Sexual Violence in Later Life: A Widespread and Growing Yet Hidden Public Health Issue

Sexual violence in later life and related trauma have been identified as a growing yet preventable public health crises, which disproportionately impact women. Research is limited and is continuing to emerge in this area, along with implications for addressing healthcare disparities, primarily among older women. In this paper, the prevalence of sexual violence in later life will be explored, along with survivor characteristics as they relate to structural inequality and health disparities. Consequences of sexual violence in later life will be explored as well, with implications for healthcare workers, focused on pressing needs for research, practice, policy and education at individual, relational, organizational and societal levels.

Older people's experiences of elder abuse in residential care settings: A scoping review

BACKGROUND

Elder abuse is a global human rights issue, particularly in residential care settings where there is limited understanding of older people's experiences of this phenomenon. This scoping review aims to map and describe the existing literature on this phenomenon.

METHODS

Using Arksey and O'Malley's scoping review methodology, further developed by Levac et al. and the Joanna Briggs Institute, a systematic search of six databases was conducted to identify relevant studies published from inception to January 2023. Studies were included if they focused on older people's experience of abuse within residential care settings. A comprehensive data extraction process was employed to identify key themes from the included studies.

RESULTS

The initial search yielded a total of 3701 articles of which eight met the inclusion criteria. The findings revealed a range of abusive experiences encountered by older people living in residential care settings, including psychological, physical, financial, neglect and sexual abuse. The common attributes of residents vulnerable to abuse were evident throughout each of the studies. Finally, the theme of organizational neglect was apparent through the absence of effective safeguarding measures in the included studies. The findings revealed the insufficient implementation of safeguarding measures increases the risk of abuse among residents.

CONCLUSION

This scoping review highlights the limited research on the experiences of older people who have encountered elder abuse in residential care settings. The findings stress the need for further research exploring the complex interplay of factors contributing to elder abuse within aged care settings. The insights gained from this scoping review can inform the development of comprehensive safeguarding strategies to prevent and address elder abuse in residential care settings, promoting the well-being and safety of older people.

PATIENT OR PUBLIC CONTRIBUTION

This project is a scoping review of the literature; therefore, no patient or public contribution was deemed necessary.

WHAT THIS PAPER CONTRIBUTES TO THE WIDER GLOBAL COMMUNITY

Most research on elder abuse has been conducted in the community rather than in Residential Care Settings where there is a limited understanding of older people's experiences of abuse within the published literature. The scoping review highlights the presence of inadequate safeguarding strategies in Residential Care Settings within the reviewed studies, providing recommendations for developing and improving safeguarding measures in Residential Care Settings to prevent abuse, neglect, and harm in the future.

Sexual Assault in Older-Age Adults: Criminal Justice Response in New Zealand

There is growing recognition that older persons, both male and female, may experience sexual assault. One clearly identified gap in the body of scientific literature is examination of the criminal justice response for older adults who have been sexually assaulted. This retrospective age-group comparative data analysis examines publicly available population and police statistics for 2018 to describe rates (per 100,000) of reported sexual assault across adult age categories (young adult, n = 748; adult, n = 1,478; middle age, n = 290; older adult, n = 58) and compare (using Chi-square bivariate analysis) the criminal justice response to sexual assault for these adult age categories in New Zealand (NZ). Sexual assault was perpetrated against victims across all age and sex groups examined. The rate of reported sexual assault against older adults was significantly lower after the age of 65 years (7.90 per 100,000) compared to younger adults aged 20-64 years (87.57 per 100,000). Across age categories no difference was found in the proportion of cases proceeded to court action. This study raises awareness of the topic of sexual assault perpetrated against older persons and shows that a substantial number of older adults experience sexual assault in cases that do not result in court action. It points to the need for policy-makers to consider the reporting of sexual assaults against older persons to justice services.

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.

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.

Elderly Sexual Abuse: An Examination of the Criminal Event

The current study investigates the modus operandi specificities for the sexual abuse against the elderly. A comparison between sex crimes against adult and elderly victims is conducted following the criminal event approach. The comparison is based on the precrime, crime, and postcrime phases of the modus operandi, operationalized through 53 variables. The sample comes from a French national police database including a total of 1,829 cases-including 130 cases of elderly sexual abuse and 1,699 cases of sexual abuse against victims aged between 18 and 45 years. Bivariate and multivariate analyses are performed to examine the differences in the two groups. Several differences are observed between the two modus operandi. Findings indicate that the precrime phase is the most important to explain these differences, and this phase of the criminal event affects the rest of the decisions taken during the crime and postcrime phases. Specifically, we have highlighted that sexual crimes against the elderly are more violent and occur more often in the victim's residence. This study suggests that offenders targeting the elderly use specific crime characteristics, and this allows to highlight practical implications in terms of investigation and offender management.

