Older women survivors of physical and sexual violence: a systematic review of the quantitative literature

Violence, Abuse and Neglect in Older Women in Rural and Remote Areas: A Scoping Review and Prevalence Meta-Analysis

This systematic review addressed the issue of the abuse and neglect of older women (age 60 and over) in rural and remote areas, examining these phenomena's prevalence, risk and protective factors, consequences, and associated perceptions. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Arksey and O'Malley methodological framework, peer-reviewed articles published until September 2023 were identified in six electronic databases. Out of the manuscripts initially identified (n = 219), 28 articles met the selection criteria. The study's quality was assessed using the Mixed Methods Appraisal Tool. The included studies provided a comprehensive overview of this phenomenon, encompassing data from 6,579 older rural women. Prevalence rates of abuse and neglect exhibited wide variability, with an average of 27.3%. Among the risk factors, financial dependence and incapacity stood out, while higher income and education levels were protective factors, among others. Emotional/psychological abuse emerged as the most common form, with significant impacts on older women's physical and mental health. Cultural norms and gender expectations also influenced perceptions of abuse and victims' coping mechanisms. In a context in which access to specialized resources and services is hampered by significant limitations, community awareness and education prove vital to address this issue, which positions social work as key to addressing these challenges. The prevalence of abuse against older rural women is significant. Emotional abuse stands out as a major issue, underscoring the need for comprehensive interventions accounting for cultural and gender factors.

Relatively Unworthy Victims? Middle-Aged Women as Rape Survivors

This study examines how the age of female survivors impacts public perceptions of rape in China. In our online survey experiment, participants consider rape as less serious when the survivor is a middle-aged woman compared to other groups of women (younger, older, or age unknown). Participants also request shorter sentencing when the survivor is a middle-aged woman than a younger woman. In China, moral codes surrounding chastity and respect for elders lead to greater emotional responses toward rape against younger and older survivors than middle-aged survivors. Our study expands studies of rape perception by theorizing public attitudes toward middle-aged survivors.

Intimate Partner Violence, Mental Health, and Aging-Related Health Among Men and Women Veterans Across the Lifespan

BACKGROUND

A growing body of evidence suggests adverse health outcomes related to intimate partner violence (IPV), including traumatic brain injury (TBI). However, most research in this area has focused on reproductive-aged women.

OBJECTIVE

To examine relationships between IPV (with and without TBI), mental health, and aging-related health outcomes among men and women Veterans across the lifespan.

DESIGN

Cross-sectional analysis of Department of Veterans Affairs (VA) administrative data from fiscal years 2000-2019. Descriptive statistics and chi-square analyses were used to compare key comorbidities in matched samples of Veterans with and without IPV (gender-stratified and matched 1:3 based on demographics and index date). Comparisons between those with IPV and TBI relative to IPV alone were also examined.

SUBJECTS

Veterans aged 18 + with and without documented IPV in Department of Veterans Affairs (VA) electronic health records (n = 4108 men, 2824 women).

MAIN MEASURES

ICD codes were used to identify IPV, TBI, and aging-related medical (sleep disorder, hypertension, diabetes, dementia) and common psychiatric (depression, posttraumatic stress disorder, alcohol use disorder, and substance use disorder) diagnoses.

KEY RESULTS

Demographic characteristics were reflective of VA-enrolled Veterans (men: mean age 66, SD 16; 72% non-Hispanic White; women: mean age 47, SD 13; 64% non-Hispanic White). Relative to Veterans without IPV, both men and women with IPV had higher rates of all examined medical (e.g., sleep disorders, men: 33% vs. 52%; women: 45% vs. 63%) and psychiatric diagnoses (e.g., depression, men 32% vs. 74%; women 59% vs. 91%; all ps < .001), with evidence of an additive effect of TBI on some psychiatric outcomes.

CONCLUSIONS

IPV is broadly associated with aging-related and mental health, and TBI is a common correlate that may further contribute to psychiatric outcomes. Findings highlight the importance of trauma-informed care and recognizing the potential role of these exposures on men and women Veterans' health across the lifespan.

Military Sexual Trauma and Menopause Symptoms Among Midlife Women Veterans

BACKGROUND

Sexual assault and/or sexual harassment during military service (military sexual trauma (MST)) can have medical and mental health consequences. Most MST research has focused on reproductive-aged women, and little is known about the long-term impact of MST on menopause and aging-related health.

OBJECTIVE

Examine associations of MST with menopause and mental health outcomes in midlife women Veterans.

DESIGN

Cross-sectional.

PARTICIPANTS

Women Veterans aged 45-64 enrolled in Department of Veterans Affairs (VA) healthcare in Northern California between March 2019 and May 2020.

MAIN MEASURES

Standardized VA screening questions assessed MST exposure. Structured-item questionnaires assessed vasomotor symptoms (VMS), vaginal symptoms, sleep difficulty, depressive symptoms, anxiety symptoms, and posttraumatic stress disorder (PTSD) symptoms. Multivariable logistic regression analyses examined associations between MST and outcomes based on clinically relevant menopause and mental health symptom thresholds.

KEY RESULTS

Of 232 participants (age = 55.95 ± 5.13), 73% reported MST, 66% reported VMS, 75% reported vaginal symptoms, 36% met criteria for moderate-to-severe insomnia, and almost half had clinically significant mental health symptoms (33% depressive symptoms, 49% anxiety, 27% probable PTSD). In multivariable analyses adjusted for age, race, ethnicity, education, body mass index, and menopause status, MST was associated with the presence of VMS (OR 2.44, 95% CI 1.26-4.72), vaginal symptoms (OR 2.23, 95% CI 1.08-4.62), clinically significant depressive symptoms (OR 3.21, 95% CI 1.45-7.10), anxiety (OR 4.78, 95% CI 2.25-10.17), and probable PTSD (OR 6.74, 95% CI 2.27-19.99). Results did not differ when military sexual assault and harassment were disaggregated, except that military sexual assault was additionally associated with moderate-to-severe insomnia (OR 3.18, 95% CI 1.72-5.88).

