Intimate partner violence prevalence in the elderly and associated factors: systematic review

Warmling, Deise; Lindner, Sheila Rubia; Coelho, Elza Berger Salema

doi:10.1590/1413-81232017229.12312017

Abstract

This article aims to identify the prevalence of intimate partner violence (IPV) in the elderly and its associated factors. A systematic review of cross-sectional population-based studies was conducted in PubMed, Lilacs and PsycInfo databases, without restrictions with respect to the period and language of publication. Two independent reviewers conducted the selection, data extraction and the methodological quality analysis. Nineteen papers were selected for the analysis. There was a variation in the type of violence, gender of respondents and tools used. Most studies had a moderate or high methodological quality. IPV occurred in elderly men and women, with greater prevalence of psychological violence and economic abuse. The most frequent associated factors were alcohol use, depression, low income, functional impairment and previous exposure to violence.

Intimate partner violence; Elderly; Prevalence; Associated factors; Elder abuse

Introduction

Population aging is a global reality, and Brazil is on a fast track lane. This phenomenon occurred initially in developed countries and has been growing steadily in developing countries¹1. Duque AM, Leal MCC, Marques APO, Eskinazi FMV, Duque AM. Violência contra idosos no ambiente doméstico: prevalência e fatores associados (Recife/PE). Cien Saude Colet 2012; 17(8):2199-2208.^,²2. Apratto Júnior PC. A violência doméstica contra idosos nas áreas de abrangência do Programa Saúde da Família de Niterói (RJ, Brasil). Cien Saude Colet 2010; 15(6):2983-2995.. In this context, elder violence is a reality in various social levels and has relevant consequences on the health of this population²2. Apratto Júnior PC. A violência doméstica contra idosos nas áreas de abrangência do Programa Saúde da Família de Niterói (RJ, Brasil). Cien Saude Colet 2010; 15(6):2983-2995.. Thus, violence is a challenge to public health, as it imposes the need for specific social policies and new directions for comprehensive elderly health care¹1. Duque AM, Leal MCC, Marques APO, Eskinazi FMV, Duque AM. Violência contra idosos no ambiente doméstico: prevalência e fatores associados (Recife/PE). Cien Saude Colet 2012; 17(8):2199-2208..

Intimate partner violence (IPV) includes any behavior that causes physical, psychological or sexual harm to those who are part of the intimate relationship. They include acts of physical assault, psychological abuse, controlling behavior³3. Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet 2002; 360(9339):1083-1088. and economic abuse⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.. In the context of elder violence, that which has been committed by an intimate partner has been less investigated, and, when addressed, is considered less severe than when applied to young women⁵5. Poole C, Rietschlin J. Intimate partner victimization among adults aged 60 and older: an analysis of the 1999 and 2004 General Social Survey. J Elder Abuse Negl 2012; 24(2):120-137.^,⁶6. Hackenberg EA, Sallinen V, Koljonen V, Handolin L. Severe intimate partner violence affecting both young and elderly patients of both sexes. Eur J Trauma Emerg Surg 2016; 43(3):319-327..

However, in US studies, women older than 55 years were more affected by IPV than younger women⁷7. Zink T, Fisher BS, Regan S, Pabst S. The prevalence and incidence of intimate partner violence in older women in primary care practices. J Gen Intern Med 2005; 20(10):884-888., with intimate partners accounting for 13-50% of the abuse committed⁸8. Fisher JW, Dyer CB. The hidden health menace of elder abuse. Physicians can help patients surmount intimate partner violence. Postgrad Med 2003; 113(4):21-24, 30.. Similarly, in Spain, 29.4% of elderly women suffered this type of violence⁹9. Montero I, Martin-Baena D, Escriba-Aguir V, Ruiz-Pérez I, Vives-Cases C, Talavera M. Intimate partner violence in older women in Spain: prevalence, health consequences, and service utilization. J Women Aging 2013; 25(4):358-371..

In Brazil, the prevalence of intimate partner violence in the study of elderly women and men was 5.9% for physical violence and 20.9% for psychological violence¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041., while in Brazil and Colombia, a study carried out with 60-74 year-olds, IPV found prevalence of psychological violence in women of 26.0% and 20.4%, respectively. This prevalence was 11.1% for men in both countries¹¹11. Guedes DT, Alvarado BE, Phillips SP, Curcio CL, Zunzunegui MV, Guerra RO. Socioeconomic status, social relations and domestic violence (DV) against elderly people in Canada, Albania, Colombia and Brazil. Arch Gerontol Geriatr 2015; 60(3):492-500..

IPV has a negative impact on the physical and mental health of the elderly. Among the victims of physical and psychological violence, there is a greater proportion of reports of muscular and skeletal pain, headache, stomach problems, anxiety, sleep disorders, stress and suicidal mindset¹²12. Bonomi AE, Anderson ML, Reid RJ, Carrell D, Fishman PA, Rivara FP, Thompson RS. Intimate partner violence in older women. Gerontologist 2007; 47(1):34-41.^,¹³13. Hadeed LF, El-Bassel N. Social support among AfroTrinidadian women experiencing intimate partner violence. Violence Against Women, 2006; 12(8):740-760.. Violence also has a social impact on the lives of the elderly, contributing to low self-esteem, social isolation and feelings of insecurity, reinforcing negative aspects of old age¹⁴14. Guedes, DT, Curcio CL, Llano BA, Zunzunequi MV, Guerra R. The gender gap in domestic violence in older adults in Latin America: the IMIAS Study. Rev Panam Salud Publica 2015; 37(4-5):293-300..

Studies¹⁵15. Dong X. Sociodemographic and socioeconomic characteristics of elder self-neglect in an US Chinese aging population. Arch Gerontol Geriatr 2016; 64:82-89.

16. Ruelas-Gonzalez MG, Duarte-Gomez MB, Flores-Hernandez S, Ortega-Altamirano DV, Cortés-Gil JD, Taboada A, Ruano AN. Prevalence and factors associated with violence and abuse of older adults in Mexico’s 2012 National Health and Nutrition Survey. Int J Equity Health 2016; 15:35.^-¹⁷17. Simone L, Wettstein A, Senn O, Rosemann T, Hasler S. Types of abuse and risk factors associated with elder abuse. Swiss Med Wkly 2016; 146:w14273. dealing with elder violence tend to analyze the elderly as victims of abuse in most cases by caregivers or relatives, and intimate partner violence is still a scarce approach in the literature. This fact may be embedded in the understanding that violence does not occur among elderly partners, masquerading as neglect or family violence, since the caregiver may be the intimate partner.

