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Older Women

In 2019, WHISE collaborated with a number of stakeholders through the Southern Melbourne PCP Elder Abuse Primary Prevention network to conduct a literature review concerning prevention of elder abuse. In summary, the review called for a framework to prevent violence in all its forms against older people.  

The issue of abuse of older Australian’s and specifically women, is of particular concern for WHISE given the number of older women living in our region and the increasing priority placed on this area by State Government, the Federal Government, community and policy makers. 

The review concluded that even though there is consistent agreement that elder abuse is a prevalent issue in the community, there is a shortage of evidence and direction on practice to address how to prevent it: 

There is a paucity of evidence about the role of primary prevention specifically to address abuse of older members of our community.  

Of the interventions described, the EAPN Steering Committee would hold they do not fall within the remit of primary prevention – rather they are secondary and tertiary response strategies. 

There are mixed views as to whether elder abuse is best understood as a form of family violence, or as a unique issue in its own right. However, we support the view of the Victorian Royal Commission into Family Violence that it must be considered as family violence. 

(Lord, et al., 2019, p. 6) 

Victoria’s Royal Commission into Family Violence includes abuse of older people in its definition of family violence saying it “encompasses other forms of violence, such as elder abuse, and violence against parents and siblings” (Neave, et al., 2016, p. 1). It has been estimated that “up to one in 20 older people can experience elder abuse, and for about half of them that abuse might be in the form of financial abuse” (Lord, et al., 2019, p. 59). Therefore, the abuse of older Australians is a prevalent issue.  

In Australia, research on elder abuse has been limited to studies looking at particular types of elder abuse (e.g. financial abuse), qualitative studies and those based on administrative data from services who provide support to older people. Such studies are unable to shed light on the proportion of older people aged 65 and over who experience elder abuse or which subtypes are most common. Nor are they able to assess other important issues, such as the extent to which elder abuse is under-reported (Qu, et al., 2021; Joosten, et al., 2017). In response the Attorney-General’s Department commissioned the most extensive empirical examination of elder abuse in Australia to date as part of the National Plan  

According to this study (Qu, et al., 2021), the prevalence of elder abuse varies according to the type of abuse, however psychological abuse was the most common subtype abuse reported at 12%. The findings from the study indicates that Australia’s overall elder abuse prevalence rate is 14.8%. 

Similarly in past studies it was reported, psychological and financial abuse are the most commonly reported types of abuse. Neglect has been estimated to be as high as 20%. Furthermore, older women have been found to be more likely than men to experience financial elder abuse (Kaspiew, et al., 2016). 

While there are few comprehensive Australian data sources that indicate the prevalence of economic abuse of older people there is some evidence that identifies the gendered nature of the issue. In 2010, Monash University analysed public advocate, helpline and public trustee data, and found that women are more likely to experience financial elder abuse than men. It also found that the primary perpetrators were sons, followed by daughters. The finding that women are more likely to experience financial elder abuse than men is consistent with Seniors Rights Victoria helpline data where women make up approximately 72 percent of calls. 

(Neave, et al., 2016, p. 99) 

Data from the 2012 Personal Safety Survey has shown that .4% of women aged 55 and older have experienced cohabitating partner violence and .2% have experienced sexual assault in the previous 12 months (Kaspiew, et al., 2016). Furthermore, data from the cohorts aged 70 or over in the Longtitudinal Study of Women’s Health has indicated a stable prevalence rate of about 20% across each wave. 

When this cohort was surveyed in 2011 (at age 85- 90), the findings suggested that 8% had experienced vulnerability to abuse, with name calling and putdowns being the most common forms. A similar level of prevalence was evident for this cohort in a preceding wave, conducted in 2008 (age 82-87), and slightly lower prevalence levels were found at younger ages (70-81 years). Measures the researchers used to assess neglect indicate a relatively stable prevalence rate of about 20% across waves, from ages 70-75 and 85-90 years. 

(Kaspiew, et al., 2016, p. 6) 

A 2015 investigation by the Australian Ageing Research Institute on matters reported through the Senior Rights Victoria helpline highlighted the impact of elder abuse on gender and in particular, the role of intersectionality: 

The total number of older women reporting abuse was approximately 2.5 times that of older men.  

Over half (62 per cent) of older people who reported an abuse matter had some kind of disability, the majority (45 per cent) being physical. 

(Joosten, et al., 2015, p. 12) 

Social Inclusion

Women’s Health East (2019) have identified unique barriers to social inclusion that older women face in our community.  

Current narratives continue to disadvantage women by failing to recognise the lifelong impacts of inequality that are further compounded in the later years.  

(Women’s Health East, 2019, p. 8) 

The gender inequality that women may have experienced at earlier stages in their lives becomes sharper and more pronounced as the age. 

(Women’s Health East, 2019, p. 9) 

Evaluating access to health services and understanding the wellbeing and health of older women from a social inclusion perspective matters. Social exclusion has been described by Levitas and colleagues (2007, p. 9) as: 

A complex and multi-dimensional process. It involves the lack or denial of resources, rights, goods and services, and the inability to participate in normal relationships and activities, available to the majority of people in society, whether in economic, social, cultural, or political arenas. It affects both the quality of life of individuals and the equity and cohesion of society as a whole. 