CONCLUSIONS

Exposure to MST is common among midlife women Veterans and shows strong and independent associations with clinically significant menopause and mental health symptoms. Findings highlight the importance of trauma-informed approaches to care that acknowledge the role of MST on Veteran women's health across the lifespan.

Context-dependent sexual changes during women's midlife transitions

For women, midlife represents an important stage of transition, including shifts in physiological, social, and sexual experiences. Prior research demonstrates that women's sexuality is more dynamic and context-dependent than men's. Most research focused on women's sexuality in mid- to later-life emphasizes physiological changes, while largely ignoring changes stemming from social, psychological, and relational contexts. The present study examined midlife women's diverse sexual experiences within the context of their lives. We conducted semi-structured interviews with 27 women, ages 39-57, and used interpretative phenomenological analysis to investigate perceptions and interpretations of midlife sexual experiences and changes. Themes included changes in sexual engagement, unwanted sexual experiences, body image, and sexual healthcare. Participants reported changes in the frequency of sex and sexual desire within the context of their diverse social roles and identities, prior intimate relationships, and sexual health. Women contrasted perceptions of their own bodies with societal perceptions of sexiness. Frequently reported negative experiences with sexual healthcare informed a distrust of healthcare systems. The diverse and changing nature of participants' experiences supports prior evidence of sexual fluidity and context-dependence. By questioning societal expectations around sexuality and body image, participants illustrated the potential of counternarratives to combat dominant beliefs and stereotypes about midlife women's sexuality. To improve sexual health and education, psychoeducational interventions for women in midlife are needed.

Comparisons Between Young, Middle-Aged, and Older Adult Sexual and Gender Minority Male Sexual Assault Survivors

OBJECTIVE

This study compared sexual abuse histories and depressive symptoms between younger, middle-aged, and older sexual and gender minority (SGM) male survivors.

DESIGN

Participants completed a brief, online screener as part of a large comparative effectiveness psychotherapy trial.

SETTING

SGM males 18 years or older, residing in the U.S. or Canada, were recruited online.

PARTICIPANTS

This study included younger (aged 18-39; n = 1,435), middle-aged (aged 40-59; n = 546), and older (aged 60+; n = 40) SGM men who reported a history of sexual abuse/assault.

MEASUREMENTS

Participants were asked about their sexual abuse history, experience of other traumas, symptoms of depression, and past 60-day mental health treatment engagement.

RESULTS

Older SGM men reported a lower rate of occurrence of adult sexual assault, exposure to other traumas, and depression. However, older and younger groups did not differ on any childhood sexual assault variable, the frequency of or number of attackers for adult sexual assault, the frequency of accidents and other injury traumas, or the occurrence or frequency of mental health treatment. Trauma load, including childhood and adult sexual assault, were more strongly related to current depressive symptoms than age group.

CONCLUSION

While there were some age-based or cohort differences in the rates of sexual trauma, the clinical response of both groups was similar. Implications for working clinically with middle-aged and older SGM men with untreated sexual assault-related mental health difficulties are discussed, including outreach and availability of gender- and older-inclusive survivor treatment and resources.

An ecological approach to understanding the impact of sexual violence: a systematic meta-review

Aim

A systematic meta-review was conducted to examine (1) the broad range of negative and positive individual and interpersonal changes following adult sexual violence, as well as (2) the risk/protective factors at multiple levels of the social ecology (e.g., individual, assault, and micro/meso/exo/macro/chronosystem factors)-influencing the impact of sexual violence.

Methods

Searches of Web of Science, Pubmed, and ProQuest resulted in inclusion of 46 systematic reviews or meta-analyses. Review findings were extracted for summary and a deductive thematic analysis was conducted.

Results

Experiencing sexual violence is associated with many negative individual and sexual difficulties as well as revictimization risk. Only a limited number of reviews reported on interpersonal and positive changes. Factors at multiple levels of the social ecology play a role in the intensity of these changes. Reviews including macrolevel factors were non-existent, however.

Conclusion

Reviews on sexual violence are fragmented in nature. Although the use of an ecological approach is often lacking, adopting such a perspective in research is necessary for a fuller understanding of the multiple influences on survivor outcomes. Future research should evaluate the occurrence of social and positive changes following sexual violence, as well as the role of macrolevel factors in influencing post-assault outcomes.

Recovering the Lost Soul: Older Women's Reflections on Past Intrafamilial Child Sexual Abuse

Intrafamilial child sexual abuse (IFCSA) is a social problem with longstanding effects on victims' lives. While scholarly literature has focused on the adverse aftermath of sexual abuse, only a few studies have acknowledged older women's perspectives on their experience of IFCSA and their journey of healing and recovery. The aim of the present study was to explore how older survivors of IFCSA construct and shape their experience of healing in later life and the meaning they assign to this process. Narrative inquiry was selected to explore the narratives of 11 older women survivors of IFCSA. Participants were interviewed using a biographical narrative interviewing method. The narratives were then transcribed and analyzed using thematic, structural, and performance analyses. Four major themes emerged from the participants' narratives: Achieving closure; Spiritual framing of IFCSA as a platform for self-growth; Becoming whole in old age; and Looking to the future after IFCSA. During the aging years, IFCSA survivors may redefine their identity and their place in the world. Using life review processes, older women in this study were striving to heal and reconcile with their past.

Only "yes" means "yes": Negotiation of Sex and Its Link With Sexual Violence

Lack of consent is an essential characteristic of sexual violence. The present study was conducted to analyze the relation between sexual consent and the risk of perpetrating sexual aggression by men and victimization suffered by women in more depth. The sample consisted of 1681 heterosexual Spanish men and women aged 18-66 years. The participants completed an online survey containing the Spanish versions of the Sexual Consent Scale Revised and the Sexual Experiences Survey. The results showed that 70.2% of the women had been sexual victims, and 20.8% of men reported having perpetrated sexual violence. On the one hand, sexual aggressors, unlike non aggressors, underestimated the relevance of obtaining sexual consent, and more aggressors reported lack of perceived behavioral control for requesting sexual consent and endorsed less positive attitudes to obtain sexual consent than non aggressors. On the other hand, sexual victims, compared to non victims, considered requesting explicit sexual consent relevant, but held certain ideas, attitudes, and behaviors that did not go along with obtaining sexual consent, which leaves women in a position of vulnerability.

