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Correspondence: Address correspondence to Bonnie S. Fisher, PhD, Division of Criminal Justice, University of Cincinnati, P.O. Box 210389, Cincinnati, OH 45221-0389. E-mail: Bonnie.Fisher{at}uc.edu
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Abstract |
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Key Words: Abuses • Health conditions • Repeat abuse • Multiple abuse • Older women
Recently, however, there has been a renewed interest in examining the extent and nature of abuse against older women. Researchers and advocates from a variety of disciplines have reported that older women experience intimate-partner and domestic violence well into old age (Grossman & Lundy, 2003; Rennison & Rand, 2003; Teaster & Roberto, 2004). It should not be too surprising that, given the paucity of older women abuse studies, our understanding of the health consequences for abused older women is woefully limited. The issues of abuse and its health consequences will not retreat anytime soon. Older women are a fast-growing population as the baby boomers enter into old age and their life expectancy continues to lengthen.
Using data from a clinical sample of 842 community-dwelling women aged 60 and older, this study makes four contributions to researchers' understanding of the extent and nature of abuse against older women and the associated health conditions. First, we measured the extent of abuse experiences in late life—that is, since age 55—to capture the experiences of women who had reached a mature stage of their life cycle. Second, we expanded upon the types of abuse examined in previous studies to include control and threat abuses. Third, we examined not only the extent of abuse but also the extent of repeat abuse and multiple abuses and their respective frequencies. Last, we investigated the relationships between type of abuse (including repeat abuse) and older women's self-reported general health, number of health conditions, and specific psychological and physical health conditions.
The Extent of Abuse Against Older Women
The estimation of the extent of abuse against older women is a young field of inquiry. Only two national-level studies have been conducted since Pillemer and Finkelhor's (1988) pioneering study revealed that older women had experienced physical violence and verbal aggression since turning 65 years old. First, results from the National Elder Abuse Incidence Study (National Center on Elder Abuse, 1998) reported that 76.3% of surveyed women aged 60 and older had experienced emotional/psychological abuse and 71.4% were victims of physical abuse. Second, the National Crime Victimization Survey estimated that 118,000 intimate-partner victimizations were committed against women 55 years and older during a 9-year period (1993–2001; Rennison & Rand, 2003).
Only a handful of single-state studies have examined the extent of abuse suffered by older women (Grossman & Lundy, 2003; Teaster & Roberto, 2004). To illustrate, using data from the Women's Health Initiative in San Antonio, Texas, Mouton and colleagues (2004) reported that 11% of post-menopausal women had reported abuse within the past year. At the 3-year follow-up, 5% of the women had reported new experiences with abuse.
Collectively these studies reveal that older women are abuse victims into their old age, yet many questions about women's abuse later in life remain largely unanswered. These questions include: (a) What types of abuse do older women experience in their later years? (b) Are these women repeatedly abused, and, if so, which type of abuse do they repeatedly experience? (c) Do these women experience multiple types of abuse, and, if so, what are the patterns? and (d) How often does abuse occur? By better understanding the extent and frequency of abuse against older women, researchers can determine whether linkages exist between the abuse older women experience and their health-related outcomes.
The Associations Between Abuse and Health-Related Outcomes
Researchers have documented that abused women are at risk for several negative health-related consequences.
Self-Reported General Health Status
Three studies are illustrative of the association between abuse and general health status. First, Koss, Koss, and Woodruff (1991), using a 16-item measure of criminal victimization, reported that victimized women aged 19–69 years old perceived themselves as less healthy than nonvictimized women (i.e., as having more somatic complaints and less physical and mental well-being). Second, investigating a sample of women aged 21–55 years old, Campbell and colleagues (2002) reported that twice as many women who had experienced intimate-partner violence over a 9-year period rated their health as fair to poor compared with women who had never experienced such abuse. And third, Coker and colleagues (2002) reported that women aged 18–65 years old who had experienced lifetime intimate-partner physical, sexual, or psychological abuse were significantly more likely than nonabuse victims to self-report current poor health.
Number of Self-Reported Health Problems or Conditions
Researchers have also shown that women who have experienced abuse are more likely to suffer more health problems compared with nonabused women. This includes suffering from more physical and mental health conditions and chronic health problems (see Sutherland, Bybee, & Sullivan, 2002). Campbell and colleagues (2002) reported that abused women had a higher rate of total physical health problems and central nervous system, gynecological, and chronic-stress symptoms compared with women who had never been abused.
