clinical focus
Deconstructing domestic violence
A recent forum brought
together industry
professionals to discuss
intimate partner violence
in older people and why
it’s different to other types
of domestic abuse.
Chanaka Wijeratne interviewed
by Dallas Bastian
I
ntimate partner violence in older people
tends to fall between the cracks, and
the true frequency of it is unknown, as
most research excludes older age groups.
These concerns prompted the South
Eastern Sydney Local Health District’s
Aged Care Psychiatry Service to host the
Domestic Violence and Older People
forum in June. The team invited people
working in healthcare, aged care, mental
health, domestic violence services and
legal services. The forum aimed to
stimulate discussion among clinicians
and community services to improve the
recognition and management of intimate
partner violence of older people.
Associate professor Chanaka Wijeratne, a
psychiatrist with the Aged Care Psychiatry
Service, said the characteristics and
implications of domestic violence in older
people are different to those of other
cohorts.
“There are age-specific issues that an
older victim must contend with, such as
physical illness, frailty, dementia and social
isolation. A victim may be required to
provide care for a long-term perpetrator of
domestic violence.”
Aged Care Insite spoke with Wijeratne
after the forum to find out what clinicians
and community workers should know
about intimate partner violence in older
cohorts and how it may differ to the
narratives they’re used to.
26 agedcareinsite.com.au
ACI: Why did the Aged Care Psychiatry
Service decide to host this event?
CW: Over the past 2–3 years, we noticed
quite a number of cases of older patients
presenting to our service, both in the
community and to the in-patient service,
where intimate partner violence was
involved. That was a little surprising to us
because the common assumption was that
this sort of behaviour burns out with age,
so clearly it’s not the case.
In light of these cases, we were keen to
investigate what kind of psychiatric and
perhaps medical or cognitive problems
drive this sort of behaviour. The other
reason for calling it was to liaise with
other professionals, such as police,
lawyers and people involved in domestic
violence services, to help us improve the
management of these cases.
You said domestic violence in older
people is different to that in other
cohorts due to age-specific issues. How
might this affect the way clinicians or
community workers approach intimate
partner violence?
If you look at any number of publications
about domestic violence, most highlight
particular minority groups, or special
interest groups, in considering domestic
violence. These are, for instance,
Indigenous people, people from a culturally
and linguistically diverse background,
people living in rural and remote areas, and
people with disabilities. But none of these
publications really say anything at all about
older people.
We believe there are age-specific
challenges for domestic violence in older
people. These include the fact that people
tend to have multiple physical illnesses,
they’re often frail and their self-care may
be impaired.
Similarly, other problems include a
reduced social network. We know that
often these older people have been subject
to domestic violence for a number of
decades, which in itself is a risk factor of
social isolation, but as people get older
and members of their social network may
themselves become sick or pass away, then
their isolation is accentuated. They’re just a
few of the age-specific challenges.
The other challenge is with regard to
couples. We may have couples who have
lived in a long-standing domestic violence
relationship and eventually one of the
partners, the perpetrator, may develop
dementia, for instance, and caring for the
perpetrator then obviously raises a number
of issues for the victim.
The first point I’d make for the healthcare
professional is to have a high index of
suspicion for it. Traditionally, and I think
this was the case with child abuse going
back maybe 50 years, we didn’t believe
that children could be abused, but I think
similarly we need a change in paradigm –
we need to be aware that older people can
be perpetrators of violence against other
older people.
Also, professionals need to be aware that
we’re dealing with a cohort of older people
who may not necessarily perceive domestic
violence to be a problem, because they
come from a particular time in our culture
when violence within a marriage was
relatively accepted, shall we say. There was
no legislation as we have now against both
elder abuse and domestic violence. There
weren’t the resources, such as domestic
violence services, for this cohort to be
aware of this as a problem.
Secondly, they may under-report it for
those reasons. So the older cohort may not
view domestic violence to be the kind of
issue or problem that younger cohorts do.
Professionals also need to be aware that
a bruise or black eye, which in an older
person could easily be explained away
as a fall or sign of frailty, may in fact be
the result of violence, which may include
intimate partner violence.