An Exploratory Analysis of Harassment in Adult Sexual Assault Cases

Little is known about victims' experiences with the perpetrator after they report a sexual assault. This study examined harassment of sexual assault victims during the prosecution process utilizing case notes from a large, southern District Attorney's office. Specifically, harassment cases were compared to cases where no harassment was reported by the victim. We found that approximately 15% of victims vocalized harassment by the defendant, his family, or friends. The results detail characteristics and factors related to how harassment was carried out in these cases. These findings unveil the importance of communicating with victims during the prosecution process and suggest control balance theory to be an appropriate lens through which to view harassing behavior.

Post-traumatic Stress Disorder in Older U.S. Military Veterans: Prevalence, Characteristics, and Psychiatric and Functional Burden

OBJECTIVE

To characterize the prevalence, characteristics, and comorbidities of subthreshold and full post-traumatic stress disorder (PTSD) in older U.S. military veterans.

DESIGN AND SETTING

A nationally representative web-based survey of older U.S. military veterans who participated in the National Health and Resilience in Veterans Study (NHRVS) between November 18, 2019 and March 8, 2020.

PARTICIPANTS

U.S. veterans aged 60 and older (n = 3,001; mean age = 73.2, SD: 7.9, range: 60-99).

MEASUREMENTS

PTSD was assessed using the PTSD Checklist for DSM-5. Self-report measures assessed sociodemographic characteristics, trauma exposures, suicidal behaviors, psychiatric and substance use disorders, as well as mental, cognitive, and physical functioning. Multivariable analyses examined correlates of subthreshold and full PTSD.

RESULTS

The vast majority of the sample (n = 2,821; 92.7%) reported exposure to one or more potentially traumatic events. Of those exposed to such events, 262 (9.6%, 95% confidence interval [CI]: 8.4%-10.9%) and 68 (1.9%, 95% CI: 1.3%-2.6%) screened positive for subthreshold and full PTSD, respectively. The prevalence of subthreshold and full PTSD was significantly higher in female veterans and veterans who use VA as their primary healthcare. Subthreshold and full PTSD groups endorsed more adverse childhood experiences and total traumas than the no/minimal PTSD symptom group, the most common traumatic experiences endorsed were combat exposure, physical or sexual assault, and life-threatening illness or injury. Veterans with subthreshold and full PTSD were also more likely to screen positive for depression, substance use disorders, suicide attempts, nonsuicidal self-injury, and suicidal ideation, and reported lower mental, cognitive, and physical functioning.

CONCLUSION

Subthreshold PTSD and full PTSD are prevalent and associated with substantial clinical burden in older U.S. veterans. Results underscore the importance of assessing both subthreshold and full PTSD in this population.

Trauma, Post-Traumatic Stress Disorder, and Treatment Among Middle-Aged and Older Women in the Nurses' Health Study II

OBJECTIVE

Trauma and post-traumatic stress disorder (PTSD) are common among women and associated with negative health outcomes across the life course. Relatively few studies, however, have examined the epidemiology of trauma, PTSD, and treatment among middle-aged and older civilian women, who are at elevated risk for adverse health outcomes. We aimed to characterize trauma, PTSD, and trauma-related treatment prevalence and correlates in a large cohort of middle-aged and older women.

DESIGN

Cross-sectional, nested substudy within the Nurses' Health Study II cohort.

SETTING

United States, 2018-2020.

PARTICIPANTS

33,327 current or former nurses, aged 53-74 years.

MEASUREMENTS

16-item modified version of the Brief Trauma Questionnaire; modified PTSD Checklist for the Diagnostic and Statistical Manual, Version 5.

RESULTS

The majority (82.2%) of women reported one or more lifetime traumas. The most common trauma types were unexpected death of a loved one (44.9%) and interpersonal violence (43.5%). Almost 30% reported occupational (nursing-related) trauma. Among the trauma-exposed, 10.5% met criteria for lifetime PTSD and 1.5% had past-month PTSD. One-third of lifetime PTSD cases were due to interpersonal violence event types. One-third of women with lifetime PTSD-and nearly half of those with PTSD from a nursing-related trauma-reported never receiving trauma-related treatment. Women aged 65 years and older with PTSD were less likely to be in treatment than those aged less than 65 years.

CONCLUSION

History of trauma and PTSD is prevalent in this population, and a treatment gap persists. Addressing this treatment gap is warranted, particularly among older women and those with nursing-related trauma.

Bridging the Gap between Homelessness in Older Adulthood and Elder Abuse: Considerations for an Age-Friendly Shelter System

Homelessness and elder abuse are two major public health issues affecting older adults that are increasing in scope due to global population aging. While these issues have typically been examined separately, this commentary considers the often overlooked intersection between homeless older people and victims of elder abuse through two pathways: (1) the systemic abuse of older adults in the shelter system; and (2) the role of elder abuse as a possible risk factor for homelessness in later life. Strategies for the development of shelter systems that support the diverse needs of an aging population are proposed.

Protection against Sexual Violence in the Colombian Legal Framework: Obstacles and Consequences for Women Victims

Sexual violence is a type of gender-based violence (GBV), as it is one of the different types of violence that is exerted against women. Sexual violence infringes fundamental human rights, and denies women’s dignity and self-determination, personal development, and well-being. Despite international treaties and a regulatory framework that legally protects Colombian women against sexual violence, it is necessary to know the effectiveness of this regulatory framework in Colombia. Therefore, the main objective of this research is to examine criminal legislation on crimes of sexual violence in Colombia with a dual purpose: first, to analyze procedural guarantees for women victims of sexual violence; second, to determine obstacles for victims of sexual violence in accordance with the legal framework. We used a legal interpretation method to perform an analysis and interpret the law. The results found that, although sexual violence is considered a type of crime, procedural guarantees are not effective as victims encounter serious obstacles with negative consequences, such as the violation of fundamental human rights.

Post-traumatic Stress Disorder in Middle Age and Beyond

OBJECTIVE

To review the clinical manifestations and treatment of post-traumatic stress disorder (PTSD) in adults and older people.

