Late Life Domestic Violence Charles P. Mouton, MD, MS Department of Community and Family Medicine Howard University College of Medicine

BACKGROUND Internationally, 1-8 % of older adults are victims of violence. About 4% of the US elderly have suffered abuse (Pillemer and Finklehor) 820,000 -1.9 million experience maltreatment annually (Tatara, Toshio and Lisa Kuzmeskus,, 1997). Derived from APS stats Women are victims in 2/3 of reported elder abuse cases

Background 8-12 million women are at risk of domestic violence (DV) 2-4 million annually 20-28% of older women report having been abused at some point

BACKGROUND(cont.) Most data on elder mistreatment are on frail, functionally dependent victims Little is known about effect of elder abuse on functionally independent older adults. Must extrapolate from spousal abuse and elder abuse/neglect literature Particularly true for ethnic minority elders

OVERVIEW OF RESEARCH To understand the prevalence and incidence of late life domestic violence in older women To understand the health effects of LLDV and violence across the lifespan Hopefully demonstrating the health effects will encourage greater attention on the part of clinicians

WHI OVERVIEW Purpose: A three component study CT: a RCT of HRT, LFD, VitD/Ca on CVD, Cancer, Osteoporosis OS: a prospective cohort study of the same endpoints Community Component Setting: The Women’s Health Initiative (WHI) sites. Participants: Over 93,000 women greater than 50 who are part of the Observational Study of the WHI across 40 clinical research centers in the US

WHI Overview Subjects recruited through mass mailing, media advertisements, Subjects completed interviewer administered questionnaires Participants in the DV ancillary study completed my Domestic Violence Screening Questionnaire separately

METHODS Setting: The Women’s Health Initiative (WHI) sites. Participants: Over 93,000 women greater than 50 who are part of the Observational Study of the WHI across 40 clinical research centers in the US.

WHI MEASUREMENTS Self-reported exposure to physical abuse “Over the past year, were you physically abused by being hit, slapped, pushed, shoved, punched or threatened with a weapon by a family member or close friend?” Self-reported exposure to verbal abuse “Over the past year, were you verbally abused by being made fun of, severely criticized, told you were a stupid or worthless person, or threatened with harm to yourself, your possessions, or your pets, by a family member or close friend?” Response Categories: No Yes, not upset Yes, moderately upset Yes, very upset

San Antonio Study questions Response categories Variables San Antonio Study questions Response categories Physical abuse Over the past year, were you hit, punched, slapped, kicked, or otherwise physically abused … Yes/no Verbal abuse Over the past year, were yelled at, scolded, teased, put down or otherwise verbally abused …. Threatened with abuse In the past year, have you ever been threatened with abuse Gun-related threats In the past year, … Have you ever been threatened with a gun Currently threatened Are you currently in a relationship where you are being threatened with abuse Sign documents Has … Made you sign documents you did not understand Borrowed money Has … Borrowed money and failed to pay you back Controls property Does… Control your property against your wishes Feels isolated Has anyone kept you from seeing you family or friends Sexually abused How often are you forced to have sex to gratify your spouse or partner None/any of the time Safe at home How often do you feel safe at home

Domestic Violence (cont.) Health status assessed by the PCS and MCS of the SF-36

Results (DV on health perceptions) Prevalence of Physical abuse = 1.24% Prevalence of Verbal abuse = 10.94% Age, Ethnicity, Education, Family Income, Occupation, Marital Status and Partner’s Job associated with both

Results (continued) Incidence of Physical abuse = 0.68% Incidence of Verbal abuse = 7.1% Age, Ethnicity, Education, Family Income, Occupation, Marital Status and Partner’s Job associated with incidence of both

Study wide Results: Physical Abuse

Study wide Results: Verbal Abuse

Study wide Results: Physical Abuse

Results: Verbal Abuse

CONCLUSIONS Older functionally independent women report experiencing physical abuse and verbal abuse This risk is mediated by sociodemographics Violence affects overall mental and physical health Larger studies needed to clarify these risks

San Antonio Results

Table 1: Descriptive Statistics of Key Variables N (%) Ethnicity White Hispanic 697 (59.5) 475 (40.5) Someone controls your property against your wishes Yes No 26 (2.1) 1228 (97.9) Physical Abuse 23 (1.8) 1240 (98.2) Feels isolated 160 (12.7) 1103 (87.3) Verbal Abuse 623 (49.0) 637 (51.0) Forced to have sex against your wishes 156 (12.7) 1075 (87.3) Threatened with abuse 244 (19.4) 1012 (80.6) Age 50-54 55-59 60-64 65-69 70 or greater 302 (24.4) 262 (21.2) 245 (19.8) 228 (18.4) 200 (16.2) Gun-related threatened 101 (92.0) 1156 (8.0) Education 8th or less Some HS or HS grad Some college or college grad Some post grad education 32 (2.6) 266 (21.6) 641 (52.2) 290 (23.6) Currently threatened 95 (7.5) 1168 (92.5) Income <$20,000 $20,000- $49,999 $50,000-$99,999 $100,000 or > 223 (18.7) 543 (45/6) 326 (27.4) 99 (8.3) Forced to sign documents you did not understand 37 (2.9) 1227 (97.1) Marital Status Never Married Divorced/separated Widowed Married or living married 55 (4.4) 210 (17.0) 187 (15.1) 785 (61.8) Borrowed money and did not repay 407 (32.5) 847 (67.5) Do you feel safe at home NO 1043 (82.5) 222 (17.5)

