Added: Mackenzie Rossetti - Date: 26.11.2021 11:26 - Views: 23859 - Clicks: 2200
The majority of the existing evidence-base on violence against women focuses on women of reproductive age 15—49and 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. 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.
Our Sex old women Geneva indicated that violence against older women is prevalent and has ificant impacts on physical and mental well-being of older women. Implications for policy and programmatic response, as well as future research directions, are highlighted.
This is an open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the manuscript and its Supporting Information files.
The funders had no role in study de, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Violence against women is a major public health problem, a gender inequality issue and a human rights violation. Indicator 5. The indicator does not include an upper age limit, and data on older women aged 50 and aboveincluding but not limited to intimate partner violence, are needed to support national and global monitoring of violence against women of all ages, including for monitoring of the SDGs.
The majority of existing violence against women surveys and data have focused on women of reproductive age 15—49as they suffer the brunt of intimate partner violence and non-partner sexual violence [ 6 ]. A growing of surveys are now including women older than 49 years, however globally there is sparse evidence concerning patterns of and types of violence against women aged 50 and older, and limited understanding of barriers to reporting and help-seeking amongst older women who are subjected to violence [ 7 ].
For older women, recent exposure to Sex old women Geneva may be interlinked with violence victimization at different stages of the life-course [ 1112 ]. Dynamics of ageing may shape experiences of violence, for example, provision of care to a dependent partner may influence decisions to disclose or report abuse [ 10 ]. They are also more likely to experience violence from other family members, including children, and from carers. Currently, the evidence-base of qualitative and quantitative data concerning violence against older women is limited, and a better understanding of these differing patterns and dynamics is needed to ensure appropriate policy or programmatic responses to violence against older women and service development and provision for older women affected by violence [ 1011 ].
To address these gaps in the evidence, we conducted a systematic review of qualitative literature on violence against older women. Gaps in research and evidence stem in part from conflicting theoretical approaches, definitions and conceptual frameworks concerning violence against older women.
The dominant theoretical frameworks are the older adult mistreatment framework and older adult protection framework [ 71314 ]. The older adult mistreatment framework conceptualizes violence against older women as a form of elder abuse, focusing on age as the primary factor influencing vulnerability to exposure to violence. In addition, the IPV framework primarily understands vulnerability to violence in terms of gender inequality and partnership dynamics, which may neglect analysis of how ageing and Sex old women Geneva violence intersect.
These differing frameworks inform multiple aspects of research, including study de, data collection and analysis, and reporting, resulting in fragmented data and evidence. For example, some research utilizing the older adult mistreatment framework lacks a focus on the gendered dimensions of violence [ 1415 ], and other studies have solely focused on women in institutional settings, neglecting measurement of violence perpetrated by intimate partners and other family members [ 13 ].
Existing syntheses of evidence on violence against older women often reflect these differing conceptual frameworks. This review reported prevalence by type of violence, but did not report on perpetrators. Analysis of studies conducted in institutional settings found women, aged 60 and above, to be ificantly more vulnerable to abuse, with psychological abuse as the most prevalent form of violence, followed by physical violence, neglect, financial and sexual abuse [ 17 ]; this analysis included data reporting staff-to-resident abuse.
Analysis of quantitative data of women aged 60 and above in the systematic review of quantitative studies of elder abuse found a global prevalence of elder abuse against women of The focus of this review was prevalence of different sub-types of violence, and type of perpetrator was not considered.
Syntheses of quantitative literature have identified prevalent forms of violence against older women, highlighting limitations in the evidence-base due to variations in definitions and methodology, and a primary emphasis on populations in high-income, Western countries.
These reviews have captured a wide range of types of violence, however, have not considered type of perpetrators or patterns of co-occurring types of violence. Alongside these systematic reviews of quantitative data, some reviews have included qualitative and mixed methods studies.
An empirical review of IPV in later life examined 27 quantitative, 22 qualitative and 7 mixed-methods studies, finding that forms of IPV amongst older women in later life shifted from a higher prevalence of physical and sexual abuse during reproductive years, to a higher prevalence of forms of psychological abuse [ 19 ]. A review of qualitative research on IPV amongst older women identified a of relevant themes, including patterns of abuse that were continuous and consistent with experiences of abuse in families of origin and relationships [ 20 ].