The concept of IPV in this age group is still little understood in the literature as a single construct, which leads us to affirm that it is important to further investigate this issue to bridge the existing gap and highlight the phenomenon in a growing and significant population that has been understudied¹⁸18. Reeves KA, Desmarais SL, Nicholls TL, Douglas KS. Intimate partner abuse of older men: considerations for the assessment of risk. J Elder Abuse Negl 2007; 19(1-2):7-27..

In view of the foregoing, this study aimed to identify from a systematic review of literature the prevalence and factors associated with IPV in the elderly.

Methodology

We conducted a survey of published studies on the prevalence of intimate partner violence in the elderly and factors associated with the phenomenon.

Registration and protocol

This systematic review was performed according to the guidelines outlined in the PRISMA Check List (Preferred Reporting Items for Systematic Reviews and Meta-Analysis - Prospective Register of Systematic Reviews)¹⁹19. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 2009; 6(7):1-6.. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews database (PROSPERO).

Eligibility Criteria

Inclusion criteria were original scientific papers that covered cross-sectional population-based studies; that analyzed the prevalence of intimate partner violence and its associated factors, with a clearly described methodology; papers with target population that included the elderly; papers published in national and international journals.

Literature reviews, letters, opinion papers, experience reports, case studies, book chapters and conference presentations were excluded. There were no restrictions regarding the publication date or language.

These criteria sought to ensure that only representative studies of the general population were inserted, since they more accurately reflect the prevalence and factors associated with IPV in the elderly population.

Search strategy

The search for papers was carried out in PubMed, Lilacs and PsycInfo databases. PubMed’s search strategy was adapted for the other databases was as follows: (“Intimate Partner Violence”[Mesh] OR “Intimate Partner Violence”[All Fields] OR “Spouse abuse”[Mesh] OR “Spouse abuse”[All Fields]) AND (“Prevalence”[Mesh] OR “Prevalence”[All Fields] OR “Cross-Sectional Studies”[Mesh] OR “Cross-Sectional Studies”[All Fields]) AND (“aged”[MeSH] OR “aged”[All Fields] OR “aged, 80 and over”[MeSH] OR “80 and over aged”[All Fields] OR elderly[All Fields]) NOT (pregnancy OR child$ OR AIDS).

Search was conducted from March to September 2016. Selected papers’ reference lists were reviewed and a manual search was done for other potentially eligible publications.

Selection of studies and data extraction and review

Studies were selected by two independent reviewers. Initially, duplicate references between databases were identified and excluded using the EndNote Web reference manager (Thomson Reuters).

According to the eligibility criteria, the selection was done through the evaluation of titles and abstracts and then full texts. Any disagreement between reviewers regarding the application of criteria would require an expert’s opinion on the specific matter and would be defined by consensus. The general characteristics of papers (year and place of collection, gender and age of respondents, sample size and violence measurement tool), prevalence and factors associated with IPV and recorded in electronic spreadsheets were extracted. Data were sorted in a documentary form, analyzed in a descriptive way and shown in tables.

Evaluation of methodological quality

The methodological quality was evaluated by two independent reviewers, using the tool proposed by Loney et al²⁰20. Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can 1998; 19(4):170-176. indicated for the critical evaluation of cross-sectional studies. Authors adopt eight items in the evaluation. For each criterion not met, the study received a zero, and scored “one” point if met. High-quality studies were those scoring 7-8 points; 4-6 points indicated moderate quality studies, and 0 to 3 points, low quality studies. No papers were excluded due to the level of methodological quality. The eight evaluation criteria are:

Sample: adequate if the study was performed with all population or with probabilistic sampling.
Sampling source: adequate if it was population census-based.
Sample size: adequate if statistically calculated.
Measurement of outcome: adequate if intimate partner violence was measured by a validated tool.
Impartial interviewer: adequate if results were surveyed by trained interviewers.
Response rate: adequate if ≥ 70.0%.
Prevalence with 95% CI: adequate if confidence intervals of intimate partner violence prevalence were shown.
Similar participants: adequate if subject under study were described and stratified per age group and similar to the study question (elderly).

Results

Eight hundred forty-two papers were identified in the searched databases and five were added from the analysis of the references of the selected studies and manual search from other sources, totaling 847 articles. Of these, 49 were excluded because they were duplicates and 707 because they did not meet the eligibility criteria after reading titles and abstracts. Thus, 91 studies were submitted to full analysis, and from this process, 19 papers⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.

22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.

23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.

24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.

25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.

26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.

27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.

28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.

29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.

30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.

31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.

32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.

33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.

34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.

35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.

36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^-³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912. were chosen for this study (Figure 1).

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Figura 1
Fluxograma do resultado da busca, seleção e inclusão dos estudos.

Of the 19 papers selected, 15 included in their samples adults and elderly⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,²⁰20. Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can 1998; 19(4):170-176.

21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.

22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.

23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.

24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.

25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.

26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.

27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.

28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.

29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.

30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.

31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.

32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.^-³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415. and four only elderly¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.

36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^-³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.. Five studies⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.^,²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^,²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.^,³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415. stratified the prevalence by age group, thus identifying IPV among the elderly. In the others, prevalence was shown for the general sample of the study, in which the elderly were included.

Papers included were published between 2004 and 2015, more frequently in the period 2012-2015⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.

29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.

30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.

31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.

32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.

33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.

34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.

35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.

36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^-³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.; surveys between 2004 and 2010²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.

25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.

26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.

27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.

28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.

29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.^-³⁰30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.^,³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.

33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.^-³⁴34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446. predominated. There was a higher concentration of studies in Europe⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.^,²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.^,³¹31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.^,³⁴34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.^,³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564. and the United States²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.^,²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^,²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.^,²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.^,³¹31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.; Brazil only had two studies¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.. In 11 studies¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.^,²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^,²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.^,²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.^,³¹31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.

32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.^-³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912., respondents were men and women concomitantly, others included only women, and there were no studies with men alone. The sample size varied from 356 to 70,156 respondents.

The most widely used tool for measuring violence was the Conflict Tactics Scale (CTS), versions 1, 2 and adaptations⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.^,²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.^,²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.^,²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.

30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.

31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.

32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.

33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.

34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.

35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.

36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^-³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.. The violence recall period varied, and the last 12 months was the most widely used⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.^,²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.^,²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.^,²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.

28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.

29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.

30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.

31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.

32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.^-³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912., followed by “in lifetime”²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^,²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.^,³⁴34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.. The main characteristics of the studies are summarized and shown in Chart 1.

