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Uncovering ‘hidden’ violence against older people

By Dr Anastasia Fadeeva, VISION Research Fellow

Violence against older people is often overlooked. As a society, we often associate violence with young people, gangs, unsafe streets, and ‘knife crime’. However, violence also takes place behind front doors, perpetuated by families and partners, and victims include older people. 

Some older people may be particularly vulnerable due to poorer physical health, disability, dependence on others, and financial challenges after retirement. Policy rarely addresses the safety of this population, with even health and social care professionals sometimes assuming that violence does not affect older people. For example, doctors may dismiss injuries or depression as inevitable problems related to old age and miss opportunities to identify victims (1). In addition, older people may be less likely to report violence and abuse because they themselves may not recognise it, do not want to accuse family members, or out of fear (2). 

Given victims of violence often remain invisible to health and social services, police, or charities, the most reliable statistics on violence often come from national surveys such as the Crime Survey for England and Wales (CSEW) conducted by the Office for National Statistics. However, for a long time the CSEW self-completion – the part of the interview with the most detail on violence and abuse – excluded those aged 60 or more, and only recently extended to include those over 74. Some national surveys specifically focus on older people, but these ask very little about violence and abuse. Additionally, despite people in care homes or other institutional settings experiencing a higher risk of violence, it can be challenging to collect information from them. Therefore, many surveys only interview people in private households, which excludes many higher-risk groups.

We need a better grasp of the extent and nature of violence and abuse in older populations. First, reliable figures can improve the allocation of resources and services targeted at the protection of older people. Second, better statistics can identify the risk factors for experiencing violence in later life and the most vulnerable groups.

In the VISION consortium, we used the Adult Psychiatric Morbidity Survey (APMS 2014) to examine violence in people aged 60 and over in England (3). While we found that older people of minoritised ethnic backgrounds are at higher risk of violence (prevalence of 6.0% versus 1.7% in white people in 12 months prior to the survey), more research needs to be done to distinguish the experiences of different ethnic groups. Our research also showed that loneliness and social isolation were strongly related to violence in later life. Older people may experience social isolation due to limiting health issues or economic situations, and perpetrators can exploit this (4). Moreover, isolation of victims is a tool commonly used by perpetrators, especially in cases of domestic abuse (5).  Knowing about these and other risk factors can help us better spot and protect potential victims.

Additionally, more needs to be learnt about the consequences of life course exposure to violence for health and well-being in later life. This is still a relatively unexplored area due to limited data and a lack of reporting from older victims and survivors. It is sometimes more difficult to establish the link between violence and health problems because the health impacts are not always immediate but can accumulate or emerge in later life (6). Also, as people develop more illnesses as they age, it is more challenging to distinguish health issues attributable to violence. Therefore we are also using the English Longitudinal Study of Ageing (ELSA) to examine temporal relationships between lifetime violence exposure and health in older age.

In an inclusive society, every member should be able to lead a life where they feel safe and respected. We are delighted that the CSEW has removed the upper age limit to data collection on domestic abuse, which is one step towards making older victims and survivors heard. Continuous work on uncovering the ‘hidden’ statistics and examining the effects of intersectional characteristics on violence is crucial in making our society more inclusive, equal, and safe for everyone. For example, one VISION study (7) has demonstrated that the risks of repeated victimisation in domestic relationships had opposite trends for men and women as they aged. We are committed to support the Hourglass Manifesto to end the abuse of older people (8), and are willing to provide decision makers with evidence to enable a safer ageing society.

Footnotes

  • 1.  SafeLives U. Safe later lives: Older people and domestic abuse, spotlights report. 2016.
  • 2.  Age UK. No Age Limit: the blind spot of older victims and survivors in the Domestic Abuse Bill. 2020.
  • 3.  Fadeeva A, Hashemi L, Cooper C, Stewart R, McManus S. Violence against older people and mental health: a probability sample survey of the general population. forthcoming.
  • 4.  Tung EL, Hawkley LC, Cagney KA, Peek ME. Social isolation, loneliness, and violence exposure in urban adults. Health Affairs. 2019;38(10):1670-8.
  • 5.  Stark E. Coercive control. Violence against women: Current theory and practice in domestic abuse, sexual violence and exploitation. 2013:17-33.
  • 6.  Knight L, Hester M. Domestic violence and mental health in older adults. International review of psychiatry. 2016;28(5):464-74.
  • 7.  Weir R. Differentiating risk: The association between relationship type and risk of repeat victimization of domestic abuse. Policing: A Journal of Policy and Practice. 2024;18:paae024.
  • 8.  Hourglass. Manifesto A Safer Ageing Society by 2050. 2024.