DATA SOURCES

Articles indexed in PubMed, Embase, psychology databases, and the Cochrane library over the past 10 years using the key words "post-traumatic stress disorder," "stress disorders," and "post-traumatic stress disorder and treatment."

STUDY SELECTION AND DATA EXTRACTION

Sixty-seven publications were reviewed and criteria supporting the primary objective were used to identify useful resources.

DATA SYNTHESIS

The literature included practice guidelines; review articles; original research articles; and product prescribing information for the clinical manifestations, diagnosis, and treatment of PTSD.

CONCLUSION

Psychotherapy is the first-line therapy for PTSD. Pharmacologic therapy is recommended, as second-line therapy, for adults living with PTSD who do not have access to psychotherapy or refuse psychotherapy. Pharmacologic therapy may also be considered in cases of partial, or no, response to psychotherapy. Current guidelines recommend prescribing one of 3 selective serotonin-reuptake inhibitors, either fluoxetine, paroxetine, or sertraline, or prescribing the serotonin norepinephrine reuptake inhibitor venlafaxine, for adult patients who do not have access to psychotherapy or prefer not to use psychotherapy. Unfortunately, these recommended medications have additional cautions for use in older people so may not be appropriate for many older people living with PTSD. Therapy for older people should be tailored to patient-specific symptoms, with careful consideration of the potential benefits and risks of the therapy and coexisting medical conditions of each patient.

Family Violence: An Insight Into Perspectives and Practices of Australian Health Practitioners

Family violence is threatening behavior carried out by a person to coerce or control another member of the family or causes the family member to be fearful. Health practitioners are well placed to play a pivotal role in identifying and responding to family violence; however, their perceived capacity to respond to patients experiencing family violence is not well understood. We aim to explore Australian health practitioners' current perspectives, practices, and perceived barriers in working with family violence, including perceived confidence in responding effectively to cases of family violence encountered during their work with patients. A total of 1,707 health practitioners primarily practicing in the wider Melbourne region were identified, and 114 health practitioners participated in the study between March 2016 and August 2016 by completing an investigator-developed questionnaire. Descriptive, qualitative, and thematic analyses were performed. The majority of participants recognized family violence to be a health issue and that family violence would impact the mental health of afflicted persons. Despite this, only a fifth of participants felt they were very confident in screening, supporting, and referring patients with family violence experiences. Perceived barriers to inquire about family violence included time constraints and greater importance placed on screening for other health issues. Health practitioners reported that additional training on screening, supporting, and referring patients would be beneficial. Australian health practitioners need to be upskilled. Recently, in Australia, state-relevant toolkits have been developed to provide succinct information about responding to initial patient presentations of family violence, how to inquire about family violence, and how to handle disclosures (and nondisclosures) by patients. Further resources could be developed to aid health practitioners in providing assistance to their patients as indicated. These initiatives would be a step toward addressing the concerns with regard to the lack of training and could possibly optimize outcomes for patients experiencing family violence.

[Socio-demographic determinants of violence in older people in Ecuador]

BACKGROUND AND OBJECTIVE

Older adults are at increased risk of violence. In order to prevent this, it is necessary to identify associated risk factors. The objective of the present study was to determine the association between violence and various socio-demographic factors (age, gender, ethnic group, level of education, and place of residence) in older adults.

MATERIAL AND METHODS

Cross-sectional study that included participants from the SABE-Ecuador study, who were selected through probabilistic sampling and came from all over the national territory. Data were analysed with R using ordinal logistic regression models.

RESULTS

Sample included 4321 older adults, women (52%) and men (48%), with a mean age of 72 years (SD 8). Having suffered violence was reported in 21.3% (n = 922) of older adults. It was observed that the odds of suffering violence was lower in men than in women (OR = 0.753, p< .001), decreased as age increased (OR = 0.989, p = .012) and decreased as level of education increased (primary vs. no education OR = 0.866, p = .001; secondary vs. no education OR = 0.622, p = .003; higher vs. no education OR = 0.323, p< .001).

CONCLUSIONS

Being a woman and having a low level of education is associated with an increased risk of violence in older adults. Reducing gender gap and improving access to education for older adults could reduce their risk of violence.

Victimization Experiences and Well-Being in Adulthood: A Systematic Review and Meta-Analysis

Scientific research has explored the impact of violence during adulthood on psychopathology. Fewer efforts have been made from a positive theoretical framework, and no systematic evidence has been provided. This manuscript describes a literature review and meta-analysis on the relationship between victimization experiences and well-being in adulthood. A literature review was performed, and 27 studies met the inclusion criteria for the systematic review 16 for the meta-analysis. The meta-analysis yielded a medium and significant overall effect size (r = -0.309, p < .001), which indicated that greater victimization experiences partly explain lower well-being outcomes. A set of theoretical and methodological issues are discussed, specifically considering the conceptualization of victimization and well-being as well as the studies design, sample characteristics, measures, and data analysis. Derived from this integrative discussion, some recommendations are also provided for future research.

Violence against older women: A systematic review of qualitative literature

The majority of the existing evidence-base on violence against women focuses on women of reproductive age (15–49), and globally there is sparse evidence concerning patterns of and types of violence against women aged 50 and older. Improved understanding of differing patterns and dynamics of violence older women experienced is needed to ensure appropriate policy or programmatic responses. To address these gaps in the evidence, we conducted a systematic review of qualitative literature on violence against older women, including any form of violence against women, rather than adopting a specific theoretical framework on what types of violence or perpetrators should be included from the outset, and focusing specifically on qualitative studies, to explore the nature and dynamics of violence against older women from the perspective of women. Following pre-planned searches of 11 electronic databases, two authors screened all identified titles, abstracts and relevant full texts for inclusion in the review. We extracted data from 52 manuscripts identified for inclusion, and conducted quality assessment and thematic synthesis from the key findings of the included studies. Results indicated that the vast majority of included studies were conducted in high-income contexts, and did not contain adequate information on study setting and context. Thematic synthesis identified several central themes, including the intersection between ageing and perceptions of, experiences of and response to violence; the centrality of social and gender norms in shaping older women’s experiences of violence; the cumulative physical and mental health impact of exposure to lifelong violence, and that specific barriers exist for older women accessing community supports and health services to address violence victimization. Our findings indicated that violence against older women is prevalent and has significant impacts on physical and mental well-being of older women. Implications for policy and programmatic response, as well as future research directions, are highlighted.

