Equality and Social Justice Committee Inquiry: The Public Health Approach to Preventing Gender-Based Violence
The Older People’s Commissioner for Wales (OPCW) welcomes the opportunity to respond to the Senedd Equality and Social Justice Committee’s consultation on the public health approach to preventing gender-based violence.
One of the Commissioner’s priorities is to stop the abuse of older people. During the Covid-19 pandemic, the Commissioner established the ‘Stopping Abuse Action’ and ‘Steering’ groups, to help to address the anticipated increases in the abuse of older people 1. The terms of reference for the inquiry need to reflect the fact that violence and abuse may be experienced across the life course, by both younger and older people. Research has shown that older people experience all the same kinds of abuse as those in younger age groups 2. Indeed, some older people may be at increased risk of abuse because of feelings of loneliness and social isolation 3. Yet, there is much evidence to show that older people who experience abuse, have been poorly served in terms of both practitioner intervention and the provision of specialist support services 4 5.
The Commissioner’s comments on the focus areas for the inquiry are discussed in the following sections:
What works in preventing gender-based violence before it occurs (primary prevention) and intervening earlier to stop violence from escalating (secondary prevention)?
Asking questions around prevention and early intervention are fundamental to the work of the inquiry, which needs to focus on “what works” to prevent the abuse of older people. Violence and abuse have devastating physical and emotional consequences for older people 6, and can result in increased rates of mortality 7.
To help prevent the abuse of older people from escalating, the inquiry should (a) examine the extent to which current service provision is effective in meeting the needs of older people and (b), the actions needed to increase the effectiveness of these services for older people. It is important that the inquiry considers the gaps in existing services, and examines the need for increased, specialist services, aimed specifically at older people experiencing abuse.
Investigating “what works” highlights the value of research and data; making explicit the need to underpin actions and interventions with a ‘tried and tested’ robust-evidence base, to maximise their effectiveness. Research can have a profoundly positive effect on the work of practitioners. When practitioners understand the factors that both increase and mitigate the abuse of older people for example, they can more effectively assess the risk of harm 8. Unfortunately, however, there is far too little data and research on the abuse of older people (its prevalence at local levels; the effectiveness of strategies for preventing abuse and the efficacy of methods of early intervention). By asking these questions, the inquiry can highlight the kinds of further research and improved data collection systems needed to help to prevent the abuse of older people.
How effective is a public health approach to preventing gender-based violence and what more needs to be done to address the needs of different groups of women including LGBTQ+, young and older people at risk of violence at home and in public spaces?
In 2022, the World Health Organisation advocated a public health approach to addressing the abuse of older people 9. Such an approach looks promising. As well as advocating for robust, evidenced-based methods of prevention and intervention, a public-health approach is a whole-system approach; it recognises the need to address and challenge the negative attitudes, assumptions, and beliefs, which underpin and shape abusive actions and behaviours. Research is increasingly highlighting the ways that ageism (negative attitudes towards old age), legitimises and increases violence and abuse towards older people 10. Critically, a public health approach to addressing the abuse of older people, provides an opportunity to raise awareness of the issue of ageism and its links to the abuse of older people. Developing strategies to challenge ageist attitudes and beliefs is critical to preventing the abuse of older people.
The abuse of older people is a predominantly hidden issue 11. Research commissioned by the OPCW shows that the experiences of older people from, for example, Black, Asian, and Minority Ethnic (BAME) groups are especially hidden 12. Such older people may not seek help because of anxieties around issues like economic or immigration status or because it would be viewed as bringing shame on their family or community13. Similarly older people from the LGBTQ+ community may experience additional challenges in disclosing abuse. Here, negative past experiences may have resulted in feelings of distrust towards professionals and services 14. It is important that additional research is undertaken to better understand the experiences of older people from these groups, and to help ensure the availability and adequacy of specialised services.
It is concerning that the inquiry appears to limit its remit to solely exploring the experiences and needs of women who experience abuse. Whilst there is no doubt that it is women who are the predominant victims of VAWDASV (violence against women, domestic abuse, and sexual violence), the inquiry must not ignore the fact that men also experience abuse. It is also known that the likelihood of men being abused, increases with age 15. Research commissioned by the OPCW highlights the significant challenges faced by older men when living within situations of domestic abuse 16, both in terms of disclosing their experiences and in accessing care and support. The remit of the inquiry needs to be extended to ensure full consideration of the needs of both older men and women at risk of or experiencing abuse.