Contact Anastasia at anastasia.fadeeva@city.ac.uk

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Presentations from the 2024 VISION Annual Conference

The presentations from the 3rd VISION annual conference are now available for downloading.

The event was held at Kings College London, Strand campus, on 11 June. The theme was Violence prevention in research and policy: Bridging silos. Keynote speakers, Dr Claudia Garcia-Moreno (World Health Organisation) and Professor Katrin Hohl (City, UoL) considered the changes needed for effective violence prevention from the perspectives of health and justice. Three symposiums highlighted interdisciplinary research from the VISION consortium and partners on:

– Violence against older people: Challenges in research and policy;

– Learning across statutory review practices: Origins, ambitions and future directions; and

– Responding to experiences and expressions of interpersonal violence in the workplace

Approximately 80 academics, central and local government officials, practitioners, and voluntary and community sector organisations attended from a range of health and crime / justice disciplines.

All the slides that could be shared are available below. Please feel free to download.

Photo caption: Symposium 3, ‘Responding to experiences and expressions of interpersonal violence in the workplace’. From left to right: Chair, Dr Olumide Adisa (University of Suffolk) and Panellists Dr Vanessa Gash (City, UoL), Dr Alison Gregory (Alison Gregory Consulting), Catherine Buglass (Employers’ Initiative on Domestic Abuse) and Dr Niels Blom (City, UoL)

Professor Gene Feder, VISION Director – Welcome – 1 download

Keynote Speaker, Dr Claudia Garcia-Moreno – Violence against women: From research to policy and action – 1 download

Symposium 1 – Violence against older people: Challenges in research and policy – 4 downloads (Hourglass, Office for National Statistics, Public Health Wales & VISION)

Symposium 2 – Learning across statutory review practices: Origins, ambitions and future directions – 1 download

Symposium 3 – Responding to experiences and expressions of interpersonal violence in the workplace – 3 downloads (Employers’ Initiative on Domestic Abuse, and 2 from VISION)

Unleashing social media potential to research violence against women and girls in Iran

Researching violence against women and girls (VAWG) in low- and middle-income countries (LMICs) presents unique challenges, primarily due to various contextual factors that hinder conventional survey methodologies. These challenges include limited funding, political obstacles, and safety concerns for both researchers and participants. Consequently, traditional survey approaches may prove unfeasible or inadequate in capturing the complex realities of VAWG in these settings.

VAWG is a particularly pressing issue in Iran, a Middle Eastern country marked by its patriarchal structure and systematic and pervasive gender discrimination. The patriarchal and legal structure of the country perpetuates gender inequalities and reinforces societal norms that tolerate or even condone violence against women. Yet, understanding the full scope of VAWG in Iran remains hindered by a lack of robust data.

In a recently published study, VISION researchers, Ladan Hashemi and Sally McManus, collaborated with counterparts from Bristol University (Nadia Aghtaie) and Iran (Fateme Babakhani) to explore the effectiveness of social media in recruiting victims of violence in Iran, shedding light on their experiences and the potential of social media as a research tool.

The findings revealed valuable insights into the manifestation and context of VAWG in Iran. Social media recruitment proved to be effective in reaching a diverse sample of victims and provided crucial insights into the dynamics of violence, the identities of perpetrators, and the settings where violence occurs. Victims often reported experiences from more than one type of perpetrator, spanning both public and domestic spheres. While social media recruitment offers broad reach and a safer environment for data collection, it also presents challenges such as sampling biases which affect the generalisability of findings.

For further information please see: Social Sciences | Free Full-Text | Using Social Media to Recruit Seldom-Heard Groups: Reaching Women and Girls with Experience of Violence in Iran (mdpi.com)

Or contact Ladan at ladan.hashemi@city.ac.uk  

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Consultation: Is there a need for a VAWG data dashboard?

In 2022, the UK Office for National Statistics (ONS) developed a prototype violence against women and girls (VAWG) dashboard. The tool presents statistics and charts on violence against women and girls in England and Wales, drawing on multiple sources. However, due to re-prioritisation at ONS, maintenance of the dashboard was halted and from 1st April 2024 it will no longer be accessible.