Specific Chronic Health Problems or Conditions
There is mounting evidence that different types of abuse and their co-occurrence are related to specific short- and long-term mental and physical health problems and conditions (Sutherland et al., 2002). The list of negative health effects includes depression, fear, chronic pain, osteoarthritis, gastrointestinal disorders, chronic stress, gynecological symptoms, chest pains, and cardiac problems (Campbell et al., 2002; Coker et al., 2002).
Repeat and Multiple Abuse
For many women, abuse is not an isolated event; abuse happens repeatedly. Women who suffer repeated abuse experience two or more incidents of the same type of abuse within a specified time period—for some, this is daily (Tjaden & Thoennes, 1998). Women also experience different types of abuse (i.e., multiple forms of abuse). Campbell and colleagues (2002) reported that 33% of the abused women surveyed experienced both physical and sexual abuse.
Research suggests that repeat and multiple abuses take a negative toll on women's health, possibly even more negative than the abuse–nonabuse distinction that is commonly used in the abuse literature. First, there is evidence that women who experience multiple types of abuse report having poor health (Koss et al., 1991). Second, the frequency of different types of abuse may affect some health outcomes but not others. Coker and colleagues (2002) also found that increased psychological intimate-partner–violence scores were strongly associated with self-reported current poor health status. Physical or sexual intimate-partner violence, however, was not related to current poor health status. Further clarifying the relationship between repeat abuse and type of health condition, Coker and associates reported that the frequency of a certain type of abuse was related to specific health conditions. That is, higher psychological intimate-partner–violence scores were significantly related to both the development of a chronic disease and current depressive symptoms. Higher physical or sexual intimate-partner–violence scores were significantly related only to current depressive symptoms.
There is evidence to suggest that experiencing multiple abuses—a combination of two types of abuse—has negative health-related consequences. Hegarty, Gunn, Chondros, and Small (2004) reported that "probably" depressed women were more likely to have experienced physical abuse and emotional abuse or harassment than "not" depressed women.
Overall, the results from these studies suggest that abuse has negative effects on women's health. There is room for further research, including the examination of the abuse–health-consequences relationship for older women. To date, no published research has examined this relationship using a sample of women aged 60 years and older, and only a few published studies have examined abuse that happened after age 55 and its relationship to women's health (see Mouton, 2003; Zink, Fisher, Regan, & Pabst, 2005).
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Women gave verbal consent by agreeing to participate in the Women's Health and Relationship Survey (WHRS). Of the 4,261 available numbers, 44% of the women (n = 1,852) were not available (answering machine or no answer). In addition, 7% (n = 297) of the numbers had been disconnected, and 6% (n = 261) were wrong numbers. Approximately 2% (n = 67) of the women were deceased, 1% (n = 45) were too sick to answer, and 0.4% (n = 15) of the women had family members who intercepted the call and would not allow them to participate. Of the 1,724 women reached by phone, 40% (n = 695) refused to participate, 1.5% (n = 26) were unable to answer the three mental competency questions correctly (their age, birth date, and the current year) to assess their mental status, and 0.5% (n = 8) refused to answer the abuse questions. This resulted in 995 usable surveys and an adjusted response rate of 58% (995 out of 1,698).
Only women aged 60 and older (n = 842) were included in the current study. All of the women in the sample were community dwelling. None lived in institutional settings, such as a nursing home.
Instrument
The WHRS was adapted from validated instruments and included questions about mental status (Lachs & Pillemer, 1995), health conditions (Tjaden & Thoennes, 1998), abuse (Shepherd & Campbell, 1992; Tjaden & Thoennes) and sociodemographics. The survey administration took 20–45 minutes, depending on whether the woman had experienced abuse.
Measures
Type of Abuse
The WHRS measured five different types of abuse: (a) psychological/emotional, (b) control, (c) threat of physical abuse, (d) physical, and (e) sexual. The abuse measures combined the uniform definitions regarding intimate-partner violence recommended by the Centers for Disease Control and Prevention with definitions housed within the elder abuse framework recognized by the U.S. National Academy of Sciences (Bonnie & Wallace, 2002; Saltzman, Fanslow, McMahon, & Shelley, 1999/2002).
We measured each of these five types of abuse by using multiple items. A principal components factor analysis performed on the six psychological/emotional and control abuse items confirmed two distinct factors. Three items loaded on one factor, psychological/emotional abuse (.85,.82, and.52); and three other items loaded on a second factor, control abuse (.81,.70, and.66).
