摘要：Objectives . We examined prevalence, 3-year incidence, and predictors of physical and verbal abuse among postmenopausal women. Methods . We used a cohort of 91 749 women aged 50 to 79 years from the Women’s Health Initiative. Outcomes included self-reported physical abuse and verbal abuse. Results . At baseline, 11.1% reported abuse sometime during the prior year, with 2.1% reporting physical abuse only, 89.1% reporting verbal abuse only, and 8.8% reporting both physical and verbal abuse. Baseline prevalence was associated with service occupations, having lower incomes, and living alone. At 3-year follow-up, 5.0% of women reported new abuse, with 2.8% reporting physical abuse only, 92.6% reporting verbal abuse only, and 4.7% reporting both physical and verbal abuse. Conclusions . Postmenopausal women are exposed to abuse at similar rates to younger women; this abuse poses a serious threat to their health. Abuse, including physical, sexual, financial, or psychological mistreatment, is a serious problem for adults aged 65 years and older. 1 According to the National Elder Abuse Incidence Study, approximately 450 000 older adults in domestic settings were abused, neglected, or both during 1996. 2 This number increases to approximately 551 000 when older adults who experienced self-neglect are included. In a population-based survey of metropolitan Boston, Pillemer and Finkelhor found a rate of elder abuse of 3.2%. 3 In the long-term care setting, 23% of older adults either have been or still are victims of abuse. 4– 6 The public health implications of abuse are its associations with premature mortality and morbidity. 7– 13 Lachs and colleagues found that among older adults who were victims of abuse, only 9% were alive 2 years later compared with 40% of older adults who had not been abused. 11 Other studies have found a risk of death for older abuse victims that is 3 times higher than for nonvictims. 12, 13 The direct medical costs associated with these violent injuries are estimated to add over $5.3 billion to the nation’s annual health expenditures (K. Fullin et al., unpublished data, 1994). Gender is an important factor in abuse exposure. Worldwide, between 10% and 50% of women report being physically assaulted at some point in their adult lives; 14% to 25% of women seen at ambulatory medical clinics and 20% of women seen in emergency departments have been physically abused. 7– 10 Older, postmenopausal women (65 years or older) are more likely than older men to be the victims of all forms of abuse, except for abandonment, even when taking into account the fact that they make up a larger proportion of the aging population. 3, 4, 14, 15 While females made up about 57.6% of the total national population aged 65 years and older in 2000, women were the victims in 76.3% of reports of emotional or psychological abuse, 71.4% of physical abuse, 63.0% of financial or material exploitation, and 60.0% of neglect. 2 Women in the early postmenopausal ages (aged 50–65 years) are exposed to abuse by intimate partners at a rate of 0.5 per 1000 and account for 30% of homicides committed by an intimate partner. 16 Cognitive or physical impairment, or both, is an additional factor in abuse exposure. In a study of mortality due to mistreatment of elders, over 85% of victims of elder abuse had some impairment of their activities of daily living. 2, 11 Unfortunately, most studies examining the associations with abuse exposure have focused on younger women in their childbearing years or on frail, functionally dependent older adults. To date, no study has examined the associations with physical and verbal abuse in functionally independent, cognitively intact, older women. We conducted this study to (1) describe the 1-year baseline prevalence and 3-year incidence of physical and verbal abuse in a cohort of functionally independent older women and (2) examine the sociodemographic factors and health behaviors associated with this prevalence and incidence of abuse.
