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Sexual Assault and Justice for Older Women: A Critical Review of the Literature
Abstract
This article provides a critical review of current literature on the sexual assault of older women-including an exploration of the specific features and emotional and physical impacts of older women's experiences-and highlights current gaps and future directions for research, practice, and theory. A review of the literature indicates that older women constitute only a small proportion of victim/survivors. However, there is evidence to suggest that existing research underestimates the extent of this issue. Older women face particular barriers to disclosure and accessing the justice system, resulting in their experiences remaining hidden. Many of these barriers also contribute toward older women's experiences being ignored, dismissed, or downplayed by potential bystanders. These barriers are explored in depth in this article and include cultural context, ageism, cognitive and health impairments, and living in a residential care setting. Responding to, and preventing, the sexual assault of older women requires a tailored approach-and we currently lack sufficient insight to develop appropriate responses. In closing, this article considers how we might work toward achieving "justice" for older women victim/survivors.
... It should be noted that police data is limited to reported and prosecuted cases, and conviction rates for sexual violence are notoriously low [12]. This trend is even more pronounced for older victims, who often face additional barriers to reporting and seeking justice [13]. ...
... Research shows that less than one in six victims of sexual assault report the assault to police, often due to feelings of embarrassment, humiliation and fear that police will not be able to help [16]. Whilst it is acknowledged that all victims of domestic and sexual violence face barriers to reporting and accessing support, older women may face unique and additional barriers to seeking help [9,13,17]. ...
... This is intensified by the historical context of their lives, where marital rape was not legally recognised [33]. The expectation of providing sex to their partner may influence older women to accept sexual abuse as an aspect of their relationship [13]. In this context, learning to "live with the abuse" and normalising sexual abuse can be understood as a coping mechanism, when opportunities for support were at best limited and for some non-existent [34]. ...
This chapter draws on qualitative longitudinal data from the research initiative: Dewis Choice (2015–2024). It examines the often-overlooked experiences of older women, aged 60 years and older, who have been subjected to sexual abuse within marriage. Focusing on three case studies, this chapter highlights the interplay of personal, societal, and systemic influences on older women’s help-seeking behaviours. Moreover, the chapter discusses the significant impact of sexual abuse on older women’s health and wellbeing, emphasising the need for tailored support services and interventions. Through a sensitive exploration of older women’s stories, this chapter seeks to amplify the voices of older female survivors, addressing a significant gap in the literature.
... Concerningly, these figures likely underestimate the true number of SVA incidents due to significant underreporting. The older population, in particular, faces considerable barriers to disclosure and reporting, such as understanding that certain acts constitute abuse, recall difficulties, communication challenges, dependency on an abuser, and feelings of shame, self-blame, and fear (Fileborn, 2017;Goldblatt et al., 2022;Ramsey-Klawsnik & Teaster, 2012). Moreover, ageist stereotypes suggest older people cannot be victims of SVA as they are neither sexually active nor attractive, having a detrimental impact on recognition and response to suspected incidents, or disclosures, at both an individual and societal level (Goldblatt et al., 2022). ...
... Over the past decade, numerous reviews have been conducted on the broader topic of elder abuse, however, few have systematically evaluated literature on SVA perpetrated against older people (e.g., Bows, 2018;Fileborn, 2017;Hand et al., 2022;Malmedal et al., 2015;Nobels et al., 2020;Smith et al., 2018). Of these, most focus on understanding individual characteristics and risk factors for incidents, along with barriers to reporting, and prevention recommendations. ...
... Similarly, additional complexities around reporting intrafamilial abuse (Gill, 2022) and sociocultural norms influencing perceptions of sexual violence (Hand et al., 2022) may have contributed to a disproportionate number of analyzed cases involving White, female victims who had been raped by a stranger. Resultingly, characteristics identified within this review may not be reflective of the significant number of SVA cases that are not recognized and reported, instead representing a potentially limited subgroup of victims and abuse types (Bows & Westmarland, 2017;Fileborn, 2017). ...
Although 9 million older adults are estimated to be victims of sexual violence and abuse (SVA) globally each year, this population is largely overlooked in criminological research. Given the known impacts of SVA, particularly for older victims, enhanced understanding of incident characteristics, and how these events unfold, is crucial to improving prevention and response. Guided by environmental criminology perspectives, a scoping review was conducted to assess the extent to which SVA events against older people have been empirically examined to gain an understanding of the immediate circumstances in which incidents occur and how this can inform early intervention and prevention. Eight databases were searched, with records included if they reported characteristics of SVA events occurring in older adulthood, were original, peer-reviewed, empirical research, and published in English. After screening 1,278 records, 33 studies were included for review. Findings demonstrate that considerable attention has been given to understanding who is involved in SVA events and what typically occurs, however, there is a dearth of information regarding when and how these crimes are perpetrated, and the situational factors influencing offending. Resultingly, prevention recommendations largely focus on actors (e.g., victims, perpetrators, witnesses), rather than the environment in which abuse occurs, emphasizing significant gaps in understanding and response to this growing issue.
... Despite several major surveys aimed at estimating prevalence rates of sexual assault in older adults, the extent of the problem is thought to be underestimated due to underreporting (see Fileborn, 2017, for a review). Underreporting is thought to occur for several reasons: the fact that perpetrators are frequently family members, fear of the consequences of reporting, cognitive impairment of the victim, the complexity of clinical forensic medicine programs, and lack of confidence in screening when aged abuse is suspected by health professionals (Goldblatt et al., 2022;Hall et al., 2020;Joubert & Posenelli, 2009;Shields et al., 2004). ...
... Furthermore, many of the studies to date have focused on screening and estimating prevalence rates for sexual assault against older female adults and have overlooked sexual assault perpetrated against older male adults (Karakurt & Silver, 2013). Obstacles to, and concerns about, sexual assault against older adults being underestimated and underreported, and the likely burgeoning population of older persons, have prompted calls for the need for raised awareness and recognition of sexual abuse in older persons and for suitable responses in justice, health, and residential care settings to be developed, as well as at the Governmental policy level (Alon et al., 2018;Fileborn, 2017;Payne, 2010). Others are advocating for the introduction of laws clearly defining mandatory reporting of sexual assault in the aged care sector (Forrester, 2008). ...
... One clearly identified gap in the body of scientific literature surrounding sexual abuse of older persons is the criminal justice response for older adults who have been sexually assaulted (Fileborn, 2017;Payne, 2010). A handful of studies that have been conducted on the criminal justice response for older adults indicate that, like sexual assault of younger persons, there are a number of barriers to justice and high attrition rates (Fileborn, 2017;Mann et al., 2019;Ramsey-Klawsnik et al., 2008). ...
... This assistance also presupposes ensuring dignity, the right to freedom and security (JEON ET AL, 2019), since the elderly person is more predisposed to social exclusion, especially in females where there is exacerbated moral and social vulnerability (SANCHES et al., 2018). Thus, identifying possible cases of violence is also the work of health professionals and everyone involved in the care process (FILEBORN, 2017;PARANHOS, 2019). ...
... Because the aggressors are mostly close people, the dependence and coexistence that links the domestic environment makes it even more difficult to seek help (FILEBORN, 2017;Pickering, 2016;BERNARDES, 2016). ...
... There are many impasses on the part of victims that generate obstacles in the search for help, such as guilt, shame, lack of information, loss of their own identity and even the erroneous idea that only physical abuse is characterized as a type of violence (FILEBORN, 2017;MCGARRY, 2017;SOARES, 2005). ...
Background: Violence against the elderly is an important public health problem, and permeates the ability of health professionals to conduct the case. Objective: What is the importance of formal and non-formal education for health professionals in identifying and acting in the face of situations of violence against elderly women? Method: This is a qualitative, exploratory research whose data collection instrument is a semi-structured questionnaire. The research participants are 34 health professionals (geriatricians and gerontologists) from the state of Paraná/Brazil. Results: The lack of an educational formation (formal or non-formal), aimed at health professionals, generates discomfort and difficulty in conducting cases in which violence against elderly women is observed. Conclusion: It is emphasized the urgency in the development of public policies for the education and protection of elderly women, and training and qualification actions for health professionals, so that these moral patients have their dignity and human rights preserved.
... the broader context of elder abuse and neglect [9], domestic violence or intimate partner violence [11]. Studies exclusively focussing on SV in older adults, describe criminal cases, and judicial response [12,13]. Yet, research on SV in older adults from a public health perspective, providing valid SV prevalence numbers and correlates, is currently lacking. ...
... This difference could be explained by several methodological choices. First, we studied SV in older adults from a different perspective compared to previous studies that researched SV based on criminal cases [12,13] or as a form of elder abuse and neglect, domestic violence or intimate partner violence [9,11]. Hence, they restricted the relation between victim and assailant to a confidant, a household member or an intimate partner respectively while our research shows that assailants are also unknown. ...
... In our study, in 47.6% of SV cases and in 28.1% of rape cases, victims perceived it as 'just something that happened'. Previous studies found that generational specificities surrounding sexuality and SV such as legal definitions and perceptions of SV, influenced disclosure rates [13,46]. Furthermore, society's attitudes regarding sexuality have become more permissive, and the definition of sexual consent has been narrowed [20]. ...
Background
Sexual violence (SV) is an important public health problem which may cause long-lasting health problems. SV in older adults remains neglected in research, policies and practices. Valid SV prevalence estimates and associated risk factors in older adults are currently unavailable. In this study we measured lifetime and past 12-months sexual victimisation in older adults living in Belgium, its correlates, assailant characteristics and the way that victims framed their SV experiences.
Methods
SV was measured using behaviourally specific questions based on a broad definition of SV. Participants were selected via a cluster random probability sampling with a random route finding approach. Information on sexual victimisation, correlates, assailant characteristics and framing was collected via structured face-to-face interviews with adults aged 70 years and older living in Belgium (community-dwelling, assisted living and nursing homes).
Results
Among the 513 participants, the lifetime SV prevalence was 44% (55% F, 29% M). Past 12-months prevalence was 8% (9% F, 8% M). Female sex and a higher number of sexual partners were associated with lifetime SV (p < .05), non-heterosexual sexual orientation with past 12-months SV (p < .05). Correlates identified to be linked to elder abuse and neglect in previous studies were not linked with SV in our sample. ‘Someone unknown’ was identified as most common assailant.
Conclusions
Sexual victimisation appears to be common in older adults in Belgium. Both correlates and assailant characteristics seem to differ from previous studies on elder abuse and neglect. Recognizing older adults as a risk group for sexual victimisation in research, policies and practices is of the utmost importance.
... . At the same time, sexual assault in late life, as a body of knowledge, is receiving increased research attention in relation to its unique characteristics (e.g., Band-Winterstein et al., 2021;Bows, 2020;Budd & Liddic, 2020;Malmedal, 2020). Studies show that in most reports of sexual assault of older people, the victims are women (Bows, 2018;Fileborn, 2017). Research has examined possible barriers to detecting and reporting sexual assault against women in late life (SAWLL; Goldblatt et al., 2020;Peirone & Dawson, 2020), as well as its severe implications for the safety, health, and well-being of older women (Bows, 2019;Mann et al., 2019;Ramsey-Klawsnik, 2017). ...
