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The Epidemic of Elder Sexual Abuse

One form of maltreatment that is widely believed to be underreported is the sexual abuse of elderly adults. Elders who live in longtime care facilities are particularly vulnerable when their health conditions prevent them from being able to give consent or disclose their abuse.

As discussed in STM Learning’s Medical Response to Adult Sexual Assault, Second Edition, research on adult sexual abuse largely neglects to address elders, although there is statistical data available. However, information on the reporting, assessment, treatment, and impact of sexual abuse of adults over the age of 60 is scarce.

Overlooking the Signs

Like any other form of abuse, elder abuse can occur in a variety of ways (eg, sexual, emotional, financial). Physical and sexual abuse are most pervasive in nursing homes, where perpetrators may be caregivers or other residents. 

Elder sexual abuse specifically refers to unwanted touching or fondling. It can also include forcing elders to become nude, taking sexual photographs, and other forms of sexual assault and battery. This type of abuse can be easily missed by caretakers or family members for several reasons. Over 80% of the time, the victim’s primary caregiver is responsible for the abuse; therefore, it can easily be hidden from others.

Additionally, some elders have a tendency to bruise and injure easily due to age and various health conditions. Because of this, physical signs of abuse may be misinterpreted as simply a consequence of aging. Similarly, emotional symptoms of anxiety and depression, with accompanying feelings of fear and confusion, are not uncommon complaints heard from elder adults. If the cause of distress is unclear, medical providers may just treat the elder for their symptoms, with the abuse then going undetected. 

Another reason abuse may go undiscovered is difficulty with the victim understanding and disclosing abusive behaviors or actions. Medical Response author Dr. Ann Burgess explains that due to a generational disconnect in the terminology used to describe sex, body parts, and assault, elders may not convey their experience in a way one of their younger caretakers or family members realize is abuse.

Fear of the stigma surrounding sexual encounters—even nonconsensual ones, such as rape—may also prevent some elders from reporting an assault. They might hold onto the idea that victims share blame in cases of sexual abuse, or they may not believe they actually were raped or assaulted. Dependency on the abuser can also be a factor in not reporting. 

Since it can be hard to recognize, caregivers and family members of elderly adults should be on the lookout for indicators of elder sexual abuse. Common signs include:

  • Pelvic injury
  • Problems walking or sitting
  • Bruises on the genitals or inner thigh
  • Bleeding from the genitals or anus
  • Irritation or pain of the genitals or anus
  • Panic attacks
  • Agitation
  • Social withdrawal
  • Engaging in inappropriate, unusual, or aggressive sexual activities
  • Suicide attempts

Barriers to Resolution

Elder victims of sexual assault are less likely to have a complete sexual assault examination following a report. This process should include the collection of an evidence kit, an internal examination, and tests for sexually transmitted infections. 

If elders do receive a forensic examination, it can be difficult to get results for the following reasons:

  • Resistance of the elder to the pelvic position
  • Difficulty in visualizing the pelvic area because of leg contractures
  • Difficulty in communicating and explaining the procedure to a cognitively-impaired elder
  • Difficulty obtaining reliable and accurate victim report of the assault, injuries sustained, and regions of pain and discomfort

Another barrier in investigation and prosecution is a limited memory and lack of capacity for communication among some elders. However, studies have shown that after abuse, elder victims demonstrate psychosocial trauma regardless of whether they can verbally discuss the incident. In fact, there was no significant difference between elders with and without dementia in terms of post-abuse behavioral symptoms of distress.

Aid for Victims

If you believe a loved one is a victim of any type of elder abuse, there are resources available:

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