Victim, Allegation, and Investigation Characteristics Associated With Substantiated Reports of Sexual Abuse of Adults in Residential Care Settings

The purpose of this study was to identify characteristics of investigations of sexual abuse concerning vulnerable adults residing in facility settings that were associated with case substantiation. Data on 410 reports of sexual abuse were collected prospectively from Adult Protective Services (APS) and state licensure agency staff in New Hampshire, Oregon, Tennessee, Texas, and Wisconsin over a six-month period. Specifically, we examined differences between reports that were substantiated and those that were not by comparing characteristics of alleged victims, alleged perpetrators, and aspects of investigation using logistic regression. We found that a relatively low proportion of cases (18%) were substantiated overall. Compared to cases that were not substantiated, cases that were substantiated were more likely to feature nursing home residents, older victims, female victims, and allegations of physical contact between the alleged perpetrator and victim. Despite the high proportion of alleged perpetrators who were facility staff (51%) compared to resident perpetrators (25%), cases with resident-to-resident allegations of abuse were much more likely to be substantiated, accounting for 63% of substantiated cases. In light of these findings, we believe it is important that investigators are trained to handle sexual abuse cases appropriately and that they are able to investigate the case thoroughly, promptly, and with as much information as possible. It is also critical that investigators make substantiation decisions using the appropriate standard for confirmation (e.g., preponderance of the evidence, beyond a reasonable doubt, clear and convincing evidence) as state law dictates.

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 differences between sex offenders who victimise older women and sex offenders who offend against children

OBJECTIVES

Within the literature on sex offending, much attention is paid to the distinction between those sex offenders who offend against adults and those who offend against children. In contrast, there is a paucity of research into sex offenders who offend specifically against elderly or older victims.

METHOD

A detailed interview and psychometric tests were conducted with a sample of 28 sex offenders who had been convicted of a sexually motivated offence against an older female. These data were compared to a sample of 23 child sex offenders.

RESULTS

Results indicate that amongst other significant differences between these sub-groups, men who offend against older women are generally younger, are more violent, and are more likely to use a weapon and cause injury and death compared to child sex offenders. The men who offended against children were more likely to think about and plan their offending, spend more time with the victim pre and post offence, admit sexual arousal during the offence, and admit to a sexual motivation for the offence.

CONCLUSIONS

This study suggests that men who sexually offend against older women and men who sexually offend against children are distinct groups. Treatment and risk management strategies should take this into account. Further exploration of this sub-group of offenders is recommended to help inform treatment and risk management strategies for sex offenders who offend against older people.

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.

Abuse of Older Men in Seven European Countries: A Multilevel Approach in the Framework of an Ecological Model

BACKGROUND

Several studies on elder abuse indicate that a large number of victims are women, but others report that men in later life are also significantly abused, especially when they show symptoms of disability and poor health, and require help for their daily activities as a result. This study focused on the prevalence of different types of abuse experienced by men and on a comparison of male victims and non-victims concerning demographic/socio-economic characteristics, lifestyle/health variables, social support and quality of life. Additionally, the study identified factors associated with different types of abuse experienced by men and characteristics associated with the victims.

METHODS

The cross-sectional data concerning abuse in the past 12 months were collected by means of interviews and self-response during January-July 2009, from a sample of 4,467 not demented individuals aged between 60-84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain and Sweden). We used a multilevel approach, within the framework of an Ecological Model, to explore the phenomenon of abuse against males as the complex result of factors from multiple levels: individual, relational, community and societal.

RESULTS

Multivariate analyses showed that older men educated to higher levels, blue-collar workers and men living in a rented accommodation were more often victims than those educated to lower levels, low-rank white-collar workers and home owners, respectively. In addition, high scores for factors such as somatic and anxiety symptoms seemed linked with an increased probability of being abused. Conversely, factors such as increased age, worries about daily expenses (financial strain) and greater social support seemed linked with a decreased probability of being abused.

CONCLUSIONS

Male elder abuse is under-recognized, under-detected and under-reported, mainly due to the vulnerability of older men and to social/cultural norms supporting traditional male characteristics of stoicism and strength. Further specific research on the topic is necessary in the light of the present findings. Such research should focus, in particular, on societal/community aspects, as well as individual and family ones, as allowed by the framework of the Ecological Model, which in turn could represent a useful method also for developing prevention strategies for elder abuse.