... 53-54). Literature accumulated in recent years exploring SAWLL indicates the diversity and the complexity of the phenomenon (e.g., Band-Winterstein et al., 2021;Bows, 2018;Fileborn, 2017). This complexity is expressed, first, in relation to the setting, because SAWLL can occur either in the community or in institutions (Bows, 2020), and second, in relation to the duration of the assault. ...
... Although this relatively low rate may suggest that the phenomenon is scarce, it may also indicate barriers to detecting SAWLL and practitioners' lack of awareness (Alon et al., 2018;Goldblatt et al., 2020). These barriers may be manifested by older women's difficulty in reporting sexual assault due to physical and cognitive deterioration (e.g., Bows, 2018;Fileborn, 2017), as well as dependency relationships, when the offender is a family member or a caregiver (Mann et al., 2014). In addition, barriers to older women reporting SAWLL may be related to cultural norms that perceive rape by spouses as the spouse's privilege and the wifely duty to comply (Rogers & Taylor, 2019), as well as beliefs about keeping information about SAWLL private (Mann et al., 2014). ...
The aim of this article is to explore the interplay between poly-victimization and sexual assault against women in late life (SAWLL) according to the life-course perspective. Two themes emerged from qualitative interviews with 18 experienced welfare and health care professionals who intervened in cases of SAWLL: sexual assault by a spouse co-occurring with other types of abuse within marital relationships, and sexual assault and other types of abuse by two or more perpetrators along the life course. In many cases, SAWLL is an expression of a broader experience of poly-victimization, which relates to vulnerability in old age.
... Studies exclusively focussing on SV in older adults, describe criminal cases, and judicial response [12,13]. Yet, research on SV in older adults from a public health perspective, providing valid SV prevalence numbers and correlates, is currently lacking. ...
... This difference could be explained by several methodological choices. First, we studied SV in older adults from a different perspective compared to previous studies that researched SV based on criminal cases [12,13] or as a form of elder abuse and neglect, domestic violence and intimate partner violence [9,11]. ...
... Previous studies found that generational specificities surrounding sexuality and SV such as legal definitions and perceptions of SV, influenced disclosure rates [13,40]. Furthermore, society's attitudes regarding sexuality have become more permissive, and the definition of sexual consent has been narrowed [14]. ...
Background: Sexual violence (SV) is an important public health problem which may cause long-lasting health problems. SV in older adults remains neglected in research, policies and practices. Valid SV prevalence estimates and associated risk factors in older adults are currently unavailable.
Objective: To measure lifetime and past 12-months sexual victimisation in older adults living in Belgium, its correlates, assailant characteristics and the way that victims framed their SV experiences.
Design: Cross-sectional general population study.
Setting: Community-dwelling, assisted living and nursing homes.
Participants: 513 people of 70 years and older living in Belgium.
Methods: SV was measured using behaviourally specific questions based on a broad definition of SV. Participants were selected via a cluster random probability sampling with a random route finding approach. Information on sexual victimisation, correlates, assailant characteristics and framing was collected via structured face-to-face interviews.
Results: Lifetime SV prevalence was 44% (55% F, 29% M). Past 12-months prevalence was 8% (9% F, 8% M). Female sex and a higher number of sexual partners were associated with lifetime SV (p <.05), non-heterosexual sexual orientation with past 12-months SV (p <.05). Correlates generally linked to elder abuse and neglect were not linked with SV. ′Someone unknown ′ was identified as most common assailant.
Conclusions: SV appears to be common in older adults in Belgium. Both correlates and assailant characteristics seem to differ from previous studies on elder abuse and neglect. Recognising older adults as a risk group for sexual victimisation in research, policies and practices is of the utmost importance.
... The lack of uniform, standardized definitions of elder sexual abuse increases the variability across studies resulting in a muddled understanding of the full scope and scale of the problem. Many prior studies of sexual violence have rested on the belief that sexual assault victimization declines dramatically as people progress through the lifecourse, and while largely true, the result has been the frequent exclusion of respondents over the age of 60 from sexual violence surveys and studies (Bows, 2017;Fileborn, 2017). Empirical literature on elder sexual abuse has developed only a broad understanding of victim, offender, and incident characteristics, omitting the multiple discreet and nuanced victim/offender details that would inform both profiles and the strategies needed for successful intervention and prevention. ...
... The most significant definitional challenge involves the age threshold necessary for inclusion as a member of the elder population. Studies frequently use inclusion ages at the lower bound ranging from 50 to 65 (Fileborn, 2017) with other works employing a more age-gendered approach utilizing the onset of menopause as necessary criteria (Morgan, Dill, & Welch, 2011). To further undermine a thorough understanding of elder sexual abuse, age diversity in the broad cohort of elder is ignored with limited examination of differing victimization experiences across ages, for example differences across the decades of 50, 60, 70, and 80+ years of age (Fileborn, 2017). ...
... Studies frequently use inclusion ages at the lower bound ranging from 50 to 65 (Fileborn, 2017) with other works employing a more age-gendered approach utilizing the onset of menopause as necessary criteria (Morgan, Dill, & Welch, 2011). To further undermine a thorough understanding of elder sexual abuse, age diversity in the broad cohort of elder is ignored with limited examination of differing victimization experiences across ages, for example differences across the decades of 50, 60, 70, and 80+ years of age (Fileborn, 2017). ...
As “baby boomers” age through the lifecourse, elderly American's are projected to comprise more than 20% of the U.S. population by 2030 (Ortman, Velkoff, & Hogan, 2014). With a dramatic population increase anticipated, elder abuse and maltreatment has emerged as a focus of violence research. Elder sexual abuse is perhaps the least perceived, acknowledged, detected, and reported type of victimization (Roberto, Teaster, & Nikzad, 2007). The present work explores elder sexual abuse, drawing on 10 years (2007–2016) of officially reported incidents from National Incident Reporting System (NIBRS) data, to address several of the limitations identified by the National Research Council (2003) including: inconsistent definitions, unclear and inadequate measures, and a lack of population-based data. Results support significant differences in elder sexual abuse profiles across victim and perpetrator sex, age, race, relationship, residence, and offense type, highlighting the need to examine contextual differences in offenders, victims, and incident-based characteristics. Intervention, policy needs, and prevention are discussed.
... Sexual assault perpetrated against older people has been documented for decades, yet scientific inquiry about this social problem remains sparse (Bows, 2018;Fileborn, 2017). It is particularly troubling this social problem is so understudied, because a recent U.S. analysis of prevalence estimates that approximately 90,289 communitydwelling older adults aged 60 and older experienced sexual violence within the past ...
... To date, research on older person's experiences of sexual violence has focused primarily on older women's experiences of sexual assault (see, for example, Burgess et al., 2005;Cook et al., 2011;Fileborn, 2017). This makes sense given much of this work finds older women to be the majority of victims compared with older men-when men are included in the sampling frame (Bows, 2018;Fileborn, 2017). ...
... To date, research on older person's experiences of sexual violence has focused primarily on older women's experiences of sexual assault (see, for example, Burgess et al., 2005;Cook et al., 2011;Fileborn, 2017). This makes sense given much of this work finds older women to be the majority of victims compared with older men-when men are included in the sampling frame (Bows, 2018;Fileborn, 2017). This leaves a gap in our knowledge, though, about the sexual victimization of older men whose sexual victimization also leaves lasting trauma (Bows, 2018;Roberto et al., 2007;Teaster et al., 2007). ...
Sexual assault perpetrated against older adults remains understudied. This research examined sexual assault incidents perpetrated against older women and men (aged 60+) reported to law enforcement. It compared these sexual assault incidents with those committed against middle-age (aged 40–59) and younger (aged 18–39) women and men. National Incident-Based Reporting System data (1992–2015) were analyzed using multinomial logistic regression models. Findings showed incidents involving an older woman, relative to a middle-age and/or younger woman, were significantly more likely to involve stranger perpetrators, occur at a private location, and involve additional violent crime or property crime. Incidents involving an older man, relative to a middle-age and/or younger man, were significantly more likely to involve offenders of more than one sex, older offenders, stranger perpetrators, and additional violent crime or property crime. Results are discussed in relation to prior work and future directions.
... Keywords old age, older women, qualitative research, sexual assault, social barriers Sexual Assault against Women in Late Life (SAWLL) is a phenomenon that has received increasing research attention in recent years. Cumulative studies indicate the diversity and complexity of this phenomenon, including human rights issues, obstacles to screening and identifying the phenomenon, and overlap among fields of knowledge: elder abuse, older women, and sexual violence (e.g., Bows, 2018b;Browne et al., 2018;Fileborn, 2016;Fileborn & Barrett, 2019;Mann et al., 2019). Sexual assault occurs at all ages and is considered a sensitive topic, generally characterized by a conspiracy of silence (Crockett et al., 2015;McGarry & Ali, 2019). ...
... The low reported prevalence of SAWLL, as well as professionals' limited awareness of this phenomenon, can be related to the "invisibility" of SAWLL victims, due to ageist social construction. Consequently, such older adults become marginalized compared with younger age groups (Fileborn, 2016;Rogers & Taylor, 2019). As most victims of sexual abuse in old age are women (Bows, 2018b;Lee et al., 2019), they might suffer from double marginalization, due to both age and gender (Crockett et al., 2018;Mann et al., 2014). ...
... An additional and significant aspect of ageism, which might be a barrier to identifying and intervening with regard to SAWLL, is professionals' perception of older adults as a-sexual and therefore not potential victims of sexual assault (e.g., Fileborn, 2016;Mann et al., 2014). Similarly, the perception of sexual assault as being related to sexual activity and sexual attractiveness can also make it more difficult for professionals to identify SAWLL (Bows, 2018a;Bows & Westmarland, 2017;Connolly et al., 2012;Vierthaler, 2008). ...
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.
... Compared to younger age groups, middle-aged and older adults have a notably lower prevalence rate of sexual violence occurring at their age, although estimates vary widely depending upon population, reporting agency, and source (e.g., selfreport vs. agency report) (Bows, 2018). Estimates from Western countries, including the United States, United Kingdom, and Australia where the majority of large-scale studies on elder abuse have focussed, place estimates as low as 0.2% (reported in research on both general and special populations of older people) and as high as 8.0% (reported from sexual violence organizations) (Bows, 2018;Fileborn, 2017). As with all estimates of sexual assault, it is speculated that these estimates may be low, a factor of underreporting due to stigma (National Sexual Violence Resource Center, 2013). ...
