_________________________________________________________________ Domestic and Sexual Violence
Children exposed to family violence are at high risk for abuse and for emotional damage that may affect them as they grow older. The Department of Justice estimates that of the 76 mil- lion children in the United States, 46 million will be exposed to some type of violence during their childhood [19]. Results of the National Survey of Children’s Exposure to Violence indicated that 20% of children were exposed to IPV at home within the last year, and an estimated two-thirds of children were exposed to more than one form of family violence [54]. Of those children exposed to IPV, 90% were direct eyewitnesses of the violence; the remaining children were exposed by either hearing the violence or seeing or being told about injuries [54]. A number of studies indicate that child witnesses are at increased risk for post-traumatic stress disorder, impaired development, aggressive behavior, anxiety, difficulties with peers, substance abuse, and academic problems than the aver- age child [52; 55; 56; 57]. Men who are exposed to intimate partner violence are more likely to perpetrate violence in their lifetimes [58]. Children exposed to violence may also be more prone to dating violence (as a perpetrator or a victim), and the ability to effectively cope with partnerships and parenting later in life may be affected, continuing the cycle of violence into the next generation [59]. Overall, children who witness domestic violence appear to display neurological and functional changes, placing them at increased risk of developing hypertension, diabetes, and cardiovascular conditions later in life [52]. In addition to witnessing violence, various studies have shown that these children may also become direct victims of violence, and children who both witness and experience violence are at the greatest risk for adverse psychosocial outcomes [60]. Research indicates that between 30% and 60% of husbands who batter their wives also batter their children [61]. Moreover, victims of abuse will often turn on their children; statistics demonstrate that 85% of domestic violence victims abuse or neglect their children. According to the U.S. Department of Justice, between 1980 and 2008, 17.5% of all homicides against female adolescents 12 to 17 years of age were committed by an intimate partner [13]. Among young women (18 to 24 years of age), the rate is 42.9%. Abused teens often do not report the abuse. Individuals 12 to 19 years of age report only 35.7% of crimes against them, compared with 54% in older age groups [62]. Accordingly, healthcare professionals who see young children and adolescents in their practice (e.g., pediatricians, family physicians, school nurses, pediatric nurse practitioners, community health nurses) should have the tools necessary to detect these “silent victims” of domestic violence and to intervene quickly to protect young children and adolescents from further abuse. Without such critical intervention, the cycle of violence will never end.
DOMESTIC VIOLENCE AND SEXUAL VIOLENCE IN SPECIAL POPULATIONS
ELDERLY Abused and neglected elders, who may be mistreated by their spouses, partners, children, or other relatives, are among the most isolated of all victims of family violence. According to the CDC, 1 in 10 older adults who live at home experience abuse, including neglect and exploitation. From 2002 to 2016, more than 643,000 older adults were treated in the emergency department for nonfatal assaults and more than 19,000 homicides occurred [63]. According to one study, only 1 in 14 cases of elder abuse are reported to the authorities [64]. In the National Intimate Partner and Sexual Violence survey, 23% of persons 70 years of age and older disclosed having experienced abuse by an intimate partner [65]. In addition, 57% experienced abuse by a person other than an intimate partner [65]. The prevalence rate of elder abuse in institutional settings is not clear. In a 2019 systematic study of elder residents in institutional settings, the most commonly reported abuse expe- rienced in the previous 12 months was psychological (33.4%), followed by physical abuse (14.1%) and financial abuse (13.8%) [66]. In a nonprobability study, 36% of nursing and aide staff disclosed to having witnessed at least one incident of physical abuse by other staff members in the preceding year. When asked whether they themselves perpetrated physical abuse against an elderly resident, 10% admitted they had [67]. In a random sample survey, 24.3% of respondents reported at least one incident of elder physical abuse perpetrated by a nursing home staff member [68]. It is important to understand that the needs of older patients will increase, as will the numbers of elder victims of domestic violence. Because elder abuse can occur in family homes, nurs- ing homes, board and care facilities, and even medical facilities, healthcare professionals should remain keenly aware of the potential for abuse. When abuse occurs between elder partners, it is primarily manifested in one of two ways, either as a long- standing pattern of marital violence or as abuse originating in old age. In the latter case, abuse may be precipitated by issues related to advanced age, including the stress that accompanies disability and changing family relationships [69]. It is important to understand that the domestic violence dynamic involves not only a victim but a perpetrator as well. For example, an adult son or daughter who lives in the parents’ home and depends on the parents for financial support may be in a position to inflict abuse. This abuse may not always manifest itself as violence but can lead to an environment in which the elder parent is controlled and isolated. The elder may be hesitant to seek help because the abuser’s absence from the home may leave the elder without a caregiver [69]. Because these elderly victims are often isolated, dependent, infirm, or mentally impaired, it is easy for the abuse to remain undetected.
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MDCT2026
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