Psychological/emotional abuse was a 3-item measure (Cronbach's 
=.64). Control abuse was a 3-item measure (Cronbach's =.59). Threat abuse was a 2-item measure (Cronbach's =.52). Physical abuse was a 4-item measure (Cronbach's =.72). Sexual abuse was a 3-item measure (Cronbach's =.71). For each abuse item, women were asked if they had experienced the behavior "since you turned 55."
Extent of Abuse
We created three variables to measure the extent to which women in the sample experienced the five types of abuse. First, we created a dichotomous variable, abuse victim, which measured whether a respondent had experienced any of the five types of abuse since she had turned 55 years old.
Second, we created a measure of repeated abuse. Repeated abuse was a count of the number of women who had experienced two or more abusive behaviors that comprised a specific type of abuse (i.e., the same type of abuse). To illustrate, three behaviors comprise psychological/emotional abuse. Women who reported having experienced two or more of these behaviors were coded as having been repeatedly psychologically/emotionally abused since age 55.
Third, multiple abuse was a measure of the number of women who had experienced any combination of at least two types of abuse. For example, a woman was coded as a victim of multiple abuse if she had experienced either both sexual and physical abuse, or both control and physical abuse.
Frequency of Abuse
In order to measure the frequency with which abuse occurred, interviewers asked women how often different forms of abuse had happened to them since they had turned 55 years old. Responses were: never, rarely, occasionally, frequently, or very frequently. Of the respondents who had experienced at least one form of abuse within a specific type of abuse, those who reported "rarely" were coded as the Rarely group and those who reported "occasionally, frequently, or very frequently" were coded as the Often group. For example, a woman who had experienced any form of psychological/emotional abuse frequently was coded as often psychologically/emotionally abused. If, within the same type of abuse, she reported one form as having happened rarely and another form as having happened frequently, she was coded using the "highest" frequency category; in this case, coded as being in the Often group.
Health-Related Consequences
Because one of the primary aims of this study was to examine the relationship between abuse experience and health-related consequences, we used several measures of health outcome. First, we created a dichotomous measure of the status of a woman's health. Interviewers asked respondents to assess their health on a 5-point scale ranging from poor to excellent. For ease of analysis, we collapsed the "poor" and "fair" categories into one category and collapsed "good," "very good," and "excellent" categories into a second category to create the dichotomous measure of self-reported health status. We found that 55% (n = 429) of the women rated their health as good to excellent, and 45% (n = 378) rated their health as poor or fair.
The second dependent variable, number of self-reported health conditions, was a count of the number of health conditions that a doctor had told each woman that she currently had. The 10 items included: high blood pressure or heart problems; lung problems (e.g., asthma or chronic obstructive pulmonary disease); diabetes or thyroid problems; bone or joint problems (e.g., osteoporosis or arthritis); depression or anxiety; digestive problems (e.g., irritable bowel syndrome or heartburn); stroke or nerve problems (e.g., Multiple Sclerosis or Parkinson's disease); blood problems (e.g., anemia); chronic pain (e.g., migraines or back pain); and any type of cancer. Respondents averaged 3.3 (SD = 1.8) health conditions.
Third, we created a dichotomous measure of whether respondents currently had or did not have a specific health condition by asking questions that required respondents to identify which health conditions a doctor had told them they had. These were the 10 health conditions listed in the preceding paragraph. More than half of the respondents reported having high blood pressure or heart problems (75%) or bone or joint problems (65%). Less than half reported having diabetes or thyroid problems (37%), chronic pain (36%), digestive problems (31%), depression or anxiety (30%), lung problems (24%), cancer (13%), stroke or nerve problems (12%), or blood problems (12%).
Control Variables
Similar to Coker and colleagues (2002) and Campbell and associates (2002), we employed several sociodemographic characteristics as control variables in the multivariate health-related consequences models. Using aged 75 and older (34%, n = 285) as the reference group, we created two age dummy variables for 60–64 years old (23%, n = 191), and 65–74 years old (44%, n = 366; percentages may equal greater than 100% due to rounding). Race/ethnicity was measured as a dichotomy: Black/African American or Other (45%, n = 373) and White (reference group, 55%, n = 453). Using less than high school education (36%, n = 297) as the reference group, we measured respondents' level of education with two dummy variables: high school diploma (31%, n = 255), and some college to college graduate (34%, n = 281). Using being married/common law (32%, n = 336) as the reference group, we measured current marital status with three dummy variables: divorced/separated (18%, n = 152), widowed (41%, n = 342), and single/never married (9%, n = 72). Using less than $20,000 (47%, n = 389) as the reference group, we measured annual household income with three dummy variables: $20,000–$40,000 (15%, n = 128), more than $40,000 (10%, n = 84), and refused to answer or did not know (28%, n = 228). Given the Appalachian heritage in southwest Ohio, we included a dichotomous measure of whether a woman was of Appalachian decent (9%, n = 79) or not (91%, n = 717).
