Table 3. Themes, sub-themes and quotations.

Theme	Sub-theme	Illustrative quotation[s]	Supporting references
Intersection of ageing and violence
	Suffering, loneliness, regret and guilt	“I lost my whole, beautiful life. I have a lot of anger in my heart…Today, I am real angry about all the years, the good, beautiful years I could have had. I am angry, because I was a good, loyal wife… With the wisdom I have today, I would have gone out with anyone but him. Sixty wasted years” [37]	[33, 34, 37, 38, 40, 42, 44, 45, 47, 50–52, 54, 56, 62, 66, 75, 78, 79]
		"There was violence along with suffering for many years; it was a suffering, but I had a goal behind all this suffering, to have my children grow, get married and get an education…. I don’t know if the suffering was worthwhile for me, I don’t know if it was worthwhile as it was very difficult. Today I look and say that I was a heroine, I was a heroine myself, with all the things I went through during the 40 years." [42]
		“When I was bringing up the children, I thought of nothing else… I just wanted to bring them up. Actually, my forgiveness was for the sake of the home and the children, without any consideration for myself; I did not value myself at all. I was the doormat of the entire household… When there was anger and quarrelling, none of the children came to ask about it… They never said anything. When he raised his hands, they did not go and ask him why he was hitting their mother. Nothing. As if they didn’t care. I am real angry. They got used to the fact that mom gets everything done. I had big expectations of life, I gave a lot, and today I am really alone. The worst pain is from the children. Perhaps if I were stronger, I could have changed things around. But I gave up a lot. I gave in." [38]
	Violence, ageing and vulnerabilities	"When I was younger, I could overcome him faster, save myself, now that I’m old and I have diabetes, now I have to be faster, and I got triglycerides in my blood. Now I’m afraid for my life, afraid he [son with schizophrenia] will kill me." [39]	[33, 37, 39, 40, 43, 44, 47, 48, 52, 53, 55–57, 59, 61, 62, 64, 66, 76]
		"Because of my nerves, my blood pressure was 200/100. My sugar was skyrocketing, my cholesterol also. Since we’ve been living apart, everything has cooled down. When we lived together, my whole body was sick. I was hurting. I was worried that I had cancer. I couldn’t believe what he had done to me. I was going to the doctor for checkups and tests all the time. I was sick with fear. My nerves made me sick. The doctor knew I had problems at home. He would say ‘Ilana, you are nervous.’ He gave me some pills, but nothing helped. I did not sleep. Nerves make a person sick. They make a woman sick. A sick woman without sickness." [37]
		“I reached the point where… I didn’t care if I went and got my medicine. I would have to argue with him that I needed $12 just to go to the clinic to get my pills.” [61]
Perpetrator-related factors
	Ageing perpetrators and continuity of abuse	“Although Mrs. V. had not been hit in many years, she was submissive to her husband and distraught about the continuing marital rape. Among the tactics used by Mr. V. to control his wife were prohibiting her from driving, working outside of the home, or managing money.” [59]	[36, 41, 45, 47–51, 56, 59, 61, 72, 76, 77]
		"Fifty years went by. I lost my whole life. He made me into an imbecile…. When I needed to buy something for the children or for myself, I had to ask him for money and he made me bring him the receipts. I have no friends, no family here; he wouldn’t let the children come into the house… Because of the paralysis (CVA) I walk sort of crooked. He walks behind me, imitating me and calling me names like ‘the limping,’ ‘the paralyzed’. Instead of feeling sorry about what happened to me, he laughs. ‘Old whore’ he called me … A month into my marriage, he beat me. I was pregnant. My mother was standing there and said to me: ‘Be patient with him. Treat him well, take care of him and everything will be OK.” [47]
	Perpetrator’s illness as a cause of violence	“We couldn’t get into the house one day; the key wouldn’t go in for some reason. He went berserk, kicking the door and I said, “Brian calm down, we’ll go to the other door.” He just kept kicking; he was just in this rage. So I backed off and went around and opened the door and came. It turned out there was damage done; he almost kicked the door in and [doctor] said in hindsight that I could have called the police then. I could have reported that because I was scared." [69]	[40, 46, 69]
		"Look, I don’t know what’s going on with my husband, he’s never been like that, never hit me before. I’m really worried about him, he’s been changing so much […] We have been married for 47 years. After he assaults me, he behaves as if he had done nothing, he seems another person.” [46]
		"He used to work, [he was] a construction worker, and then suddenly he became agitated one day, and threw me against the wall. I cracked my head open; they stitched me up in the hospital and sent me right back home. Sometimes, he grabs me—by the stomach, by the throat, starts running, pushes me aside, and runs from room to room. I can’t rest, can’t watch TV, it bothers him…. He had become someone else, not the person I knew, so we went to the doctor.” [40]
Social and gender norms regarding response to violence
