Comparing Routes of Reporting in Elder Sexual Abuse Cases

Societal, Organizational, Relational, and Individual Perceptions of Sexual Violence Against Older Adults and Its Prevention: A Systematic Scoping Review

BACKGROUND AND OBJECTIVES

Older adults are not regarded as sexual and are widely excluded from sexual violence (SV) research, policies, and practice; little is known about SV against older adults and its prevention.

RESEARCH DESIGN AND METHODS

An 8-database scoping review explored perceptions of SV against older adults, barriers to prevention, and solutions for prevention. Included were peer-reviewed and gray sources published since 2010, supported by primary research, on perceptions of SV in later life and prevention. A thematic analysis was conducted to explore key themes.

RESULTS

Of 148 potentially relevant sources returned, 95 were fully read after screening titles and abstracts; 19 were critically appraised and 18 were assessed for analysis. Seven overarching themes emerged, surrounding (a) knowledge and awareness, (b) research, (c) policy changes and development, (d) intersectional prejudice, (e) SV being taboo, (f) sociocultural differences, and (g) confusion regarding the definition and nature of SV.

DISCUSSION AND IMPLICATIONS

These findings offer relevant considerations for practice, policy, and research, which will be further discussed.

Forms of sexual assault against older women in the context of acquaintance relationships: An intersectional perspective

This study addresses forms of sexual assault against women in late life (SAWLL) from an intersectional perspective, focusing on acquaintance relationships. Qualitative research was conducted, using in-depth interviews with 18 welfare and healthcare professionals who treated sexual assault survivors. Five forms (themes) emerged, relevant to the identification of SAWLL: (1) Coercive sexual assault in the context of changes brought on by old age, (2) contempt and sexual humiliation based on ageist and sexist social constructions, (3) violation of the older women's dignity in the multigenerational context, (4) life-long incestuous relationships and sexual assault against older women and (5) erotic touching and exhibitionism in caregiving relationships. The revealed forms emphasise the vulnerability of older women who are sexually assaulted in domestic relationships by perpetrators whom they know. These forms can contribute to filling the existing gap in knowledge on SAWLL and promote the visibility of sexually assaulted older women in the justice system. In addition, they can aid law enforcement, health and welfare professionals and policymakers to advance the general understanding of SAWLL as well as improve the response to this phenomenon.

"Who Would Sexually Assault an 80-Year-Old Woman?": Barriers to Exploring and Exposing Sexual Assault Against Women in Late Life

The phenomenon of Sexual Assault against Women in Late Life (SAWLL) has received increasing research attention in recent years. Yet, there is still only scant knowledge on it, compared with research on the sexual assault of younger women. Sexual assault is considered a sensitive topic, generally characterized by a conspiracy of silence. The aim of this article is to explore the barriers that hinder the identification and exposure of SAWLL, as reported by professionals. The research question was as follows: How do welfare and health care professionals present the motives and processes that obstruct exploring, exposing, and intervening in cases of SAWLL? A qualitative research design was used. Participants were 18 experienced welfare and health care professionals engaged in intervention with sexual assault in late life victims as well as offenders. Data were collected through in-depth, semi-structured interviews, which were later transcribed and thematically analyzed. Four themes emerged from the data analysis: (a) Leading Negative Emotions, (b) Lack of Language, (c) Implications of Cumulative and Complex Trauma, and (d) Social Exclusion. Women and professionals alike undergo complementary processes involving silence and silencing. These processes construct a "wall" of barriers, requiring professionals' sensitivity and awareness to deconstruct these barriers. Professional intervention through open discourse with the abused women can break this conspiracy of silence. We recommend that training programs for professionals intervening in cases of elder abuse and neglect will be directed along two paths: The first path should focus on professionals' competence and skills, and the second path should address the women's specific needs. These programs will include a particular module that will specifically address SAWLL. This module should comprise knowledge on typical emotional reactions to SAWLL, the use of language in creating reality, cumulative and complex trauma, and the social construction of ageism and sexism, which lead to social exclusion.

Unexplored Needs of the Older Adults: Experiences From Elders Helpline in Bengaluru

Elders Helpline has been operational in Bangalore by joint effort of the Nightingales Medical Trust (NMT) and the City Police since its inception in 2002. The Elders Helpline is unique as it is the first of its kind in India that offers services for the welfare of the older people in Bangalore city. The objectives of this article were to review the process of setting up of the helpline services, its evolution, range of services offered, to evaluate the services to ascertain the social difficulties with a focus on abuse experienced by the older people in Bangalore and find out the common themes. From the records, the Elders Helpline has responded to as many as 144058 calls between April 2009 and March 2020. This article reviewed functions of the Elders Helpline including supervision and training to its staff members, offering counselling to the Older adults by resolving family conflicts and other social issues by upholding and safeguarding their rights. The article highlights the need and impact of Elders Helpline suggesting the need to expand this type of Helpline to other Districts of the country. This study indicates that the Elders Helpline has become a platform for the elderly people to express their concerns and to make them feel secure. The Elders Helpline model is now launched nationally in October 2021 through the expansion of helpline services. There is a need to gather more comprehensive data and for ongoing research and training to reach out many needy older people.