A systematic review and meta-synthesis of qualitative studies of IPV and older women focused on how exposure to IPV influenced health-seeking behaviours, specifically mental health care [ 21 ]. An empirical review of quantitative and qualitative studies of sexual violence against older people identified widespread variation in Sex old women Geneva rates across studies, and a range of perpetrators, primarily intimate partners or adult children [ 22 ].
However, amongst these existing systematic reviews of qualitative literature, none have focused specifically on older women, while also being inclusive of any form of violence. In order to improve understanding of violence against older women, it is important to explore patterns, dynamics and experiences through examination of the qualitative literature.
Qualitative data on violence against older women complements quantitative evidence not only by offering insight into lived experiences of older women subjected to violence, but also by expanding and clarifying types of violence, perpetrators, linkages to particular risk factors, and physical, mental and social impacts of violence against older women. In the present review, we aimed to build on systematic reviews and strengthen the evidence-base by i including studies and evidence focused specifically on women; ii 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; iii focusing on women aged 50 and above as many surveys often specifically focus on women of reproductive age, which is considered to be up to 49 years of age ; and iv focusing specifically on qualitative studies, to explore the nature and dynamics of violence against older women from the perspective of women.
We include the following forms of violence: elder abuse, family violence and intimate partner violence. Family violence is often used interchangeable with intimate partner violence, however, also encompasses abuse and violence perpetrated by other family members, for example, adult children or in-laws.
While there is no universal agreed-upon definition of older women, for the purposes of this review, we define older women as women aged 50 and above, while recognizing that aging and age are social phenomenon, and definitions vary across organizations, cultures and communities.
We conducted searches that combined the following domains as part of the research question: 1 age 50 and above ; AND 2 women; AND 3 violence; AND 4 qualitative methodology. The search strategy for PubMed is included in S1 File. Searches were conducted in April and updated in July We did not limit the search by year of publication or language. We also hand searched reference lists of relevant existing systematic reviews, which we identified both through background research and through the formal database searches, and reviewed relevant references 44 identified.
We consulted with 49 experts on violence against older women or older adults, including researchers, practitioners and policy makers, from all regions globally. All experts were contacted and followed-up with a minimum of 2 contacts. We reviewed the full text of 43 articles and ultimately included 2 in the full review.
Grey literature was not systematically searched; grey literature submitted by experts was initially considered for inclusion, however, conducting comparable data extraction and quality assessment for grey literature alongside the peer-reviewed literature was not possible. We identified 18 non-English language articles for full-text review. For 17 of these articles, we identified a native speaker external reviewer who was provided with inclusion and exclusion criteria and consulted with authors regarding final inclusion 4 Portuguese, 7 Spanish, 1 Hebrew, 1 Dutch, 1 German, 1 Danish, 2 French.
One non-English article in Farsi was not reviewed as the research team could not engage a Farsi speaker to review the article. The external reviewers consulted with SRM to decide on inclusion of full texts, and conducted data extraction and quality assessment on 3 articles identified for inclusion 2 Spanish, 1 Portuguese [ 27 — 29 ]. After removing duplicates, study selection proceeded in two stages: in the first stage, two authors SRM and MEL reviewed titles and abstracts of all identified manuscripts. Studies including men or also including women aged younger than 50 were included if specific and separate sex and age-specific analyses were included.
We included studies employing any type of qualitative methodology, and mixed methods studies were included if qualitative data was presented separately. Studies were excluded if the whole sample was children, adolescents or adults under the age of 50; if the sample only included men; if the methodology was quantitative, or in the case of mixed methods studies, if the qualitative were not separately presented, and if the data only included the perspectives on violence against women as reported by care providers, health professionals, legal professionals and nursing home managers.
After the first stage of title and abstract review, we reviewed the full text of any manuscript considered relevant by either of the authors. In the second stage, two authors SRM and MEL independently reviewed all articles selected for full text review for eligibility, to reach consensus on inclusion. Any discrepancies were resolved with the input of an external reviewer. Fig 1 indicates the full search and study selection process. PLoS Med 6 6 : e For more information, visit www.