The VISION consortium is consulting on whether there is need for a VAWG data dashboard. This consultation is seeking views on:

  •  Whether the dashboard was useful
  •  Who used it and why
  •  If the dashboard was to continue, what aspects should be kept, dropped or added.

The consultation link is here: Qualtrics Survey | Qualtrics Experience Management

Anyone interested in the idea of a VAWG data dashboard is welcome to respond to the survey, particularly if interested in using one in the future.

Answer as many questions as you like. You can provide contact details or complete this anonymously. The findings will be used to draft a report and provide recommendations on whether the dashboard should continue. The report will include a list of the groups and organisations that participated (where details are provided). Individuals will not be named, although quotes may be taken from the text provided. The report may be published, for example on the VISION website.

The ONS VAWG dashboard was available online until 31 March 2024. Therefore, if you would like to participate in this consultation, please view the sample screenshots of the tool below.

This consultation closes Monday 22 April.

For further information, please contact us at VISION_Management_Team@city.ac.uk

VISION/VASC Webinar Series: IPV and the LGBTQI+ communities

This event is in the past.

We are pleased to announce the VISION and Violence & Society Centre (VASC) Webinar Series.

The purpose of the series is to provide a platform for academia, government and the voluntary and community sector that work to reduce and prevent violence to present their work / research to a wider audience. This is a multidisciplinary platform and we welcome speakers from across a variety of fields such as health, crime, policing, ethnicity, migration, sociology, social work, primary care, front line services, etc.

Our first webinar is Tuesday, 20 February 2024, 1300 – 1350. We welcome Dr Steven Maxwell, Research Associate in the School of Social & Environmental Sustainability and Associate in the School of Health and Wellbeing, at the University of Glasgow.

Steven will present his research on intimate partner violence within the LGBTQI+ communities. He is a former mental health nurse and completed his PhD in Global Public Health at University College London in 2021. Steven’s PhD explored HIV pre-exposure prophylaxis uptake/adherence among men who have sex with men who engaged in sexualised drug use. His current interest is researching health inequities/social justices across minority and deprived populations, particularly sexual & mental health, and related substance use.   

To register for the event in order to receive the Teams invitation and / or if interested in presenting at a future Series, please contact: VISION_Management_Team@city.ac.uk

The VISION/VASC Webinar Series is sponsored by the UK Prevention and Research Partnership consortium, Violence, Health and Society (MR-V049879) and the Violence and Society Centre at City, University of London.

Cost effectiveness of primary care training & support programme for secondary prevention of DVA

Recent research evaluated the cost-effectiveness of the Identification and Referral to Improve Safety plus (IRIS+) intervention compared with usual care using feasibility data derived from seven UK general practice sites.

IRIS+ is a training and support programme for clinicians working in primary care to aid in their identification of those experiencing or perpetrating domestic violence / abuse (DVA).

VISION Deputy Director, Dr Estela Capelas Barbosa and Director, Professor Gene Feder, worked with their University of Bristol colleagues to conduct a cost–utility analysis, a form of economic evaluation comparing cost with patient-centred outcome measures, as a means to measure the benefit obtained from the treatment or intervention.

The specific cost-utility analysis they conducted assessed the potential cost-effectiveness of IRIS+ which assists primary care staff in identifying, documenting and referring not only women, but also men and children who may have experienced DVA as victims, perpetrators or both.

The analysis showed that in practices that adopted the IRIS+ intervention, a savings of £92 per patient occurred. The incremental net monetary benefit was positive (£145) and the IRIS+ intervention was cost-effective in 55% of simulations (when the model is repeated with different assumptions).

The research team therefore concluded that the IRIS+ intervention could be cost-effective in the UK from a societal perspective though there are large uncertainties. To resolve these the team will conduct a large trial with further economic analysis.

For further information please see: Primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a cost-effectiveness feasibility model | BMJ Open

Or contact Dr Estela Capelas Barbosa at e.capelasbarbosa@bristol.ac.uk

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COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse

Dr Estela Capelas Barbosa, VISION Deputy Director has recently published, COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse: a mixed methods rapid study in the BMC Primary Care journal, with Lucy Downes, IRIS Network Director.

Increased incidence and/or reporting of domestic abuse (DA) occurred during the COVID-19 pandemic. As a result of the lockdowns across the UK, services providing support to victims had to adapt and consider adding methods of remote outreach to their programmes.