Sexual Abuse of Elderly Victims Investigated by the Police: From Motives to Crime Characteristics

Elderly sexual abuse has been almost completely ignored from researchers and practitioners alike. However, the occidental population is aging and living longer, suggesting that the number of cases of elderly sexual abuse should increase. Moreover, elderly sexual assaults have been described as being more violent, resulting in more severe injuries, and are more frequently committed by strangers, making criminal investigations more difficult to solve. The current study aims to identify the various motivations associated with elderly sexual abuse and to test whether it is possible to link offender and modus operandi characteristics to these motivations. In other words, the main objective is to identify "why" the elderly are sexually abused, "how," and "by whom"? Using two-step cluster analysis on a sample of 128 cases of extra-familial elderly sexual assaults (aged 65 years or more) from France, four clusters of offenders' motivation were identified. Congruent with previous studies, results showed that elderly sexual abuse was motivated by sex, anger, and opportunities. However, a fourth cluster was identified, describing offenders motivated by experimentation. These offenders, in addition to being young with a lack of criminal experience, were also more likely to perform the most intrusive sexual acts and to use physical violence, sometimes to the point of killing their victim. To test the external validity of our cluster solution, a series of bivariate analyses were conducted. Results showed that the four motivations were also associated with specific offender and crime characteristics. These findings highlight the importance of looking at the motivations underlying elderly sexual abuse to suggest better interventions strategies as well as improve the criminal investigation of these cases.

The Lived Experience of Older Women Who Are Sexually Abused in the Context of Lifelong IPV

The present study explores the lived experience of older women who are sexually abused in the context of lifelong intimate partner violence (IPV). An interpretive phenomenological analysis was used, and semi-structured interviews were performed with 19 older women survivors of lifelong IPV and sexual violence. Three themes emerged: sexual violence shaping lifelong IPV, the occurrence of sexual violence in old age in the context of lifelong IPV, and cumulative insights and reflections on being a survivor of lifelong IPV and sexual violence. The transition to aging has a profound impact on the violent relationship dynamics and this should be considered in practical interventions.

Breaking the Taboo: Sexual Assault in Late Life as a Multifaceted Phenomenon-Toward an Integrative Theoretical Framework

Sexual assault (SA) in late life has been receiving growing attention over the past two decades. It is directed primarily against older women and has been the least frequently reported form of abuse. Despite the growing awareness and body of knowledge on this phenomenon, the theoretical framework is still limited. Therefore, the aim of the present article is to suggest a theoretical conceptualization of the multifaceted phenomenon of sexual assault against women in late life (SAWLL). This conceptualization has been developed through several stages: (a) identification of three grounded fields of inquiry that are relevant to SAWLL: SA, elder mistreatment, and intimate partner violence; (b) classification of SAWLL along four paths: (1) ongoing SA in the context of lifelong IPV; (2) SA beginning in old age in the family within the community, involving spouses, family members, caregivers, dating mates, and so on; (3) ongoing SA, continuing in institutions, perpetrated by family members; and (4) SA in institutions, beginning in old age, relating to staff, residents, and family members; (c) We suggest three additional theoretical perspectives: trauma, a life-course perspective, and social constructionism, which provide further in-depth knowledge for understanding SAWLL. The combination of the three abovementioned stages composes an integrative theoretical framework, addressing SAWLL as a multifaceted phenomenon.

Elder Mistreatment in an Italian Population: Prevalence and Correlates

This study aimed to examine the prevalence of elder mistreatment (EM) in an Italian population and to determine the risk factors. The sample consisted of 393 older adults (M_age = 77.07; standard deviation = 9.45) of whom 60.1% were females. The prevalence of EM was of 20.1%. Older elders who were separated, divorced, with a poor state of health, and problems of autonomy were more likely to experience EM. The most common forms of EM were physical/sexual (9.9%) and emotional mistreatment (9.9%). The most common perpetrators were paid caregivers and members of the victim's family. A path analysis model suggested that limited autonomy and poor perceived health status appeared to be predictors of EM. We conclude that the results of this study have important implications in terms of reducing mistreatment of older adults. Understanding EM is essential to promoting equality, tolerance, and supportive attitudes and developing better prevention policies and practices.