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Chart 1
Characteristics of the studies included in the systematic review of intimate partner violence prevalence and its associated factors in the elderly.

Evaluation of the methodological quality

Based on the evaluation of the methodological quality proposed by Loney et al.²⁰20. Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can 1998; 19(4):170-176., among the studies, seven²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.^,²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.^,²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.^,³¹31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.^,³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912. achieved high quality; eleven⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.^,²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.

24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.^-²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^,²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.^,³⁰30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.^,³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.^,³⁴34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446. obtained moderate quality, and one²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462. had low quality. Studies developed with samples consisting exclusively of the elderly¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.

36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^-³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912. achieved high or moderate quality, with an overall mean score of 6.5 points, while those with samples composed of adults and the elderly reached an overall mean score of 5.7 points. This positive difference for the group of studies exclusively with the elderly is mainly due to the item that analyzes the similarity of participants with the research question (adequate if there was a description of the subjects under study stratified by age group and similar to the research question). No work achieved the maximum score, and prevalence with a 95% confidence interval (95% CI) the item with the lowest overall mean, both for studies exclusively with the elderly and those that investigated adults and the elderly. Table 1 shows details of the methodological quality evaluation.

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Table 1
Result of the evaluation of the methodological quality of the included studies.

Prevalence of Intimate Partner Violence

In the 19 studies analyzed, 14⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.

23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.

24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.

25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^-²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.^,³¹31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.

32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.

33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.

34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.

35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.

36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^-³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912. had their prevalence stratified by nature of intimate partner violence (physical, psychological, sexual, controlling behavior, economic abuse), whether isolated⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.^,²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.^,²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.^,³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.^,³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.^,³⁴34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912. or combined⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.^,²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^,³¹31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.^,³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564..

Nine studies identified IPV prevalence according to the nature of the act combined and evidenced the following proportions in the elderly: 14.1% for physical and psychological violence²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768. among women in the last 12 months; 10-12.9% for physical and sexual violence in women⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^,³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564. and 5.6% for men, in lifetime²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.. In papers that showed the nature of violence in isolation, worth highlighting are values of psychological violence in the 60-69 age group (25.5% in women and 21.2% in men) and 70 years+ (24.5% % in women and 20.1% in men).

In studies that investigated only the elderly¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.

36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^-³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912., or these separately from adults⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.^,²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^,²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.^,³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415., IPV type prevalence ranged from 1.8-5.9% for physical violence¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912., 1.2% for sexual violence³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446. and 1.9-36.1% for psychological violence⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.. We highlight the variation found in coefficients of psychological IPV, since studies used the same measurement tool, namely, the CTS (versions 1 or 2). The country with the highest prevalence was China (36.1%)³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446., followed by Germany (13%)⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111., Brazil (5.9%)¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041. and the United States (1.9%) ³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.. It is noteworthy that only one study³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415. investigated in the elderly separately the controlling behavior (21%) and economic abuse (13%) in women aged 66-86 years. In the six studies that identified general prevalence in adults and the elderly, it ranged from 5.5% in the United States²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522. to 55.8% in Nigeria²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278..

The phenomenon of intimate partner violence in elderly men was identified in a study by Afifi et al.²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691., which found a higher IPV prevalence in this population (4.9%) when compared to elderly women (3.3%). In contrast, Breiding et al.²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118. and Lee et al.³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415. showed that the perpetration by elderly men is more prevalent than by elderly women, as can be seen in the different percentage measures regarding the nature of IPV, respectively: physical (5.1% versus 1.6%)³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.; psychological (25.5% versus 21.2%)³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.; physical and sexual (12.6% versus 5.6%)²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.. While coefficients are higher in women, there are also significant proportions in men, pointing to the relevance of investigating the occurrence of violence in both genders.

There were methodological variations regarding the nature, severity and directionality (suffered or perpetrated) of the violence investigated, gender of respondents and measurement tools used. The different methods implied heterogeneous prevalence. Chart 2 shows the prevalence identified according to the methodological approach of each study.

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Chart 2
Prevalence of intimate partner violence in included studies.

Factors associated with intimate partner violence

Alcohol use⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.^,²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.^,²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.^,²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.^,³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446. was the most frequent factor associated with IPV, followed by depression²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.^,³⁰30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.

31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.^-³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.. More specifically, there was a positive association with violence, tobacco use²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.^,²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462., tranquilizers³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96. and other drugs²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691., as well as anxiety³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564., stress³⁸38. Cezario ACF, Fonseca DS, Lopes NC, Lourenço LM. Violência entre parceiros íntimos: uma comparação dos índices em relacionamentos hetero e homossexuais. Temas psicol 2015; 23(3):565-575., sleep and eating disorders²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691..

Regarding the sociodemographic and economic factors, worth highlighting are low income²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.^,²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.^,²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912. and low schooling²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.^,²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912., being divorced/separated²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912. and being a young elderly¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.. With respect to conditions related to physical health, functional impairment¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912., poor health assessment²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651. and HIV infection²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278. were associated with IPV.

Previous exposure to violence was analyzed by two studies³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446., and both found an association between IPV and having witnessed parental violence in childhood. Stöckl et al.³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564. linked the occurrence of physical and sexual violence among 55-65 year-olds to having suffered physical violence in childhood or violence by an aggressor other than their partner, indicating a possible perpetuation of life-threatening violence.

Most studies⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.^,²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.

24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.

25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.

26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.^-²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.^,²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.

30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.

31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.

32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.

33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.

34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.

35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.

36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.^-³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912. have employed regression analysis models. All the results presented were statistically significant. IPV-associated factors are shown in Table 2.

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Table 2
Factors associated with Intimate Partner Violence according to the studies analyzed.

Discussion

In this review, we highlight the occurrence of intimate partner violence in elderly men and women, with psychological violence and economic abuse being the most prevalent in this age group. The most frequent associated factors were alcohol consumption, depression, low income, functional impairment and exposure to violence in childhood.

National and international studies evidenced a relevant production between 2004 and 2015, mainly in Europe and the United States. This predominance may be related to the fact that these locations have a greater number of journals indexed in the databases consulted³⁸38. Cezario ACF, Fonseca DS, Lopes NC, Lourenço LM. Violência entre parceiros íntimos: uma comparação dos índices em relacionamentos hetero e homossexuais. Temas psicol 2015; 23(3):565-575. and specific journals on elder violence, but also because these countries have a higher proportion of elderly people, where factors related to aging are more investigated. The Latin American publication on this topic is incipient, represented by two Brazilian studies¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437..