Data Analysis
Descriptive statistics and bivariate and multivariate data analyses are reported here. Appropriate tests of significance are presented for the bivariate analyses. In order to examine the relationship between type of abuse and health-related consequences, we estimated several multivariate models. Depending on the distribution of the dependent variable, we estimated either a logit model or an analysis of covariance model. We estimated all of the multivariate logit models using STATA, version 7.0 (StataCorp, 2001). We calculated the descriptive statistics and estimated the analysis of covariance models with SPSS 11.5 for Windows (SPSS Inc., 2002).
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The frequency of the occurrence of abuse also reveals noteworthy patterns. Of the older women who had experienced a specific type of abuse, in the case of 4 of the 5 types of abuse, more than 45% of the women had experienced abuse often since age 55: control abuse (88%), psychological/emotional abuse (57%), threat abuse (48%), and sexual abuse (46%). Slightly less, but still a substantial proportion (41%), had experienced physical abuse often since age 55.
Asking who perpetrated the abuse also revealed interesting results (not presented here). Interviewers did not ask respondents about the identity of the perpetrator of psychological/emotional abuse due to their concern for the respondent's discomfort with answering the first set of experience questions about psychological/emotional abuse. Interviewers did ask respondents about different categories of perpetrators (i.e., spouse/boyfriend, relative, or non-relative) for the other types of abuse. Almost three-fourths of the women (73%, n = 66) reported that a relative—child, grandchild, or other relative—had threatened them, compared with 21% of women who had been threatened by a spouse/boyfriend and 14% by a non-relative. A majority of the women reported that their spouse/boyfriend had perpetrated control abuse (56%, n = 19) and sexual abuse (73%, n = 19). Physical abuse did not exhibit the same pattern as to who was the perpetrator. Of the physically abused women, 45% (n = 14) reported that a relative had been the perpetrator, compared with 39% (n = 12) who reported that their spouse/boyfriend had. Almost 20% (n = 6) of these women reported that a non-relative had physically abused them.
The Extent and Frequency of Multiple Abuses
Table 2 presents additional insight into the multiple-abuse experiences of older women who had experienced two different types of abuse (i.e., had been victims of multiple abuse). The diagonal in bold shows the unconditional percentages, or the percentage of women who had been victims of the specific type of abuse listed in each column (same percentages as reported in Table 1). The conditional likelihood for women who had been abused in the specific manner as noted in the columns is presented in the off diagonal. For example, among the women who had been physically abused, 69% had been threatened, 44% reported having experienced control abuse, and 31% reported having been sexually abused. In more than half of the conditional likelihoods (13 out of the 20 pairs), 25% or more women had experienced multiple types of abuse. It appears that multiple abuses were characteristic of the type of abuse from which these victimized women suffered.
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Extent and Frequency of Abuse Measures Refined
Two noteworthy results convinced us to refine our measures of extent and frequency of abuse. First, the extent of abuse results suggests that many older women had experienced repeat abuse and multiple types of abuse. The results in Table 2 suggest that psychological/emotional abuse occurred in conjunction with other types of abuse (control, threat, physical, or sexual). Nearly 30% (28.7%, n = 110) of abuse victims were multiple-abuse victims who had suffered from psychological/emotional abuse. The remaining abuse victims had experienced only one type of abuse. The majority of older abused women (67%, n = 262) had experienced only psychological/emotional abuse, and 5% (n = 21) had experienced only control, threat, physical, or sexual abuse since age 55. The analysis of those women who had only experienced control, threat, physical, or sexual abuse is not reported here due to the small number of cases.
In order to measure the possible effects that each of these three types of abuse experience may have had on health outcomes, we created two dummy variables that refined the extent-of-abuse measures in light of the multiple-abuse results. These new variables measured whether a woman had experienced (a) only psychological/emotional abuse, and no control, threat, physical, or sexual abuse, or (b) multiple abuses (psychological/emotional abuse plus any another type of abuse). Women who had not experienced any type of abuse since turning 55 years old were the reference group.
