Intimate partner violence prevalent among older women beyond guideline-recommended screening age
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Intimate partner violence remained prevalent among middle-aged and older women and was associated with morbidity in these populations, according to results of a cohort study published in JAMA Network Open.
Researchers noted that screening for intimate partner violence among women aged older than 44 years may improve detection and provision of evidence-based services to at-risk individuals.
“Our goal in this study was to better understand the performance and outcomes of intimate partner violence screening among women aged 45 years and older, since the current U.S. Preventive Services Task Force guidelines do not recommend screening over age 44 years,” Lena K. Makaroun, MD, MS, core investigator at the VA Pittsburgh Center for Health Equity Research and Promotion, told Healio Psychiatry. “However, the VA has proactively been screening women of all ages, recognizing that intimate partner violence is not exclusively something that young women experience. We hoped to show what happens when middle-aged and older women are screened, as well as to highlight differences in downstream important health-related outcomes for women who screen positive compared with those who screen negative.”
Prior studies, including a survey study of 91,749 women aged 50 to 79 years, suggested that women who experienced intimate partner violence in later life may have experienced abuse throughout their lifetime and continue to experience repeated abuse in older age. In the current study, Makaroun and colleagues included 4,481 women aged 45 years and older who were screened for past-year intimate partner violence in 13 Veterans Health Administration outpatient clinics in 11 states between April 2014 and April 2016. They used positive screening result for past-year intimate partner violence as the exposure. Mental and physical health conditions identified using ICD-9 and ICD-10 codes from VHA medical record data, as well as VHA health services utilization identified using inpatient and outpatient VHA encounter data, in the 20 months after screening served as main outcomes and measures.
Among the participants, 65.5% were aged 45 to 59 years (middle-aged), 34.5% were aged 60 years or older and 43.6% were black. Results showed 8.7% (n = 255) of middle-aged women and 5.1% (n = 79) of older women screened positive for past-year intimate partner violence. Adjusted logistic regression models among middle-aged women showed associations between screening positive for intimate partner violence and subsequent diagnoses of anxiety (adjusted OR [aOR] = 2; 95% CI, 1.5-2.7), depression (aOR = 2.3; 95% CI, 1.8-3), PTSD (aOR = 2.3; 95% CI, 1.8-3), suicidal ideation and/or behavior (aOR = 3.8; 95% CI, 2.1-6.9) and substance use disorder (aOR = 2.5; 95% CI, 1.8-3.5). The researchers observed similar but attenuated associations for older women, such as for substance use disorder (aOR = 2.2; 95% CI, 1.1-4.4). Adjusted negative binomial regression models among middle-aged women showed associations between screening positive for intimate partner violence and a higher rate of subsequent psychosocial (ie, mental health) visits (adjusted rate ratio [aRR] = 2.4; 95% CI, 2-2.9), primary care visits (aRR = 1.2; 95% CI, 1.1-1.3) and ED visits (aRR = 1.5; 95% CI, 1.2-1.8). The researchers reported a higher rate of psychosocial visits (aRR = 1.9; 95% CI, 1.3-2.7) but not of other visit types among older women who screened positive for intimate partner violence
“There is nothing magical about age 45 [years] where, poof, people are immune to the complex nature of intimate relationships,” Makaroun said. “Older adults not only participate in long-term intimate partnerships but enter into new partnerships as they age. Just like younger adults, older adults may experience violence in their relationships, but important and unique considerations must be taken when addressing this, as older adults may have specific needs related to cognition, physical function, finances and housing that impact their relationships. I am hopeful that this study will build public awareness of this issue in older adults and break down some of our ageist beliefs about who experiences intimate partner violence, with an ultimate goal of preventing it across the lifespan.” – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.