IPV measurement was performed primarily through Conflicts Tactics Scale - FORM R (CTS-1)³⁹39. Hasselmann MH, Reichenheim ME. Adaptação transcultural da versão em português da Conflict Tactics Scales Form R (CTS-1), usada para aferir violência no casal: equivalências semântica e de mensuração. Cad Saude Publica 2003; 19(4):1083-1093., which assesses physical and psychological violence, and Review Conflicts Tactics Scale (CTS-2)⁴⁰40. Moraes CL, Hasselmann MH, Reichenheim ME. Adaptação transcultural para o português do instrumento “Revised Conflict Tactics Scales (CTS2)” utilizado para identificar violência entre casais. Cad Saude Publica 2002; 18(1):163-176., which measures physical, sexual, and psychological violence. While the CTS tool is not specific to the elderly population, it meets the validity and reliability criteria, which gives reliability to the studies⁴¹41. Espíndola CR, Blay SL. Prevalência de maus-tratos na terceira idade: revisão sistemática. Rev Saude Publica 2007; 41(2):301-306.. Economic abuse and controlling behavior among intimate partners, which were relevant in the elderly, were measured by their own questionnaires due to the lack of validated tools. Thus, it is necessary to develop and validate tools that include such violence between intimate partners to better understand the phenomenon in this population.

The methodological quality of the studies was considered moderate and high, which reinforces the reliability and representativeness of the results of the analyzed populations. The mere selection of population-based studies contributed to the quality achieved, since most studies met the three criteria for sample evaluation.

The comparison of prevalence was difficult due to studies’ methodological diversity, related to both tools used and the types of review, which were stratified by different variables such as gender, age group, nature, intensity and directionality of violence. Espíndola and Blay⁴¹41. Espíndola CR, Blay SL. Prevalência de maus-tratos na terceira idade: revisão sistemática. Rev Saude Publica 2007; 41(2):301-306., when investigating elder abuse in a review study, identified such diversity of information. However, the prevalence shown in the studies (Chart 2) indicate the relevance and magnitude of IPV in the elderly.

The various possibilities of combining the nature of violence (physical, sexual, psychological, controlling behavior and economic abuse) in research show the cruel setting of the phenomenon and limits comparison between studies. Even with this difficulty, analyzed studies⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.^,²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.^,³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.^,³⁴34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446. point to high prevalence that have stratified IPV according to their nature.

However, it is assumed that intimate partner violence in the elderly is not unique to this age group, since violence is a relational process, probably established in adulthood, perpetuating in lifetime. Rennison and Rand⁴²42. Rennison CM, Rand MR. Nonlethal intimate partner violence against women: A comparison of three age cohorts. Violence Against Women 2003; 9(12):1417-1428. argue that prevalence of physical and sexual violence declines among the elderly, but psychological violence persists and may even increase in frequency and severity⁴²42. Rennison CM, Rand MR. Nonlethal intimate partner violence against women: A comparison of three age cohorts. Violence Against Women 2003; 9(12):1417-1428.^,⁴³43. Daly JM, Hartz AJ, Stromquist AM, Peek-Asa C, Jogerst GJ. Self-reported elder domestic partner violence in one rural Iowa county. Journal of Emotional Abuse 2008; 7(4):115-134..

Among the studies analyzed, the economic abuse identified by Stöckl et al.³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564. stands out, with a prevalence of 13% among 66-86 year-olds in Germany. It is understood that hardships inherent to aging, such as dependence on family and, consequently, intimate partners can exacerbate this elderly’s exposure to both financial exploitation situations and physical and psychological violence. This setting occurs domestically and tends to perpetuate, with the possible aggravation of both violence and health conditions of the elderly. Kwong et al.⁴⁴44. Kwong MJ, Bartholomew K, Henderson AJZ, Trinke SJ. The Intergenerational Transmission of Relationship Violence. J Fam Psychol 2003; 17(3):288-301. corroborate the finding and point out that violence has deep cumulative effects in lifetime, which scale-up in this period of greater physical and emotional vulnerability.

Papers of this review highlight the violence identified in both genders²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.^,²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.^,³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.. These results emphasize the fact that there are people in situations of violence, both men and women, who may suffer or perpetrate it in an intimate relationship, and such findings are also found in other studies⁴⁵45. Fisher BS, Regan SL. The extent and frequency of abuse in the lives of older women and their relationship with health outcomes. Gerontologist 2006; 46(2):200-209.

46. Alvim SF, Souza L. Violência conjugal em uma perspectiva relacional: homens e mulheres agredidos/agressores. Psicol. teor. prat. 2005; 7(2):171-206.

47. Schraiber LB, Barros CRS, Couto MT, Figueiredo WS, Albuquerque FP. Homens, masculinidade e violência: estudo em serviços de atenção primária à saúde. Rev. bras. epidemiol. 2012; 15(4):790-803.^-⁴⁸48. Zaleski M, Pinsky I, Laranjeira R, Ramisetty-Mikler S, Caetano R. Violência entre parceiros íntimos e consumo de álcool. Rev Saude Publica 2010; 44(1):53-59..

Men were identified in the review as victims of intimate partner violence in two studies²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.^,³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96., and in one of them²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522., there was a higher prevalence (4.9%) of IPV in men than in women (3.3%). According to Afifi et al.⁴⁹49. Afifi TO, MacMillan H, Cox BJ, Asmundson GJG, Stein MB, Sareen J. Mental health correlates of intimate partner violence in marital relationships in a nationally representative sample of males and females. J Interpers Violence 2009; 24(8):1398-1417., IPV against men in the literature in general is still scarce and, when investigated, it is only focused on these as aggressors. Lindner et al.⁵⁰50. Lindner SR, Coelho EBS, Bolsoni CC, Rojas PF, Boing AF. Prevalência de violência física por parceiro íntimo em homens e mulheres de Florianópolis, Santa Catarina, Brasil: estudo de base populacional. Cad Saude Publica 2015; 31(4):815-826. affirm that it is relevant to investigate man not only as the perpetrator of violence, but also as a victim. One constraint reported by Carmo et al.⁵¹51. Carmo R, Grams A, Magalhaes T. Men as victims of intimate partner violence. J Forensic Leg Med 2011; 18(8):355-359. was that men would tend to hide the assault suffered, since exposure would break with social gender roles, which attribute them characteristics of invulnerability and virility, thus contributing to the underreporting of this type of violence. Factors that permeate these relationships must be evidenced and disseminated, so that they may translate into the implementation of public policies geared to men and women in situations of violence.