To measure repeat abuse, we created a nonrepeat-/repeat-abuse measure for those women who had experienced psychological/emotional abuse. As is shown in Table 1, 176 women (21% of the entire sample) had experienced repeated psychological/emotional abuse. Given the very small number of repeat victims within the other abuse categories, we did not create a nonrepeat-/repeat-abuse measure for these types of abuse.
Second, as the results on frequency of abuse presented in Table 1 suggest, a substantial proportion of older women had experienced abuse often. Taking into account the effects of the frequency with which these women had experienced psychological/emotional abuse or multiple types of abuse (psychological/emotional plus another type of abuse), we created four dummy variables. We further dichotomized each of the two dummy variables for specific type of abuse into two frequency groups: Rarely or Often. We found that 51% of the psychologically/emotionally abused women and 81% of the multiple-abuse victims experienced abuse often.
Bivariate and Multivariate Results: Type and Frequency of Abuse and Health Outcomes
Demographic Correlates of Type of Abuse
To examine the bivariate effects of the demographic characteristics used as control variables in the multivariate models, we examined their relationship with the type of abuse (psychological/emotional, repeated, and multiple abuse). The results of the chi-square test of independence showed that, of the demographic variables used as control variables in the multivariate analyses, only race was not significantly associated with any of the measures of abuse: abuse victimization (
2 =.434, df = 1, p = 0.51), repeated psychological/emotional abuse (2 = 0.272, df = 1, p = 0.60), or multiple abuses (2 =.346, df = 1, p = 0.56). Level of education was not significantly related to experiencing multiple abuse (2 = 0.367, df = 3, p = 0.94). Being of Appalachian decent was not related to repeated abuse (2 = 0.340, df = 1, p = 0.59) or multiple abuse (2 = 1.18, df = 1, p = 0.28). Marital status was not related to multiple abuse (2 = 4.89, df = 4, p = 0.30). All of the relationships between the other control variables (e.g., age, income, and marital status) and the type of abuse were significant at p <.05 (the exception being the relationship between level of education and multiple abuse). A significantly larger percentage of younger older women (60–64 years old) had been abuse victims, victims of repeated abuse, and victims of multiple abuse compared with women older than age 65.
Type of Abuse and Health Outcomes
Table 3 presents the effects of experiencing different types of abuse since age 55 on health outcomes. There are several noteworthy results. First, none of the abuse measures were significantly related to older women's self-reported poor health status. Second, older women who had experienced abuse were significantly more likely than nonvictims to self-report more health conditions, on average. Third, regardless of how psychological/emotional abuse was operationalized—as occurring alone, repeatedly, or with other types of abuse—this type of abuse took a negative toll on women's current health. Women who had been psychologically/emotionally abused reported significantly more health conditions, on average, than did women who had not been abused in this manner.
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Frequency of Abuse
Table 4 presents the effects of the frequency of different types of abuse since age 55 on health outcomes. These results show some noteworthy patterns supportive of those reported in Table 3.
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As the literature review stated, the effect of abuse on younger women's health is becoming well documented. However, researchers have only begun to unravel the effects of abuse on the health of older women; more study is needed. Within the broader elder abuse literature, researchers have reported that older people who suffer abuse or mistreatment experience a much higher incidence of depression (Finkelhor & Pillemer, 1988; Pillemer & Prescott, 1989); and that experiencing elder abuse or mistreatment is a risk factor for nursing home placement in the older population (Lachs, Williams, O'Brien, & Pillemer, 2002) and higher mortality rates (Lachs, Williams, O'Brien, Pillemer, & Charlson, 1998). The present results are supportive of researchers' overall conclusion: Abuse takes a negative toll on the quality of life of older persons. The current results suggest that both the physical and mental health of older women are negatively affected by abuse.