Those who are socially excluded therefore do not have the resources, capabilities and opportunities to learn, work, engage and live healthy and well lives.  

Women’s Health East (2019) have summarised some key evidence around women and ageing, telling us that overall women: 

  • Make up the majority of the oldest population in Australia. 
  • Make up the majority of carers across all age groups. 
  • Make up the majority (60%) of aged care residents (AIHW, 2018). 
  • Are less likely to volunteer than men with volunteering being associated with better health (DHHS, 2017) 
  • Have higher levels of anxiety and depression (Bowling, 2007; McCredie, 2009) and live with more chronic disease than men (AIHW, 2016). 

Research has found that older women are more likely than older men to be socially excluded (Women’s Health East, 2019; Brotherhood of St Laurence, 2019). Furthermore, older people are more socially excluded than younger people (Brotherhood of St Laurence, 2019). 

While social exclusion is faced by all older men, research undertaken by Women’s Health East (2019) unpacks specific gendered drivers to exclusion which highlights the impact of exclusion on older women. Women’s Health East (2019) describe social exclusion as a process rather than an outcome which, combined with the cumulative effects of gender on health, compounds the lived experience of many women in older age cohorts. Older women are more likely than older men to (Women’s Health East, 2019): 

  • Experience entrenched poverty. 
  • Experience housing stress and homelessness and be less able to maintain homeownership and afford private rental accommodation if they are living alone (a common situation given the lifespan of women compared to men). 
  • Have poor financial literacy due to stereotype expectations of gender roles throughout a woman’s life.  
  • Be perceived as having outdated skills, too slow to learn new things or deliver an unsatisfactory job due to the negative impact experienced by women during their lives due to caring responsibilities, larger gaps in their work career, and other associated impacts due to the low value placed on caring duties. 
  • Experience invisibility in society due to social pressures on women’s appearance 
  • Be digitally disengaged and have lower levels of digital literacy. 
  • Have a higher chance of not having a driver’s license. 
  • Have higher rates of dementia and live with severe or profound core activity limitation. 
  • Live with a higher prevalence of disability and less likely to receive support services. 

Role of health promotion and primary prevention in women’s health in supporting older women

Health promotion and primary prevention initiatives for older women in our region will benefit from taking a social inclusion perspective as it will enable us to see the whole system of impacts experienced by older women in our community.

Social exclusion risk factors provide a helpful framework for assessing need (Women’s Health East, 2019) and building capacity in community and agencies to better understand specific risk factors for older women will enable primary prevention work to create and provide suitable services for older women.  

The current industry view in our region is that no primary prevention framework or evidence-based practice exists to prevent elder abuse (Lord, et al., 2019). Furthermore, health promotion of the conditions that effect older women are limited to broad public policy and primary prevention strategies impacting the whole of population’s wellbeing such as, prevention of obesity, alcohol campaigns, and other broad gender-specific strategies such as, prevention of violence against women and sexual and reproductive health.

Specific healthy aging approaches are typically online/internet-sourced and do not include the impact of gender as a social determinant of health and its impact on the aging process despite research recommendations to increase visibility of women and remove barriers to gender equality in national policies (Carmel, 2019). While some guidelines do exist, these appear to make specific recommendations for women around aging and nutritional health only (DHHS, 2015). 

In 2016, the Council on the Ageing (COTA) Victoria, the leading not-for-profit organisation representing the interests and rights of people aged 50 and over in Victoria, released a report on outcomes from a listening tour about gender equality and older women. Initially, the tour was held to inform a submission to the Victorian Government’s own gender equality strategy, however, the issue of equality resonated so profoundly with COTA’s constituency that the organisation produced the paper to describe the impact of discrimination on growing-up female and ageing.

The conclusions of the report on the impact of gender and aging on women reflect those found by Women’s Health East. COTA Victoria (2016) put forward key strategies for supporting older women and their wellbeing in the community including: 

  • Advocating for older women to put forward their lived experience, narrative and context in policy debates and work on gender equality as “their views and experiences should actively inform and shape any future initiatives” (p.2). Co-design of health promotion and primary prevention work for older women is vital and this reflects Women’s Health East’s (2019) recommendations.   
  • The need to educate boys and men to respect and value women as well as respecting themselves. 
  • While many legislative and regulatory barriers have been dealt with, there is still a need to address the systemic barriers that older women continue to face. That is, the intersectionality that gender and aging has on discrimination and disadvantage is significant. Ageism and sexism are concomitants to poverty and lack of wellbeing. 

The wellbeing of the intersecting groups which form the population of ‘older Australians’ is not currently reported (AIHW, 2018). Nonetheless, we do know that there is a diverse range of lived experiences amongst all older women and health promotion and primary prevention workers need to ensure that they apply an intersectional lens to their practice. This approach is important for addressing social exclusion, ageism, and disadvantage. For example, the impact of long-term periods of social isolation and prejudice of older people who identify as LGBTIQA+, need to be acknowledged. Amongst these impacts will be the long-term stigma, trauma and discrimination that many older women may have experienced and which may have impacted their wellbeing and life well into older age.  

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