Sexual Violence Against Older People: A Review of the Empirical Literature

Aging and sexual violence are both established areas of research, but little attention has been paid to research into sexual violence against older people. This article presents a critical review of the literature reporting empirical research in three overlapping fields of inquiry: elder abuse, domestic violence, and sexual violence, identifying points of theoretical and methodological similarity and difference across academic disciplines. Using a range of search terms combining age, sexual violence, and elder abuse, the following databases were searched: EBSCOHOST, Ingenta-Ingenta connect, and JSTOR. In total, the databases searches returned 31 relevant articles and an additional 9 relevant articles were found through manual searches of bibliographies and Google searches, which were grouped into three categories: elder abuse, domestic violence in later life, and sexual violence against older people. Four themes common across these fields emerged: prevalence, characteristics of victims and risk factors, impacts and coping strategies, and perpetrator and assault characteristics. The findings in each area are discussed in detail, exposing gaps in knowledge and understandings of sexual violence against older women. The article ends by defining a future research agenda for this underexplored phenomenon that is of increasing importance in a context of global aging.

The epidemiology of sexual assault of older female nursing home residents, in Victoria Australia, between 2000 and 2015

Sexual assault is the least acknowledged, detected, and reported type of assault against nursing home residents. Nursing home staff are responsible for reporting suspected allegations to the police, who will contact a clinical forensic examiner to conduct a forensic medical examination. This study examined the epidemiology of sexual assaults of older women (aged 65 years and older) residing in nursing homes in Victoria, Australia, between 2000 and 2015, whose alleged incidents were referred to a clinical forensic examiner for a forensic medical examination. A retrospective analysis of alleged sexual assaults reported to the Clinical Forensic Medicine Unit at the Victorian Institute of Forensic Medicine between 1 January 2000 and 31 December 2015 was conducted. The study identified 28 forensic medical examinations performed for alleged sexual assault. The alleged victims frequently had cognitive impairments; injuries were infrequent; and alleged victims were cooperative. The forensic medical examiner responded within 72 h of reporting; and frequently noted limitations to physical examinations of the alleged victim. The actual number of sexual assaults during this period may be masked by under-reporting and, lack of identification by nursing home staff. There are many unresolved issues including: incidence, levels of reporting, nature of investigations, responses required to assist the victim, and the interventions needed to prevent sexual assault. Better data is vital. This data should be standardized, validated, reliable, and gathered prospectively across Australia and internationally.

Professionals' Awareness of Sexual Abuse in Late Life: An Exploratory Survey

BACKGROUND

The sexual abuse phenomenon is considered taboo. It has been discussed, to date, mainly in relation to children and young women, with insufficient attention to sexual abuse in a late-life context.

OBJECTIVES

The aim of this survey was to explore professionals' awareness of elder sexual abuse (ESA).

DESIGN

The survey was conducted among 161 Jewish and Arab professionals from health care and social services, who worked with older adults in Israel.

RESULTS

Of the entire sample, 70 professionals (only 43%) reported encountering at least one to three cases of ESA. A total of 98% of the victims were women, and the primary offender was the spouse (75%). In most cases (70%), the victim reported the abuse, which was mainly sexual assault (64%). All participants (100%) noted taking action.

CONCLUSION

This exploratory survey indicates that professionals are partially aware of the existence of and the need to address the ESA phenomenon.

Older adults affected by polyvictimization: A review of early research

In contrast to work within the child-abuse field, polyvictimization of older adults did not become a focus of professional attention until this decade. Despite this lack of formal identification, a search of the research and practice literature revealed that prior research investigating single forms of or other elder abuse issues contained evidence of what was variously termed "multiple," "multi-faceted," "co-occurring," or "hybrid" elder abuse. A wide range of victims (1.4%-89.7%) identified in existing elder abuse studies was found to have experienced what constitutes "polyvictimization." This late-life polyvictimization evidence, the contexts in which victims are harmed, and information regarding the impact of multifaceted elder abuse are all presented and discussed in this article. Selected published cases illustrate the clinical dynamics operating in late-life polyvictimization situations.

Development of Quality Indicators to Address Abuse and Neglect in Home-Based Primary Care and Palliative Care

OBJECTIVES

To develop candidate quality indicators (QIs) for the quality standard of "addressing abuse and neglect" in the setting of home-based medical care.

DESIGN

Systematic literature review of both the peer-reviewed and gray literature.

SETTING

Home-based primary and palliative care practices.

PARTICIPANTS

Homebound community-dwelling older adults.

