An Exploration of Victimization in the Older Lesbian Population

Intimate partner violence (IPV) impacts significantly on the lives and health of those who experience abuse The impact of IPV exerts a detrimental impact on mental health as well as physical health, but this is often not recognized by professionals WHAT THE STUDY ADDS TO EXISTING KNOWLEDGE: This study highlights the impact of IPV on the lives and health of older women from the perspective of older women themselves The approach taken to the study illuminates the ways in which older women describe their experiences within the broader narratives of their experiences This study has explored the particular situation for older women as told through creative expression and their own stories of survivorship. Nurses and other healthcare professionals need to be aware of the enduring impact of IPV for older women, particularly within the context of mental health Those working with older women also need to be alert to the potential barriers to disclosure and disjuncture between professional dialogue and personal narrative ABSTRACT: Introduction Intimate partner violence (IPV) exerts a detrimental impact on the lives and health of all who experience abuse. This includes both physical and mental health and well-being. The experiences of older women however may be different, and these differences may not be recognized or accounted for within existing care provision. Aim To explore the impact of IPV on the lives and health of older women told from the particular perspective of older women themselves as these accounts are largely absence from existing IPV discourse. Method An arts-based research approach with five older women survivors of IPV through the codevelopment and organization of an arts-based workshop. The workshop essentially encompassed four main arts strands and included the creation of clay models and poetry. Findings The findings of the study highlight the significant impact of IPV on the lives, mental health and well-being of older women. This included feelings of social isolation, inability to trust others and a loss of self-identity. Discussion Intimate partner violence is a global issue and as such of relevance for those working in healthcare contexts beyond the UK. While there is a growing body of evidence surrounding IPV and older women, this has largely been presented through researcher-led accounts and as such the narratives of women themselves may not have been adequately acknowledged. Unlike much of the existing evidence, this study has explored the particular situation for older women as told through creative expression and their own stories of survivorship. In this study, the fluidity of the potential materials available in the workshops meant that both the representations through which the women spoke and the primacy of their voices, over those of more traditional researcher accounts, were in evidence throughout. Implications for Practice Mental health nurses and practitioners are often on the front line for care and support for older client populations. IPV across the life span is a global issue for healthcare practitioners. It is anticipated that the findings of this study will provide the mechanism through which mental health nurses and other practitioners may reflect on older women's accounts of IPV as told by older women in this study in their own words. Reframing from dominant professional discourse to personal narrative is central to person-centred approaches and is central to contemporary practice. Ultimately, this has the potential to improve the effectiveness of care provision and support. Relevance to Mental Health Nursing The findings presented in this study have the potential to provide a powerful tool for those working within mental health contexts and healthcare professionals working with older populations more generally to consider both the hidden nature of IPV and the ways in which IPV can significantly impact on mental health and well-being in later life.

Background Intimate partner violence (IPV), a subtype of domestic violence, is a pervasive global problem with life-long impacts. Among U.S. older adults, the prevalence of psychological IPV (PAIPV) is 2.1%, and physical IPV (PVIPV) is 0.8%. Sadly, underrepresented individuals, including immigrants, have less access to resources that can serve as IPV protective factors. Due to the growing immigrant and older population in the U.S., it is essential to identify their unique IPV characteristics. Objective and Method: This study used and analyzed the latest publicly available cross-sectional data from the National Intimate Partner and Sexual Violence Survey 2016/17 (n=10,957) of a selected national sample of English and Spanish-speaking immigrants (n=1,121) to identify their odds of experiencing PAIPV or PVIPV-based on identified demographic characteristics, including age. Additionally, of interest and identified was the prevalence of PAIPV and PVIPV among older immigrants 65+ years (n=124). Results Contrary to the literature, among older immigrants aged 65+ years, PVIPV (10.7%) was more prevalent than PAIPV (9.1%). In an adjusted regression model for PAIPV at 95% CI, Spanish and/or English-speaking immigrants aged 65+ years were 3.147 [1.065, 9.299] significantly more likely to experience PAIPV than younger immigrants. However, age was not significantly associated with PVIPV. To conclude, IPV presents itself in unique etiologies among older immigrants. This study is an initial step toward using national data to understand IPV better for a combined male and female sample of older immigrants in the U.S. Further discussed will be the distinct differences in the study findings.