Association of Health Conditions and Health Service Utilization With Intimate Partner Violence Identified via Routine Screening Among Middle-Aged and Older Women

IMPORTANCE

The US Preventive Services Task Force recently determined that there is insufficient evidence to recommend routine screening for intimate partner violence (IPV) in women who are middle-aged and older. Certain Veterans Health Administration (VHA) clinics have been routinely screening women of all ages for IPV since 2014.

OBJECTIVES

To examine the proportion of women older than childbearing age (ie, ≥45 years) who have positive results when routinely screened for past-year IPV at VHA clinics and to evaluate the associations of a positive screening result with health conditions and health service utilization.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included 4481 women aged 45 years and older who were screened for past-year IPV in 13 VHA outpatient clinics in 11 states between April 2014 and April 2016. Data analysis was conducted from March 2019 to August 2019.

EXPOSURE

Positive screening result for past-year IPV.

MAIN OUTCOMES AND MEASURES

Mental and physical health conditions (identified using International Classification of Diseases, Ninth Edition [ICD-9] and ICD-10 codes from VHA medical record data) and VHA health services utilization (identified using inpatient and outpatient VHA encounter data) in the 20 months after screening.

RESULTS

In this study, 2937 of 4481 women (65.5%) were middle-aged (ie, aged 45 to 59 years), and 1544 (34.5%) were older (ie, aged ≥60 years), with 1955 (43.6%) black participants. A total of 255 middle-aged women (8.7%; mean [SD] age, 51 [4] years) and 79 older women (5.1%; mean [SD] age, 64 [5] years) screened positive for past-year IPV. In adjusted logistic regression models among middle-aged women, screening positive for IPV was associated with subsequent diagnoses of anxiety (adjusted odds ratio [aOR], 2.00; 95% CI, 1.50-2.70; P < .001), depression (aOR, 2.30; 95% CI, 1.80-3.00; P < .001), posttraumatic stress disorder (aOR, 2.30; 95% CI, 1.80-3.00; P < .001), suicidal ideation and/or behavior (aOR, 3.80; 95% CI, 2.10-6.90; P < .001), and substance use disorder (aOR, 2.50; 95% CI, 1.80-3.50; P < .001). Similar but attenuated associations were seen for older women (eg, substance use disorder: aOR, 2.20; 95% CI, 1.10-4.40; P = .04). In adjusted negative binomial regression models among middle-aged women, screening positive for IPV was associated with a higher rate of subsequent psychosocial (eg, mental health) visits (adjusted rate ratio [aRR], 2.40; 95% CI, 2.00-2.90; P < .001), primary care visits (aRR, 1.20; 95% CI, 1.10-1.30; P < .001), and emergency department visits (aRR, 1.50; 95% CI 1.20-1.80; P < .001). Older women screening positive for IPV had a higher rate of psychosocial visits (aRR, 1.90; 95% CI, 1.30-2.70; P < .001) but not of other visit types.

CONCLUSIONS AND RELEVANCE

To our knowledge, this study was the largest to evaluate routine screening for IPV among women aged 45 years and older, and it found that IPV remained prevalent and was associated with morbidity for these women. Screening for IPV in women older than 44 years may improve detection and provision of evidence-based services to this growing population.

Military Sexual Trauma in Older Women Veterans: Prevalence and Comorbidities

BACKGROUND

Recent attention has highlighted the common occurrence and health consequences of military sexual trauma (MST) in younger women veterans. However, almost nothing is known about MST in older veterans.

OBJECTIVE

To describe MST among older women veterans, including prevalence and common comorbidities.

DESIGN

Cross-sectional observational study, using data from national Department of Veterans Affairs medical records.

PARTICIPANTS

Population-based sample of women Veterans aged 55+ with at least one documented MST screen response and at least one clinical encounter in fiscal years 2005-2015.

MAIN MEASURES

MST screen: medical diagnoses (diabetes, hypertension, hyperlipidemia, myocardial infarction, cerebrovascular disease, congestive heart failure, obesity, chronic pain conditions, back pain, dementia, insomnia, sleep apnea, menopause symptoms) and mental health diagnoses (anxiety, depression, posttraumatic stress disorder, tobacco use, alcohol use disorder, substance use disorder, opioid use disorder, suicidal ideation) from International Classification of Diseases, Ninth Revision Clinical Modification codes in the medical record.

KEY RESULTS

In this cohort of older women veterans (n = 70,864, mean age 65.8 ± 10.4 years), 13% had a positive MST screen. In multivariable regression analyses adjusted for age, race/ethnicity, and marital status, MST was strongly associated with most mental health diagnoses, particularly posttraumatic stress disorder (OR 7.25, 95% CI 6.84-7.68), depression (OR 2.39, 95% CI 2.28-2.50), and suicidal ideation (OR 2.42, 95% CI 2.08-2.82). MST was also associated with multiple medical conditions, particularly sleep disorders (insomnia OR 1.61, 95% CI 1.43-1.82; sleep apnea OR 1.48, 95% CI 1.37-1.61) and pain (chronic pain OR 1.58, 95% CI 1.50-1.67; back pain OR 1.40, 95% CI 1.34-1.47).

CONCLUSIONS

A history of MST is common among older women veterans and associated with a range of medical and mental health diagnoses. These findings call attention to the need for additional research in this understudied population, and the importance of trauma-informed care approaches for women across the lifespan.

Associations of Intimate Partner Violence, Sexual Assault, and Posttraumatic Stress Disorder With Menopause Symptoms Among Midlife and Older Women

Importance

Little is known about the prevalence of traumatic exposures among midlife and older women and the association of these traumatic exposures with health issues.

Objective

To examine the associations of intimate partner violence (IPV), sexual assault, and posttraumatic stress with menopause symptoms among midlife and older women.