We deed a data extraction Excel spreheet specifically for the purposes of the review, including characteristics of included studies location of the research, research questionmethodology conceptual framework or theoretical approach, data collection methods, data analysis methods, samplingcharacteristics of the sample inclusion and exclusion criteria, brief description of the sampletypes and nature of violence context of violence, perpetrator and brief description of impacts of violence.
We extracted main findings, participant quotations where possible, and study limitations, if reported. Data extraction was conducted by one author MELand checked for accuracy by a second author SRMwith discrepancies resolved by discussion to reach consensus. The adapted scale included the following questions Sex old women Geneva 30 ]:.
Two authors SRM, MEL assessed the quality of the studies, asing a 1 for each affirmative response and 0 for each negative response, for a final score out of Disagreement was resolved by discussion between the two authors. Quality assessment was not used to determine if any studies should be excluded, but rather to assess the strength of each study.
An Excel spreheet to compile all relevant findings and quotations from the studies for thematic analysis was developed. We used line-by-line coding on a sub-set of articles, developing a set of over-arching themes and sub-themes for a draft codebook. The coding proceeded as an iterative process, with the two authors each separately coding the main findings using the draft codebook, discussing codingand refining the codebook based on overlap and redundancies identified.
After all data were coded, we tallied all occurrences of each code and further explored areas of overlap and merged sub-themes with low s of codes, finalizing the broad themes and focused sub-themes. For non-English articles included, the external reviewer translated primary quotations into English and thematic analysis on these articles was conducted alongside the English language articles. Our searches Sex old women Geneva 11 databases yielded articles, with an additional articles identified through cross- referencing and expert recommendation.
After removing duplicates, articles remained. We identified Sex old women Geneva that were potentially eligible and included in full text screening. Two of these articles had not yet been published. Additionally, 1 Farsi language study was unable to be translated and assessed against the Sex old women Geneva criteria. Fifty-two articles met criteria for inclusion in this systematic review Fig 1. The 52 included articles represent data from 31 studies. One article came from India, a lower-middle income country.
Application of the adapted version of CASP scale yielded variable across the 52 articles assessed [see Table 2 ]. Ratings of research methodology, statement of research aims and selection of appropriate research de were overall high. The majority 46 articles [ 2932 — 76 ] gave support for research findings with references to primary data participant quotations, case study vignettes, case file excerpts.
Ten articles [ 41464950596577 — 80 ] lacked data analysis descriptions. Only 12 articles [ 293538 — 4045515872 — 7479 ] reflected on the relationship between the researchers and the participants reflexivity. Five articles [ 4344567375 ] described obtaining consent, but lacked descriptions of ethical approval, and 10 articles [ 32384253575962657880 ] lacked descriptions of both ethical approval and obtaining consent. A ificant of articles [ 3234 — 4245 — 4749 — 51535456575961 — 66697072 — 7577 — 79 ] lacked adequate descriptions of the study setting and context.
Older women described IPV, family violence and elder abuse of various types, perpetrated by a range of perpetrators [ Table 1 ]. Older women described on-going instances of neglect, verbal abuse and financial exploitation in a study conducted in India [ 41 ], in other cases, physical violence characterized earlier and on-going experiences of violence within intimate partner relationships [ 37404754 ]. IPV in particular was described by older women as occurring throughout different stages in the relationship, spanning their youth and into older age.
Shifts in types of violence, from predominantly physical violence to predominant psychological abuse and neglect, were commonly described in studies that encompassed and on-going IPV [ 3451 ]. Studies focused on IPV commonly described both and on-going violence, and a smaller described only or primarily violence experienced while aged 50 or above [ 6469 ].
Violence occurring within the family was discussed in 15 articles [ 353943444648495563666869717679 ], with perpetrators including family members not including children [ 2743444849596368Sex old women Geneva71 ] and adult children [ 353948667679 ].
Studies captured instances of physical and verbal aggression by mentally ill adult children against older women [ 66 ], violence enacted by elderly with dementia against older women who were caregivers [ 46 ], and forms of neglect, financial exploitation and emotional abuse enacted by family members, including children [ 44 ].