Sexual minority rights in contemporary Africa is a contentious issue, where in some countries, same-sexuality is portrayed by media and politicians as “un-African” and a “white disease” imported from the West. Same-sex sexual activity is criminalised in 31 African countries. Political, legal and religious frameworks exacerbate homophobic attitudes, and related discrimination and hate crimes toward individuals who identify as lesbian, gay, bisexual or transgender (LGBT). We focus here on the rights of people in prison to protection from harm (same-sex sexual violence and sexually transmitted diseases), and who (in many African countries) are ignored in national HIV prevention programming. Prison conditions in Africa are harsh and congested, with inadequate basic needs provisions and this fuels exposure of the vulnerable to sexual violence and engagement in survival sex. HIV rates in prisons are also disproportionately higher than in the community. We present a socio-legal assessment on Malawi where same-sex sexual behaviours are criminalised. The assessment highlights how inmates’ exposure to sexual violence is invisible in political, legal, human rights and public health/HIV agendas in Malawi. Notwithstanding that the Malawi Penal Code and Prison Act prohibits same-sex sexual activity, there are enormous complications with victim disclosure, as claims of rape infer that sodomy has occurred, resulting in victim arrest. We focus here on tackling sexual violence and HIV, and advocate for broad based torture prevention initiatives in prisons to protect the vulnerable from inter-personal sexual violence, and consequent acquisition and onward transmission of HIV. The voices of people in prison in Malawi are regrettably still kept out of societal and public health discourses.

Child and Adolescent Health and Development: Realizing Neglected Potential

Neighborhood Effects and Intimate Partner and Sexual Violence: Latest Results

Because a substantial proportion of sexual violence, stalking, and intimate partner violence is experienced at a young age, primary prevention of these forms of violence must begin early. Prevention efforts should take into consideration that female sexual violence and stalking victimization is perpetrated predominately by men and that a substantial proportion of male sexual violence and stalking victimization (including rape, unwanted sexual contact, noncontact unwanted sexual experiences, and stalking) also is perpetrated by men. CDC seeks to prevent these forms of violence with strategies that address known risk factors for perpetration and by changing social norms and behaviors by using bystander and other prevention strategies. In addition, primary prevention of intimate partner violence is focused on the promotion of healthy relationship behaviors and other protective factors, with the goal of helping adolescents develop these positive behaviors before their first relationships. The early promotion of healthy relationships while behaviors are still relatively modifiable makes it more likely that young persons can avoid violence in their relationships.