Design, Setting, and Participants

A cross-sectional analysis of data from a multiethnic cohort of 2016 women 40 to 80 years of age in the Kaiser Permanente Northern California health care system was conducted from November 15, 2008, to March 30, 2012. Statistical analysis was conducted from June 8, 2016, to September 6, 2017.

Exposures

Lifetime physical or emotional IPV, sexual assault, and current symptoms of posttraumatic stress disorder, assessed with standardized questionnaires.

Main Outcomes and Measures

Difficulty sleeping, vasomotor symptoms, and vaginal symptoms, assessed with standardized questionnaires.

Results

Among the 2016 women enrolled, the mean (SD) age was 60.5 (9.5) years, and 792 of 2011 with race/ethnicity data (39.4)% were non-Latina white (403 [20.0%] Latina, 429 [21.3%] black, and 387 [19.2%] Asian). Lifetime emotional IPV was reported by 423 women (21.0%), lifetime physical IPV was reported by 316 women (15.7%), sexual assault was reported by 382 women (18.9%), and 450 of 2000 women (22.5%) had current clinically significant symptoms of posttraumatic stress disorder. In multivariable analyses adjusted for age, race/ethnicity, educational level, body mass index, menopause status, hormone therapy, and parity, symptoms of posttraumatic stress disorder were associated with difficulty sleeping (odds ratio [OR], 3.02; 95% CI, 2.22-4.09), vasomotor symptoms (hot flashes: OR, 1.69; 95% CI, 1.34-2.12; night sweats: OR, 1.72; 95% CI, 1.37-2.15), and vaginal symptoms (vaginal dryness: OR, 1.73; 95% CI, 1.37-2.18; vaginal irritation: OR, 2.20; 95% CI, 1.66-2.93; pain with intercourse: OR, 2.16; 95% CI, 1.57-2.98). Emotional IPV was associated with difficulty sleeping (OR, 1.36; 95% CI, 1.09-1.71), night sweats (OR, 1.50; 95% CI, 1.19-1.89), and pain with intercourse (OR, 1.60; 95% CI, 1.14-2.25). Physical IPV was associated with night sweats (OR, 1.33; 95% CI, 1.03-1.72). Sexual assault was associated with vaginal symptoms (vaginal dryness: OR, 1.41; 95% CI, 1.10-1.82; vaginal irritation: OR, 1.42; 95% CI, 1.04-1.95; pain with intercourse: OR, 1.44; 95% CI, 1.00-2.06).

Conclusions and Relevance

Lifetime history of IPV or sexual assault and current clinically significant symptoms of posttraumatic stress disorder are common and are associated with menopause symptoms. These findings highlight the need for greater recognition of these exposures by clinicians caring for midlife and older women.

Using Prolonged Exposure With an Older Male U.S. Veteran With Childhood Sexual Abuse-Related PTSD

Older adults have generally not been included in randomized clinical trials of psychotherapy for posttraumatic stress disorder (PTSD). Of the case reports and treatment outcome studies that have included those aged 55 and older, most did not include men with sexual abuse-related PTSD. This case report presents the successful application of Prolonged Exposure (PE) to a 58-year-old single, Caucasian noncombat U.S. Army veteran with severe, chronic PTSD related to several sexual assaults, including childhood sexual abuse. PE is a manualized, short-term, evidence-based psychotherapy for the treatment of PTSD which involves psychoeducation, breathing retraining, in vivo exposure, and imaginal exposure. PTSD and depressive symptoms demonstrated clinically meaningful improvement during the course of treatment. In addition, he experienced significant improvement in quality of life as well as meaning and purpose from baseline to posttreatment. Implications for clinically working with older men with untreated childhood sexual abuse-related PTSD later in life are presented. Future research directions are discussed.

A framework for polyvictimization in later life

This article provides a context and overview for what is known about polyvictimization in later life. Drawing from previous literature, the article includes a definition of the phenomenon, as well as theoretical constructs by which it may be understood. We place other forms of polyvictimization within the context of elder abuse, recognize frameworks for conceptualizing polyvictimization in later life, and distinguish between polyvictimization at younger ages and polyvictimization in later life. The paper concludes with implications of the framework for research, practice, and policy.

Sexual Assault and Justice for Older Women: A Critical Review of the Literature

This article provides a critical review of current literature on the sexual assault of older women-including an exploration of the specific features and emotional and physical impacts of older women's experiences-and highlights current gaps and future directions for research, practice, and theory. A review of the literature indicates that older women constitute only a small proportion of victim/survivors. However, there is evidence to suggest that existing research underestimates the extent of this issue. Older women face particular barriers to disclosure and accessing the justice system, resulting in their experiences remaining hidden. Many of these barriers also contribute toward older women's experiences being ignored, dismissed, or downplayed by potential bystanders. These barriers are explored in depth in this article and include cultural context, ageism, cognitive and health impairments, and living in a residential care setting. Responding to, and preventing, the sexual assault of older women requires a tailored approach-and we currently lack sufficient insight to develop appropriate responses. In closing, this article considers how we might work toward achieving "justice" for older women victim/survivors.

Patterns of Smoking and Unhealthy Alcohol Use Following Sexual Trauma Among U.S. Service Members

In the first known longitudinal study of the topic, we examined whether experiencing sexual assault or sexual harassment while in the military was associated with increased risk for subsequent unhealthy alcohol use and smoking among U.S. service members in the Millennium Cohort Study (2001-2012). Adjusted complementary log-log models were fit to estimate the relative risk of (a) smoking relapse among former smokers (men: n = 4,610; women: n = 1,453); (b) initiation of unhealthy alcohol use (problem drinking and/or drinking over recommended limits) among those with no known history of unhealthy alcohol use (men: n = 8,459; women: n = 4,816); and (c) relapse among those previously reporting unhealthy alcohol use (men: n = 3,487; women: n = 1,318). Men who reported experiencing sexual assault while in the military had sixfold higher risk for smoking relapse: relative risk (RR) = 6.62; 95% confidence interval (CI) [2.34, 18.73], than men who did not. Women who reported experiencing sexual assault while in the military had almost twice the risk for alcohol relapse: RR = 1.73; 95% CI [1.06, 2.83]. There were no other significant associations. These findings suggest that men and women may respond differently following sexual trauma, and support future concerted policy efforts by military leadership to prevent, detect, and intervene on sexual assault.

