How professionals’ false assumptions allow domestic abuse between older couples to go unnoticed

Mary Russell died from a bleed to the brain after being assaulted by her husband, Albert, in 2010. That year she had reported nine separate incidents of physical abuse by her husband, some to more than one agency, and for many there was corroborating evidence of injury. In the seven months leading up to her death she made several 999 calls. Despite this, each time police officers arrived at the couple’s home they knew nothing of the previous callouts.

According to the serious case review into her death, Mary Russell had had “considerable contact with…Essex Police, Southend adult social care, her GP and others, in relation to domestic abuse from her husband”.

Although there was a good level of liaison between social services and the police it did not translate into effective joint working and although both could have called a safeguarding strategy meeting, neither did. The review added that there was:

Poor appreciation of the risks of domestic abuse in old age…and officers were aware of the undesirability of bringing a frail elderly man into custody.”

At the time of her death, Mary Russell was 81 and her husband was 86; they had been married for 56 years. The Crown Prosecution Service decided there was insufficient evidence to prosecute him and he has since died.

Failure to recognise

If you are shocked at the thought of an older man being capable of such a crime then you are not alone. A review of the impact of domestic abuse for older women in Health and Social Care in the Community in 2011 highlighted that the issue is significant and but that health and social care professionals fail to recognise domestic abuse between older couples.

Consequently, they rarely ask questions about it and may assume that injuries, unhappiness, depression or confusion are the result of age-related conditions. They may think that intimate partner abuse lessens as people age and that older men cannot be a serious threat particularly if they are physically frail; Albert Russell, for example, had limited mobility, had suffered several falls and, on several occasions when police were called to their house, his wife said his behaviour was caused by Alzheimer’s. This turned out not to be the case but a mental health assessment was never carried out. To complicate the issue, he had accused his wife of abusing him.

Photo: M Schuppich/Fotolia

Types of abuse

Three types of intimate partner abuse involving older people have been distinguished that social workers should bear in mind when working with this age group:

1. ‘Abuse grown old’, when the abuse started earlier in life and persists into old age.
2. Recent abuse, when older people find themselves in abusive relationships with partners they have met later in life.
3. Late onset domestic abuse that begins in old age.

The latter can occur for various reasons: the relationship may have been strained or emotionally abusive earlier in life and this may worsen as the couple age. Or it could be caused by other issues including retirement, disability, sexual changes, dementia or other cognitive conditions.

The serious case review into Mary Russell’s death concluded that as the population ages, the incidence of domestic abuse in older age will grow.

Lack of statistics

But lack of awareness is compounded by a lack of statistics. The first – and to date only – prevalence study in the UK into abuse and neglect of older people, commissioned by the Department of Health and Comic Relief and published in 2007, found that 51% of people who had suffered abuse or neglect said this had been perpetrated by a partner or spouse. There are still no annual statistics collated on the numbers of older people affected by domestic abuse. And the British Crime Survey, which includes a self-report model for particular types of violence including domestic, doesn’t monitor age groups beyond 59.

The latest government statistics on safeguarding adult return data for 2013-14 show that the majority of referrals concerned women (60%) and 63% concerned people aged 65 or over; but statistics on the perpetrators only looked at whether they were known to the victim or not.

Even if statistics were collated they wouldn’t provide the whole picture. Older women may have similar reasons as their younger counterparts for not wanting to report abuse – such as shame, stigma, fear of reprisal, or just non-recognition that they are being abused – but there are also more complicated reasons that are bound up with age:

• Marriage was for life and what happened within the home was considered private.
• They are afraid to live alone after being with someone for many years.
• Living with longstanding abuse may have added to feelings of isolation, poor self-esteem, lack of career or independent income.
• They don’t know who to ask for help.
• They are being cared for by their partner.
• They are their partner’s carer.
• They don’t have a good support network because friends may have retired and moved away or died.

Why older women do not disclose abuse

Older women often believe that marriage is a case of ‘you’ve made your bed, now lie in it’, says Monsura Mahmud, advice case worker at Solace Women’s Aid’s Silver Project, which works with over-55s. “And some women might not disclose because they fear that the only option will be to go into a care home.”

Another issue, she says, is that:

Professionals may think that if a woman has been experiencing abuse for a long time then it can’t be that serious.”

Adult children can think the same way and cannot understand why their mother would want to change things at such a late stage in their life because this can leave the children with conflicting loyalties over which parent needs most support, she adds.