MEASUREMENTS

Articles were identified to inform the development of candidate indicators of the quality by which home-based primary and palliative care practices addressed abuse and neglect. The literature guided the development of patient-level QIs and practice-level quality standards. A technical expert panel (TEP) representing exemplary home-based primary care and palliative care providers then participated in a modified Delphi process to assess the validity and feasibility of each measure and identify candidate QIs suitable for testing in the field.

RESULTS

The literature review yielded 4,371 titles and abstracts that were reviewed; 25 publications met final inclusion criteria and informed development of nine candidate QIs. The TEP rated all but one of the nine candidate indicators as having high validity and feasibility.

CONCLUSION

Translating the complex problem of addressing abuse and neglect into QIs may ultimately serve to improve care delivered to vulnerable home-limited adults who receive home-based medical care.

All Elder Abuse Perpetrators Are Not Alike: The Heterogeneity of Elder Abuse Perpetrators and Implications for Intervention

The tendency to label all elder abuse perpetrators as the "bad guys" has diminished our ability to respond effectively. A review of the literature demonstrates that elder abuse perpetrators are in fact heterogeneous with important differences across types of abuse. A reformulation of perpetrator interventions away from a singular emphasis on prosecution to meaningful alternatives that utilize criminal justice and/or therapeutic approaches tailored to the needs of the case is needed. These interventions must incorporate the needs of both victims and perpetrators, take into consideration the type of abuse involved, acknowledge the variations in perpetrator culpability, and recognize the continuum of complexity among these cases. Without addressing these nuances, intervention and prevention efforts will be futile if not harmful.

The Sexual Victimization of Older Women Living in Nursing Homes

This study examined 64 cases of sexual victimization of women ages 65+ (mean = 81) living in facilities that were investigated by APS and regulatory agencies in five states over a six-month period. Typically, abuse involved molestation (53%) and unwelcome sexual interest in the body (20%). Abilities and needs of women in substantiated and unsubstantiated cases were comparable. Resident perpetrators were more likely to be substantiated than staff or any other perpetrator (p = 0.008). Our results underscore the need to evaluate differences associated with gender, age, and residence, and to train on reporting and intervention by disciplines serving victims.

Keeping older adults safe, protected, and healthy by preventing financial exploitation

As the number of older adults increases, the incidence of financial exploitation is also expected to rise. This prevalent older adult maltreatment often goes undetected and unreported and may result in poor physiologic and/or psychological health outcomes that are not perceived as abuse-related by healthcare providers. This article focuses on financial exploitation of older adults as a health care problem, as it often occurs when vulnerable older adults are receiving help and/or health care services from trusted caregivers.

Sexual aggression between residents in nursing homes: literature synthesis of an underrecognized problem

Evidence exists suggesting that most sexual aggression against older adults occurs in long-term care facilities. Fellow residents are the most common perpetrators, often demonstrating inappropriate hypersexual behavior caused by dementing illness. This resident-to-resident sexual aggression (RRSA) is defined as sexual interactions between long-term care residents that, in a community setting, at least one of the recipients would be likely to construe as unwelcome and that have high potential to cause physical or psychological distress in one or both of the involved residents. Although RRSA may be common, and physical and psychological consequences for victims may be significant, this phenomenon has received little direct attention from researchers. This is a review of the existing literature and relevant related research examining elder sexual abuse and hypersexual behavior that describes the epidemiological features of this phenomenon, including risk factors for perpetrators and victims. The legitimate and recognized need for nursing home residents, even those with advanced dementing illness, to express themselves sexually makes preventing and managing sexual aggression in nursing homes more challenging. This review discusses the ethical dilemma this situation creates and the need to evaluate the capacity to consent to sexual activity of residents with dementing illness and to re-evaluate capacity as the diseases progress. Suggestions are offered for managing incidents of RRSA and for future research, including the importance of designing effective interventions.

Forensic psychiatric/mental health nursing: responsive to social need

Forensic nursing is an emerging global nursing specialty, with subspecialties that focus on nursing practice at the clinical-legal interface of tending to victims and offenders, living and deceased. An integrated review of the literature provides an overview of the role development of forensic nursing subspecialties. The subspecialties of forensic nursing that deal with the mental health care of victims and offenders are the focus of this paper. Forensic nursing, like all forensic specialties, developed from a need in society for a medico-legal role. This paper discusses the global role of forensic nursing and argues that role development has been both proactive and responsive to vital needs of victims and offenders in society. Advanced practice forensic nurses have taken leadership roles in the role development of this nursing specialty. A future challenge for forensic psychiatric/mental health nurses with advanced education is to take leadership roles in all areas of psychiatric assessment, intervention, and evaluation of clients.