Back to table of contents Previous article Next article Professional NewsFull AccessFree WPA Curriculum Available on Intimate Partner, Sexual ViolenceMark MoranMark MoranSearch for more papers by this authorPublished Online:17 Oct 2016https://doi.org/10.1176/appi.pn.2016.10b1AbstractThe curriculum is designed for training medical students, psychiatrists in residency programs, and practicing psychiatrists, with increasing levels of competency at each level.A new competency-based curriculum focusing on intimate partner violence and sexual violence against women, issued by the World Psychiatric Association (WPA), seeks to educate medical students, trainees, and practicing psychiatrists about interviewing, assessing, and treating women victims of intimate partner or sexual violence. The WPA’s International Competency-Based Curriculum for Mental Health Care Providers on Intimate Partner Violence/Sexual Violence Against Women, issued in July, is a 55-page document freely accessible on the WPA website. It outlines a wide range of teaching tools—didactic material, PowerPoint slides, case vignettes, and videos. “We owe it to our trainees to help them be up to speed on inter-viewing, assessing, and treating women exposed to intimate partner violence and sexual violence.” —Donna Stewart, M.D.The curriculum was developed by a steering committee of the WPA Section on Women’s Mental Health. Donna Stewart, M.D., co-chair of the committee and University Professor and chair of Women’s Health at the University of Toronto, said that psychiatric educators are welcome to use the resources in whole or in part with attribution.In an interview with Psychiatric News, Stewart said research indicates that few women who experience abuse or violence ever tell a health professional, and few physicians ask about intimate partner or sexual victimization. She said that’s true in mental health settings as well. The major barriers offered by psychiatrists for failing to discuss intimate partner or sexual violence include lack of adequate training about how to ask or respond, lack of knowledge regarding prevalence, skepticism about treatment effectiveness, concern about legal involvement, uncertainty about appropriate referrals, physician discomfort with the issues, time constraints, fear of offending or losing patients, and fear of safety for the women or oneself. “Worldwide the prevalence of intimate partner violence is at least 30 percent,” Stewart continued. “And we know that intimate partner violence and sexual violence dramatically affect mental health.” She added that while it is recognized that men can be victims of intimate partner violence, it is women who are disproportionately on the receiving end of such violence and tend to suffer greater injury.The curriculum is built around observable “competencies”—similar to the core competencies set by the Accreditation Council for Graduate Medical Education—that should be mastered in successive stages. The nine competencies described in the curriculum, each of which is divided into subtopics, require learners to be able to do the following: Define physical, psychological, and sexual intimate partner violence. Discuss prevalence.Be aware of myths and preconceptions.Have knowledge of sequelae. Assess for presence in a clinical setting.Provide psychological first aid.Have knowledge of resources.Communicate and document details of assessment.Manage violence-related psychological trauma.The curriculum offers five forms of resources. These include the World Health Organization’s Guidance on Health for Women subjected to intimate partner violence or sexual violence; links and abstracts of key papers, books, manual, and toolkits; a number of PowerPoint slides on intimate partner and sexual violence; case vignettes and teaching points; and video-based learning vignettes accessible on YouTube.One case vignette, for instance, is on “Treatment of Posttraumatic Stress Disorder After Sexual Violence (or Intimate Partner Violence)”: A family doctor refers a 25-year-old woman who was raped six months ago by an ex-partner to a community psychiatrist for intrusive memories of the assault, distressing dreams, flashbacks, avoidance of being alone, sadness, anxiety, trouble concentrating, hypervigilance, and inability to work. The woman was previously well and has no psychiatric history. The vignette is accompanied by teaching points about diagnosis, the range of treatment options, and documentation. Stewart said that the WPA’s Section on Women’s Mental Health began work on the curriculum three years ago, when the steering committee was selected from international leaders with expertise in intimate partner violence and sexual violence. It was cited as a priority by WPA President Dineesh Buhgra, M.D., Ph.D., of the United Kingdom. The co-chair of the curriculum steering committee is Prabha Chandra, M.D., professor and chair of the Department of Psychiatry at the National Institute of Mental Health and Neurosciences in Bangalore, India. Past APA President Michelle Riba, M.D., a member of the WPA Section on Women’s Mental Health and secretary of scientific publications for the WPA, said the curriculum is being disseminated at psychiatric meetings around the world, including APA’s, and a number of universities and training programs have already begun using it. The curriculum is accompanied by the Position Statement on Intimate Partner Violence and Sexual Violence Against Women, also issued in July, that declares the WPA’s support for public and professional awareness of violence against women as a critical women’s mental health determinant and for research to develop and evaluate the best treatments for women who have been victimized. “As many as 30 percent of our female patients will have experienced intimate partner violence, so we owe it to our trainees to help them be up to speed on interviewing, assessing, and treating women exposed to intimate partner violence and sexual violence,” Stewart said. “And practicing psychiatrists owe it to themselves and their patients to be current as well.” ■The International Competency-Based Curriculum for Mental Health Care Providers on Intimate Partner Violence/Sexual Violence Against Women can be accessed here. The WPA Position Statement on Intimate Partner Violence and Sexual Violence Against Women is available here. ISSUES NewArchived

