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Hand MD, Lee MY, Dabelko-Schoeny H, Kaiser M, Mengo C. Societal, Organizational, Relational, and Individual Perceptions of Sexual Violence Against Older Adults and Its Prevention: A Systematic Scoping Review. THE GERONTOLOGIST 2022; 62:e597-e613. [PMID: 34606600 DOI: 10.1093/geront/gnab144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Michelle D Hand
- Department of Social Work, George Mason University, Fairfax, Virginia, USA
| | - Mo Yee Lee
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
| | | | - Michelle Kaiser
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
| | - Cecilia Mengo
- College of Social Work, The Ohio State University, Columbus, Ohio, USA
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Song Y, Mohamed Nassur A, Rupasinghe V, Haq F, Boström AM, Reid C, Andersen E, Wagg A, Hoben M, Goodarzi Z, Squires JE, Estabrooks CA, Weeks LE. Factors associated with residents’ responsive behaviours towards staff in long-term care homes: A systematic review. THE GERONTOLOGIST 2022; 63:674-689. [PMID: 35094085 PMCID: PMC10167766 DOI: 10.1093/geront/gnac016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Objectives
When staff experience responsive behaviors from residents, this can lead to decreased quality of work-life and lower quality of care in long-term care homes. We synthesised research on factors associated with resident responsive behaviours directed towards care staff and characteristics of interventions to reduce the behaviours.
Research Design and Methods
We conducted a mixed-methods systematic review with quantitative and qualitative research. We searched 12 bibliographic databases and “grey” literature, using two keywords (long-term care, responsive behaviours) and their synonyms. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. We developed a coding scheme using the ecological model as an organising structure and prepared narrative summaries for each factor.
Results
From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training background (individual level); staff approaches to care (interpersonal level); leadership and staffing resources (institutional level); and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of behaviours, and quantitative findings on the impact of staff approaches to care on behaviours. Effects of interventions (n=14) to reduce the behaviours were inconclusive.
Discussion and Implications
We identified the need for enhanced understanding of the interrelationships among factors associated with resident responsive behaviours towards staff and processes leading to the behaviours. To address these gaps and to inform theory-based effective interventions for preventing or mitigating responsive behaviours, we suggest intervention studies with systematic process evaluations.
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Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | | | | | - Fajr Haq
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Colin Reid
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Elizabeth Andersen
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary Alberta, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Smith DE, Wright MT, Ibrahim JE. Aged care nurses' perception of unwanted sexual behaviour in Australian residential aged care services. Australas J Ageing 2021; 41:153-159. [PMID: 34792228 DOI: 10.1111/ajag.13014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/02/2021] [Accepted: 10/13/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore aged care nurses' awareness and experience of unwanted sexual behaviour (USB) in residential aged care services (RACS). METHODS An anonymous online questionnaire was administered to an opportunistic sample of RACS nurses enrolled to complete an e-learning course in Australia. From the 167 participants who expressed interest to enrol, 129 were eligible and 53 returned completed consent forms. RESULTS 46/53 responded of which most were females (41/45, 91.1%). Few respondents reported resident-resident USB (<35%) or staff-resident USB (<22%) happened once a year. Most respondents had not been informed by a resident of USB (>75%) or had personally reported USB within their internal reporting system (>77%). Respondents were also unaware if their facility had lodged an incident report to the regulator or law enforcement authorities within the past 12 months (34/46, 73.9%). Finally, most considered there to be no barriers to reporting USB (35/46, 77.8%). CONCLUSIONS Respondents' awareness and estimates of USB directed at residents were much lower than known national prevalence rates. This lack of awareness could be a substantive barrier to recognition and optimal management of this form of abuse.
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Affiliation(s)
- Daisy E Smith
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Meghan T Wright
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Joseph E Ibrahim
- Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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Smith DE, Wright MT, Pham TH, Ibrahim JE. Evaluation of an online course for prevention of unwanted sexual behaviour in residential aged care services-A pilot study. Int J Older People Nurs 2021; 17:e12412. [PMID: 34399034 DOI: 10.1111/opn.12412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/26/2021] [Accepted: 07/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Residential aged care services (RACS) staff have substantial gaps in knowledge to prevent and manage unwanted sexual behaviour (USB) in RACS. OBJECTIVES This study aimed to explore the feasibility of a pilot online course (intervention) addressing USB in RACS. METHOD Development of a self-guided e-learning educational course was based on existing research, national and international approaches to human rights approaches to sexual assault and underwent internal and external peer review. An anonymous, online, cross-sectional survey was conducted post-intervention completion. RAC-Communiqué subscribers were recruited via an e-invitation. English speaking enrolled or registered nurses, employed in an Australian RACS, were eligible. From the 167 participants who expressed interest to enrol, 129 were eligible and 45 returned completed consent forms. Fifteen survey items regarding perceived competence and intervention satisfaction were analysed. RESULTS The intervention addressed content pertaining to staffs' legal and regulatory requirements, managing incidents and awareness of key services. Thirty-eight of 45 eligible participants responded (84.4%). Participants reported they would recommend the intervention to a colleague (n = 36, 97.3%). Participants self-reported (i) advanced learning post-completion; (ii) raised awareness (n = 29, 78.4%) (iii) prompted current practice reflection (n = 35, 94.6%) and (iv) prompted improving USB workplace management (n = 34, 91.9%). Results are subjected to social desirability bias. CONCLUSIONS The intervention was relevant, engaging and practical. The findings contribute to a more comprehensive understanding of the specific training topics relevant and useful to RACS staff. IMPLICATION FOR PRACTICE E-learning tools could be an effective teaching method for USB in RACS. The intervention may be a useful tool to encourage staff to reflect and change current practice.