	Silence, stigma and family	"I had a goal that my children would reach something good, and thank God, there was no other way, there was no other way… what I have suffered for so many years and I didn’t know. I knew how to get out for the kids’ sake, but not for myself. The kids get married, and go on with their lives, and I am left, left with all I have gone through. It is so difficult to speak about it, the same pain and with the same person, and today I look on my plight and I cannot leave him. …" [42]	[33–35, 38, 40–42, 46, 48, 57, 65–69, 71, 73–76, 79, 80]
		“If I complained about him, he said that when I called the police, before the police arrive, I’d be dead. I did not know that there is help for intimate partner violence cases. I did not know because I had no friends; I did not talk to anyone! My life was from home to work and from work to home. He beat me sometimes.” [81]
	Perceptions of abuse and violence as normal	"I mean I suppose you could say I have been abused, I’ve never been badly beaten, but I have been hit and with all the temper and that sort of thing, but then there was never anywhere to go and I’m really not aware that there’s anywhere specifically for older people and I’m not aware that they even do anything.” [55]	[27, 29, 32, 41, 55, 70, 71, 74, 75]
		“Most of the time, they [physicians] think you are just getting a little carried away, you are a little high-strung, you are very nervous, you have al- ways been this way, so calm down…So I didn’t go to the doctor when he beat me so badly. It’s a little embarrassing at my age." [74]
Lifelong IPV
	Continuation of patterns of IPV in old age	"He started beating me on the second day of our marriage, he’s been hitting me all these years." [71]	[33, 40, 49, 59, 70–72, 77]
	Earlier experiences of violence	"He started beating me on the second day of our marriage, he’s been hitting me all these years." [71]	[48, 49, 57, 61, 70, 71, 80]
	Cumulative impacts of violence	"The worst thing is that so many years of abuse caused me many health problems, especially with my nerves, and depression. This was due to mistreatment. No one can have happiness or live well dealing with so much trouble. I also have other health problems, but the worst for me are those related to my nerves, depression, and lack of sleep. I have back problems; high cholesterol, ulcers, anemia and I have a liver problem… a lot of problems! It never ends. Even after getting divorce, we still suffer the consequences." [81]	[34, 37, 41, 47, 50, 51, 54, 67, 68]
		“I have a problem with my stomach. I did five tests and nothing was found! It is the anger I swallow. I have this pain in my stomach because the anger I feel of him.” [68]
		“Bruises heal in time but words last forever. When you are told over and over how stupid, ugly, and insane you are, you really believe it. I am not financially or physically capable of going anywhere." [51]
Needs of older women affected by violence
	Social and community support	“If my friends knew the truth about who I was living with, then they would become really angry with me. I was losing contact with my friends because they were saying, “How could you let him treat you like this, particularly when you are in such dire need of support?” It was easier for me to just be quiet, but it’s very difficult to go through such an abusive situation without having friends to talk with, though I did lose some friends.” [64]	[41, 45, 52, 64, 65, 68, 75–78]
		"I never invite any of my friends or relatives to come home, because of the fear that he will insult them. None comes to visit me, because I have stopped calling them” (Participant in IDI)" [41]
		“I have talked to them [my neighbours]. I have asked them to help me. The neighbours know everything, but they keep quiet! They do not want to get involved. No one comes here. No one! Only you came here today [crying]” [68]
	Barriers to accessing services	“My internist really could not deal much with this [IPV]. I mean he saw my husband as a patient also. He [spouse] was a brittle diabetic, and then he had a heart condition… he was a sick old man.” [74]	[28, 29, 52, 54, 55, 57, 74, 76]
		"My family doctor is a good friend…didn’t involve him because I didn’t get…really hurt. I mean, I was choked, but I didn’t get my eyes beat up or…but no I wouldn’t have gone to him." [74]
Coping mechanisms
	Leaving a relationship	“I didn’t like the way my daughter-in-law treated me. So I asked my son to find me another place to stay. Another son of mine was here, so he found a place for both of us to stay.” [76]	[33, 34, 37, 38, 42, 45–48, 57, 65, 69, 70, 73, 76]
	Isolation, substance use and emotion-based coping strategies	‘I coped by going into my own private world; I took Valium … I saw myself as a failure and felt sorry for myself. [50]	[33, 34, 37–39, 47, 50, 51, 61, 68, 69, 73, 79]
		"Why would I need this kind of life? How can a man do things like that? Why did I agree to that? What do I have inside me today? It is all empty; an empty shell. What am I left with? Nothing. All together, my entire life was for nothing, a big loss…I destroyed it all. I gave up on myself, became non-existent. I think I am a lost case. I am the loser in all this. What is left? I am all eaten up. I have no emotional strength left. I don’t feel like doing anything." [47]
	Behaviors to enhance safety	"The two years were coming up for the restraining order, I start getting these nightmares he’s going to be at my door wanting to move in. I was living here, and he was living in [place] about a mile from home. So I go back to court and apply for renewal of the restraining order, and I am told there is no such thing as a renewal, you just apply again." [70]	[36, 67, 69, 70, 75]