The Silver Project was funded from March 2010 – January 2013 by the Equality and Human Rights Commission. During this time it worked with 133 women and the majority of cases involved ongoing support from between one month up to 12 months. Most clients were aged between 55-64, but 52 were over 65.

Safety planning

Women who seek help from the Silver Project are offered a risk assessment and safety planning. “It is the same for older women as it is for younger women – the most dangerous time is when they are about to leave or just after they have left. For those who want to stay in the relationship we look at incidents and how they can prepare themselves,” says Mahmud.

“With older women we have to take into consideration their age and ability. It is not so easy for them to leave the situation quickly. We advise them to talk to their GP or a hospital social worker so that someone knows about the abuse and it has been logged. It’s about approaching it slightly differently to how you would with a younger woman. And their recovery tends to take longer  because they have had years of abuse.”

Fear of loss is another reason for older women remaining in the home, says Hilary Abrahams, independent researcher in domestic violence and homelessness:

If you get out of a relationship early there is some loss. But if you have spent 40+ years with someone you lose everything, so how are you going to get it back, how and where are you going to live and what will the rest of the family think?”

Lack of information

Lack of information for older people is another part of the jigsaw. Materials on domestic abuse and related services typically depict younger women, so, says Abrahams, “is that going to encourage an older woman to think ‘this is happening to me?’.”

“There needs to be more information about domestic abuse and the fact that it isn’t just physical violence so that people can put a name to what is happening to them. Information needs to be put where older people will find it, for example, at GP surgeries and hospitals.”

Camden Council did just that with its awareness-raising campaign, launched in March 2015, aimed at the over-50s in relation to domestic abuse. ‘Know It’s Not Too Late’ features posters at bus stops, health centres, community organisations and businesses. Presentations and leaflets were also developed for GP surgeries in the borough.

And in a bid to address the wider lack of awareness, the government revised its definition of domestic violence in 2013 to include “controlling [or] coercive behaviour”, as well as “threatening behaviour, violence or abuse between people who have been intimate partners or family members regardless of gender or sexuality”.

Few specialist services

Where to go can be a huge dilemma as there are a lack of specific services for older women who want to leave an abusive partner. Although refuges accept all ages, they are often communal, noisy, full of drama and unsettling environments for older women.  Mahmud says: “The majority of older women don’t go into refuges, they don’t feel  comfortable being in that space because with no one of their age group there they feel isolated. They often don’t want to experience shared living with other families.

“And refuges aren’t always appropriate if a woman has a disability or care needs and they are unlikely to accept a carer coming in and out to see her.”

A growing tendency for new refuges to consist of self-contained flats could be a better option, she adds.

Photo: Maya Kruchancova/Fotolia

So what are the alternatives?

“Sheltered housing is an option, or extra care or supported housing or they can stay in their own home and take out an injunction against the perpetrator. Registered social landlords who take women directly offer a range of housing from retirement homes to sheltered housing and nursing homes,” says Mahmud. “It’s good that they have a wider range of options, however, there are not many properties within London and many with very long waiting lists therefore making them impractical for an immediate move. However, they are a good option for the long term.”

Less likely to leave

The reasons for not reporting abuse in the first place can also be the reasons that result in older women staying in the situation. “We don’t know for sure if there is a tendency that they are less likely to leave than younger women, but finances, accommodation and living on your own without a support network do make it difficult to leave,” says Bridget Penhale, reader in mental health of older people at the University of East Anglia and co-author of Mind the Gap!, a 2013 report into intimate partner violence against older women.

“And over a period of time it can become ‘normal’, particularly if it is non-physical abuse, it is just accepted as what happens and is not perceived as being abusive.”

For those who choose to stay, outreach projects run by domestic violence organisations for older women providing support groups in the community can help them be safer at home, she says.

Independent social worker Jacki Pritchard’s 2000 report looking at the needs of older women who had been abused found that older women often remained in abusive situations because they did not know who to turn to for help.

Training is crucial

Training for professionals is crucial, says Pritchard who runs safeguarding adults and abuse of adults training courses for local authorities where domestic violence is an intrinsic element, as well as support groups for adults who are being, or have been, abused.

“Domestic violence is flagged up in children and families and touched on in safeguarding adults. Older people teams don’t have specialist training and they are under pressure to do assessments quickly and put a care package in. I think sometimes they don’t look beyond the presenting problems.”