Informing evidence-based practice: a review of research analyzing adult protective services data

The mission of Adult Protective Services (APS) is to protect older and vulnerable adults from abuse, neglect, and exploitation. The complexity of APS cases and the potential for life-changing interventions point to the need for research that examines and evaluates APS practices. A literature review identified 50 studies published during a 16-year period that used APS agencies, clients, data, or resources to test hypotheses regarding elder abuse. The analysis revealed promising efforts toward knowledge development about elder mistreatment and self-neglect. This article provides an overview of salient findings, notes the scarcity of studies that analyze the effectiveness of APS, and highlights the need for additional research. Lessons learned are described, and APS practitioners and researchers are urged to work collaboratively to develop key practice-related questions about APS processes and outcomes that can be tested with appropriate research methodologies.

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.

Sexual Abuse of Older Residents in Nursing Homes: A Focus Group Interview of Nursing Home Staff

The objective of this study was to increase knowledge of sexual abuse against older residents in nursing homes. A qualitative approach was used. Through a focus group interview with staff in nursing homes, the aim was to reveal employees' thoughts, experiences, and attitudes. Findings from the focus group interview show that sexual abuse of older residents is a taboo topic among health professionals. Acts of sexual abuse are difficult to imagine; it is hard to believe that it occurs. The fact that staff are not aware that it could happen, or have a hard time believing that it actually happens, can amplify the residents' vulnerable position as potential victims of abuse, and it makes it even more challenging to report or uncover such acts. The study highlights the need for education of all health care workers in Norway as well as more research on sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step towards addressing sexual abuse of the aged in a more appropriate way. Further research must aim to reveal more about this taboo area.

Variability in Findings From Adult Protective Services Investigations of Elder Abuse in California

Adult Protective Services (APS) workers in California investigate complaints of elder abuse and must determine the validity of a complaint with minimal guidelines. It is unclear whether APS workers reach similar conclusions given cases with similar circumstances. To assess variation in case findings and reasons for them, we used data from monthly reports of completed investigations, and investigation outcomes from all 58 California counties from September 2004 to August 2005, telephone interviews with 54 of 58 counties, and site visits to 17 counties. We also compared the data from 2004-2005 with more recent data from 2013. Large variability was found from county to county in the proportions of cases found to be conclusive, inconclusive, and unfounded. The combined analyses revealed significant differences in how individual APS workers interpret definitions of different types of case outcomes, varying skill and experience of the APS workers, individual and county agency factors, and other reasons that influence variability in case findings. Widespread inconsistencies in the outcomes of elder abuse investigations raise issues to be addressed on multiple levels, including the use of APS data for developing policy, standardizing training of APS workers, and seeking just outcomes for the victims of elder abuse.

Resident-to-Resident Abuse: A Scoping Review

L'abus de résidents par d'autres résidents parmi de foyers de soins de longue durée (SLD) implique l'agressivité et la violence et peut avoir des conséquences graves pour tous les deux, agresseurs et victimes. Jusqu'à présent, il n'y a eu aucune tentative d'évaluer systématiquement la portée de ce problème au Canada. Pour combler cette lacune, nous avons entrepris une étude de délimitation de l'étendue pour améliorer la compréhension de l'abus chez les résidents des foyers de SLD. Nous présentons aussi un ensemble redigé de données canadiennes sur l'abus chez les résidents. On a cherché neuf bases de données bibliographiques électroniques; un total de 784 résumés a été trouvés, mais seulement 32 ont satisfait les critères d'inclusion. La majorité des documents (75 pour cent) étaient des études de cas rétro-perspectives, des études qualitatives et critiques/commentaires. Parmi eux, seuls 14 se consacrent exclusivement à l'abus parmi les résidents. L'ensemble redigé de données canadiennes suggère que l'abus des résidents par d'autres résidents représente environ un tiers des cas d'abus signalés. Afin de faire connaître cette phénomène et d'aider à diminuer son incidence, des recommandations pour la recherche future, la pratique clinique et la politique sont fournis.

