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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.

For further information, please see: Violence against older people and associations with mental health: A national probability sample survey of the general population in England – ScienceDirect

Or please contact Anastasia at anastasia.fadeeva@city.ac.uk

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.

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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

Welcome_VISION-Annual-Conference-2024Download

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

Keynote-Speaker-2_Research-to-policy-and-action_2Download

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

Symposium-1_Older-people-and-violence_HourglassDownload
Symposium-1_Older-people-and-violence_ONSDownload
Symposium-1_Older-people-and-violence_PHWDownload
Symposium-1_Older-people-and-violence_VISIONDownload

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

Symposium-2_Statutory-Review-Practice_AllDownload

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

Symposium-3_Violence-and-the-workplace_VISIONDownload
Symposium-3_Violence-and-the-workplace_EIDADownload
Symposium-3_Violence-and-the-workplace_VISION-2Download

Measuring ethnicity and the implications for violence inequalities

The question of how we measure, categorise, and represent ethnicity poses a growing challenge for identifying and addressing ethnic inequalities. Conceptual critiques and qualitative studies highlight the complexities and challenges of measuring ethnicity, yet there remains a lack of quantitative studies investigating the implications of these complexities for inequalities research.

VISION researchers, Hannah Manzur, Niels Blom, and Estela Capelas Barbosa, address this gap by scrutinizing methodological processes and analysing the implications of measurement and categorisation in the Crime Survey for England and Wales (CSEW), critiquing the UK’s standardised measurement of ethnicity in national survey data and government statistics.

Based on their comparative quantitative analysis of standardised ethnicity categories and regional origins and their evaluation of the CSEW and census’ methodologies, they propose an alternative categorisation of ethnicity, focusing on the ‘Mixed’, ‘Asian’, and ‘Latinx/Hispanic’ ethnic groups.

Using adjusted crosstabulations and logistic regression models, they found variations in ethnic patterns of violence victimisation based on standardised measures and their alternative recategorisation, particularly relating to the distinction between ‘Asian’ sub-groups, the recategorisation of ‘Mixed’ ethnicities, and the inclusion of ‘Latinx/Hispanic’ as a distinctive ethnic group.

Their findings reveal valuable insights into the implications of ethnic categorisation for understanding violence inequalities, with significant implications for further policy and research areas.

For further information please see: Social Sciences | Free Full-Text | (Mis)Representing Ethnicity in UK Government Statistics and Its Implications for Violence Inequalities (mdpi.com)

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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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VISION Research Fellows presenting at Crime Surveys User Conference 2024

VISION researchers Dr Polina Obolenskaya, Dr Elouise Davies and Dr Niels Blom will present at the Crime Surveys User Conference 2024 on 6 February 2024 in Islington, London.

The event brings data producers and data users together to share updates on the development of the surveys and to showcase research that is being carried out using the data. It is organised by the UK Data Service in collaboration with the Office for National Statistics, Scottish Government and the Home Office.

Polina, Elouise and Niels will each discuss the findings of their recent research using the Crime Survey for England and Wales:

  • Polina – The rise, fall and stall of violence in England and Wales: How have risks of violence changed for groups in the population?
  • Elouise – When there’s more than one assailant: Understanding variation in victims’ needs
  • Niels – New Crime Survey for England and Wales integration code: Impact for investigating
    rare events such as different intimate partner perpetrator types

For further information on the conference, please see: Crime Surveys User Conference 2024.

For further information on their research, please contact Polina, Elouise or Niels at: polina.obolenskaya@city.ac.uk; e.davies4@lancaster.ac.uk; or niels.blom@city.ac.uk

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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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Multiple perpetrator violent events and variation in victims’ needs  

Dr Elouise Davies

As an early career researcher in Criminology, I am interested in violent crime, domestic violence and threats to kill. Specifically, my research has focused on the measurement and outcomes of violence and how the harms of violence differ for different types of victims.  

In Comparing Single Perpetrator and Multiple Perpetrator Violent Events in the Crime Survey for England and Wales (CSEW) I look at the complex structure of violent events reported by CSEW participants. My aim was to compare the needs of victims of violence perpetrated by groups, with the needs of victims of violence perpetrated by a single offender.  

Victimisation surveys are the gold standard in measuring crime (Tilley and Tseloni 2016). They supplement police data. While police data can only capture crimes that are reported to the police, the CSEW captures up to 50% more by also including those events not reported to the police (ONS, 2020). We can use this to understand which types of crime and which victims are not appearing in police data.  

My analyses of CSEW data have revealed that victims of multiple perpetrator violent events more often report their experiences to the police than victims of single perpetrator violent events. They were also more likely to receive medical attention and treatment at hospital after the violent incident and were also more likely to have contact with victims’ services.   

These findings highlight how victims of violent events with one perpetrator may well be underrepresented in records drawn from police, health, and specialist services. It is important that research based on such data sources are aware of this issue in coverage.  