What is the role of the public and specialist (including the police, schools, the NHS, the third sector and other organisations that women and girls turn to for support), in identifying, tackling and preventing violence against women, and their role in supporting victims and survivors?
As highlighted above, the remit of the inquiry needs to be extended to consider the value of a public health approach to addressing violence towards both men and women.
It can be challenging to recognise and respond to the abuse of older people 17. Research shows that some practitioners fail to identify the abuse of older people and make assumptions as to the possible cause of an older person’s physical injury, for example 18. In other situations, practitioners become aware that an older person is experiencing abuse but fail to intervene in appropriate ways 19. Recent research shows that there is a correlation between the quality of training on the abuse of older people, and practitioners’ levels of confidence in identifying and responding to the abuse of older people 20. The research shows that if practitioners are to effectively identify and respond to the abuse of older people, they must receive effective, targeted training.
Training on the abuse of older people, must enable practitioners to challenge their ideas around the abuse of older people (its possible causes and dynamics) and should highlight inequalities in older people’s access to criminal justice. Such training must raise practitioners’ awareness of the need to consider a criminal justice response, when working with older people experiencing abuse and neglect. There is a far greater chance of preventing violence against older people, if the perpetrators of such violence are held to full account for their actions and behaviours. It is concerning that older people, have such limited access to criminal justice when experiencing violence and abuse. Criminal prosecutions are rarely brought against those who perpetrate violence and abuse towards older people 21. There are many possible reasons for older people’s lack of access to criminal justice, some of which have to do with a lack of recorded data on crimes perpetrated against older people 22. One theme within the literature relevant to explaining low levels of access to criminal justice, is the issue of ‘practitioner mindsets’ when working within situations where older people are abused or neglected. It is argued that the abuse of older people is often conceptualised differently to other situations of abuse and is seen as a matter to be dealt with by health and welfare services, rather than by criminal justice agencies. In 2010, J. Williams stated that the ‘welfarist approach’ had decriminalised the abuse of older people. Whilst he acknowledged that not every case of abuse against an older person should be prosecuted, he nevertheless argued that there should be an ‘appropriate’ and ‘proportionate’ response from the police 23.
It is of course, important that organisations and professionals are clear regarding their roles and responsibilities in identifying, tackling, and preventing violence and abuse. However, the work of the inquiry should be extended to consider not only what different groups of practitioners do, but to also consider the ways in which that work is carried out (its effectiveness). Consideration must be given to those systemic factors, which undermine preventative efforts towards preventing violence and abuse towards older people and which compromise the effectiveness of practitioner interventions. VAWDASV services are currently facing unprecedented levels of challenge 24. Issues such as volume of workload, pressure on time, and concerns over the sustainability of current funding models, are seen as having a significantly adverse impact on the work of the sector. The work of the inquiry should highlight these issues and consider what is needed for their resolution. Exploring ways of promoting collaborative working across organisations will also be critical to ensuring effective support.
The inquiry presents an important opportunity to highlight the additional challenges faced by older people who experience violence and abuse, and to ensure the development of appropriate services to prevent the abuse of older people in Wales. To do so, themCommittee must widen its terms of reference to ensure full consideration of the specific challenges faced by older people when experiencing abuse. These challenges include amongst other things, a lack of research and data on the abuse of older people, which then limits the extent to which practitioners can engage in effective, ‘evidence-based’ practice. This response has highlighted the need for more research in this area (including research on the experiences of those older people from marginalised groups); better systems for disaggregated data collection, and improved, bespoke practitioner training if abuse and violence towards older people is to be prevented.
1 Older People’s Commissioner for Wales. Stopping Abuse Action Group: Stopping the Abuse of Older People – Older People’s Commissioner for Wales
2 Older Peoples Commissioner for Wales. 2021. Support Services for Older People Experiencing Abuse in Wales. Available at: Support_Services_for_Older_People_Experiencing_Abuse_in_Wales.pdf (olderpeople.wales)
3 3 Mysyuk, Y., Westendorp, R.G.J. and Lindenberg, J.2016. How Older Persons explain why they become victims of abuse. Age and Ageing (45), pp. 695-702.