... In the case of middle-aged and older adults, this stigma may also reflect a pervasive ageist belief that sexual concerns, including issues of sexual consent, are irrelevant following the reproductive prime of life. This may lead to claims of sexual misconduct directed at an aged person to be ignored, dismissed, or written-off due to the perceived incompatibility of age and sexual activity (Connolly et al., 2012;Fileborn, 2017). This is especially problematic as risks of being victimized may increase among these age groups as people live longer, negotiate new sexual relationships in mid-and later life as a result of changing societal norms, and desire to remain sexually expressive into their later years (Dalrymple et al., 2017;Deacon et al., 1995;Heywood et al., 2019;Thomas et al., 2015). ...
... In addition to looking at a common basic understanding, we were interested in what other standards participants included when prompted to define sexual consent. Given notable generational shifts in consent communication, understanding, and even law (Fileborn, 2017), we anticipated age group differences in the scope of sexual consent definitions. ...
Sexual violence or misconduct can occur at any age, yet sexual consent understanding is not well studied, especially beyond early adulthood. This project aimed to describe how sexual consent is conceptualized across the adult lifespan, drawing comparisons between young, middle-aged, and older adults. Additionally, we examined variables that may differ by age group and influence sexual consent conceptualization. In a survey, young adults (n= 266), middle-aged adults (n= 236), and older adults (n= 51) were asked to define sexual consent and complete a measure on the appropriateness of giving and receiving consent in different types of sexual relationships. Participants also reported on their exposure to formal sex education and their current sexual relationship status. More than half (57.4%) of participants included basic elements of a simple core definition (agreement in reference to sexual acts), and most (63.3%) expanded beyond a simple definition. Age groups differed significantly on variables expected to influence sexual consent definitions, including exposure to sexual education and sexual consent attitudes. Age group differences were not found when examining the simple core definition, but young adults and middle-aged adults differed significantly in their expansion on the definition. Sexual consent attitudes were also significantly related to the scope of the supplied definition. These findings suggest that sexual consent definitions vary in scope across at least a portion of the lifespan and that the importance placed on sexual consent may be a reasonable intervention target regardless of age differences in sexual experience and education.
... A small body of academic research has developed to address this gap in evidence (for a comprehensive review rf. 18,19 ). However, most of these studies have been limited to small samples drawn from forensic or medical case files, or from a single police force database. ...
... However, most of these studies have been limited to small samples drawn from forensic or medical case files, or from a single police force database. Separately, an important body of work has emerged over the last two decades highlighting the prevalence and consequences of domestic violence against older women [18][19][20][21][22][23][24] and elder abuse (e.g. 16 ). ...
Objectives
To explore the extent, nature and consequences of sexual violence in later life.
Methods
Data were obtained from all police forces in England, Wales and Northern Ireland on rape and sexual assault by penetration (Sexual Offences Act 2003) offences involving a victim aged ≥ 60 years, recorded between 1 January 2009 and 31 December 2013. Qualitative interviews were conducted with 27 practitioners working in specialist violence or age‐related organisations and with three female survivors.
Results
The majority of victims were female, and most offenders were male. Offenders were generally younger than victims, and most offences occurred in the victim's home, although one in five occurred in a care home. Physical, psychological and social consequences were described which create specific challenges in accessing and receiving support.
Conclusion
An intersectional life course analysis of sexual violence is required to develop a better understanding of the consequences, particularly for older women.
... This is the first published study to include a focus on the challenges that the age of survivors can create for practitioners working in sexual violence organizations. Focusing on the intersections of age and gender, this article responds to calls from previous researchers (Fileborn, 2016;Jones & Powell, 2006;Whittaker, 1995) to examine sexual violence against older people through a feminist lens. ...
... Practitioners' perspectives of the effects of sexual violence on older people, and challenges in accessing and providing support, reinforce recent calls in the feminist literature to increase awareness of sexual violence and improve responsiveness as a way of moving toward prevention of sexual violence against older women (Fileborn, 2016). By adopting a critical feminist gerontological lens, a greater understanding of the ways age and gender intersect to create multiple challenges and effects for older survivors is developed; in this study, generational norms, values, and attitudes intersected with age-related health conditions and issues, and gender, to shape and influence the experiences, impacts, and challenges for older survivors and practitioners. ...
Despite half a century of research on both sexual violence and elder abuse, the intersection between the two remains largely unexplored. Using theoretical lenses of feminist criminology and critical feminist gerontology, this article explores the intersection between age and sexual violence drawing on interviews with 23 practitioners supporting older survivors (aged 60 and over). They reported physical and emotional effects of sexual violence leading to limited lifestyles, disengagement from social networks, and reliance on pathogenic coping strategies. Provision of effective support was complicated by challenges associated with aging bodies and the social stigma associated with both sexual victimhood and older age. Additional challenges lay in supporting older male survivors and those living with dementia. The article ends by discussing implications for practice and an agenda for future research.
... By examining the literature across three fields and the ranging contexts, a more comprehensive picture of sexual violence against older people is possible. While there have been other reviews in each individual field (Ball, 2005;Cooper, Selwood, & Livingston, 2008;Daly, Merchantm, & Jogerst, 2011;Fileborn, 2016;Roberto, Mcpherson, & Brossoie, 2013;Yan, Chan, & Tiwari, 2015), this is the first comprehensive review that brings together all of the empirical data across the fields in relation to sexual violence against older people. It builds on earlier reviews by Ball (2005) and more recently by Fileborn (2016), which both examined sexual violence against older people but addressed different areas of literature. ...
... While there have been other reviews in each individual field (Ball, 2005;Cooper, Selwood, & Livingston, 2008;Daly, Merchantm, & Jogerst, 2011;Fileborn, 2016;Roberto, Mcpherson, & Brossoie, 2013;Yan, Chan, & Tiwari, 2015), this is the first comprehensive review that brings together all of the empirical data across the fields in relation to sexual violence against older people. It builds on earlier reviews by Ball (2005) and more recently by Fileborn (2016), which both examined sexual violence against older people but addressed different areas of literature. Ball's review was not a systematic review and focused more narrowly on the literature specifically relating to sexual violence and older people, which did not incorporate elder abuse or intimate partner violence. ...
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 article should be free to view here: http://journals.sagepub.com/doi/full/10.1177/1524838016683455
... There have been a few literature reviews conducted on women's experience of justice, including on justice for older women (Fileborn, 2017b) and the impact of race on criminal legal responses to sexual assault (Shaw & Lee, 2019). There have also been two reviews on restorative justice (Cheon & Regehr, 2006;Donaghy, 2020), which is broadly understood as a transformative approach which may involve mediation meetings with a survivor and their perpetrator; the focus of the meetings is on the "repair of harms and of ruptured social bonds" (Daly & Immarigeon, 1998, p. 21). ...
Justice after sexual assault is often understood and enacted through the criminal legal system such that the outcomes are binary (i.e., justice is achieved or not achieved). Previous research indicates that survivors have specific wants and needs following an assault in order to experience justice, which may or may not align with current practices. We conducted a critical interpretive synthesis of 5 databases to create a sampling frame of 4,203 records; the final analysis included 81 articles, book chapters, and policy documents. Results indicate that justice is an individualized and dynamic process which may include the experience of voice, connectedness, participating in a process, accountability, and prevention. The experiences of safety and control are central to each of these domains. Survivors may seek and enact these justice domains through several avenues, including the criminal justice and legal systems, restorative justice, medical/mental health spaces, activism, art, and social media. Existing actors within currently available justice systems, including legal, medical, and mental health personnel should encourage survivors to identify and define their own experience of justice, including locating helpful behaviors rooted in safety and control, and resist a binary model of justice. Extant systems should therefore be flexible and accessible to help survivors realize their preferred modes of justice.
... This may lead the perpetrator to feel that disabled women would be relatively powerless to resist (Martin et al., 2006;Casteel et al., 2008;Ludici et al., 2017). Older women, however, face particular barriers to disclosure of sexual assault, this results in their experiences remaining hidden (Fileborn, 2017). ...
This paper explores the experiences and perceptions of Zora, an older Muslim woman living with a disability in the UK. Older disabled Muslim women in the UK often face multiple discriminations based on disability, age, gender, religious, and racial grounds and this has arguably been intensified by the COVID-19 pandemic. Drawing on multiple narrative interviews with Zora, this paper focuses on the intersections of disability, ageing, gender, race and religion within a particular social context during the COVID-19 pandemic in the UK. The paper describes the complex ways in which Zora experienced various modes of everyday disablism which were not related to the COVID-19 virus itself, rather the consequences of the movement restrictions associated with it. Much of the oppression and barriers she described were socially determined, both through direct discrimination, stares and prejudicial attitudes, and indirectly through stigmatization and an embodied fear of the reaction of others in public spaces. Nevertheless, Zora did not present herself as a victim. Instead she portrayed herself in affirmative terms, as a ‘brave’ woman who resisted and overcame daily social challenges and movement restrictions as part of working toward creating a more accessible, inclusive and age-friendly society. One that is inhabitable for herself and other older disabled women facing an uncertain future.
... Sexual assault in late life is a phenomenon that has gained increasing public awareness and research attention in recent years (Bows, 2018(Bows, , 2019Fileborn, 2017;Fileborn & Barrett, 2019;Mann et al., 2014). ...
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.
... In the face of lack of information, statistics can be skewed and the full extent of femicide of elderly women remains undocumented. In a pioneering study, Fileborn (2017) demonstrated that existing research underestimates the extent of sexual assault against older women since they make up a small proportion of the victims or survivors of this type of violence. She points out how elderly women face particular barriers to disclosure and accessing the justice system, resulting in their reports of violence remaining hidden. ...
This study of femicide involving elderly women, or female geronticide, aims to fill a gap in the research literature. The article is divided into three parts: a review of the literature on femicide, geronticide, and specifically female geronticide; a review of the literature utilizing Israel as a case-study and an empirical report on the findings of the first longitudinal study on female geronticide in Israel, which demonstrates that over a period of 10 years (2006–2015) female geronticide was perpetrated solely by intimate male partners. Findings of the study also show post hoc that while femicide is perpetrated in disproportionate numbers by, and towards, members of particular ethnic categories, such as Ethiopian immigrants and foreign migrants, there were no cases of female geronticide in these two groups. The likelihood of an elderly woman being murdered by her intimate partner or family member was higher among the following groups in the following order: immigrants from the former Soviet Union; Israeli-born Jews and; Israeli Arabs. The findings are important for policy-makers in Israel but have applications globally.
... In recent years, several reviews have been published on SV in older adults, looking at it from a criminal perspective [30][31][32]. They focus on criminal cases and describe assailant characteristics, barriers to disclosure and justice response. ...
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 cutoff 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.
... Ethnicity needs much further research, but studies show that Black, Hispanic, Latina, Mexican and Asian women are likely to be blamed for sexual violence and blame themselves (Donovan, 2007;Foley et al., 1995;George & Martinez, 2002;Lefley et al., 1993;Maier, 2008). Even the age of the woman can change the perception of the rape or the woman's credibility (Bows, 2016;Fileborn, 2017;Lea et al., 2011;Muram et al., 1992;Walby & Allen, 2004). This is especially important since the Crime Survey England and Wales did not count any statistics on the rape of women over 59 until 2015 despite the fact that older research had shown that of a large sample of older women, 79% of older women were raped by a stranger and that 72% of the rapes happened in their own homes (Muram et al., 1992) -which is a rare type of rape (Lea et al., 2011). ...