The majority of these studies focused on violence experienced in older age, while one study explored dynamics of abuse between children and mothers across the lifespan [ 3539 ]. Types of elder abuse included verbal abuse, physical assault and inappropriate sexual advances [ 58 ] and sexual assault [ 59 ].
Financial control spanned instances of elder abuse, family violence and IPV [ 435362647678 ], and was described as co-occurring with and resulting in other forms of violence. Themes and sub-themes identified through coding are displayed in Table 3. A of sub-themes emerged emphasizing the interconnections between the experience of ageing amongst older women, and dynamics, impacts, experiences and perceptions of violence.
Older women emphasized suffering, loneliness, regret and guilt in their s of living and coping with violence, particularly psychological violence [ 343738404244454750 — 5254566266Sex old women Geneva7879 ]. Respondents linked regret with time and age, emphasizing decisions, lost opportunities, and wasting time due to living with an abusive partner [ 33343745 ].
Older women expressed feelings of guilt over the abuse they experienced, and regret and guilt for exposing their children to violence [ 38455052546679 ]. Several studies linked suffering, regret and loneliness specifically to psychological violence, which was described as more prominent in older age, pervasive and damaging to social relationships and self-esteem [ 5156 ]. The studies that explored these themes primarily encompassed s of violence experienced throughout intimate relationships—while women were younger and through to older age.
Older women described that ageing diminished their physical and emotional capabilities to cope with experiences of violence [ 33373947 ]. This sub-theme appeared in 12 manuscripts [ 333739404347485355596276 ] and was expressed in relation to various forms of violence—IPV [ 333747 ], including violence perpetrated by a spouse due to dementia [ 40 ], violence in the context of a new relationship or second marriage [ 4853555962 ], violence perpetrated by a mentally ill child [ 39 ], violence perpetrated by children-in-law [ 76 ], and elder abuse [ 43 ].
These studies primarily focused on current experiences of violence of older women, as changes in physical and emotional capacity to cope was described in relation to present victimization. As a result of diminishing physical and cognitive capacities of ageing, old women experienced vulnerabilities and dependency dynamics—with partners, adult children and caregivers—that exposed them to situations of abuse [ 4447525657616466 ].
Women reported that lack of financial autonomy, often compounded by years of controlling behaviors perpetrated by a violent spouse, was a central factor in women remaining in abusive spousal, caregiving and family relationships [ 4447525664 ]. Some included studies reported on perpetrator-related factors that initiated or exacerbated forms of violence against older women. Older women emphasized contexts surrounding IPV in which the perpetrator continues to exercise control, power, and violence, despite their failing health and old age [ 4147 — 49515659727677 ].
Controlling behaviours were also experienced in the context of cultural norms; for example, in a study of Sri Lankan immigrant women in Canada, older women described forms of control enacted by children and children-in-law. This sub-theme only emerged in three manuscripts [ 404669 ], however, it is the only instance among the included studies in which older women described first or new experiences of IPV in older age.
Older women who provided care for spouses with dementia reported aggressive behavior, physical violence, and verbal abuse [ 4069 ]. Older women described the ways in which social and gender norms shaped their experiences of and responses to violence. Older women described several social norms that shaped their past decisions in response to violence including: silence surrounding violence and the reporting of violence [ 4180 ], fears of shame and stigma related to leaving a marriage [ 656973 ], and ideals of being a good mother by putting up with violence for the sake of her children [ 384274 ].
Remaining in a relationship as a strategy was often employed due to older women feeling obligated to care for an abusive partner who was now sick or unable to live alone [ 33 ]. In several cases, remaining in the relationship was a coping mechanism of last resort, given the multiple barriers present to women leaving the relationship, whether with an intimate partner, other family member or caregiver [ 48 ]. Women also described strong beliefs in social norms that supported staying with a sick or frail abusive partner or abusive child [ 33354046576676 Sex old women Geneva.
Many women viewed seeking help and confiding in others as embarrassing and unacceptable; one woman explained, "I was ashamed.Sex old women Geneva
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