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Affiliation(s)
- Daisy E Smith
- Health Law & Aging Unit, Department of Forensic Medicine, Monash University, Southbank, Australia, Australia
| | - Meghan T Wright
- Health Law & Aging Unit, Department of Forensic Medicine, Monash University, Southbank, Australia, Australia
| | - Tony H Pham
- Health Law & Aging Unit, Department of Forensic Medicine, Monash University, Southbank, Australia, Australia
| | - Joseph E Ibrahim
- Health Law & Aging Unit, Department of Forensic Medicine, Monash University, Southbank, Australia, Australia
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Band-Winterstein T, Avieli H. The Lived Experience of Older Women Who Are Sexually Abused in the Context of Lifelong IPV. Violence Against Women 2021; 28:443-464. [PMID: 33818218 DOI: 10.1177/10778012211000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Band-Winterstein T, Goldblatt H, Lev S. Breaking the Taboo: Sexual Assault in Late Life as a Multifaceted Phenomenon-Toward an Integrative Theoretical Framework. TRAUMA, VIOLENCE & ABUSE 2021; 22:112-124. [PMID: 30813855 DOI: 10.1177/1524838019832979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Tova Band-Winterstein
- Department of Gerontology, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Sagit Lev
- School of Social Work, Bar-Ilan University, Ramat Gan, Israel
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Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: A Systematic Review. J Am Med Dir Assoc 2020; 21:1852-1861.e8. [DOI: 10.1016/j.jamda.2020.05.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 01/19/2023]
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Nobels A, Vandeviver C, Beaulieu M, Cismaru Inescu A, Nisen L, Van Den Noortgate N, Vander Beken T, Lemmens G, Keygnaert I. "Too Grey To Be True?" Sexual Violence in Older Adults: A Critical Interpretive Synthesis of Evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114117. [PMID: 32526986 PMCID: PMC7312038 DOI: 10.3390/ijerph17114117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 01/18/2023]
Abstract
Sexual violence (SV) is an important public health issue with a major impact on victims and their peers, offspring and community. However, SV in older adults is under-researched. This paper aims to establish the prevalence and nature of SV in older adults in Europe, link this with existing policies and health care workers’ response to sexual health needs in older age, and critically revise the currently used frameworks in public health research. To fill this gap in the literature, we applied a Critical Interpretative Synthesis (CIS) approach. The CIS approach uses techniques from grounded theory and processes from systematic review. It allows to critically interpret key findings from both academic as well as grey literature, engendering theory refining. In the first phase of purposive sampling, we conducted a systematic review of academic sources and included 14 references. The cut-off age used to define old age varied between 60 and 70 years old among the included studies. Subsequently we added another 14 references in the second phase of theoretical sampling. We ultimately included 16 peer-reviewed articles and 12 documents from the grey literature. The CIS results demonstrate that knowledge of SV in older adults is still limited. The current research suggests that SV in older adults rarely occurs, however, prevalence rates are likely to be underestimated because of methodological shortcomings. The complexity of SV in older adults is not acknowledged in ongoing research due to the conflation of SV with other types of violence. Information on specific risk factors and about assailants committing SV in old age is absent. Policy documents dealing with sexual and reproductive health, rights and ageing make no mention of SV in older adults. In clinical practice, the sexual health needs of older adults often remain unmet. In conclusion, our findings suggest that older adults are forgotten in prevention and response to SV. Greater awareness about this topic could contribute to a revision of current policies and health care practices, leading to more tailored care for older victims of SV.
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Affiliation(s)
- Anne Nobels
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health (ICRH), Ghent University, C. Heymanslaan 10, ICRH, 9000 Ghent, Belgium;
- Correspondence: ; Tel.: +32-9-332-35-64
| | - Christophe Vandeviver
- Department of Criminology, Criminal Law and Social Law, Ghent University, Universiteitstraat 4, 9000 Ghent, Belgium; (C.V.); (T.V.B.)