Thesis Summary
Victim blaming and self-blame are common experiences for women who have been subjected to sexual violence and abuse. This thesis employs a comprehensive mixed-methods approach from a critical relativist feminist epistemology which includes a review of the literature of victim blaming of women, the development and initial validation of a new psychometric measure of victim blaming of women (BOWSVA Scale), two qualitative studies exploring understanding of victim blaming and self-blame with women who have experienced sexual violence and professionals who work in sexual violence support; resulting in a final discussion proposing a new integrated model of victim blaming of women.
Research aims and methodology
Study 1: Interviews with women who have been subjected to sexual violence and abuse
This study utilised a semi-structured interview framework to explore the way women construct their understanding and experiences of victim blaming and self-blame through talk. Through interviews with nine women aged 19 to 76 years old, participants were asked to consider why they thought women were blamed for sexual violence, why women might blame themselves for sexual violence along with their own experiences of being blamed by others and blaming the self. The study sought to provide a more nuanced view of the experience of victim blaming and self-blame from women who had experienced diverse forms of sexual violence throughout the lifespan. The interview data was analysed using critical discursive analysis from a feminist perspective to search for patterns and themes in the way women talked about victim blaming and self-blame of themselves and other women.
Study 2: Interviews with professionals who support women after sexual violence and abuse
This study utilised a semi-structured interview framework identical to the first study to explore the way the professionals working with the women construct their understanding and experiences of working with women who have experienced victim blaming and self-blame after sexual violence. Through interviews with eleven professionals working in rape centres and sexual violence support services, participants were asked to consider why they thought women were blamed for sexual violence, why women might blame themselves for sexual violence along with their own professional techniques used to try to deconstruct victim blaming and self-blame narratives of women they support. The study sought to provide a comparison between women who have experienced sexual violence and the professionals who support them. The main comparison being; do women seeking support and the professionals supporting them have a similar understanding of victim blaming and self-blame – and how do the professionals try to help women to understand that it was not their fault?
Study 3: Development and validation of a psychometric measure of victim blaming of women subjected to sexual violence and abuse
Evaluation of the existing measures used in the victim blaming literature (Updated IRMAS, Mcmahon & Farmer, 2010; AMMSA, Gerger et al., 2007; RMAS, Burt, 1980; PVBS, Cramer et al. 2013) found that none of the existing psychometric measures were specifically built to measure the amount of blame being apportioned to the female victim and to the male perpetrator in common scenarios of sexual violence towards women. Instead, the psychometric measures were found to be testing for constructs such as sexism, rape myths, victim characteristics, perpetrator myths and general attitudes towards sexual violence.
This finding led to the development and validation study of the Blame of Women subjected to Sexual Violence and Abuse Scale (BOWSVA Scale). In this study, previous measures were evaluated using concept mapping and content analysis to discover the gaps and problems with previous measurement approaches to victim blaming. The BOWSVA items containing manipulated sexual violence scenarios in which women were assaulted by men, were then developed after a team of peer experts were consulted for face validity. The resulting BOWSVA items were tested on over 450 adults in the general population to generate enough data to conduct factor analysis to develop and test the items as a psychometric construct to measure the apportioning of blame to women who have experienced sexual violence or abuse. A 7-factor solution was derived and accepted in principle, with much more research required to continue to validate the measure and items.
... In addition, sexual assault frequently occurs within the context of IPV (Kennedy, Bybee, McCauley, & Prock, 2018). An increased understanding of the holistic nature of sexual assault, health, and occupations is necessary for nurses to continue to facilitate and support patient health, as sexual assault victims and survivors do utilize health care in diverse settings, including in the workplace (Fileborn, 2017;Goyal et al., 2017). ...
Purpose: While researchers have established that sexual assault may adversely affect successful employment and academic achievement, little is known about the barriers and facilitators of occupational well-being from the perspective of sexual assault survivors. This study assessed the barriers and facilitators of occupational well-being. Design: Constructivist grounded theory. Method: Digitally recorded, semistructured interviews were used to collect data. Data were collected from 22 adult female sexual assault survivors. Analysis consisted of coding, creation of data matrices, and within and across case analysis. Findings: Theoretical saturation was achieved after interviews with 22 participants. Barriers to occupational well-being were mental health symptoms and diagnoses, substance abuse, inflexible attendance policies, and workplace bullying. Facilitators to occupational well-being were personal coping strategies, and organizational and social support. Conclusions: Sexual assault has significant effects on the occupational well-being of women. The work or academic environment can exacerbate the harms of sexual assault or facilitate healing in sexual assault survivors. To facilitate the occupational well-being of sexual assault survivors, workplaces and academic institutions can adopt a trauma-informed approach, create policies that allow for time off to deal with sequela of sexual assault, implement anti-bullying programs, and make resources for gendered violence available.
... Current knowledge on SA, as a separate behavioral subcategory from physical assault, in general (e.g., Marshall, Laws, & Barbaree, 1990), and in late life, in particular, is limited and ambiguous (e.g., Fileborn, 2016;Payne & Gainey, 2009). A possible explanation relates to taboos, stigmas, and prejudices that shape and frequently accompany the phenomenon, both at the social as well as the interpersonal level. ...
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.
... The aim of this survey was to explore professionals' awareness of sexual abuse in late life. The results support findings of the small number of previous studies conducted on this topic (Fileborn, 2016;Malmedal et al., 2015;Ramsey-Klawsnik, 2004;Ramsey-Klawsnik et al., 2007;Rosay & Mulford, 2017). ...
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.
Dementia is known to unequally affect women, whether as women living with dementia, or women who provide unwaged or paid care, yet dementia and long-term care (‘LTC’) research and policy often ignore gender. Using Australia as a case study and building on critical dementia, critical disability, and feminist scholarship, this discourse analysis study explored representations in the Australian Royal Commission into Aged Care Quality and Safety (‘ACRC’) Final Report of experiences of women with dementia, and women care partners of people with dementia, using long-term care. This paper argues gender remained an overlooked topic in relation to dementia in the ACRC Final Report. This paper found women and dementia were co-constructed according to normative gendered scripts of passive femininity. In particular, harms experienced by women with dementia in long-term care were overlooked, while the feminised labour of women care partners was taken for granted. In failing to address normative gendered patterns, the ACRC Final Report entrenches rather than unseats marginalisation of women in dementia research and policy and is a missed opportunity to address gendered labour, discrimination and harms in long-term care. Ultimately, the paper highlights the need to recognise long-term care as a key site for critical dementia and feminist scholarly and activist interventions and intersectional approaches in reforms.
This paper conducts a comparative and exploratory study on altruistic and pay-to-stay care systems, exploring the intersection of tradition and contemporary society. The research delves into the underlying mechanisms of both care systems, shedding light on the daily lives, challenges, and vulnerabilities of older women residing in care homes. Emphasising the state's and market's evolving role in the older care system, the study highlights the relatively recent market invasion. Employing an exploratory and descriptive research design, the sample comprises fifty-six women aged 60 and above in Lucknow city's (Uttar Pradesh, India) care homes. Given the heterogeneity among women in care homes regarding social and moral values, the study utilises multi-stage random, stratified, and purposive sampling techniques as needed for the analysis. Data had been gathered from two care homes-one not charging residents and another a paid facility catering to lower-middle and middle-income groups. The researcher spent a year and a half working in these homes, conducting interviews with all respondents. The paper uncovers distinctions in care homes based not only on altruism and pay-to-stay but also on caste and class dynamics, contributing to social inequality and limiting social mobility. The stratification of the State and market results in varying quality of life for older women. While the market holds potential for innovation and improved service quality, economically dependent women often defer this choice to their family members. Socioeconomic status significantly influences the decision to lead a dignified life, with some women reluctantly relying on the state for survival after being abandoned by their families, leaving them hapless and hopeless.
Background:
The United Nations has declared 2021-2030 the 'Decade of Healthy Ageing' and identified the need to strengthen the evidence base on interpretations and determinants of healthy ageing to inform policy.
Objectives:
This study sought to interrogate a 'policy blind spot' and examine interpretations and experiences of sexuality and sexual health within the context of ageing well among women aged 50+.
Design:
The qualitative study design was underpinned by an interpretivist epistemology. Research was guided by principles of feminist scholarship and located in an affirmative ageing framework.
Methods:
Semi-structured individual interviews were conducted between April-June 2019 with 21 English-speaking women aged 52-76. Women were recruited through community organizations in North West England. Transcripts were analysed using a framework approach to thematic analysis, applying an inductive approach to theme generation.
Results:
Narratives encompassed six broad themes: reflections on 'ageing well'; age alone does not define sexuality and sexual health; interpretations of sexual health and sexuality; vulnerability and resistance in later-life sexual health; narratives of (in)visibility; and reimagining services to promote sexual health in later life. There was a dominant belief that sexual health represents a component of ageing well, despite a broad spectrum of sexual expression and health challenges. Sexual expression was diversely shaped by conflicting societal expectations within an evolving digitized environment. In clinical settings, however, sexual health discussions were often muted or framed from a disease-focussed lens. Women expressed a preference for holistic, person-centred sexual health provision from an orientation of wellness to support varied sexual expression, sensitive to wider health, life and relationship realities.
Conclusion:
This work strengthens calls to disentangle sexual health from disease-centred narratives and legitimize sexual health as part of the healthy ageing agenda.
This study examines how the age of female survivors impacts public perceptions of rape in China. In our online survey experiment, participants consider rape as less serious when the survivor is a middle-aged woman compared to other groups of women (younger, older, or age unknown). Participants also request shorter sentencing when the survivor is a middle-aged woman than a younger woman. In China, moral codes surrounding chastity and respect for elders lead to greater emotional responses toward rape against younger and older survivors than middle-aged survivors. Our study expands studies of rape perception by theorizing public attitudes toward middle-aged survivors.
Résumé
Contrairement aux préjugés, les personnes aînées ne sont pas asexuelles ou post-sexuelles. Elles sont titulaires de droits sexuels, reconnus dans de nombreux textes législatifs. Cependant, la mise en œuvre de ces droits pose des défis, particulièrement pour les personnes aînées vivant en établissement et souffrant de problèmes neurocognitifs. Le Code criminel interdit tout contact sexuel entre personnes qui ne sont pas en mesure de consentir ou lorsqu’un des partenaires ne peut consentir. Cette règle a été critiquée parce qu’elle nie le droit à l’expression sexuelle de personnes aînées incapables de consentir en raison de maladies neurocognitives. Mon étude analyse un enjeu majeur en matière de lutte contre la maltraitance envers les personnes aînées : comment reconnaître et respecter à la fois le droit à l’expression sexuelle des personnes aînées vivant en établissement et leur droit à la sécurité, lorsque les maladies neurocognitives altèrent l’aptitude à consentir.