Further research is needed to investigate why some victims do not access services and how access to services can be improved for those who are currently underrepresented. 

For further information, please contact Elouise at e.davies4@lancaster.ac.uk

References

Tilley, N., & Tseloni, A. (2016). Choosing and Using Statistical Sources in Criminology: What Can the Crime Survey for England and Wales Tell Us? Legal Information Management, 16(2), 78-90. https://doi.org/10.1017/S1472669616000219   

Office for National Statistics (2020) The nature of violent crime in England and Wales: Year ending March 2020. London: ONS. https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/thenatureofviolentcrimeinenglandandwales/yearendingmarch2020   

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Presentations from 2nd VISION annual conference now available

We are pleased to provide the presentations from our 2nd annual conference held 21 September 2023 at Mary Ward House in London. 

The theme was Responding to violence across the life course. Sessions included presentations on childhood and teenage years; working life, poverty & economic impacts; older years; and social inclusion in policy and research. The conference concluded with a panel discussion on violence and complex systems.

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

Please feel free to download the presentations below. Each session is one download.

Photo caption: Dr Ladan Hashemi, Senior Research Fellow at VISION, answers a question after her presentation, ‘Adverse Childhood Experiences and Childhood Obesity:​ Exploring Potential Mediating and Moderating Factors​’

Download the Welcome slides

VISION-Annual-Conference-2023_Welcome-1Download

Download the slides from Session 1 – Childhood and teenage years

VISION-Annual-Conference-2023_Session-1-Childhood-and-teenage-yearsDownload

Download the slides from Session 2 – Social inclusion in policy & research

VISION-Annual-Conference-2023_Session-2-Social-inclusion-in-policy-and-researchDownload

Download the slides from Session 3 – Working life, poverty and economic impacts

VISION-Annual-Conference-2023_Session-3-Working-life-and-economic-impactsDownload

Download the slides from Session 4 – Older people

VISION-Annual-Conference-2023_Session-4-Older-people

Measuring violence using administrative data collected by specialist domestic and sexual violence and abuse support services

Interpersonal violence, which can include various forms of domestic and sexual violence and abuse (DSVA) is a leading cause of death, particularly among young adults. In the UK, specialist DSVA services provide much-needed support to victim-survivors of these types of violence, and some provide support for perpetrators to change their behaviour. To monitor and support their work, specialist services collect data on violence. This data has the potential to improve understanding of violence but presents unique challenges.

In this review, VISION researchers Dr Annie Bunce, Dr Sophie Carlisle and Dr Estela Capelas Barbosa describe and discuss some of the key challenges facing the data collected by specialist services.

Inconsistencies in data collection arise due to the differing remits and priorities of specialist services, which mean violence and abuse are defined and measured in slightly different ways by these organisations. Particularly, the review highlights the significant variation in outcomes and outcome measurement tools used to evidence the effectiveness of services and interventions.

Specialist support services collect valuable data on many and multiple types of violence, the wide impacts of violence on victim-survivors’ lives, and information about perpetrators. As the data are not collected for research purposes, a considerable amount of work is often required to make the data suitable for statistical analysis. Critically, the piecemeal and insecure funding of specialist services limits their capacity to collect and analyse data.

Together these issues make it challenging to collate data from specialist services and use it to inform measurements of violence. 

The researchers recommend the development of a core outcomes framework, exploration of methods for linking specialist services data with other sources of administrative data on violence, and sustainable funding for third sector specialist support services.

For further information please see: Social Sciences | Free Full-Text | The Concept and Measurement of Interpersonal Violence in Specialist Services Data: Inconsistencies, Outcomes and the Challenges of Synthesising Evidence (mdpi.com)

Or contact Dr Annie Bunce at annie.bunce@city.ac.uk

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Varying definitions and measurements of violence limit reduction strategies

Violence reduction is a United Nations (UN) sustainable development goal (SDG) and is important to both the public health and criminology fields. The collaboration between the two has the potential to create and improve prevention strategies but has been hampered by the usage of different definitions and measurements.

In this paper, VISION researchers Dr Niels Blom, Dr Anastasia Fadeeva and Dr Estela Capelas Barbosa explore the definitions and measurements of violence by the World Health Organization, UN, and Council of Europe to arrive at a harmonized framework aligned with the SDGs.

Violence and abuse are defined by these organizations as intentional actions that (are likely to) lead to harm, irrespective of physicality or legality. When recording violence and abuse, health- and justice-based administrative systems use different codes which cannot directly be translated without resorting to broad overarching categories.

The researchers propose a framework to record violence that includes individual and event identifiers, forms of violence and abuse (including physical, sexual, and psychological), harm, and individual and event characteristics.

For further information please see: Social Sciences | Free Full-Text | The Concept and Measurement of Violence and Abuse in Health and Justice Fields: Toward a Framework Aligned with the UN Sustainable Development Goals (mdpi.com)

Or contact Niels at Niels.Blom@city.ac.uk

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