Sexual abuse of older nursing home residents: a literature review

Despite an increasing literature related to elder abuse, sexual abuse of older persons in general and of vulnerable adults living in nursing homes in particular is still sparsely described. The purpose of this study was to assess the state of knowledge on the subject of sexual abuse against older nursing home residents through a literature review. Systematic searches in reference databases including Cinahl, Medline, OVID Nursing Database, ISI Web of Science, PsycINFO, Cochrane Library, and SveMed + were conducted. Through several phases of selection of the articles, using strict inclusion and exclusion criteria, six articles were chosen for a deeper examination. Findings from the review show that sexual abuse occurs in nursing homes and that both older women and men are victims of sexual abuse. Perpetrators appear mainly to be staff and other residents and mainly to be men, but also women abuse both older men and older women. Findings from the literature review show that there is a need for knowledge and further research on the topic of sexual abuse against older residents in nursing homes. Furthermore, there is a need for good policies and reporting systems, as an important step in seriously addressing sexual abuse against older persons.

Rosalie Wolf Memorial Lecture: Reconsidering assumptions regarding men as elder abuse perpetrators and as elder abuse victims

From research findings and practice experiences, it is concluded that abuse of older men is especially invisible and underreported, compared to abuse of older women. It is proposed that attention should be directed not to gender, but to those conditions in different countries and cultures leading to abuse of both older men and women, including (but not limited to) economic problems, few alternatives to family care of the elderly, violence, changing characteristics of the family, ageism, and sexism. Advocates for the prevention of elder abuse should work together in combating, reducing, and eliminating the problem of elder abuse of both older men and older women.

Institutional abuse of older adults: what we know, what we need to know

Although Canadian policies support "aging in place," there still will be a number of older adults who will require institutional care in the future. Most research on elder abuse, however, has focused on domestic abuse and has paid less attention to institutional abuse. The purpose of this article is to comprehensively review current research to identify gaps in knowledge and methodological issues in the study of institutional abuse. Overall, 49 studies in English and 20 studies in French were reviewed, and 11 key-informant interviews were conducted with methodological experts. Methodological challenges are addressed in light of the review and interviews.

Elder Abuse and Neglect in Canada: The Glass is Still Half Full

Cet article examine les développements dans le domaine de la maltraitance et de la négligence des aînés depuis la publication de Elder Abuse and Neglect in Canada (Butterworths, 1991). Les arguments présentés ici sont de deux ordres : d’abord, nous n’avons aucune idée de la taille ou de la nature du problèmes de la violence et de la négligence dans la communauté ou dans les institutions et, d’autre part, nous ne savons pas comment résoudre ces problèmes ou leurs questions connexes qui ont été masqués par la rhétorique et le recyclage de l’information pendant les 20 dernières années. C’est le temps d’avancer au-delà de la « phase de sensibilisation ». Ce à quoi nous devons nous attaquer à l’avenir est aussi évident aujourd’hui qu’il ne l’était il y a 20 ans. Notre connaissance est incomplète parce qu’il nous manque le type d’enquêtes dont le besoin se fait le plus urgent: les études de prévalence dans la communauté et les institutions, un développement théoriquement solide, et des essais cliniques randomisé pour tester à la fois nos interventions socialement et juridiquement.

Elder abuse in assisted living

Assisted Living (AL) currently represents one of the most numerous institutional care settings for elders. Very little information exists on abuse in AL. Descriptive information on elder abuse reported by nurse aides working in AL is presented from a survey sent to nurse aides. The questionnaire had items addressing verbal, physical, psychological, caregiving, medication, material, and sexual abuse. The responses to the questions included in the verbal abuse, physical abuse, psychological abuse, caregiving abuse, medication abuse, and material exploitation abuse sections (28 questions) show that suspected abuse is not uncommon. We could not objectively verify the cases of abuse described in the survey, still, they give a first indication that staff abuse may occur in AL. This may be significant given the large number of ALs in the United States and may influence the health, quality of life, and safety of many residents.

Sexual assault of older women by strangers

This study examines victim, offender, and offence characteristics associated with sexual assaults by strangers of older women compared to those against younger women. Cases are obtained from the Serious Crime Analysis Section of the United Kingdom National Policing Improvement Agency (NPIA; formerly Centrex). All possible cases of rape, attempted rape, and lesser sexual assault involving a single female victim aged 60 or older are selected (n = 53). These are matched with a sample of sexual assaults against women aged between 20 to 45 years ( n = 53). Research findings reveal significant differences in relation to a number of variables, including ethnicity of the offender, number of previous convictions of the offender, and characteristics associated with the assault itself. The results of this research reveal new information about violent sexual assaults on older women by strangers and have implications for practitioners dealing with such cases.

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.