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.
Cet article interroge le regard que portent nos sociétés sur les violences sexuelles subies par les personnes âgées, en explorant l’âgisme comme facteur qui peut expliquer la perception actuelle entourant la sexualité et les violences sexuelles envers elles. Bien que la violence sexuelle soit une thématique largement étudiée, sur le plan international, peu de recherches se concentrent sur les personnes âgées. Suivant les différentes perspectives et disciplines, leur prévalence à l’encontre des personnes âgées varie entre 0,9 et 15 %. À l’instar des populations plus jeunes, les personnes âgées ayant subi des violences sexuelles sont également plus à risques de subir une victimisation secondaire si elles ne sont pas crues lors de leur témoignage. La victimisation secondaire consiste à revivre le traumatisme par un événement lié ou non au traumatisme initial. Les professionnels de la santé ne sont pas formés pour accueillir, détecter et orienter leurs patients âgés, victimes de violences sexuelles. Cet article se termine en proposant quelques pistes de réflexion quant au modèle de société dans laquelle nous aimerions vivre et vieillir.
Despite calls recognizing the need for culturally sensitive responses to minimize the occurrence of secondary victimization for African American women following an experience of sexual assault, few studies have focused on hearing from African American women survivors about their experiences receiving healthcare services in a hospital setting following sexual assault. Employing critical ethnography as our methodology and using intersectionality theory as a lens, we centered the voices of African American women survivors about their experiences receiving nursing care in urban acute care or hospital settings in the Upper Midwest of the United States following sexual assault. In this qualitative study, 30 African American women survivors were interviewed using in-depth, semi-structured interviews about their post-sexual assault care. Interviews were analyzed using thematic analysis. An important theme identified focused on survivors' experiences of dehumanization when receiving healthcare services following sexual assault. These experiences included: discrediting, dismissing, shaming, and blaming. To mitigate and prevent secondary victimization in the future, we present practice and education change recommendations for nurses, and healthcare providers more broadly, based on the voices of African American female survivors of sexual assault.
To explore perspectives on sexuality, sexual health, and sexual health care of older adult women with a history of criminal legal system involvement, we conducted phone interviews with women aged 50 years or older who were living in the community but had a history of jail and/or prison incarceration. Interview questions and initial analysis were guided by the sexual health framework for public health and Mitchell's sexual wellness model. Data analysis followed a framework method. Nine women, aged 53-66, participated in phone interviews between December 2020 and December 2021. Slightly over half the participants were Black; none were Hispanic. Most were single. We formulated a sex-in-aging (SAGE) framework comprising three categories and two overarching themes. Women with a history of criminal-legal system involvement have heterogeneous views on sex and sexual health and describe a range of desire and sexual activity as they age, including shifting ideas about what they expect from partners, how they keep themselves safe in sexual and intimate relationships, and how life circumstances that are often associated with criminal legal system involvement (substance use, trauma) impact their interest in sex as they age. The SAGE framework integrates these categories and themes and offers a starting point for further research and intervention development.
The #metoo campaign brought the reality of sexual violence against women into the public consciousness, but it needed celebrities to capture people’s attention. For the first time, it was being reported in the main media as highly pervasive and endemic rather than sensational and exceptional. Unfortunately, the campaign did not include older women in nursing homes. Defenseless, cognitively impaired, most of them are too vulnerable to speak out. Elderly women who can report assaults are silenced by disbelief, dismissal, or denial. These silent victims are also ignored by nursing homes, staff, health professionals, families, legal actors, governments, society, and scholars alike. Internationally, the paucity of research on the subject is staggering. Institutional sexual abuse is still taboo. The goal of #metoo was to highlight the breadth and impact of sexual violence worldwide. The frailest abused women in nursing homes need to be seen and heard and most of all, they need to be protected.
Street harassment represents one of the most pervasive forms of sexual violence. While it is commonly understood as a gender-based harm, it also intersects with racist, homophobic, transphobic, ableist, and other forms of abuse. Although it is rarely responded to through government policy, research illustrates that street harassment can have profoundly negative impacts of those who experience it. This article provides a comprehensive review of the current "state of the field" of street harassment research. We undertook two extensive searches of the EBSCO Discovery database in 2015 and 2020, followed by the use of reference snowballing and a Google Scholar search in order to triangulate results. Studies included in the sample were published in English, peer-reviewed and centrally focused on street harassment. Dissertations and nongovernmental organization reports were also included due to the small number of studies in this field. One hundred eighty-two sources were included in the final sample. Findings show that publications on this topic have increased substantially across the two reviews. We provide a thematic overview of key research findings to date and argue throughout that current research suffers from conceptual and typological slippage and does not consistently take into account the need for an intersectional analysis. We close with suggestions for future directions in research and practice, given the emergent nature of the field.
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.
This article presents the results of a review of literature abuse of older women. A systematic search was conducted in five electronic databases for empirical articles published from 2017 through 2019. Of the 727 articles initially captured, 20 articles met the inclusion criteria for review. Across the 20 articles, four primary focal areas emerged: prevalence and incidence of violence and abuse, type of abuse, vulnerable populations, and health outcomes. Most of the studies addressed issues identified in prior publications as the study authors attempted to untangle previous findings, expand study samples, and employ novel approaches to data collection. Only 5 articles focused specifically on violence and abuse experienced by older women; older women comprised at least 50% of the sample in each of the other articles. In the latter studies, when gender was included as a study variable, the study authors reported few differences between older women and men with respect to risk factor for and outcomes of violence and abuse. More gender-specific research is needed to better understand the circumstances and outcomes of their lived experiences and to inform the development of preventive strategies and gender-sensitive interventions for mitigating elder abuse.
Elder abuse is a global problem. However, notwithstanding its suspected prevalence, it remains relatively hidden, frequently occurring in the familial environment. Abuse against older persons violates a number of human rights including, for instance, the rights to security of the person; freedom from cruel, inhuman or degrading treatment; freedom of movement; an adequate standard of living; and the highest attainable standard of health. It is also irreconcilable with the core human rights values of dignity, autonomy and liberty. The law has an essential role to play in promoting respect for these values and protecting the human rights of older persons, particularly in relation to promoting pathways to access both formal and informal mechanisms for justice. A multitude of stakeholders, however, will be needed to successfully address elder abuse and the repercussions this can have on older persons, including promoting the participation of older persons themselves in developing strategies and interventions. Authentic engagement from institutional stakeholders is also essential, notably banking and financial institutions, as well as aged care facilities. This chapter builds upon previous work to apply the foundational human rights framework developed in Chap. 3 to the elder abuse context. It argues that a human rights framework has the potential to achieve the socio-cultural paradigm shift necessary to effect real change in successfully preventing elder abuse and addressing the ageist attitudes that enable such abuse.
Geriatric Forensic Medicine and Pathology - edited by Kim A. Collins September 2020
Introduction
Supporting people subjected to sexual violence includes provision of sexual and reproductive healthcare. There is a need to ensure an environment for safe and supported disclosure of sexual violence in these clinical settings. The purpose of this research is to gain a deeper understanding of how, why, for whom and in what circumstances safe and supported disclosure occurs in sexual health services.
Methods and analysis
To understand how safe and supported disclosure of sexual violence works within sexual health services a realist review will be undertaken with the following steps: (1) Focussing of the review including a scoping literature search and guidance from an advisory group. (2) Developing the initial programme theories and a search strategy using context-mechanism-outcome (CMO) configurations. (3) Selection, data extraction and appraisal based on relevance and rigour. (4) Data analysis and synthesis to further develop and refine programme theory, CMO configurations with consideration of middle-range and substantive theories.
Data analysis
A realist logic of analysis will be used to align data from each phase of the review, with CMO configurations being developed. Programme theories will be sought from the review that can be further tested in the field.
Ethics and dissemination
This study has been approved by the ethics committee at University of Birmingham, and has Health Research Authority approval. Findings will be disseminated through knowledge exchange with stakeholders, publications in peer-reviewed journals, conference presentations and formal and informal reports. In addition, as part of a doctoral study, the findings will be tested in multisite case studies.
PROSPERO registration details
CRD4201912998. Dates of the planned realist review, from protocol design to completion, January 2019 to July 2020.
Bu çalışmada yaş ayrımcılığı kavramının tanımlanması, belirleyicilerinin ve sonuçlarının değerlendirilmesi
amaçlanmıştır. Çalışma kapsamında dünyadaki ve Türkiye’deki güncel durum incelenmiş olup yaş ayrımcılığına bağlı
olarak ortaya çıkan toplumsal ve bireysel problemler ele alınmıştır. Sorunlara ilişkin çözümler sunulmuştur. Yaşlı
bireyler, 65 yaş ve üzerindeki bireyler olarak tanımlanmaktadır. Yaşlı nüfusun sayısal olarak tüm dünyada artma eğilimi;
bir sorun olarak toplumsal yaşamı ve bireylerin sağlık düzeylerini olumsuz etkilemektedir. Bu demografik değişime hazır
olmayan toplumlarda zaman içerisinde daha fazla sayıda yaşlı bireyin savunmasız duruma düşmesi beklenmektedir.
Bu süreçte yaş ayrımcılığının anlaşılması ve yaş ayrımcılığına yönelik farkındalığın arttırılması büyük önem
göstermektedir. Yaş ayrımcılığının önlenmesine yönelik uluslararası mücadelenin desteklenmesi, devletler düzeyinde
üretilen politikaların yaşlıların toplumsal yaşama katılımını arttıracak şekilde düzenlenmesi gerekmektedir. Bireylerin
yaşlanmaya ve yaşlı bireylere yönelik gerçek olmayan olumsuz düşüncelerinin önüne geçilmesi; nesiller arasında
iletişimin arttırılarak yaşlanmaya ve yaşlı bireylere yönelik olumlu tutumların geliştirilmesi sağlanmalıdır.
In this chapter, we present and interrogate findings from an exploratory, qualitative research project on aged care service providers’ ‘best-practice’ responses to older women who have been sexually assaulted as older women or were viewed as ‘at-risk’ of being targeted for sexual assault. Aged care service providers are likely to have access to women who are otherwise isolated and positioned as vulnerable and have the potential to provide a key source of support and intervention. We present findings on the contexts in which participants came into contact with older women who had experienced or were ‘at-risk’ of sexual assault, and the barriers and facilitators to responding ‘well’ to these incidents. Our findings present important practical implications for supporting aged care service providers in responding appropriately to older women in their care who experience sexual assault.
