Violence against older adults is a complex and multidimensional problem that impacts on social, psychological and physical dimensions, affecting the public heath and the human rights [1]. According to the International Network for the Prevention of Elder Abuse (INPEA), violence against older adults is defined as: “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person” [2].
The World Health Organization (WHO) states that the prevalence of violence experienced by the elderly ranges from 1% to 35% [3]. In Brazil, two studies [4, 5] have analysed the prevalence of physical violence against older men and women in small towns: Camaragibe, Pernambuco [6] with 144,466 inhabitants [4]; and Niterói, Rio de Janeiro [7] with a population of 487,562 [4]. These studies (with sample sizes of 315 and 343 subjects respectively) reported that the prevalence of physical domestic violence against older adults was about 10% [6–7]. This results indicate that the prevalence found in these Brazilian studies is high when compared with 2.2% in Ireland [8] and 2.6% in United Kingdom [9]. On other hand, the findings of Brazilian studies is close to those found in Canada, which range between 4% and 10% [2], in Spain (11.9%) [9], and in Portugal (12.3%) [10]. However, they are low when compared with 18.4% in Israel, with 21.4% in Hong Kong [9] and a range from 13.9% to 25.8% in Chinese older adults living in the Greater Chicago area [11].
Among the subtypes of violence against older adults, psychological abuse is one of the most prevalent [12]. Results of a study on psychological abuse among older women conducted in the United States of America indicate a prevalence of 45%. Among those who have suffered psychological abuse, 48% reported two or more abusive actions, such as: abusive language, overly critical, screaming, possessive behaviour or jealousy signs. Furthermore, among older women experiencing different subtypes of violence, researchers found a range of 86% and 95% suffering psychological abuse [12]. Among Portuguese people, the prevalence of psychological abuse was 6.3%, the same as financial (6.3%). Other types of violence included: Physical abuse (2.3%), neglect (0.4%), and sexual abuse (0.2%) [10]. The prevalence of psychological abuse among Chinese older adults living in the Greater area of Chicago was 1.1%-9.8%, physical abuse was 1.1%, sexual abuse was 0.2%, caregiver neglect was 4.6%-11.1%, and financial exploitation was 8.8%-9.3% [11].
The psychological abuse may occur in isolation or in combination with other kinds of abuse [12]. However, many older adults do not consider it as a type of domestic violence [13]. In addiction, psychological abuse tends to receive little attention from researchers [14].
Psychological abuse of older adults refers to “a verbal or gestural action whose aim is to terrorize, to humiliate, to restrict freedom, or to isolate older adults from society” [15]. This subtype of abuse can bring negative consequences to the victims’ life and health, what includes decreased sense of power, shame, fear of retaliation, fear of institutionalization, isolation, anxiety, depressive symptoms and changes in health status [14].
The other types of abuse are defined as: physical abuse, financial/material abuse, sexual abuse, and neglect. First is defined as the infliction of pain or injury, physical coercion, or physical/chemical restraint. Second is described as the illegal or improper exploitation and/or use of funds or resources. Third corresponds to a non-consensual contact of any kind with an older person and fourth is the intentional or unintentional refusal or failure to fulfil a care-taking obligation’ [2,3].
Both men and women can be categorized as either perpetrators or victims of domestic violence. However, more than 70% of the victims of all types of violence are women [16]. In surveys, women who reported experiencing psychological violence also reported a lower quality of health than those experiencing physical violence [14].
INPEA highlighted that whereas one in four older adults are at risk of domestic violence, only a small proportion of domestic violence against older adults is actually reported [2]. Underreporting may be due to: victims hesitating to admit they are being victimized, religious and cultural beliefs, social norms, fear of reprisal, protection provided for the abuser, shame, guilt, helplessness, and despair [17]. In Brazil, the report of abuse of older adults is mandatory for health professionals such as nurses, physicians, dentists, and psychologists [18]. However, a study found that 60% of doctors and nurses in Brazil have not received any formal education about domestic violence and, consequently, they feel unprepared to provide appropriate care and referral [19]. The most cases of domestic violence against older adults in Brazil are only reported when they result in physical injuries [20].
Brazil currently has 23.5 million people over 60 years old, representing 12.1% of the total population from which 13.1 million (55.70%) are women [4]. The number o folder adults expected in 2025 is approximately 30 million, what is equivalent to 15% of the population [5]. Analysing social and economic aspects of the Brazilian population, we can state that illiteracy decreased, from 11.5% in 2004 to 8.3% in 2013; and schooling increased from 78.1% in 2012 to 81.2% in 2013. Regarding to the poverty, about one million people left misery in 2012 and the income inequity lowered by 54.9% from 2002 to 2012. However, in Brazil, there still are 15.7 million people living in poverty and a high level of social inequity [4]. This context stems from the relationship of command/subservience among poor people and the owners of farms, a structure that formed the basis of the Brazilian culture, even after the abolishment of slavery.
Moreover, Brazilian culture is marked by traditional gender values and patriarchy, in which the male is defined as the subject of sexuality and the female as its object [21]. Brazilians have often considered themselves as a nonracist society due to the historical blending of indigenous American, Iberian, and African peoples into a single national identity. However, ‘race’ in Brazil is embodied in everyday valuations of sexual attractiveness that are gender, race, and class-oriented. Ageism in Brazil should be addressed in the context of multiple discriminations [22].
In response to the international movement for adopting specific measures to protect older adults, the Brazilian National Elderly Policy was published in 1994 [23]. The Senior Citizens’ Statute was published in 2003 [24], and the National Elderly Health Policy was published in 2006 [25]. These policies and documents have helped improve legal protections for older adults and have strengthened legal guidelines to address violent situations among this population. Despite such programs, statistical trends of psychological domestic violence against older people in Brazil are still not known.
There is also a lack of qualitative research focused on psychological domestic violence from the older women’s point of view. Therefore, the aim of this study is to understand older adult women’s experience of psychological domestic violence. The primary research question for this study was: What are older Brazilian women’s experiences of psychological domestic violence? The related questions were: 1) How older Brazilian women experience their daily life when they are victims of psychological domestic violence? 2) How do older Brazilian women respond to psychological domestic violence? and 3) What are older Brazilian women’s needs, expectations, and aims in dealing with the psychological domestic violence in their lives?