Among factors associated with elder violence, alcohol use was the most identified in the studies of this review⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.^,²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.^,²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.^,²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.^,²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.^,³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.^,³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.. According to these findings, Nagassar et al.⁵²52. Nagassar RP, Rawlins JM, Sampson NR, Zackerali J, Chankadyal K, Ramasir C, Boodram R. The prevalence of domestic violence within different socio-economic classes in Central Trinidad. West Indian Med J 2010; 59(1):20-25. affirm that alcohol and other drugs abuse is one of the main reasons for physical violence, as well as a factor associated with an increased likelihood of violent acts⁵²52. Nagassar RP, Rawlins JM, Sampson NR, Zackerali J, Chankadyal K, Ramasir C, Boodram R. The prevalence of domestic violence within different socio-economic classes in Central Trinidad. West Indian Med J 2010; 59(1):20-25.^,⁵³53. d’Oliveira AFPL, Schraiber LB, França-Junior I, Ludermir AB, Portella AP, Diniz CS, Couto MT, Valença O. Fatores associados à violência por parceiro íntimo em mulheres brasileiras. Rev Saude Publica 2009; 43(2):299-311.. It can be assumed that the intake of alcoholic beverages would be a strategy adopted by the victims to deal with stress caused by the context of violence⁵²52. Nagassar RP, Rawlins JM, Sampson NR, Zackerali J, Chankadyal K, Ramasir C, Boodram R. The prevalence of domestic violence within different socio-economic classes in Central Trinidad. West Indian Med J 2010; 59(1):20-25.^,⁵⁴54. Vieira LJES, Pordeus AMJ, Ferreira RC, Moreira DP, Maia PB, Saviolli KC. Fatores de risco para violência contra a mulher no contexto doméstico e coletivo. Saúde Soc. 2008; 17(3):113-125.. One research evidence⁵⁵55. Kaysen D, Dillworth TM, Simpson T, Waldrop A, Larimer ME, Resick PA. Domestic violence and alcohol use: Trauma-related symptoms and motives for drinking. Addict Behav 2007; 32(6):1272-1283. indicates that heavy drinking contributes to violence, but this does not mean that alcohol is a primary, necessary and sufficient condition for violence. Thus, alcohol would not determine such behaviors, but would contribute to their manifesting more intensely or severely.

Depression was also a factor associated with IPV in this review, such as Renner et al.³¹31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58., who found higher likelihood of victims suffering from depressive symptoms, both for men (2.4 times) and women (3.0 times) when compared with those who did not suffer violence. However, abuse perpetration was associated with increased depressive symptoms for women, not for men. Even if cross-sectional studies cannot establish a causal and temporal relationship between the facts, longitudinal studies show that IPV can lead to depression⁵⁶56. Leonard KE. Alcohol and intimate partner violence: when can we say that heavy drinking is a contributing cause of violence? Addiction 2005; 100(4):422-425., as well as precede or facilitate situations of violence⁵⁷57. Lindhorst T, Oxford M. The long-term effects of intimate partner violence on adolescent mothers’ depressive symptoms. Soc Sci Med 2008; 66(6):1322-1333..

Functional impairment was associated with IPV in two analyzed studies¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446., stating that violence may increase vulnerability, leaving the elderly with reduced ability to defend themselves against ill-treatment. They also consider that the reduced functional capacity for instrumental activities of daily living (IADL) limits the independent social participation of the elderly, restricting contact with other people, besides relatives or caregivers who live together, hindering the search for health services and specialized services to report to when subjected to violence.

It is noteworthy that only one paper²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462. of this review addressed HIV-IPV association, but this study did not separate adults and the elderly, and there were gaps in the specific issues among older people, and research on the subject is relevant. Alencar and Ciosak⁵⁹59. Alencar RA, Ciosak SI. Aids em idosos: motivos que levam ao diagnóstico tardio. Rev Bras Enferm 2016; 69(6):1140-1146. point out that the investigation of anti-HIV serology for the elderly is not routine in the primary health care services. Elder sexuality is made invisible by health professionals because they do not consider that they can be sexually active, and the investigation of sexual health is not part of routine consultations. However, in Brazil, the number of elderly people (> 60 years) corresponded to 2.5% of those infected in 2002, increasing to 5.0% in 2013. Increased HIV epidemic among the elderly has also occurred worldwide⁵⁹59. Alencar RA, Ciosak SI. Aids em idosos: motivos que levam ao diagnóstico tardio. Rev Bras Enferm 2016; 69(6):1140-1146.^,⁶⁰60. Rabkin M, Kruk ME, El-Sadr WM. HIV, aging and continuity care: strengthening health systems to support services for noncommunicable diseases in low-income countries. AIDS 2012; 26(Supl. 1):S77-83..

Low income²⁰20. Loney PL, Chambers LW, Bennett KJ, Roberts JG, Stratford PW. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can 1998; 19(4):170-176.^,²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.^,²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651. and low schooling²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.^,²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.^,³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446. are factors associated with IPV in the elderly, since they trigger conflicts between the intimate partners²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.. However, one study³⁴34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698. found that older people aged 66-86 are more likely to be in a situation of violence when women have professional qualifications and men have high schooling. One hypothesis is that because of greater empowerment of women, them would be more independent than the partner and could challenge traditional gender roles, increasing the risk of violence⁶¹61. Liu H, Lin X, Xu Y, Chen S, Shi J, Morisky D. Emerging HIV epidemic among older adults in Nanning, China. AIDS Patient Care STDS 2012; 26(10):565-567.^,⁶²62. Jewkes R. Intimate partner violence: causes and prevention. Lancet 2002; 359(9315):1423-1429..

A striking part in this study is that, in the papers reviewed, previous exposure to violence, such as witnessing parental violence¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.^,³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564. or suffering physical punishment in childhood³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564. was associated with IPV in the elderly. Paixão et al.⁶³63. Paixão GPN, Gomes NP, Diniz NMF, Lira MOSC, Carvalho MRS, Silva RS. Women experiencing the intergenerationality of conjugal violence. Rev. Latino-Am. Enfermagem 2015; 23(5):874-879. corroborate this finding when analyzing the intergenerationality of spouse violence experienced by women, stating that there is a relationship between violence witnessed in the family of origin and intimate partner violence. Violence intergenerational effects trigger their lifelong permanence, and the high prevalence of IPV in adulthood certainly contributes to their perpetuation in old age⁴⁵45. Fisher BS, Regan SL. The extent and frequency of abuse in the lives of older women and their relationship with health outcomes. Gerontologist 2006; 46(2):200-209..