In 2014, the Australian Department of Social Services funded a national project on the sexual assault of older women. This research, known as ‘Norma’s Project’, analysed data from interviews and surveys involving 90 family members and service providers from the justice, health, aged care and community sectors. The sexual assault of older women is a hidden issue that is under-reported and under-researched. This chapter includes a discussion of current statistics and relevant literature and will be structured around the key findings: sexual assaults of older women occur in a range of contexts (relationships to victim) and settings (private homes, aged care facilities, healthcare services, public places); case studies which illustrate the diversity of vulnerabilities among women, the range of perpetrators involved, and the inadequacy of responses from professionals; the improvements required in community awareness, professional education, service protocols and policy focus to address this important issue.
The issue of sexual abuse, assault, rape and unwanted pregnancies among mentally disabled women is largely under-reported for many reasons. Several myths prevail including that mentally disabled women offer little interest to sexual predators, together with a negative public attitude and this contributes to the problem. We report the case of a single centre in Albania, where repetitive sexual assaults were perpetrated against three mentally disabled women. Three unwanted pregnancies followed. The issue gained public attention after three criminal abortions were performed secretly with the aim of covering up the story. Charges were raised against the director of the centre and an employee from the nursing staff. Proceedings are still ongoing. We discuss some details from the forensic investigation and consider several systemic weaknesses that have exposed this vulnerable target group to the risk of being severely and repetitively abused. We believe greater staff awareness, and a better medical and legal framework, are indispensable to deter further offences especially where facilities are under-resourced as here.
Sexual violence occurs in all societies, and across all social classes. Sexual assault permeates all socioeconomic classes and affects millions worldwide. Most victims do not report the assault; those that do often present to an emergency department.
Comprehensive understanding of rape and sexual assault can give health care providers the tools for more effectively handling of these issues. What is the history of rape/sexual assault? What is the epidemiology of sexual violence? What are health effects of sexual assault? What are the psychological aspects of sexual assault on women? What are the characteristics of sex offenders? How can health care providers manage sexual violence towards women? Is sexual violence described in the Bible? The Biblical texts were examined and verses that describe the rape of women were studied closely from the contemporary viewpoint.
Objectives:
This study presents prevalence and characteristics of physical and sexual assaults, and their relationship to posttraumatic stress disorder (PTSD), and mood and anxiety disorders in a nationally representative sample of older women.
Design and setting:
Face-to-face interviews conducted with adult participants from wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions.
Participants:
A total of 3,354 community-residing women of age 65 years and older.
Measurement:
Alcohol Use Disorder and Associated Disabilities Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, current mood and anxiety disorders.
Results:
Almost 14% of participants reported a history of physical or sexual assault or both during their lifetimes. Assaults were often repeated rather than isolated events. Although the majority of participants did not identify interpersonal violence as their "worst" traumatic event, those who experienced interpersonal violence were generally more likely than those without such history to meet the criteria for past-year and lifetime PTSDs, depression, and anxiety.
Conclusions:
Some women who have been physically or sexually assaulted decades earlier continue to report significant levels of mood and anxiety disorders into late adulthood. Several ways to increase the identification and treatment of older female trauma survivors by healthcare providers are suggested.
Discourses on old age and ageing are framed in narrow and binary ways, either as a decline narrative or through discourses of positive and successful ageing. The decline narrative, on the one hand, is highly centred on the decline of the ageing body as frail, leaky and unbounded, and on how old age is characterised by non-productivity, increasing passivity and dependency. Discourses on successful ageing, on the other hand, rely heavily on neo-liberal imperatives of activity, autonomy and responsibility. In successful ageing, the specificities of ageing bodies are largely overlooked while the capacity of the old person to retain a youthful body, for example, with the aid of sexuopharmaceuticals, is celebrated. This article argues for the need of a theorising of old age that goes beyond the binaries of decline and success. Drawing on the work of feminist corpomaterialists Rosi Braidotti and Elisabeth Grosz, the article proposes affirmative old age as an alternative conceptualisation of old age.
As a theoretical project, affirmative old age aims to acknowledge the material specificities of the ageing body and is an attempt to theorise the ageing body in terms of difference but without understanding it as a body marked by decline, lack or negation.
Older age is often associated with asexuality. That is, older individuals are not viewed as desiring of sex, nor as sexually desirable to others. Broader social and cultural norms that downplay women’s sexual desire and agency further compound these phenomena. Whether this popular image accurately reflects older women’s sexual desires, behaviour and capacity to experience pleasure is unclear. Drawing on semi-structured interviews with 43 partnered Australian women aged 55-81, this article considers women’s sexual experiences and desires in older age. The findings of our research confirm that older women’s experiences of sex and sexual desire are diverse and fluid. Some of the factors that influenced participants’ sexual behaviour and desire will be considered in this article, as will their understandings of what “counts” as sexual satisfaction and “successful sex”. The factors affecting sexual behaviour and desire also influence the way in which women are able to negotiate sexual interaction with their partners. Participants expressed a need for education and resources in order to gain greater control and to make autonomous choices over their sexual experiences, desire and ability to give and receive pleasure. The implications of these findings for practitioners are also considered.
Keywords: sexuality, older women, sexual desire, sexual education, sexual resources
This qualitative study examines meanings and experiences of ageism for older
Australians. While the concept is widely applied in academic social analysis,
the term is not understood or used by many of the informants. They talk freely,
however, about negative experiences in ‘being seen as old’ and ‘being treated
as old’. Active ageing is viewed as a positive way of presenting and
interpreting oneself as separate from the ‘old’ group. Informants recognise
that older people as a group experience negative treatment in terms of poor
access to transport and housing, low incomes, forced retirement and
inadequate nursing home care. While few have experienced overt or brutal
ageism, interaction in everyday life involves some negative treatment,
occasional positive ‘sageism’, and others ‘keeping watch’ for one's vulnerabilities.
Health professionals are a major source of ageist treatment. Some
older people limit their lives by accommodating ageism, while others actively
negotiate new images of ageing for themselves and those who will be old in the
future.
PurposeThere is extensive literature related to the experience of sexual assault of women with a majority focused on younger women, college-aged women, or older women. There is little research about the experience of sexual assault of mid-life women.Design and Methods
This paper synthesizes the current literature associated with sexual assault by describing the increased number of single women in the population, defining terms associated with sexual assault, examining rape myths, characteristics of the victim, describing the relationship of victim to assailant, extent of victimization experienced by women, common physical injuries, age-related physiological changes, psychological considerations, and post-traumatic stress disorder specific to mid-life women.FindingsThe population of single women has increased across the life span. Current studies utilize varying definitions of sexual assault, examine results across variable age groups, and include the responses of single women with married women. Characteristics of victims demonstrate similarities by age group, relationship type, living conditions, and physical or mental capabilities that affect the occurrence of sexual assault.Practice ImplicationsThere are few studies that examine the sexual assault experiences of single mid-life women. Further research into the experiences of single mid-life women is warranted to provide direction for nursing education programs and clinical practice.
Abstract We describe the annual prevalence of sexual abuse among community dwelling older adults in the United States. We also describe factors associated with experiencing sexual abuse. We used data from 24,343 older adults from the 2005 Behavioral Risk Factor Surveillance System pooled across 18 states. We estimated prevalence of sexual abuse, bivariate distributions, and odds ratio associations across demographic, health, and contextual factors. Our results show that 0.9% of older adults reported experiencing sexual abuse in the previous year. This represents approximately 90,289 community dwelling older adults. We also report on factors associated with experiencing recent sexual abuse. There was a significant gender-by-binge drinking interaction, with a stronger association among women. There is a need for health promotion efforts targeted specifically towards older adults, encouraging them to seek services, if possible, after exposure to sexual abuse.
Intimate violence against older battered women has been neglected by researchers as well as by practitioners and advocates. The aim of this paper is to describe and analyze the experiences and perceptions of older battered women in coping with and surviving the violence. Qualitative in-depth interviews were conducted with twenty older battered women prior to group intervention. The analysis of interviews revealed four major themes: (1) Experiencing the self from two opposite poles: heroines or fools; (2) Giving up the self for the sake of family members; (3) Children as meaningful others: Friends or foes? (4) Lost in time between a painful past and a trap-like future. These findings are discussed in terms of women's overall existential experience. Some implications for future intervention are suggested.
This paper addresses the appropriate legal and policy approach to sexual conduct involving people with dementia in care homes,
where the mental capacity of one or both partners is compromised. Such conduct is prohibited by sections34–42 of the Sexual
Offences Act 2003, but this article asks whether this blanket prohibition is necessarily the appropriate response. The article
considers a variety of alternative responses, eventually arguing that clearer guidance regarding prosecution should be issued.
KeywordsSexual expression and human rights-Sexuality-Dementia-Care homes-Senior Citizens’ homes-Capacity and sexual conduct
Rape conviction rates have fallen to all-time lows in recent years, prompting governments to explore a range of strategies
to improve them. This paper argues that, while the current legal impunity for rape cannot be condoned, increasing conviction
rates is not in itself a valid objective of law reform. The paper problematises the measure of rape law that conviction rates
provide by developing an account of (some) feminist aims for rape law reform. Three feminist aims and associated measures
are explained—all of which look beyond conviction rates to qualitative and victim-centred outcomes of criminal justice processes.
Applying these measures, I argue that strategies designed solely to increase conviction rates are more likely to work against,
rather than in support of, feminist aims. The paper thus underscores the need for continued feminist engagement with rape
law reform, broadly conceived, notwithstanding its acute limitations for feminist anti-violence politics.
KeywordsConviction rates–Feminist aims–Law reform–Measures–Rape–Sexual assault
We estimated prevalence and assessed correlates of emotional, physical, sexual, and financial mistreatment and potential neglect (defined as an identified need for assistance that no one was actively addressing) of adults aged 60 years or older in a randomly selected national sample.
We compiled a representative sample by random digit dialing across geographic strata. We used computer-assisted telephone interviewing to standardize collection of demographic, risk factor, and mistreatment data. We subjected prevalence estimates and mistreatment correlates to logistic regression.
We analyzed data from 5777 respondents. One-year prevalence was 4.6% for emotional abuse, 1.6% for physical abuse, 0.6% for sexual abuse, 5.1% for potential neglect, and 5.2% for current financial abuse by a family member. One in 10 respondents reported emotional, physical, or sexual mistreatment or potential neglect in the past year. The most consistent correlates of mistreatment across abuse types were low social support and previous traumatic event exposure.
Our data showed that abuse of the elderly is prevalent. Addressing low social support with preventive interventions could have significant public health implications.
The clinical records of five men who had sexually assaulted women aged 60 or over were compared to the records of seven men who had sexually assaulted younger victims. Details of childhood adjustment, psychiatric and criminal histories, psychiatric diagnosis, psychological assessment findings, and offence characteristics were examined to determine psychological and social factors specifically associated with the sexual assault of older women. The findings suggest that when victims are older women, the sexual assault is likely to be particularly brutal and largely motivated by anger, a need for power, or sadistic intent. Further, the gratuitous violence involved in the offences and clinical evidence of psychotic features, suggest more severe psychopathological processes in men who sexually assault older women than in those who assault younger victims. Implications for theory and clinical practice are discussed.