Identification and Referral to Improve Safety (IRIS) is a programme to improve the response to domestic abuse in general practice, providing training for general practice teams and support for patients affected by DA. The COVID-19 pandemic required those running the programme to adapt to online training and remote support.

Estela and Lucy employed a mixed methods rapid approach to this research in order to gather evidence around the relevance, desirability and acceptability of IRIS operating remotely. Quantitative IRIS referral data were triangulated with data from surveys and interviews. They found that the adaptation to online training and support of IRIS was acceptable and desirable.

This study contributes to practice by asserting the desirability and acceptability of training clinicians to be able to identify, ask about DA and refer to the IRIS programme during telephone/online consultations. The findings from this study may be of interest to (public) health commissioners when making commissioning decisions to improve the general practice response to domestic abuse.

For further information please see: COVID-19 adaptations to a training and support programme to improve primary care response to domestic abuse: a mixed methods rapid study | BMC Primary Care (springer.com)

Or contact Dr Estela Capelas Barbosa at e.capelasbarbosa@bristol.ac.uk

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VISION Adolescent Domestic Abuse conference

This event is in the past.

If registered, please enter through the main entrance in the University Building, across from Northampton Square, a green space with a gazebo. There is also a silver sculpture in front of University Building.

Only those that registered will be able to enter the conference room.

To register please see: VISION and VASC Adolescent Domestic Abuse conference

The UK Prevention Research Partnership Violence, Health & Society (VISION) consortium and the Violence and Society Centre at City, University of London, are pleased to announce the Adolescent Domestic Abuse conference.

Thursday 18th April 2024, 10:00 – 17:00 followed by a reception 
Oliver Thompson Lecture Theatre (Tait Bldg), City, University of London, EC1B 0HB 

Adolescent domestic abuse, which includes physical, emotional, and/or sexual abuse that occurs between young people who are, or were, dating, is often overlooked in research, policy and practice. The current definition of domestic abuse leaves those aged under 16 in teenage relationships falling into the gap between child protection procedures and adult-focused domestic abuse policy. 

The conference brings together academics, practitioners, and policy makers to share existing research, policy and practice.

Registration is required and free. This is an in person conference only and catering will be provided. If you cannot attend but would like the slides, please contact the email listed below.

The programme: 

  • 9:30 – 10:00 Registration & refreshments 
  • 10:00 – 10:20 Welcome & setting the scene, Dr Ruth Weir, Violence and Society Centre, City, University of London and Katy Barrow-Grint, Assistant Chief Constable, Thames Valley Police
  • 10:20 – 10:40 Introductory Speaker, Louisa Rolfe OBE, Metropolitan Police and National Police Chief Council lead for Domestic Abuse
  • 10:40 – 11:00 Rapid evidence review on domestic abuse in teenage relationships, Flavia Lamarre, and Dr Ruth Weir, City, University of London
  • 11:00 – 11:30 Learning from the lived experience, SafeLives Changemakers
  • 11:30 – 12:00 Researching abuse within teenage relationships: A critique of a decade’s work and what we could do better, Professor Christine Barter, Co-Director of the Connect Centre for International Research on Interpersonal Violence and Harm, University of Central Lancashire 
  • 12:00 – 13:00 Lunch
  • 13:00 – 14:20 Panel 1: Teenage relationships and abuse: What the research says, chaired by Professor Sally McManus, Director of the Violence and Society Centre and Deputy Director of the VISION research project
  • Panel 1: Step up, Speak Out: Amplifying young people’s voices in understanding and responding to adolescent domestic abuse, Janelle Rabe, Centre for Research into Violence and Abuse, Durham University
  • Panel 1: In practice it can be so much harder’: Young people’s approaches and experiences of supporting friends experiencing domestic abuse, Jen Daw and Sally Steadman South, SafeLives
  • Panel 1: Healthy relationships: children and young people attitudes and influences, Hannah Williams and Sarah Davidge, Women’s Aid
  • Panel 1: Intimate partner femicide against young women, Dr Shilan Caman, Karolinska Institutet, Sweden
  • 14:20 – 14:35 Break
  • 14:35 – 15:35 Panel 2: Sexual violence in teenage relationships, chaired by Katy Barrow-Grint, Thames Valley Police
  • Panel 2: “Always the rule that you can’t say no”: Adolescent women’s experiences of sexual violence in dating relationships – Dr Kirsty McGregor, Loughborough University 
  • Panel 2: Empowering Youth: Addressing Online Pornography and Adolescent Domestic Abuse – Insights from the CONSENT Project – Berta Vall, Elena Lloberas and Jaume Grané, Blanquerna, Barcelona, Spain and The European Network for Work with Perpetrators of Domestic Violence, Berlin, Germany
  • Panel 2: Image-Based Sexual Abuse as a Facet of Domestic Abuse in Young People’s Relationships – Dr Alishya Dhir, Durham University
  • 15:35 – 15:50 Break
  • 15:50 – 16:50 Panel 3: Specialist services and local government, chaired by Dr Olumide Adisa, University of Suffolk
  • Panel 3: The role and value of Early Intervention Workers in supporting children and young people aged 11–18 in a domestic abuse service context – Elaha Walizadeh and Leonor Capelier, Refuge 
  • Panel 3: Prevention, Identification, Intervention and Protection: Learning on teenage domestic abuse from a multi-agency model in the London Borough of Islington – Aisling Barker, Islington Borough Council
  • Panel 3: Tackling adolescent domestic abuse in Lambeth – Rose Parker, Erika Pavely, Ariana Markowitz, and Siofra Peeren, Lambeth Health Inequalities Research and Evaluation Network 
  • 16:50 – 17:00 Closing remarks and next steps
  • 17.00 – onwards Drinks reception, Conference attendees are invited to a drinks reception in the Oliver Thompson foyer