Woman to Woman (W2W): Adapting an HIV risk reduction intervention for older women

Woman to Woman (W2W) is a novel adaptation of the Sisters Informing Sisters about Topics on AIDS (SISTA) HIV prevention program. This article describes the process of adapting and piloting W2W based on recommendations from existing HIV prevention research. Six older women, all of whom had histories of homelessness and the majority of whom identified as African American, enrolled in the study, which piloted the adapted intervention and materials, evaluated the acceptability of the program, and assessed the measures related to the intervention. Participants described satisfaction with the program and had high rates of attendance; observations regarding the measures suggest the need to further develop assessments of HIV knowledge, condom use self-efficacy, and risk behaviors in this context.

Older Adults with PTSD: Brief State of Research and Evidence-Based Psychotherapy Case Illustration

Although lifetime exposure to potentially traumatic events among older adults is fairly high, rates of full-blown post-traumatic stress disorder (PTSD) are estimated at about 4.5%, a rate lower than that for middle-aged and young adults. Nevertheless, PTSD seems to be an under-recognized and under-treated condition in older adults. Assessment and treatment can be challenging in this population for various reasons, including potential cognitive or sensory decline and comorbid mental and physical disorders. This article provides highlights of the empirical research on PTSD in late life, including information on its effects on cognition and physical health. The bulk of this piece is spent on reviewing the theory, description of, and efficacy for an evidence-based psychotherapy, Prolonged Exposure (PE), for PTSD. A detailed successful application of PE with an older veteran with severe, chronic PTSD in the Department of Veterans Affairs Health Care System is presented. Evidence-based psychotherapy for PTSD can be safely and effectively used with older individuals.

Older women, intimate partner violence and mental health: a consideration of the particular issues for health and healthcare practice

AIMS AND OBJECTIVES

To explore qualitative evidence in older women with a history of intimate partner violence and their accounts and experiences of mental health.

BACKGROUND

Intimate partner violence significantly impacts the health and well-being of women who experience it. However, women who experience intimate partner violence do not form a homogenous group and the effect on older women has not been adequately distinguished. While there is a growing body of evidence to address this deficit, studies to date have tended to concentrate on older women's experiences of intimate partner violence in totality and as such mental health issues have been subsumed as a part of the whole.

DESIGN

Meta-ethnographic synthesis of qualitative evidence.

METHODS

A systematic search of PUBMED, Cumulative Index to Nursing and Allied Health Literature, COCHRANE, Medline and PsycInfo, Sci was completed. The search included articles published up until the end of December 2015.

RESULTS

The review identified that intimate partner violence exerts a significant impact on the mental health of older women. Intimate partner violence for women in later life is inherently complex, especially where the boundaries of violence and vulnerability have been blurred historically both within the intimate partner violence discourse and through provision and practice.

CONCLUSIONS

This study adds to the developing knowledge and understanding of intimate partner violence for older women as a part of the growing body of evidence of the impact of intimate partner violence on the health and well-being of those who experience abuse more generally. When age and gender intersect with intimate partner violence, there are specific implications and health professionals and service providers need to be aware of these.

RELEVANCE TO CLINICAL PRACTICE

urses and healthcare professionals are professionally accountable for the effective management and support of women who have experienced abuse. It is therefore crucial that they are able to understand and identify the possible complexity of presentations of abuse and this includes older women.

Trauma and PTSD in older adults: Prevalence, course, concomitants and clinical considerations

This review presents recent empirical developments on Posttraumatic Stress Disorder (PTSD) in older adults, highlighting some of the most interesting lines of investigation that have taken place over the past few years. The majority of the extant literature has focused on male veterans or former prisoners of war, Caucasians, and those from the United States. Major advances have taken place in terms longitudinal investigations of representative samples of veterans and their health and functioning in relation to traumatic exposure. The current review explores the prevalence and impact, course and associated consequences, as well as available treatment for older adult survivors of traumatic experiences in an effort to increase education and awareness to improve overall health and functioning among this population.

Correlates of psychological distress among urban trauma-exposed adults: Influence of age and coping preferences

OBJECTIVE

This article examines direct and moderating effects of age on coping preferences for psychological distress among a sample of trauma-exposed adults to inform treatment approaches for this population.

METHOD

Using data from a community survey of trauma-exposed, urban-dwelling adults (n = 181), direct and moderating effects of coping preferences on the relationship between age and psychological distress were examined using hierarchical linear regression.

RESULTS

Direct effects with distress were supported for age, gender, and coping preferences of avoidance and positive reframing. No direct effects with problem-focused coping were present; however, a significant interaction resulted with the relationship between age and level of reported distress.

DISCUSSION

Problem-focused coping may provide a buffering effect on experiences with distress for older trauma-exposed adults. Findings highlight the benefits of directive and action-oriented approaches to care for aging adults. Implications for future intervention research and clinical considerations for treating trauma over the life course are discussed. (PsycINFO Database Record

Risk and Protective Factors for Depressive Symptoms Among Indigenous Older Adults: Intimate Partner Violence (IPV) and Social Support

Research on depression and intimate partner violence (IPV) experienced by Indigenous older adults is virtually nonexistent. Given the associations between IPV and depression and their disproportionately high rates among Indigenous peoples in a context of historical oppression, the purpose of this inquiry is to examine how IPV and social support are associated with depressive symptoms for Indigenous older adults. We expand the knowledge base on IPV in later life, which primarily focuses on female samples, by including older men. We predicted: (a) IPV will be positively associated with depressive symptoms and (b) levels of social support will be negatively associated with depressive symptoms. Hierarchical regression analyses of data from a sample of Indigenous older adults (N = 233) in the Upper Midwest indicated that physical aggression (but not psychological aggression, sexual coercion, injury, or negotiation) was positively associated with depressive symptoms, whereas social support was negatively associated with depressive symptoms.