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
| | - Marie Beaulieu
- School of Social Work and Research Centre on Aging, University of Sherbooke, Sherbrooke, QC J1H 5N4, Canada;
| | - Adina Cismaru Inescu
- ESPRIst, Études et évaluations, University of Liège, 4000 Liège, Belgium; (A.C.I.); (L.N.)
| | - Laurent Nisen
- ESPRIst, Études et évaluations, University of Liège, 4000 Liège, Belgium; (A.C.I.); (L.N.)
| | - Nele Van Den Noortgate
- Department of Geriatrics, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium;
| | - Tom Vander Beken
- Department of Criminology, Criminal Law and Social Law, Ghent University, Universiteitstraat 4, 9000 Ghent, Belgium; (C.V.); (T.V.B.)
| | - Gilbert Lemmens
- Department of Psychiatry and Medical Psychology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium;
| | - Ines Keygnaert
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, International Centre for Reproductive Health (ICRH), Ghent University, C. Heymanslaan 10, ICRH, 9000 Ghent, Belgium;
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Botngård A, Eide AH, Mosqueda L, Malmedal W. Elder abuse in Norwegian nursing homes: a cross-sectional exploratory study. BMC Health Serv Res 2020; 20:9. [PMID: 31900138 PMCID: PMC6942332 DOI: 10.1186/s12913-019-4861-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/22/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Elder abuse is a global public health and human rights problem that is predicted to increase as many countries experience a rapid growth in their population of older adults. Elder abuse undermines an older person's well-being and is associated with a range of serious health consequences. In institutional care settings, older residents are particularly vulnerable and hence at higher risk of being abused, but few countries have explored the extent and nature of this phenomenon in national studies. The aim of this study is to estimate the prevalence of observed and perpetrated staff-to-resident abuse in Norwegian nursing homes. METHODS We conducted a cross-sectional exploratory study of nursing staff in 100 randomly drawn Norwegian nursing homes. Nursing staff completed a pen and paper survey measuring how often during the past year they had observed staff commit acts of neglect and psychological, physical, financial/material, and sexual abuse towards residents. They also reported how often they had perpetrated acts of abuse themselves, and these rates were disaggregated by nursing staff's gender, age and education. RESULTS Of 3693 nursing staff (response rate 60.1%), 76% had observed one or more incidents of elder abuse during the past year, and 60.3% reported they had perpetrated one or more incidents of abuse in the same period. Psychological abuse and neglect were most commonly reported. Male staff reported more acts of physical abuse, while female staff reported more acts of neglect. Higher education of staff was associated with higher rates of self-reported psychological abuse, physical abuse and neglect. CONCLUSIONS This first national survey of staff in Norwegian nursing homes is one of the largest studies globally estimating the prevalence of elder abuse in institutional settings. Overall, we found staff-to-resident abuse to be relatively common, and our findings propose a need for preventive strategies to improve the quality of life and safety of residents in Norwegian nursing homes.
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Affiliation(s)
- Anja Botngård
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Arne Henning Eide
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Research, SINTEF Digital, Oslo, Norway
| | - Laura Mosqueda
- Keck School of Medicine of University of Southern California, Los Angeles, USA
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Joyce CM. Prevalence and nature of resident-to-resident abuse incidents in Australian residential aged care. Australas J Ageing 2019; 39:269-276. [PMID: 31814276 PMCID: PMC7687084 DOI: 10.1111/ajag.12752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the prevalence of resident-to-resident abuse (RRA) in aged care facilities and to explore the nature, contributing factors and outcomes of abuse incidents. METHODS Retrospective cohort study of residents in 13 aged care facilities between 1 January and 31 December 2017, using data extracted from organisational incident reports. RESULTS A total of 169 RRA incidents were recorded, representing 0.56 incidents per 1000 bed days. 7.6% of residents were targets, and 6.9% exhibited aggression, in one or more RRA incidents over one year. In the majority of incidents (152, 89.9%), the aggressor had a cognitive impairment. Impacts on targets were mostly minor. The most common aggressor intervention was behaviour management (142; 84.0%). CONCLUSIONS Resident-to-resident abuse was found to be lower than in other reports. Typically, it involves residents with cognitive impairment and does not result in serious harm. Managing behavioural symptoms associated with cognitive impairment is critical in preventing and managing RRA.
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Affiliation(s)
- Catherine M Joyce
- Benetas, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Smith D, Cunningham N, Willoughby M, Young C, Odell M, Ibrahim J, Bugeja L. The epidemiology of sexual assault of older female nursing home residents, in Victoria Australia, between 2000 and 2015. Leg Med (Tokyo) 2018; 36:89-95. [PMID: 30469073 DOI: 10.1016/j.legalmed.2018.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/07/2018] [Accepted: 11/10/2018] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Daisy Smith
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia.
| | - Nicola Cunningham
- Victorian Institute of Forensic Medicine, Clinical Forensic Medicine, Southbank, Victoria 3006, Australia
| | - Melissa Willoughby
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
| | - Carmel Young
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
| | - Morris Odell
- Victorian Institute of Forensic Medicine, Clinical Forensic Medicine, Southbank, Victoria 3006, Australia
| | - Joseph Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
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