Understanding responses to domestic violence and abuse among older adults: a systematic review and meta-synthesis of stakeholder perspectives

Abstract

Domestic violence and abuse (DVA) among older adults is an increasingly recognized public health and human rights concern with significant physical, psychological, and social consequences. This systematic review and meta-synthesis aimed to synthesize qualitative evidence on response strategies for older adults experiencing domestic violence and abuse and to identify key factors influencing helpful intervention and support. A systematic review and qualitative meta-synthesis were conducted following PRISMA 2020 and ENTREQ guidelines. Six electronic databases (MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase) were searched from inception to February 2026. Qualitative studies exploring response strategies, help-seeking, coping, and professional responses among older adults experiencing domestic violence and abuse were included. Studies addressing abuse by adult children, intimate partners, and other family members within home settings were included, even when authors used “elder abuse” terminology, provided the abuse context was domestic rather than institutional. Study selection, data extraction, and quality appraisal using the Critical Appraisal Skills Programme (CASP) checklist were conducted independently by reviewers. Data were analyzed using thematic synthesis to identify descriptive and analytical themes. A total of 29 qualitative studies were included. Four overarching themes were identified: [1] barriers to disclosure and help-seeking, including fear, stigma, dependency, and generational norms; [2] factors perceived as facilitating helpful responses, such as trust, validation, and accessibility of support services; [3] the role of professional and organizational responses, highlighting the importance of training, screening, and multidisciplinary collaboration; and [4] survivor-centered coping and resilience strategies, including informal support networks and adaptive coping mechanisms. Beyond descriptive synthesis, our analysis generated several novel conceptual insights, including the conceptualization of an “ecology of silence” that reinforces non-disclosure through mutually reinforcing barriers, the identification of a “coping paradox” wherein strategies that protect psychological integrity in the short term may prolong exposure to abuse, and the articulation of professional validation as a mechanism of cognitive transformation rather than merely emotional support. Findings demonstrated that perceived helpful responses require person-centered, trauma-informed, and age-sensitive approaches that address the complex social, relational, and structural contexts of abuse in later life. Response strategies for older adults experiencing domestic violence and abuse must address unique age-related vulnerabilities, structural barriers, and relational dynamics. Stakeholder perspectives indicate that perceived helpful responses involve accessible services, trained professionals, and supportive environments that promote safety, autonomy, and empowerment. The findings underscore the importance of recognizing the diverse relationship contexts in which DVA occurs in later life—including abuse by adult children, intimate partners, and other family members—and the need for responses tailored to these distinct dynamics. These findings provide important implications for policy, practice, and service development, emphasizing the need for integrated, age-appropriate interventions to improve outcomes for older survivors of domestic violence and abuse.