She adds: “The social work role is to recognise [domestic abuse], report it and investigate it. There need to be long-term protection/safeguarding plans in place. We are still very much behind child protection and social workers aren’t writing plans that are in-depth enough: they need to say who is going to go in and what they are going to do and they need to signpost people to specialists for proper therapeutic support.”

As well as supporting the women themselves, the Silver Project delivers training to social services safeguarding and housing teams in London. “We start with basic awareness and look at who the perpetrators are and the types of abuse. We use the Duluth model for domestic violence in later life [see diagram below] which outlines the different types of abuse and how they are perpetrated, for example, abuse of dependency/neglect such as taking away someone’s walking frame, wheelchair, glasses or dentures,” says Mahmud.

“We then look at the services they can refer to, how to safeguard someone, risk assessments, safety planning and using a multi-agency risk assessment conference (MARAC).”

It doesn’t help that most areas use the domestic abuse, stalking and honour based violence risk identification checklist (DASH-RIC) as an assessment tool to identify and discuss risk with victims. As the Local Government Association and Association of Directors of Adult Social Services 2013 guide, Adult Safeguarding and Domestic Abuse, points out, the tool is “predisposed to assess risks for women with children and is known to have limitations for identification of the risk factors experienced by disabled and older people so professional judgement will be key”.

The statutory guidance under the Care Act 2014 lists domestic abuse as one of a number of types of abuse or neglect that may trigger local authorities’ duty to make a safeguarding enquiry, under section 42 of the act. These apply to adults who appear to have needs for care, are experiencing abuse or neglect and, as a result of those needs, are unable to protect themselves. There is hope that this will go some way towards pushing the issue higher up professionals’ agenda.

Confusion between domestic abuse and elder abuse

But an added complication for professionals trying to spot signs of domestic abuse is confusion over the terms elder abuse and domestic abuse. The LGA/Adass guide, an updated version of which was published last month, says this may be due to the “assumptions that pervade ‘elder abuse’, which can fail to acknowledge the underlying complexities of power relations within abusive relationships in later life”.

Abrahams says: “Elder abuse is by children to parents, or by carers or professionals to older people, it is all lumped together rather than treated individually.

“Social workers sometimes don’t want to see domestic abuse; do you want to challenge an 80-year-old man for beating up his 78-year-old wife? I think there is ageism and infantilism involved and a tendency to treat older people as a homogenous group.”

She adds: “Social workers should look out for [signs of power and control] for example, an older person never being left on their own or one always speaking for the other.”

Photo: Image Broker/Rex

Polly Neate, chief  executive of Women’s Aid, agrees: “Domestic abuse is a pattern of deliberate coercion and control by an intimate partner. The abuse may have been going on for decades, unless the woman is in a new relationship. Elder abuse can be new and carried out by family members or care workers. It is different and that needs to be recognised.

“With domestic abuse, the perpetrator might be old and frail with needs, so the social worker might respond to them in a way that they might not if they were younger, or a carer. There might be the suggestion that the perpetrator is violent because they are elderly and frustrated, or because of an age-related condition, or that they can’t be doing that much damage because they are old. But it can be emotional or psychological abuse and the impact could be even greater if it’s been going on for decades. Professionals can make assumptions that need to be challenged.”

Focus on care not relationship

Penhale agrees: “For social workers there can be a lot of emphasis on adult safeguarding, but instead of looking at the relationship they are looking at the  care dynamics – if it is even picked up in the first place. By focusing on the care and care-giving and any problems there, they can miss the dynamics of power and control in the relationship.

“Trying to untangle how much of the problem is to do with [poor or neglectful] care-giving or with domestic abuse is hard for professionals.

Social workers are programmed to look at care needs and abuse in relation to neglect rather than think this is a historical long-standing abusive relationship or a new situation, but the emphasis needs to be on the intimate relationship rather than care.”

Inspiring hope

Meanwhile, Pritchard has a story that inspires hope. “When I was working as a local authority social worker years ago I met two women, one aged 93 and the other 95; both had been victims of physical and emotional abuse. I spent time talking to them and building a relationship. They both left their husbands after being able to talk about the abuse to me over fairly lengthy periods of time.

“They had both been married for over 70 years and felt that time was running out and they wanted to live their lives on their terms. They were rehoused in sheltered accommodation and lived for another two years. They told me it was the best thing they ever did because they had found happiness, even just for a little while. So, my message is, it’s never too late.”