This study has three main implications for people who serve the health care needs of older women. First, with regard to those practitioners in the health care arena who provide care to older women, it is important that providers acknowledge that abuse is happening and that it is affecting the health of these older women. The present results are a first step toward aiding in the understanding that women who are experiencing abuse may not report lower general health compared with women who are not being abused, yet are more likely to experience detrimental effects to their health if one examines for specific health conditions. Second, because older women who are being abused are more likely than nonvictims to report a higher total number of health conditions and to experience certain health conditions such as depression, anxiety, digestive problems, and chronic pain, these conditions may serve as red flags to health providers to screen for possible abuse within intimate-partner and interpersonal relationships. Third, the type of abuse most frequently experienced by the older women in this study was psychological/emotional abuse. This confirms findings by Harris (1996) that physical and sexual abuse decreases with age, whereas psychological abuse remains. Although great progress has been made in the elder abuse and domestic violence arenas to come to a consensus on uniform definitions of abuse, it is important to continue to define different categories of abuse (e.g., psychological, emotional, and control) because older women may have a more difficult time identifying this behavior as abuse. Zink, Regan, Jacobson, and Pabst (2003), in a qualitative study of abused women, found that in many cases women did not even identify psychological/emotional abuse as abuse. Or women reported that things in their marriage were okay now that it was only psychological/emotional abuse and that the physical and sexual abuse had decreased or stopped. However, in the present study, we found that, for those women who were experiencing abuse, the likelihood that they were experiencing different kinds of abuse was high. Consequently, if an older woman does admit to one type of abuse, it is likely that she is experiencing or has experienced other types of abuse as well, and that she experiences abuse more than once and possibly often.
This study also has implications for individuals who provide social services for older women. First, it is important for providers to be trained to look for signs of psychological/emotional abuse in older women, as the present results suggest that (a) this is the type of abuse that is most likely to occur, and (b) this type of abuse is most likely to co-occur with other more severe forms of abuse. It is common for providers who suspect abuse to make referrals to agencies such as adult protective services. However, in the case of domestic abuse, this may be an inappropriate referral. In many states, adult protective services is only allowed to intervene if the victim is physically or mentally impaired, which may not be the case in every instance. Consequently, neither the cause nor the effects of the abuse will be addressed. Many people who provide services to the elderly are taught to think only about caregiver stress as a possible cause of abuse. In such cases, they may make referrals to get aging service providers into the home. In some situations this may exacerbate an already abusive situation. Advocates such as Brandl (1997) and researchers (Fisher et al., 2003; Vinton, 2003) have suggested that professionals in the aging field need to be more informed about the resources available for the victims of domestic violence. Similarly, professionals in the domestic violence field need to become more familiar with the resources available on aging (Fisher et al., 2004; Grossman & Lundy, 2003). As women who are being abused continue to age and live longer, it will become increasingly imperative that more and more cross-training take place between these two fields. Lastly, this study found that control, threat, physical, and sexual abuse is perpetrated by many people who are routinely involved in their victim's lives. The perpetrator can be a spouse or boyfriend, other relative, or non-relative. Consequently, health care and social service providers need to insist, if possible, for a few minutes alone with the older woman to question her about possible abuse and even the identity of the abuser.
This study is not without limitations. First, this is a cross-sectional study, which limits our ability to make causal inferences about the effects of health and abuse. We are unable to ascertain if abuse is the cause of the increase in health conditions or if having more health conditions puts women at more risk for being abused. Second, many of the potential survey respondents were never reached, and, because of the Health Insurance Portability and Accountability Act regulations, we were unable to find out any information on non-responders. Third, the abuse and health information is uncorroborated self-report and could not be confirmed through medical record review. The abuse is also self-report; however, because women are unlikely to report abuse, the abuse reported for this study may actually be an underreporting of the abuse taking place. Fourth, interviewers asked women to recall events that may have happened several years ago. It must also be kept in mind that the marital status and abuse relationship is one that must be viewed with caution. Respondents were asked about their current marital status—not their marital status at the time of the abuse. A respondent may have been abused by her spouse a year ago, and the spouse has since died.
Despite its limitations, this study is an important first step in documenting the existence of the different types of abuse happening to older women, its repetitive nature and frequency, and its effect on health. It is imperative that health care and service providers be aware of the health implications of abuse and understand the need for identification and training in both aging and domestic violence. As the population continues to age, awareness of resources available through both aging and domestic violence networks will become necessary.
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1 Division of Criminal Justice, University of Cincinnati, OH.
2 Department of Family Medicine, University of Cincinnati, OH.
Decision Editor: Linda S. Noelker, PhD
Received for publication March 17, 2005. Accepted for publication December 14, 2005.
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This article has been cited by other articles:
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  K. F. Stein Elderly Abuse: A Critical Issue on the Psychiatric and Mental Health Nursing Agenda Journal of the American Psychiatric Nurses Association, January 1, 2007; 12(6): 311 - 312. [PDF]
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