As this systematic review of IPV in the elderly is unprecedented, information is provided to broaden knowledge about the phenomenon, aiming to contribute to the establishment of actions and strategies to prevent violence by elderly intimate partners. It is important to carry out new epidemiological studies with representative samples of the elderly population to investigate IPV prevalence and associated factors, which addresses the directionality of violence suffered and perpetrated between men and women.

In order to give visibility to the nature of the most prevalent IPV among the elderly, we suggest developing and validating specific tools for this population group, which include economic abuse and controlling behavior among intimate partners, given their relevance in this age group. The specificities and vulnerabilities of the elderly should be taken into account, with further analysis of issues regarding mental health, sexual health and functional disability, which are still incipient in the literature on IPV in this age group.

However, some limitations can be pointed out in this review. The low number of scientific publications on the subject in the elderly population stands out. In addition, we note that information is available from studies with methodological limitations, due to the non-stratification of results between adults and the elderly. Most studies were conducted from self-reported interviews as a way to keep respondents’ privacy and confidentiality. However, this type of evaluation is subject to memory bias, over or underestimation of the fact, as well as fear or shame of exposing to the interviewer situations of violence experienced in the intimate relationship.

Noteworthy is publication bias, which may occur due to the non-publication of studies in indexed journals due to the limited number of papers per journal, language, methodology, among others. With regard to the very heterogeneous characteristics of the studies found, we only conducted a qualitative evaluation of the results and quantitative data synthesis was not possible through meta-analysis.

This review shows a method according to the current recommendations for the elaboration of systematic reviews, such as comprehensive sources search, specific search strategy, no language restrictions or publication period, selection and extraction of data in pairs and evaluation of the methodological quality of the studies included. The adoption of these measures shows relevant results, which provide an overview of national and international scientific knowledge produced on prevalence and factors associated with intimate partner violence in the elderly.

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⁴⁷
Schraiber LB, Barros CRS, Couto MT, Figueiredo WS, Albuquerque FP. Homens, masculinidade e violência: estudo em serviços de atenção primária à saúde. Rev. bras. epidemiol. 2012; 15(4):790-803.
⁴⁸
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⁴⁹
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⁵¹
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⁵²
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⁵³
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⁵⁴
Vieira LJES, Pordeus AMJ, Ferreira RC, Moreira DP, Maia PB, Saviolli KC. Fatores de risco para violência contra a mulher no contexto doméstico e coletivo. Saúde Soc 2008; 17(3):113-125.
⁵⁵
Kaysen D, Dillworth TM, Simpson T, Waldrop A, Larimer ME, Resick PA. Domestic violence and alcohol use: Trauma-related symptoms and motives for drinking. Addict Behav 2007; 32(6):1272-1283.
⁵⁶
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⁵⁷
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⁶⁰
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⁶¹
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⁶²
Jewkes R. Intimate partner violence: causes and prevention. Lancet 2002; 359(9315):1423-1429.
⁶³
Paixão GPN, Gomes NP, Diniz NMF, Lira MOSC, Carvalho MRS, Silva RS. Women experiencing the intergenerationality of conjugal violence. Rev. Latino-Am. Enfermagem 2015; 23(5):874-879.

Publication Dates

Publication in this collection
Sept 2017

History

Received
01 Mar 2017
Accepted
18 Apr 2017
Reviewed
22 May 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Duque AM, Leal MCC, Marques APO, Eskinazi FMV, Duque AM. Violência contra idosos no ambiente doméstico: prevalência e fatores associados (Recife/PE). Cien Saude Colet 2012; 17(8):2199-2208.

[2] ²
Apratto Júnior PC. A violência doméstica contra idosos nas áreas de abrangência do Programa Saúde da Família de Niterói (RJ, Brasil). Cien Saude Colet 2010; 15(6):2983-2995.

[3] ³
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[22] ²²
Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.

[23] ²³
Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.

[24] ²⁴
Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.

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Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.

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Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.

[27] ²⁷
Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.

[28] ²⁸
Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.

[29] ²⁹
Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.

[30] ³⁰
Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.

[31] ³¹
Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.

[32] ³²
Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.

[33] ³³
Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.

[34] ³⁴
Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.

[35] ³⁵
Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.

[36] ³⁶
Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.

[37] ³⁷
Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.

[38] ³⁸
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Author, year of publication	Year of Collection	Location	Gender	Age Group	Sample Size	IPV measurement tool
Studies with adults and elderly
Mouton, 2004²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.	NA	United States	F	50-79	91,749	Own questionnaire
Reichenheim, 2006²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.	2002/ 2003	Brazil	F	15-69	6,760	CTS 1
Cohen, 2006²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.	1999	Canada	F/M	≥ 15	16,216	CTS 2 + own questionnaire
Aekplakorn, 2007²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.	2005	Thailand	F	17-78	580	Own questionnaire
Breiding, 2008²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.	2005	United States	F/M	≥ 18	70,156	Own questionnaire
Svavarsdottir, 2009²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.	2005/ 2006	Iceland	F	22-67	2,746	WAST
Sareen, 2009²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.	2004/ 2005	United States	F	≥ 20	13,928	CTS 1- adapted
Brisibe, 2012²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.	2006	Nigeria	F/M	16-65	346	Own questionnaire
Afifi, 2012²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.	2004/ 2005	United States	F/M	≥ 20	25,778	CTS 1 - adapted
Sonego, 2013³⁰30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.	2009/ 2010	Spain	F	18-70	2,835	CTS 1 - adapted + own questionnaire
Renner, 2014³¹31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.	1994 to 1997	United States	F/M	≥ 20	1,096	CTS 1- adapted
Hellemans, 2014³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.	2009	Belgium	F/M	18-75	1,472	CTS 1 - adapted + own questionnaire
Lee, 2014³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.	2006	South Korea	F/M	≥ 30	8,877	CTS 1- adapted
Stöckl, 2015⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.	2003/ 2004	Germany	F	16-86	10,264	CTS 2 + own questionnaire
Hellemans, 2015³⁴34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.	2011/ 2012	Belgium	F/M	18-80	1,448	CTS 1 + WHO VAW
Studies with elderly only
Stöckl, 2012³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.	2003	Germany	F	65-86	10,264	CTS 2
Yan, 2012³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.	2004	China	F/M	60-100	5,049	CTS 2
Burnes, 2015³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.	NA	United States	F/M	≥ 60	4,156	CTS 1- adapted
Paiva, 2015¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.	2014	Brazil	F/M	≥ 60	729	CTS 1