This study sought to develop a profile of rape cases within a Constabulary in the South West of England, and identity factors associated with attrition. All cases of rape or attempted rape of a female or male over the age of 16 from 1996 to 2000 were identified. Quantitative and qualitative data on 379 cases was collected using the CIS and questionnaires sent to the relevant Chief Investigating Officer. The profile of attrition differed in several respects from previous research. Analysis of the extensive written comments provided by the officers afforded insight into the police perspective on rape. The findings are discussed with reference to future research and practice.
This article explores the current law, policy and practice issues relevant to sexuality and dementia, particularly in care home settings. These issues include: the assessment of the sexual needs of people with dementia; how decision-making capacity about sex is considered and supported; the rights-based issues for service users and carers; how sexual relationships within care homes may be facilitated; and some of the complexities in practice. It is argued that these issues have not been appropriately addressed in the past and identifies some of the possible societal, cultural and individual barriers to people in care settings, especially those with dementia, expressing their sexuality. There is an increasing need to consider these issues due to: demographic changes; developments in legal and policy frameworks; and better understanding of people’s rights and capacity to make decisions. The article focuses on services in Northern Ireland where a proposed new legal framework, the Mental Capacity (Health, Welfare and Finance) Bill, will have important implications for future practice in this area. The immediate implications for practice are also discussed and recommendations are outlined for: assessment; person-centred approaches; strategies for intervention; training and support; and policy development.
Geriatric Sexuality remains one of the more sensitive and controversial issues to be confronted in today's clinical setting. Research indicates that older adults continue to be sexually active well into later life. Older adults with dementing illnesses experience deleterious changes in sexual functioning that can affect their quality of life. However, few health care professionals ask older adults about their sexual functioning. This paper addresses means of fostering acceptance by professionals and families and creating an environment that nurtures sexuality in couples coping with dementia.
Little is known and less is written about post-traumatic stress disorder (PTSD) in institutionalized older adults, especially in the context of their past exposure to child sexual assault. The behavioral and psychological manifestations displayed by child sexual abuse survivors are considered especially in the context of possible symptom reactivation throughout the life course. Analysis is offered of the ways in which aging itself and the organizational practices of long-term care institutions may serve to reactivate and exacerbate long-dormant child sexual abuse thoughts, feelings, and symptoms in residents. Specific recommendations for needed research as well as nursing home staff training, programming, and policy are put forward.
Twenty-eight cases of suspected elder abuse were identified and described by elder protective service workers. All the victims were female, and 71% experienced significant limitations in capacity for independent functioning and self-protection. Indicators of sexual abuse included victim self-report and third party observation of assault, physical injury, and psychosocial symptoms. All but one of the suspected offenders were male. Eighty-one percent were caregivers for the women they allegedly assaulted, and 78% were family members, predominantly sons and husbands. Repeated vaginal rape was the most prevalent type of reported assault. Findings of the study are presented, and issues relative to the sexual victimization of elders are discussed.
Sexual assault is a crime of violence affecting modern American society. Victims of sexual assault tend to be women from a broad cross-section of social, economic, ethnic, and age groups. The postmenopausal woman is not immune from sexual assault and is increasingly a victim. The author presents the topic of sexual assault within the general framework of the physician's role in caring for a postmenopausal victim of this crime.
There is little professional literature, research, or training regarding edler sexual abuse, despite the fact that cases are being identified in many locales. This article presents guidelines and techniques for identifying and interviewing possible elder victims of sexual abuse. Specific techniques are illustrated for working with non-verbal elders. Intervention strategies are suggested for cases in which sexual abuse has been substantiated.
Ninety cases of suspected elder sexual abuse were identified by professionals working with vulnerable elderly people in Britain. A female to male victim ratio of 6:1 was indicated and some 85% of all victims were aged 75 years and over. In all but two cases, the abuser was male. Almost 90% of the victims were dependent on their abusers for care. Preliminary findings of the study are presented and the implications of the research are considered.
Sexual abuse of older adults is an issue that even the most proficient and competent of service providers to older adults feel poorly-equipped to handle professionally. This paper describes a three-day competency-based training curriculum on adult/elder sexual abuse developed for Adult Services and Adult Protective Services workers in Virginia. A rationale and background description are provided, followed by a discussion of the basic themes and principles on which the course was based. A list of course objectives and a summary of course content are provided, as well as informal evaluative data on success of the curriculum development project. The paper concludes with recommendations for other practitioners in aging interested in the development and delivery of similar training programs.
Objectives: This qualitative study canvassed residents' perceptions of the needs and barriers to the expression of sexuality in long-term care. Methods: Sixteen residents, including five with dementia, from six aged care facilities in two Australian states were interviewed. Data were analysed using a constant comparative method. Results: Four categories describe residents' views about sexuality, their needs and barriers to its expression: ‘It still matters’; ‘Reminiscence and resignation’, ‘It's personal’, and ‘It's an unconducive environment’. Discussion: Residents, including those with dementia, saw themselves as sexual beings and with a continuing need and desire to express their sexuality. The manner in which it was expressed varied. Many barriers to sexual expression were noted, including negative attitudes of staff, lack of privacy and limited opportunities for the establishment of new relationships or the continuation of old ones. Interviewees agreed that how a resident expressed their sexuality was their business and no one else's.
This study evaluated elderly victims of rape and determined the variables affected solely by the patient's age. It was conducted in a non-hospital-based clinic that serves as the primary resource for rape victims in Shelby County, Tennessee. Fifty-three women, 55 years of age or older, were compared with 53 patients aged 18 to 45 who were selected for the control group. The racial composition was similar for both groups. There was no difference in the time interval to examination. Among the elderly, the majority of assaults (71.7%) took place at the victim's home, and most were by an unknown assailant. Genital injuries were more prevalent among the elderly victims. Intimidation by physical force was all that was necessary to subdue the victim in most cases, and the assailants' racial distribution was similar in both groups.
A great deal of research has considered the dynamics of sexual assault and the way that sexual assault cases are processed and handled in the criminal justice system. Most of this research has focused on sexual assault cases involving younger victims. Very little criminological research has considered the dynamics of elder sexual abuse. To fill this void, the current study uses a sample of 127 elder sexual abuse cases and 314 elder physical abuse cases to shed some light on the dynamics of elder sexual abuse and the way the justice system processes these cases. Attention is also given to the way that the processing of elder sexual abuse cases can be distinguished from the processing of elder physical abuse cases. Results show that a wide range of elder sexual abuse cases are committed and these cases are processed differently than elder physical abuse cases. Implications are provided.
Although sexual violence against women has received increasing attention over the past decades, the sexual assault of the elderly has not been as well addressed. One group, however, brings news of these cases to us weekly, if not daily. Print media (and the Internet) report on these cases and the crises and trauma that follow for the victims and their families. For purposes of this article we reviewed newspaper, LexisNexis, and PubMed databases from 1995 to 2004. This forensic mental health article seeks to raise clinicians' awareness and sensitivity to the plight of the elder rape victim by illustrating facts with documented cases and offering suggestions for brief and crisis-oriented intervention. © The Author 2005. Published by Oxford University Press. All rights reserved.
This study examined correlates of past-year chronic medical conditions and lifetime contact with health care professionals for mental health and substance abuse problems in women with differing histories of sexual victimization (N = 627) identified from the National Comorbidity Survey (e.g., assault in childhood, adulthood, or both life phases). Posttraumatic stress disorder (PTSD) and stressful life events were associated with greater odds of chronic medical conditions among women sexually assaulted in childhood only. Additional traumatic events were associated with greater odds of chronic medical conditions among victims of adult sexual assault. Older age and being married were associated with greater odds of lifetime health care professional contact for mental health/substance abuse issues among certain victim subgroups. Stressful life events were related to greater help-seeking for child victims, and traumatic events were related to greater help-seeking in adult victims. Alcohol dependence symptoms and PTSD were each associated with greater odds of lifetime health care professional contact among women victimized in both life phases, whereas depression was related to greater odds of help-seeking for women victimized in one life phase only. Psychosocial factors may play unique roles in health outcomes for women with different sexual assault histories.
The study objective was to compare elders with a dementia with those without a dementia as to method of disclosure of sexual abuse, forensic markers of sexual abuse and legal outcome of cases. A convenience sample was obtained of 284 forensic cases known to a multidisciplinary group of professionals who investigated, examined or consulted on elder sexual abuse victims. The Comprehensive Sexual Assault Assessment (CSAAT) was used to enter data from case files. 60 percent of the 284 elders were diagnosed with some degree of dementia. Elders with dementia, compared to those without a diagnosis, were abused more often by persons known to them (family member, caregiver or another nursing home resident) than a stranger, presented behavior cues of distress rather than verbal disclosures, were easily confused and verbally manipulated, and were beaten. Suspects who were identified whom abused elders with dementia had less chance of being arrested, indicted or plea bargained. All reported suspected cases of elder sexual abuse need a complete physical examination as well as a sexual assault evidence kit. Patterns of verbal, behavioral or physical changes of elders can be used to support an allegation of sexual assault.
This paper addresses the theme of responsibility when resident sexual expression becomes a component of care work. A short review of the medical and social models of care is followed by an exploration of findings from case study material from a doctoral research programme undertaken in one social work residential home in Scotland. While it is not possible to generalize from this small empirical study, the findings offer some interesting insights. The 'halo' effect of dementia where people are often viewed as not responsible for their actions is questioned. The ambiguous nature of the condition points to dementia being a contested area. Resident responsibility appears dependent on how mentally capable each of the staff perceive the resident to be and this may vary. Responsibility appears also a concern for women staff. It was seen as staffs' own responsibility not to place themselves at risk from the sexual advances of male residents at the social evenings of the home or at other times. If staff were accosted some were made to feel in some way responsible. Training, a proactive approach by managers to resident sexual expression, and long-term emotional support for staff appeared lacking.
The case analysis explores an emergency department visit by a 67-year-old female with early dementia post-brain attack, with complaints of possible sexual assault or abuse. This patient resides in a long-term skilled nursing facility. The case outlines the forensic care provided by the Advanced Practice Forensic Nurse (APFN) once medically cleared by the emergency department Advanced Practice Nurse (APN). The case discussion includes issues related to sexuality in aging populations, consent, sexual abuse or assault in institutions, and forensic care of older persons. Expected genital injuries in older women that result from sexual assault and abuse are also explored. The case discussion will analyze the key elements for critical thinking and clinical reasoning and demonstrate standards of care for the APFN and APN practice.
Despite the not infrequent occurrence of the rape of an elderly woman and the subsequent public shock that is generated, this type of offence remains poorly reported in the medical and scientific literature. This article reviews what little literature is available and brings together the existing knowledge about the phenomenon. The paucity of hard data is emphasized along with the almost complete lack of understanding in respect of the underlying motivations within this offender group. Further work is required, namely the development of theoretical models and the conducting of robust observational studies.