Bivariate Associations of Ethnicity and Sociodemographics with abuse Variable Physical Abuse Verbal %Yes %No OR (95% CI) OR (95% CI) Ethnicity White Hispanic 55 45 60 40 1.21 (0.50, 0.94) 57 43 1.17 (0.87, 1.58) Age 50-54 55-59 60-64 65-69 70 or greater 38 24 14 21 20 19 17 P=0.09 32 23 13 P=0.001 Education 8th or less Some HS or grad Some College or grad Some post grad ed 9 29 5 2 22 52 P=0.02 3 26 53 18 25 P=0.03 Income <$20,000 $20,000-$49,999 $50,000-$99,999 $100,000 or > 33 46 28 8 P=0.06 27 16 47 31 6 P=0.6 Marital Status Never Married Divorced/separated Widowed Married or living married 10 76 15 63 1 12 82 59 P<0.001

Bivariate Associations of Ethnicity and Sociodemographics with abuse Variable Threatened with abuse Gun-related threats Currently threatened %Yes %No OR (95% CI) Ethnicity White Hispanic 52 48 62 38 1.50 (1.11, 2.01) 61 39 1.64 (1.07, 2.49) 42 58 2.18 (1.41, 3.37) Age 50-54 55-59 60-64 65-69 70 or greater 19 17 16 10 21 22 20 18 P<0.001 26 14 8 23 33 24 13 9 P=0.004 Education 8th or less Some HS or HS grad Some College or college grad Some post grad ed 2 56 3 51 25 P=0.4 54 1 32 55 12 P<0.01 Income <$20,000 $20,000-$49,999 $50,000-$99,999 $100,000 or > 45 6 46 29 P=0.005 41 28 P=0.3 15 P=<0.001 Marital Status Never Married Divorced/separated Widowed Married or living married 30 11 5 65 P=0.01 57 64 63 P=0.6

Bivariate Associations of Ethnicity and Sociodemographics with abuse Variable Force to sign documents Borrowed money Someone else control your property %Yes %No OR (95% CI) Ethnicity White Hispanic 35 65 60 40 2.78 (1.36, 5.68) 55 45 62 38 1.34 (1.04, 1.72) 48 52 1.62 (0.71, 3.71) Age 50-54 55-59 60-64 65-69 70 or greater 44 22 17 11 6 24 21 20 18 P=0.003 28 15 23 19 33 12 16 P=0.5 Education 8th or less Some HS or HS grad Some College or grad Some post grad ed 3 2 53 P=0.2 50 P=0.09 Income <$20,000 $20,000-$49,999 $50,000-$99,999 $100,000 or > 49 8 46 P=0.4 47 27 9 P=0.008 26 4 Marital Status Never Married Divorced/separated Widowed Married or living married 5 64 P=0.02 14 67 57 P=0.001 P=0.8

Bivariate Associations of Ethnicity and Sociodemographics with abuse Variable Feels Isolated Forced to have sex against Safe at home wishes %Yes %No OR (95% CI) Ethnicity White Hispanic 51 49 61 39 1.46 (1.02, 2.07) 47 53 1.72 (1.20, 2.46) 62 38 0.58 (0.43, 0.79) Age 50-54 55-59 60-64 65-69 70 or greater 35 25 20 11 9 23 21 19 17 P<0.001 34 24 16 18 22 P=0.3 Education 8th or less Some HS or HS grad Some College or grad Some post grad ed 4 50 2 P0.4 3 52 P=0.10 Income <$20,000 $20,000-$49,999 $50,000-$99,999 $100,000 or > 57 44 29 P=0.001 26 41 46 8 P=0.2 31 42 Marital Status Never Married Divorced/separated Widowed Married or living married 15 64 5 10 58 P=0.02 1 7 75 63 P=0.03 14 66

MULTIVARIATE RESULTS

MULTIVARIATE RESULTS

MULTIVARIATE RESULTS

Summary of Results Hispanic women were more likely to be exposed to threats of abuse, gun-related threats, financial exploitation, isolation and sexual abuse than White women. However, most of these associations with attenuated by including sociodemographic factors Hispanic felt less safe at home even after controlling for sociodemographic factors