Author, year of publication	Sample	Sampling Source	Sample Size	Outcome Measurement		Impartial interviewer
Studies with adults and elderly

High methodological quality
Reichenheim, 2006²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.	1	1	1		1	1	1		1	0	7
Sareen, 2009²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.	1	1	1		1	1	1		0	1	7
Afifi, 2012²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.	1	1	1		1	1	1		0	1	7
Renner, 2014³¹31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.	1	1	1		1	1	0		1	1	7
Lee, 2014³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.	1	1	1		1	1	1		0	1	7
Moderate methodological quality
Mouton, 2004²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.	1	1	1		0	1	1		0	1	6
Breiding, 2008²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.	1	1	1		0	1	0		1	1	6
Stöckl, 2012³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.	1	1	1		1	1	0		0	1	6
Aekplakorn, 2007²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.	0	1	1		0	1	1		0	1	5
Hellemans, 2014³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.	1	1	1		1	1	0		0	0	5
Hellemans, 2015³⁴34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.	1	1	1		1	1	0		0	0	5
Cohen, 2006²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.	0	0	1		0	1	1		0	1	4
Brisibe, 2012²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.	1	1	1		0	0	1		0	0	4
Sonego, 2013³⁰30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.	1	1	0		1	1	0		0	0	4
Low methodological quality
Svavarsdottir, 2009 ²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.	1	1	0		1	0	0		0	0	3
Total	13 (86.7%)	14 (93.4%)	13 (86.7%)		10 (66.7%)	13 (86.7%)	8 (53.4%)		3 (20.0%)	9 (60.0%)	Mean = 5.7

Studies with elderly only

High methodological quality
Yan, 2012 ³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.	1	1	1	1		1	1	0		1	7
Burnes, 2015³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.	1	1	1	1		1	1	1		1	7
Moderate methodological quality
Stöckl, 2012³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.	1	1	1	1		1	0	0		1	6
Paiva, 2015¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.	1	1	1	1		1	0	0		1	6
Total	4 (100%)	4 (100%)	4 (100%)	4 (100%)		4 (100%)	2 (50%)	1 (20%)		4 (100%)	Mean = 6.5

