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

2. BACKGROUND
Internationally, 1-8 % of older adults are victims of violence.
About 4% of the US elderly have suffered abuse (Pillemer and Finklehor)
820, 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

3. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 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

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

14. 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

15. 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

16. Study wide Results: Physical Abuse

17. Study wide Results: Verbal Abuse

18. Study wide Results: Physical Abuse

19. Results: Verbal Abuse

20. 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

21. San Antonio Results

22. 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
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 th 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)

23. 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

24. 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

25. 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

26. 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

27. MULTIVARIATE RESULTS

28. MULTIVARIATE RESULTS

29. MULTIVARIATE RESULTS

30. 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