic violence in older people is the lack of up-to-date and specific national research.

Jackie Barron, policy and research lead at charity Women’s Aid, which last year produced a report on domestic violence in older women, says: ‘It is virtually impossible to find out the exact numbers of women who have experienced domestic abuse
in old age.’

In 2007, a prevalence study on elder abuse undertaken by the Department of Health and Comic Relief estimated that 227,000 older people had been neglected or abused in their own homes in the previous year and that domestic violence accounted for a significant proportion of that figure.

The government’s definition of domestic violence includes physical, emotional, sexual and financial abuse by partners or family members. However, the last British Crime Survey to offer self-completion questionnaires on domestic violence to women over 59 was in 1992. It found that fewer than 4% of women over 60 said they had experienced physical abuse in their relationships, compared with 17% of 16 to 29-year-olds.

However, Ms Barron points out that older people may be more reluctant to disclose the problem. ‘Older women might feel the stigma of talking about domestic abuse more than younger women,’ she explains.

There are also many practical reasons why older women may find it harder to speak out. ‘It is much harder the longer you have been in a relationship to uproot yourself and go into a refuge and even if they do, there are very few facilities catering for older people,’ she says.

‘Their pensions may be tied to their partner’s or they may be disabled or caring for a disabled partner – who could also be abusive. There has to be recognition from nurses of the difficulties surrounding disclosure,’ she adds.

The issue also requires a perception shift on the part of the general public, says Daniel Blake, policy development manager at campaign organisation Action on Elder Abuse. ‘We live in a society that doesn’t accept that older people can be victims
of domestic violence or that older people can be abusers,’ he says.

‘Health professionals struggle to see domestic violence happening to women beyond the age of 45. They struggle to accept that they can be in intimate relationships or that people can be violent when they are older,’ he adds.

He cites anecdotal examples of older women presenting to health services with cuts and bruises and not being asked whether they have experienced domestic abuse, which nurses freely admitted was because of the women’s ages.

‘The cuts and bruises should have triggered a screening process. This would have happened if it had been a younger woman,’ he says.

Ms McGarry agrees. ‘Elder abuse tends to homogenise older people and takes out of context these women’s experiences,’
she says. ‘It covers a whole spectrum of abuse and its triggers may be completely different, such as stress or neglect, whereas this is not the same with domestic violence, which is about power relationships.’

Ms Barron says we need clearer definitions. ‘It is important that nurses separate out domestic violence as a form
of abuse. It’s got to be clear that it is the abuser who is responsible for the abuse and that it doesn’t become seen as a “frustrated carers” issue,’ she says.

‘As soon as you start focusing on the characteristics of the victim – such as if they are elderly or disabled – it starts taking responsibility away from the abuser.’

But Tracy Paine, chairperson of the RCN forum for nurses working with older people, sees no need to separate domestic abuse from elder abuse.

‘It comes under the umbrella of raising awareness of abuses experienced by vulnerable adults, particularly older people,’ she says.

She adds that it can be difficult to distinguish between the two types of abuse when the trigger for either can be some circumstances specific to older people, such as the stress of caring for a person with dementia, or financial worries.

There is, however, consensus on a need for greater clarity in nursing guidelines on domestic abuse in older people and specific training on how to address the problem.

‘Nurses should be aware of the issue and the only way to do that is through education,’ says Ms Paine.

Ms Barron hopes the Nottingham study will result in a policy of routine enquiry on domestic abuse in older people, similar to the one introduced for maternity services.

This would require health professionals working with older people to be trained in sensitive enquiry.

Routine enquiry is becoming common practice in some acute services, particularly A&E, but Ms Barron acknowledges that
it may be more difficult for community nurses to broach the subject in privacy.

She hopes that comprehensive training in how to recognise the signs of domestic abuse and in sensitive enquiry will help nurses overcome these obstacles.

Ms Barron says that while health professionals might not be aware of all the different potential abusive scenarios, they do need to be able to refer people on to services where they can access support. ‘They need to be aware of what is available in the local area and think about how the person can access them,’ she says.

‘Nurses should be aware that domestic violence does happen among older people and that the abuser may be the one who
is cared for, even if they seem fragile,’she adds.

‘If the abuser is the carer people shouldn’t make excuses for them and should believe what the abused person is saying.’

A six-point plan for nurses on tackling this abuse

  • Do not assume that because a person is older they cannot be experienceing domestic abuse or because their partner is frail they cannot be a perpetrator of such abuse

  • Be aware of the different types of abuse and how domestic violence may differ from elder abuse

  • Be aware of how to undertake sensitive enquiry that does not put the person being abused at more risk

  • Ensure you have local policies in place for identifying incidents of domestic violence and take a team approach on delivering appropriate support

  • Know what support services are available and how to access them

  • Become involved in domestic violence forums. These are run by local crime and disorder partnerships, which include representatives of PCTs, councils and the police

Click here to see this week's Update on elder abuse

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