e16098 Background: Esophageal adenocarcinoma (EAC) is a rapidly growing cancer in the United States. Although often associated with older populations, there is interest in understanding incidence trends across all age groups, particularly younger individuals (< 49 years). This study evaluates both the incidence of EAC and stage distribution across age groups to inform targeted screening and prevention strategies. Methods: This retrospective cohort study utilized data from the National Cancer Database (NCDB) from 2012 to 2021. Annual incidence rates were analyzed across three age groups (< 49, 50–69, and 70–90 years) and visualized with linear trend lines. Stage distribution at diagnosis (Stages 0–IV) was also compared among these age groups to identify differences in disease presentation. Results: Incidence trends revealed significant differences among age groups. Linear regression analysis showed a slight decline in incidence for the < 49 age group (slope = -0.0016) over the 10-year period, with rates remaining low and stable. In contrast, the 50–69 and 70–90 age groups demonstrated similar upward trends (slope = 0.0527) reflecting a moderate and consistent increase in incidence over time. The 50–69 age group had the highest overall incidence rates, increasing from approximately 2.0 to 2.5 per 100,000 between 2012 and 2021. Stage distribution analysis revealed that younger patients (< 49 years) were more likely to present with advanced-stage disease, with 47.08% diagnosed at Stage IV compared to 38.99% in the 50–69 group and 34.26% in the 70–90 group. Early-stage diagnoses (Stages 0/I) were most common in the 70–90 age group (20.05%) and least common in the < 49 group (13.42%). Conclusions: The incidence of EAC is increasing in middle-aged (50–69) and older (70–90) populations, while younger individuals (< 49) maintain stable but low rates of disease. However, the younger group is disproportionately diagnosed at advanced stages, highlighting a need for greater awareness and potential early detection efforts in high-risk young individuals. Meanwhile, middle-aged and older populations should remain the primary focus of prevention and screening programs to address the rising burden of EAC in these age groups.

The prevalence of Helicobacter pylori remains high in the older population. Specific age-related peculiarities may impact the outcomes of H. pylori treatment. The aim of the study was to evaluate the diagnostics and effectiveness of H. pylori eradication between the younger and older European populations. “European Registry on H. pylori Management (Hp-EuReg)” data from 2013 to 2022 were analyzed. Patients were divided into older (≥ 60 years) and younger (18–59 years) groups. Modified intention-to-treat (mITT) and per-protocol (PP) analysis was performed. 49,461 patients included of which 14,467 (29%) were older-aged. Concomitant medications and penicillin allergy were more frequent among the older patients. Differences between younger and older populations were observed in treatment duration in first-line treatment and in proton pump inhibitors (PPIs) doses in second-line treatment. The overall incidence of adverse events was lower in the older adults group. The overall first-line treatment mITT effectiveness was 88% in younger and 90% in the older patients (p < 0.05). The overall second-line mITT treatment effectiveness was 84% in both groups. The effectiveness of the most frequent first- and second-line triple therapies was suboptimal (< 90%) in both groups. Optimal efficacy (≥ 90%) was achieved by using bismuth and non-bismuth-based quadruple therapies. In conclusion, the approach to the diagnostics and treatment of H. pylori infection did not generally differ between younger and older patients. Main differences were reported in the concurrent medications, allergy to penicillin and adverse events both in first- and second-line treatment. Optimal effectiveness rates were mostly achieved by using bismuth and non-bismuth-based quadruple therapies. No clinically relevant differences in the effectiveness between the age groups were observed.

Supportive attitudes towards intimate partner violence against women (IPVAW) normalize and promote these aggressive behaviors. As a result, more and more research is proposing the identification, analysis and intervention of these attitudes. However, the vast majority of this research focuses on students. The main objective of this paper is to analyze these supportive attitudes throughout the lifecycle. An opportunity sample of 200 Spanish participants, by age and sex fixed quotas, took part in this study. Attitudes were measured using the Inventory of Distorted Thoughts about Women and Violence, the Inventory of Beliefs about Intimate Partner Violence and the Gender Violence Implicit Association Test, a personalized form of Implicit Association Test (IAT). The results show that explicitly measured supportive attitudes towards intimate partner violence against women differ between age groups, adopting a U-shape distribution: lower acceptance among middle-aged-adults and young-adults and higher acceptance among adolescents and older adults. However, when these attitudes were implicitly measured, the IPVAW rejection increased with age, which is a counter-intuitive result and inconsistent with previous theoretical evidence. In summary, these results support an age effect that differs according to the measure of attitudes used and highlight some difficulties related to based-on-reaction-time measures among older people. This suggests the need for further research on the topic, especially among the older population.