Author, year of publication	IPV recall period	Elderly age range	IPV prevalence in the sample	IPV prevalence in elderly
Studies with adults and elderly
Mouton, 2004²¹21. Mouton CP, Rodabough RJ, Rovi SL, Hunt JL, Talamantes MA, Brzyski RG, Burge SK. Prevalence and 3-year incidence of abuse among postmenopausal women. Am J Public Health 2004; 94(4):605-612.	Last 12 months	50-79 years	General - 11.1%	NA
Reichenheim, 2006²²22. Reichenheim ME, Moraes CL, Szklo A, Hasselmann MH, Souza ER, Lozana JA, Figueiredo V. The magnitude of intimate partner violence in Brazil: portraits from 15 capital cities and the Federal District. Cad Saude Publica 2006; 22(2):425-437.	Last 12 months	NA	Psychological - 75%	NA
			Physical minor - 21.5%
			Physical severe - 12.9%
Cohen, 2006 ²³23. Cohen MM, Forte T, Du Mont J, Hyman I, Romans S. Adding insult to injury: intimate partner violence among women and men reporting activity limitations. Ann Epidemiol 2006; 16(8):644-651.	Last 5 years	≥ 55 years	Physical/woman - 7.8%	NA
			Physical/men - 6.6%
			Sexual/woman - 1.4%
			Psychological/woman -17.7%
			Psychological/man -18.2%
			Financial/woman - 7.5%
			Financial/man -1.4%
Aekplakorn, 2007 ²⁴24. Aekplakorn W, Kongsakon R. Intimate partner violence among women in slum communities in Bangkok, Thailand. Singapore Med J 2007; 48(8):763-768.	Last 12 months	≥ 55 years	Physical and psychological - 27.2%	Physical and psychological - 14,1%
Breiding, 2008²⁵25. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors of intimate partner violence in eighteen U.S. states/territories, 2005. Am J Prev Med 2008; 34(2):112-118.	Lifetime	≥ 65 years	Physical and sexual/woman - 26.4%	Physical and sexual/woman - 12,9%
			Physical and sexual/man - 15.9%	Physical and sexual/man - 5,6%
Svavarsdottir, 2009 ²⁶26. Svavarsdottir EK, Orlygsdottir B. Intimate partner abuse factors associated with women’s health: a general population study. J Adv Nurs 2009; 65(7):1452-1462.	Lifetime	NA	Physical/married - 2.0%	NA
			Physical/ cohabiting - 3.3%
			Psychological/married - 16.7%
			Psychological/cohabiting - 18.2%
			Sexual/married - 1.2%
			Sexual/live together - 1.3%
Sareen, 2009²⁷27. Sareen J, Pagura J, Grant B. Is intimate partner violence associated with HIV infection among women in the United States? Gen Hosp Psychiatry 2009; 31(3):274-278.	Last 12 months	NA	General - 5.5%	NA
Brisibe, 2012²⁸28. Brisibe S, Ordinioha B, Dienye PO. Intersection Between Alcohol Abuse and Intimate Partner’s Violence in a Rural Ijaw Community in Bayelsa State, South-South Nigeria. J Interpers Violence 2012; 27(3):513-522.	Last 12 months	NA	General- 55.8%	NA
Afifi, 2012²⁹29. Afifi TO, Henriksen CA, Asmundson GJ, Sareen J. Victimization and perpetration of intimate partner violence and substance use disorders in a nationally representative sample. J Nerv Ment Dis 2012; 200(8):684-691.	Last 12 months	≥ 65 years	Victimization; Perpetration	Victimization; Perpetration
			General/women – 5.5%; 7.0%	General/women – 3,3%; 3,5%
			General/men – 5.8%; 4.2%	General/men – 4,9%; 6,8%
Sonego, 2013³⁰30. Sonego M, Gandarillas A, Zorrilla B, Lasheras L, Pires M, Anes A, Ordobás M. Unperceived intimate partner violence and women’s health. Gac Sanit 2013; 27(5):440-446.	Last 12 months	NA	General - 12.2%	NA
Renner, 2014³¹31. Renner LM, Habib L, Stromquist AM, Peek-Asa C. The association of intimate partner violence and depressive symptoms in a cohort of rural couples. J Rural Health 2014; 30(1):50-58.	Last 12 months	NA	Physical and emocional/woman - 50.9%	NA
	Last 12 months	NA	Physical and emotional/man - 40.0%	NA
Hellemans, 2014³²32. Hellemans S, Buysse A, De Smet O, Wietzker A. Intimate partner violence in Belgium: Prevalence, individual health outcomes, and relational correlates. Psychologica Belgica 2014; 54(1):79-96.	Last 12 months	NA	Physical - 1.3%	NA
			Sexual (women) - 0.3%
			Psychological - 14.0%
Lee, 2014³³33. Lee M, Stefani KM, Park EC. Gender-specific differences in risk for intimate partner violence in South Korea. BMC Public Health 2014; 14(1):415.	Last 12 months	≥ 60 years	Victimization; Perpetration	Victimization; Perpetration
			Verbal/ woman	Verbal/ woman
			General - 28.2%; 26.7%	60-69 years - 25,5%; 22,8%
			General - 28.2%; 26.7%	>70 years - 24,5%; 20,9%
			Verbal/ man	Verbal/ man
			General - 24.4%; 25.0%	60-69 years - 21,2%; 23,5%
				>70 years - 20,1%; 21,4%
			Physical/ woman	Physical/ woman
			General - 6.9%; 3.4%	60-69 years - 5,1%; 1,4%
				>70 years - 3,1%; 1,0%
			Physical/ man	Physical/ man
			General - 3.4%; 5.1%	60-69 years - 1,6%; 3,7%
				>70 years - 1,0%; 2,6%
Stöckl, 2015⁴4. Stockl H, Penhale B. Intimate Partner Violence and Its Association With Physical and Mental Health Symptoms Among Older Women in Germany. J Interpers Violence 2015; 30(17):3089-111.	Last 12 months	66-86 years	Physical or sexual	Physical or sexual
			16-49 years - 8%	66-86 years - 1%
			50-65 years - 3%
			Psychological	Psychological
			16-49 years 13%	66-86 years - 13%
			50-65 years 13%
			Controlling behavior	Controlling behavior
			16-49 years 21%	66-86 years - 21%
			50-65 years 21%
			Economic abuse	Economic abuse
			16-49 years 12%	66-86 years - 13%
			50-65 years 14%
Hellemans, 2015³⁴34. Hellemans S, Loeys T, Dewitte M, De Smet O, Buysse A. Prevalence of Intimate Partner Violence Victimization and Victims’ Relational and Sexual Well-Being. J Fam Viol 2015; 30(6):685-698.	Lifetime	NA	Physical - 10.0%	NA
	Lifetime	NA	Psychological - 56.7%	NA
Studies with elderly only
Stöckl, 2012³⁵35. Stöckl H, Watts C, Penhale B. Intimate Partner Violence Against Older Women in Germany: Prevalence and Associated Factors. J Interpers Violence 2012; 27(13):2545-2564.	Current, last year, last 5 years and in lifetime	50-86 years	Physical and/or sexual in life	Physical and/or sexual in lifetime
			General - 18%	50-65 years: 23%
				66-86 years: 10%
			Physical and/or sexual in the last 5 years	Physical and/or sexual in the last 5 years
			General - 2%	50-65 years: 3%
				66-86 years: 1%
			Physical and/or sexual in the last year	Physical and/or sexual in the last year
			General - 1%	50-65 years: 2%
				66-86 years: 0%
			Physical and/or sexual in the current relationship	Physical and/or sexual in the current relationship
			General - 11%	50-65 years: 14%
			General - 11%	66-86 years: 5%
Yan, 2012³⁶36. Yan E, Chan KL. Prevalence and correlates of intimate partner violence among older Chinese couples in Hong Kong. Int Psychogeriatr 2012; 24(9):1437-1446.	Lifetime; last 12 months	60-100 years	Lifetime; last year
			Physical - 6.6 %; 2.5%
			Sexual - 3.2%; 1.2%
			Psychological - 53.6%; 36.1%
			General - 7.7%; 2.9%
Burnes, 2015³⁷37. Burnes D, Pillemer K, Caccamise PL, Mason A, Henderson CRJ, Berman J, Cook AM, Shukoff D, Brownell P, Powell M, Salamone A, Lachs Ms. Prevalence of and Risk Factors for Elder Abuse and Neglect in the Community: A Population-Based Study. J Am Geriatr Soc 2015; 63(9):1906-1912.	Last 12 months	≥ 60 years	Psychological	Psychological
			General - 1.9%	60-69 = 0,9%
				70-84 = 0,8%
				> 85 = 0,1%
			Physical	Physical
			General - 1.8%	60-69 = 1,0%
				70-84 = 0,6%
				> 85 = 0,2%
Paiva, 2015¹⁰10. Paiva MM, Tavares DMS. Violência física e psicológica contra idosos: prevalência e fatores associados. Rev Bras Enferm 2015; 68(6):1035-1041.	Last 12 months	60 years	Physical	Physical
			General - 5.9%	60-80 = 6,4%
			General - 5.9%	> 85 = 3,8%
			Psychological	Psychological
			General - 20.9%	60-80 = 22,1%
			General - 20.9%	> 80 = 15,0%

Factors associated with intimate partner violence	Papers that evidenced the associated factor n (%)
Health-related behaviors
Alcohol use	7 (36.9%)
Tobacco use	2 (10.6%)
Use of other drugs	1 (5.3%)
Mental health conditions
Depression	4 (21.0%)
Stress	2 (10.6%)
Use of tranquilizers	1 (5.3%)
Sleep disorders	1 (5.3%)
Anxiety	1 (5.3%)
Physical health conditions
Functional impairment	2 (10.6%)
HIV infection	1 (5.3%)
Gastrointestinal and pelvic symptoms	1 (5.3%)
Sexual dysfunction	1 (5.3%)
Poor health evaluation
Economic and sociodemographic factors
Low income	4 (21.0%)
Low schooling	3 (15.8%)
Being divorced / separated	2 (10.6%)
Being a young elderly	2 (10.6%)
Women schooling higher than her husbands	1 (5.3%)
Being single	1 (5.3%)
Living with spouse	1 (5.3%)
Previous exposure to violence
Witnessing parental violence in childhood	2 (10.6%)
Suffering physical punishment in childhood	1 (5.3%)
Suffering physical or sexual violence by non-partner	1 (5.3%)

Saúde Pública

Saúde Pública

Intimate partner violence prevalence in the elderly and associated factors: systematic review

Abstract

Introduction

Methodology

Registration and protocol

Eligibility Criteria

Search strategy

Selection of studies and data extraction and review

Evaluation of methodological quality

Results

Evaluation of the methodological quality

Prevalence of Intimate Partner Violence

Factors associated with intimate partner violence

Discussion

References

Publication Dates

History