The abstracts

The abstracts and information on the poster presentations and stands are below for downloading.

For further information and any questions, please contact VISION at VISION_Management_Team@city.ac.uk

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Making change happen in primary care: the story of IRIS

VISION Director and Professor of Primary Care at the University of Bristol Medical School, Gene Feder, was a keynote speaker at the webinar: Making change happen in primary care – The IRIS story, on 28 November 2023.

With his co-presenter, Medina Johnson, CEO of IRIS, they shared the story of the concept and ambition that led to the beginning of the social enterprise established in 2017 to promote and improve the healthcare response to domestic violence and abuse (DVA).

DVA is a violation of human rights that damages the health of women and families. The health care sector, including primary care, has been slow to respond to the needs of patients affected by DVA, not least because of uncertainty about the effectiveness of training clinicians in identification and engagement with survivors of abuse.

To address that uncertainty, Gene and Medina conducted a cluster-randomised trial in Hackney and Bristol, finding that both identification and referral to specialist DVA services substantially increased in the intervention practices.

In the webinar they mapped the (not always smooth) trajectory from trial results to a nationally available programme commissioned by Integrated Care Boards (ICBs) and local authorities in over 50 areas to date, including getting into guidelines/policy, further implementation research, negotiating with commissioners, and setting up a social enterprise (IRISi) to drive the scaling up of the intervention.

For further information please watch the webinar video below.

For any questions or comments, please contact IRISi at info@irisi.org

Criminology hindered by lack of longitudinal data to study consequences of victimisation

VISION researchers Dr Vanessa Gash and Dr Niels Blom write in their latest publication, Measures of Violence within the United Kingdom Household Longitudinal Survey and the Crime Survey for England and Wales: An Empirical Assessment, that the field of criminology has been hampered by a lack of longitudinal data to examine the consequences of victimisation.

However, recently, ‘Understanding Society’, the United Kingdom Household Panel Survey (UKHLS), began fielding a small battery of questions relating to violence experience. Here, we examined the strengths and weaknesses of these UKHLS measures with similar indices from the Crime Survey for England and Wales (CSEW), a widely used and regarded but cross-sectional survey.

Vanessa and Niels empirically assessed the extent to which the UKHLS variables are comparable with those in the CSEW to determine the viability of the UKHLS for the longitudinal study of (fear of) violence and its consequences.

Overall, they regarded the UKHLS to provide an important resource for future panel research on the consequences of victimisation. They found the indicators measuring physical assault to be similar in both sets of data, but also noted differences in prevalence and/or different distributions by socioeconomic group for the indices relating to being threatened and of feeling unsafe.

Nonetheless, Vanessa and Niels maintain their utility for researchers in this field, allowing researchers to uncover new inequalities in violence exposure.

For further information please see: Measures of Violence within the United Kingdom Household Longitudinal Survey and the Crime Survey for England and Wales: An Empirical Assessment

Or contact Dr Vanessa Gash at vanessa.gash.1@city.ac.uk

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