Exploring the Impact of Childhood Abuse on HIV Social and Attitudinal Factors Among Adults With and Without this History in Sub-Saharan Africa: Findings from NIMH Project Accept (HPTN 043)

Using data from four sites in three African countries, this community randomized study examined the association between childhood sexual and/or physical abuse (CSA and/or CPA) and HIV disclosure, HIV-related stigma, stress, and social support among adults with and without a history of abuse. A history of abuse among men was associated with higher levels of adult-reported stress and HIV-related stigma, and with significantly lower rates of HIV test result disclosure to current partners. Women with a history of CSA and/or CPA had significantly higher perceived stigma, discrimination and stress. Although childhood abuse was significantly associated with adult stress and stigmatization, participants with histories of CSA and/or CPA also reported significantly higher perceived social support compared to people without such experiences. These findings may reflect support received in response to disclosure of CSA or CPA or emotional ambivalence in relationships that have been found to be associated with child abuse. We conclude that it is critical for HIV prevention interventions to advocate for the primary prevention of child abuse, for early identification of adolescents and adults who report experiencing childhood abuse, and to address stigma and stress-related attitudinal, behavioral and relationship difficulties experiences as an aftermath of early abuse that increase their risk of HIV.

Posttraumatic stress symptoms, co-morbid psychiatric symptoms and distorted cognitions among flood victims of different ages

BACKGROUND

In literature, the effect of age on posttraumatic stress disorder (PTSD) is inconclusive; the effect on flood-related PTSD is particularly unclear. Little is known on distorted cognitions among flood victims, although cognition distortions and PTSD have been linked among victims of other traumas.

AIMS

To investigate: (1) whether flood-related PTSD, psychiatric co-morbidity and cognitive distortions would differ according to age and (2) distinctive patterns of association between the preceding variables for different age groups.

METHODS

One hundred and fifty-four flood victims of different ages completed standardized questionnaires measuring PTSD, psychiatric co-morbidity and cognitive distortions.

RESULTS

Adolescents and young adults reported significantly fewer PTSD, psychiatric co-morbidity and distorted cognition symptoms than people who were older. Preoccupation with danger and hopelessness were associated with both outcomes for adolescents, people in their thirties and middle-aged/older people. For young adults, helplessness was associated with PTSD; hopelessness and preoccupation with danger with psychiatric co-morbidity.

CONCLUSIONS

Adolescents and young adults buffered against flood-related psychological distress better than older people. Distorted cognitions related to distress outcomes differently depending on age.

Sleep Disturbances in the Elderly

Sleep disturbances are a common presenting symptom of older-age adults to their physicians. This article explores normal changes in sleep pattern with aging and primary sleep disorders in the elderly. Behavioral factors and primary psychiatric disorders affecting sleep in this population are reviewed. Further discussion examines sleep changes associated with 2 common forms of neurocognitive disorder: Alzheimer disease and Lewy Body Dementia. Common medical illnesses in the elderly are discussed in relation to sleep symptoms. Nonpharmacological and pharmacologic treatment strategies are summarized, with emphasis placed on risk of side effects in older adults. Future targets are considered.

The Role of Religious Involvement in the Relationship Between Early Trauma and Health Outcomes Among Adult Survivors

The purpose of this study was to determine the role of religious involvement and related indicators - religious coping, intrinsic religiosity, forgiveness and gratitude - in reducing the negative impact of early traumatic stress on the mental and physical health of adult survivors. Multiple linear regressions were used to analyze self-reported data of 10,283 Seventh-day Adventist men and women across North America. The study also included an original analysis on a subsample (n = 496) of the larger group, examining diabetes risk factors in conjunction with Adverse Childhood Events (ACE) data. Higher early trauma scores were associated with decreased mental health (B = -1.93 p < .0001) and physical health (B = -1.53, p < .0001). The negative effect of early trauma on mental health was reduced by intrinsic religiosity (B = .52, p = .011), positive religious coping (B = .61, p = .025), forgiveness (B = .32 p = .025), and gratitude (B = .87 p = .001). Adult survivors of early trauma experienced worse mental and physical health; however, forgiveness, gratitude, positive religious coping, and intrinsic religiosity were protective against poor mental health. The findings support a holistic perspective in the care of childhood trauma survivors.

Post-traumatic stress disorder and HIV risk behaviors among rural American Indian/Alaska Native women

We assessed the relationship between post-traumatic stress disorder (PTSD), binge drinking, and HIV sexual risk behavior by examining number of unprotected sex acts and number of sexual partners in the past 6 months among 129 sexually active American Indian women. A total of 51 (39.5%) young women met PTSD criteria. Among women who met the PTSD criteria, binge drinking was associated with a 35% increased rate of unprotected sex (IRR 1.35, p < .05), and there was a stronger association between increased binge drinking and risk of more sexual partners (IRR 1.21, p < .001) than among women who did not meet PTSD criteria (IRR 1.08, p < .01) with a difference of 13% (p < .05). HIV intervention and prevention interventions in this population likely would benefit from the inclusion of efforts to reduce binge drinking and increase treatment of PTSD symptoms.

Prevalence of physical and sexual assault and mental health disorders in older women: findings from a nationally representative sample

OBJECTIVES

This study presents prevalence and characteristics of physical and sexual assaults, and their relationship to posttraumatic stress disorder (PTSD), and mood and anxiety disorders in a nationally representative sample of older women.

DESIGN AND SETTING

Face-to-face interviews conducted with adult participants from wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions.

PARTICIPANTS

A total of 3,354 community-residing women of age 65 years and older.

MEASUREMENT

Alcohol Use Disorder and Associated Disabilities Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, current mood and anxiety disorders.

RESULTS

Almost 14% of participants reported a history of physical or sexual assault or both during their lifetimes. Assaults were often repeated rather than isolated events. Although the majority of participants did not identify interpersonal violence as their "worst" traumatic event, those who experienced interpersonal violence were generally more likely than those without such history to meet the criteria for past-year and lifetime PTSDs, depression, and anxiety.

CONCLUSIONS

Some women who have been physically or sexually assaulted decades earlier continue to report significant levels of mood and anxiety disorders into late adulthood. Several ways to increase the identification and treatment of older female trauma survivors by healthcare providers are suggested.