4 Older People’s Commissioner for Wales. Accommodation and Support for Older People Experiencing Abuse. Available at: https://olderpeople.wales/wp-content/uploads/2022/04/Accommodation-Workshop-Report-1.pdf
5 Older Peoples Commissioner for Wales. 2021. Support Services for Older People Experiencing Abuse in Wales. Available at: Support_Services_for_Older_People_Experiencing_Abuse_in_Wales.pdf (olderpeople.wales)
6 Penhale, B. (2003). Older Women, Domestic Violence, and Elder Abuse: A Review of Commonalties, Differences and Shared Approaches. Journal of Elder Abuse and Neglect 15(3-4), pp. 163-183.
7 Lachs, M.S., Williams, C.S. and O’Brien, S. (1998). The Mortality of Elder Mistreatment. Journal of American Medical Association (230), pp. 428-432.
8 Storey, J.E. 2020. Risk Factors for Elder Abuse and Neglect: A review of the Literature. Aggression and Violent Behaviour (50), pp. 1-13.
9 World Health Organisation. 2022. Tackling Abuse of Older People: Five Priorities for the United Nations Decade of Healthy Ageing (2021-2030). Available at: Tackling abuse of older people: five priorities for the United Nations Decade of Healthy Ageing (2021–2030) (who.int)
10 Dow, B., Joosten, M. 2012. Understanding Elder Abuse: A Social Rights Perspective. International Psychogeriatrics 4(6), pp. 853-855.
11 Pankhuri, B. and Soletti, A. 2019. Hushed Voices: Views and Experiences of Older Women on Partner Abuse in Later Life. Ageing International 44(1), pp. 41-46.
12 Older Peoples Commissioner for Wales. 2021. Support Services for Older People Experiencing Abuse in Wales. Available at: Support_Services_for_Older_People_Experiencing_Abuse_in_Wales.pdf (olderpeople.wales)
13 Older Peoples Commissioner for Wales. 2021. Support Services for Older People Experiencing Abuse in Wales. Available at: Support_Services_for_Older_People_Experiencing_Abuse_in_Wales.pdf (olderpeople.wales)
14 Older Peoples Commissioner for Wales. 2021. Support Services for Older People Experiencing Abuse in Wales. Available at: Support_Services_for_Older_People_Experiencing_Abuse_in_Wales.pdf (olderpeople.wales)
15 Office for National Statistics 2021. Domestic Abuse in England and Wales Overview (November 202):
Domestic abuse in England and Wales overview – Office for National Statistics (ons.gov.uk)
16 Older People’s Commissioner for Wales. 2022. Improving Support and Services for Older Men Experiencing Domestic Abuse. Available at: https://olderpeople.wales/wp-content/uploads/2022/08/Improving-support-and-services-for-older-men-experiencing-domestic-abuse.pdf
17 McCreary, K.E. 2012. Elder Abuse: Ethical Decision-Making. Clinical Scholars Review 5(1), pp. 55-59.
18 Matthews, S. A, O., Reynolds, J. 2015. Bruising in Older Adults: What Do Social Workers Need to Know? The Journal of Adult Protection 17(6), pp. 351-359.
19 Nursing Times. 2002. Are Nurses Equipped to Manage Actual or Suspected Elder Abuse? Available at: Are nurses equipped to manage actual or suspected elder abuse? | Nursing Times
20 Fang, J.H., Chen, I. H., Lai, H.R., Lee, P.I., Miao, N.F. 2022. Factors associated with Nurses’ Willingness to Handle the Abuse of Older People. Nurse Education in Practice (65), pp.
21 Rees, J. BBC. 2019. Prosecutor wants more convictions for crimes against the elderly. Available at: Prosecutor wants more convictions for crimes against elderly – BBC News
22 HMCPSI and CPS. 2019. The Poor Relation: The Police and Crime Prosecution Service’s Response to Crimes against Older People. Available at: https://www.justiceinspectorates.gov.uk/hmicfrs/wp-content/uploads/crimes-against-older-people.pdf
23 Williams, J. 2012. Elder Abuse: Criminological Perspective. In Brookman, F., Maguire, M., Pierpoint, H. and Bennet, T. Handbook on Crime. Dawson Books.
24 Welsh Women’s Aid. 2022. A Perfect Storm: The Funding Crisis Pushing Welsh VAWDASV servic