BackgroundThe older dialysis population is increasing, and several studies have investigated the effect of actual age on the relationship between clinical parameters or clinical practice and prognosis. There is concern that biological age does not necessarily reflect the actual effects of aging, and it is important to take heterogeneity into account when considering the older population. In this study, we investigated whether such heterogeneities exist in a large number of clinical parameters and how any disparities might be affected by the domains of clinical indices.MethodsWe investigated the published, summarized results of the Japanese Society for Dialysis Therapy Renal Data Registry, a nationwide survey of the Japanese dialysis population, for the year 2013.ResultsThe potential population comprised 306,925 dialysis patients. We investigated coefficient of variations (CVs) of 25 clinical indices across age groups and compared them with the CVs of the 45–59 years age group as a reference group, using tests for homogeneity of variances. Almost all variables showed some heterogeneity by age. The domain for muscle mass or visceral protein exhibited greater heterogeneity in older patients, but surprisingly, the domain for body mass or physique exhibited less heterogeneity. The mean values of most parameters declined in the older population.ConclusionsThis study demonstrated that variations exist in clinical indices in the older dialysis population. Apart from biological age, we should take these heterogeneities into account when interpreting the findings of clinical studies involving older dialysis patients and in their individualized management.

Research on intimate partner violence (IPV) screening and response has focused largely on women of reproductive age, yet all patient populations may experience IPV and benefit from identification and response in the healthcare setting. Through analysis of in-depth interviews, this study examines perspectives of clinicians across a variety of healthcare disciplines and roles on conducting IPV screening and response protocols with older patient populations, often previously excluded from routine IPV screening. Study findings reveal mixed experiences with older patient response to being asked about possible IPV in their relationships and mixed clinician perceptions about the value and necessity for routine IPV screening among older adult patient populations. The findings point to a need for increased patient and clinician education about IPV risk among older adults and possible reconsideration of approaches to assessment of both IPV as well as other forms of elder abuse among older patient populations.

Intimate Partner Violence

The costs and consequences of intimate partner violence (IPV) and sexual violence (SV) are well-documented; however, little is known about how experiences of violence are connected to specific economic insecurities including food, healthcare, and housing insecurity among both men and women. This study investigates (1) the prevalence of food, healthcare, and housing insecurity across gender and racial groups exposed to IPV and SV and (2) associations between exposure to past-year IPV and SV and past-year food, healthcare, and housing insecurity controlling for confounding factors. A cross-sectional survey design was used in this study. Data from 2010 National Intimate Partner and Sexual Violence Survey (NISVS) were analyzed in a nationally representative sample of men (N = 8079) and women (N = 9970). Logistic regressions were used to model associations between past-year intimate partner and sexual violence and dependent variables of food, healthcare, and housing insecurity. Analyses were stratified by gender and included control variables of age, income, education, and race/ethnicity. Higher rates of food, housing, and healthcare insecurity were found among men and women of color exposed to violence, particularly among respondents who identified as Black/African American, Latinx, American Indian/Alaska Native, and other racial/ethnic minority groups. For men, IPV and SV was associated with higher odds for experiencing food (AOR = 2.40, p <.001), housing (AOR = 2.06, p <.001), and healthcare insecurity (AOR = 2.39, p <.001). For women, IPV and SV was also associated with higher odds for experiencing food (AOR = 2.16, p <.001), housing (AOR = 1.94, p <.001), and healthcare insecurity (AOR = 2.38, p <.001). Findings identify specific economic needs among survivors and suggest that the burdens of IPV and SV are not equitably shared across racial/ethnic populations. Findings can inform policy that aims to reduce inequalities in food, housing, and healthcare associated with IPV and SV.

Victims of violence might have higher risks of revictimization, but this has been insufficiently examined among older populations. The present study used cross-sectional data among 3,157 U.S. Chinese older adults in Chicago, Illinois. Multiple logistic regression analyses were used to examine the relationships among subtypes (psychological, physical/sexual, financial exploitation, caregiver neglect) of child maltreatment (CM), intimate partner violence (IPV), and EM. Violence experiences were positively associated. CM psychological was positively associated with IPV psychological (OR 7.60, 95% CI 4.29-13.45) and EM psychological (OR 3.79, 95% CI 2.20-6.51). CM physical/sexual was positively associated with IPV physical/sexual (OR 1.86, 95% CI 1.02-3.38) and IPV physical/sexual was positively associated with EM physical/sexual (OR 8.54, 95% CI 3.53,20.64). EM financial exploitation was positively associated with all types of CM and IPV, whereas EM caregiver neglect has no significant association with any CM or IPV. Clinical and policy implications of the findings will be discussed.