Relatively little is known about the lives of transgender people once they are through their gender transition. Even less is known about transgender elders, either those who transitioned many decades ago and now have grown older or those who are transitioning in mid- or later-life. This article reports on the findings of three online surveys of transgender adults age 50 years and older on three topics: sexual violence, elder abuse, and sexuality. Sexual violence and elder abuse had been experienced by a strong majority of those surveyed. The sexuality survey demonstrated clearly that there is a vast range of diversity in transgender people's sexual lives and that the majority of midlife and older transgender people believed their gender identity influenced their sexuality.
Little empirical research has been published concerning sexual offending against older female victims. We analysed all recorded sexual offences against adult women over 5.25 years in a circumscribed semi-rural area, calculated prevalence rates and attributable risk values, and used case control and descriptive methodology to analyse the crime scene characteristics. Sexual offences committed against older or elderly women are uncommon. Sexual offences against women aged 60+ years are not characterized by excessive violence and are typically carried out in a residential domestic setting by a single male assailant who is significantly older than is the case for typical sex offenders. Sexual offences where the female victim is 30+ years older than the male offender are typically minor assaults perpetrated by young drunk males in public places. Fears about increasing numbers of elderly female victims of sexual assault based on established demographic trends in Western societies may be misplaced. Sexual offences in which there is a large age gap between victim and perpetrator are likely to represent a different form of criminological phenomenon.
A report from the National Center on Elder Abuse (NCEA) defines sexual abuse as nonconsensual sexual contact of any kind with an elderly person. While such forces as ageism, sexism, and hypercognitivism uniquely situate women with dementia as at risk for sexual maltreatment, autonomy-centered bioethical approaches may, like the NCEA, fail to differentiate between coercive and assentual forms of “nonconsensual” sexual activity. This critical analysis brings to light the complexity of sexual ethics in the context of cognitive impairment. The author argues, from a relationship-centered perspective, that although women with dementia are particularly vulnerable to abuse certainly some, if not most, sexual activity between loving spouses may be morally permissible even when one partner has dementia and cannot consent.
Information on the scale and scope of resident-to-resident abuse, including verbal, physical, material, psychological, and sexual abuse, is presented. Nursing homes (n = 249) from ten states were used, with a total of 4,451 nurse aides in these facilities returning the questionnaire. Most nursing homes experienced verbal, physical, material, and psychological abuse, but sexual abuse was less common. Our findings clearly show that both the scale and scope of resident-to-resident abuse is high in nursing homes. Resident-to-resident abuse is common enough to be considered an issue of concern impacting the quality of life and safety of many residents.
Sexual self-determination is considered a fundamental human right by most of us living in Western societies. While we must abide by laws regarding consent and coercion, in general we expect to be able to engage in sexual behaviour whenever, and with whomever, we choose. For older people with dementia living in residential aged care facilities (RACFs), however, the issue becomes more complex. Staff often struggle to balance residents' rights with their duty of care, and negative attitudes towards older people's sexuality can lead to residents' sexual expression being overlooked, ignored, or even discouraged. In particular, questions as to whether residents with dementia are able to consent to sexual activity or physically intimate relationships pose a challenge to RACF staff, and current legislation does little to assist them. This paper will address these issues, and will argue that, while every effort should be made to ensure that no resident comes to harm, RACFs must respect the rights of residents with dementia to make decisions about their sexuality, intimacy and physical relationships.
This article explores the convergence of sexual medicine and anti-aging medicine as they have refashioned standards of sexual functionality and reconstructed sexual life courses. Reversing the long-held stereotypes of asexual or post-sexual seniors, expectations of continued sexual functionality as an indicator of health in later life now underpin a growing medical and therapeutic industry. While more positive images of eldersex are certainly an improvement over past views that saw older people as both undesiring and undesirable, this article suggests that caution should be exercised regarding an overly celebratory reading of the medicalized construction of "sexy seniors."
The clinical records of five men who had sexually assaulted women aged 60 or over were compared to the records of seven men who had sexually assaulted younger victims. Details of childhood adjustment, psychiatric and criminal histories, psychiatric diagnosis, psychological assessment findings, and offence characteristics were examined to determine psychological and social factors specifically associated with the sexual assault of older women. The findings suggest that when victims are older women, the sexual assault is likely to be particularly brutal and largely motivated by anger, a need for power, or sadistic intent. Further, the gratuitous violence involved in the offences and clinical evidence of psychotic features, suggest more severe psychopathological processes in men who sexually assault older women than in those who assault younger victims. Implications for theory and clinical practice are discussed.
Sexual assault of older women may occur within the context of elder mistreatment, domestic violence, or victimization of homeless
or mentally ill individuals. Older women with self-care deficits due to impaired physical, cognitive, or psychiatric function
or substance use may be vulnerable to sexual assault either because of an inability to self-defend or make wise choices about
their environment, or due to exposure to potential offenders. Using consecutive clinical cases of women ages 50 and older
(N = 198) who presented for a sexual assault exam, the authors searched for differences in victim, suspected offender, and
assault characteristics by alleged victims’ living arrangement (institutional, domestic, homeless, or unknown). The authors
found significant differences by living arrangement in age and impaired consciousness at onset of assault; relationship of
suspected offender to victim; and in type(s) of coercion, weapon(s) used, and body trauma. Findings have implications for
practice, research, and policy.
Key wordssexual abuse-older adults-elder mistreatment-domestic violence in later life-homeless women-vulnerable populations
Interpersonal traumatic experiences (childhood abuse, sexual assault, and intimate partner violence) are common in older adult women and associated with negative short-term and long-term outcomes. Thus, assessing trauma symptoms is essential to providing adequate services. This article explores challenges of measuring trauma in older women, describes the Posttraumatic Diagnostic Scale (Foa, 199514.
Foa , E. B. ( 1995 ) . Posttraumatic Stress Diagnostic Scale (PDS) manual . Minneapolis, MN : National Computer Systems . View all references), and evaluates the appropriateness of this instrument using data from a current study of older adult women. Symptom severity scores did not consistently reflect the experiences of the sample. Eschewing a clinical interview to assess the impact of interpersonal trauma in older adult women may be a mistake.
Admission to a nursing home might challenge the way in which individuals experience their own sexuality, but it does not automatically diminish their need and desire for sexual fulfillment. Despite the fact that sexuality proves to be an intrinsic part of human existence, the sexual expression of geriatric residents remains a sensitive subject for many caregivers and family members. It evokes a variety of ethical issues and concerns, especially when dementia patients are involved. The overall objective of this review was to examine the ethical arguments and concepts about the debate on sexuality within a nursing home environment.
We conducted a systematic search for argument-based ethics literature focusing on sexuality in institutionalized elderly people. Twenty-five appropriate studies were identified.
A thematic analysis of the included literature led us to distinguish two major groups of ethical arguments: (i) principles and (ii) care. Ethics arguments on sexuality in institutionalized elderly are particularly guided by the principle of respect for autonomy and the concomitant notion of informed consent. Arguments related to care were also apparent within the research literature although they received considerably less attention than the arguments related to the principles of respect for autonomy, beneficence, nonmaleficence and justice.
The lack of clarity in the conceptualization of the arguments referred to in the research literature indicates that there is a pressing need for a better defined, more fundamental philosophical-ethical analysis of the values at stake.
This systematic review synthesizes the quantitative empirical literature concerning older women survivors of physical and sexual assault.
A literature search was conducted using a range of scholarly databases. Information is presented here on the prevalence, correlates, and consequences of these types of interpersonal violence in older women. Additionally, age-related differences in prevalence, psychiatric distress, and characteristics of violence, including information on perpetrators, are reviewed.
Overall, older women report lower lifetime and past year rates of physical and sexual assault and associated negative psychologic consequences compared to younger and middle-aged women. Additionally, older women who experienced interpersonal violence report greater psychiatric distress, including posttraumatic stress disorder (PTSD), than older women who have not experienced such events.
Some women who have been physically or sexually assaulted decades earlier in life continue to report significant levels of PTSD well into older adulthood. Gaps in the literature, including lack of information on ethnicity and culture, are presented, and future research directions are proposed.
To determine whether postmenopausal women have a greater susceptibility to genital and extragenital injuries as a result of sexual assault.
Retrospective review of patient notes.
The Havens sexual assault referral centres, Camberwell and Paddington, London, UK.
A total of 122 postmenopausal and 130 premenopausal women.
Eligible women were identified. Standardised Haven forms completed during forensic examination were retrieved for each participant, and relevant information was extrapolated to study forms.
Demographic and assault-related characteristics, prevalence of genital and extragenital injury, type, size and location of injury, and logistic regression predicting study group.
37% of postmenopausal women and 17% of premenopausal women sustained genital injury (multivariate analysis OR 3.31, 95% CI 1.39-7.91), and 71% of postmenopausal women and 69% of premenopausal women were found to have extragenital injury (univariate analysis OR 1.35, 95% CI 0.79-2.32, not significant). Of those with extragenital injury, 41.4% of postmenopausal women and 20.9% of premenopausal women sustained large bruises (P < 0.01).
When controlling for the effects of demographic and assault-related characteristics, postmenopausal women were more than three times more likely to sustain genital injury than premenopausal women following a sexual assault. No significant difference between the two groups was found for extragenital injuries; however, of those who sustained an extragenital injury, postmenopausal women were significantly more likely to have large bruises than premenopausal women.
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.
In this article, we review the literature on physical and sexual elder abuse within the context of risk theory and feminist sociology. Employing data from the 1999 General Social Survey, we also examine several variables potentially associated with the risk for physical or sexual abuse of elders. Women, Aboriginal Canadians, and elders who are divorced, living in urban areas with low income have a higher risk of physical or sexual abuse. This supports risk and anxiety as factors. Further testing of elder abuse using this theoretical framework is required.
This article reports research findings concerning 119 alleged sexual perpetrators who were reported to state authorities for abusing elderly individuals residing in care facilities. The largest group of accused was employees of the facilities, followed by facility residents. Family members of the alleged victims and visitors to the facilities also were among those reported as sexually abusive. Investigation of the allegations by Adult Protective Services and regulatory staff resulted in 32 of these individuals being confirmed as sexual perpetrators against vulnerable elders. Male and female alleged and confirmed sexual perpetrators were identified as well as both male and female elderly sexual abuse victims. Perpetrator characteristics, victim vulnerabilities, abuse acts, locations of assaults, and available case outcomes are presented. Implications of the findings are discussed.
Physiological and anatomical changes that occur as a result of menopause alter sexual response and sexual function. These changes can result in genital injuries from both consensual sexual intercourse and sexual assault. The purpose of this article is to review the literature examining what is known about postmenopausal women and genital injuries. Only seven research studies were found that examine genital injuries in postmenopausal women after sexual assault. Of the comparative studies, a majority determined that postmenopausal women are more likely to sustain genital injuries after sexual assault than younger women. No literature was found that specifically investigates genital injuries incurred as a result of consensual sexual intercourse versus sexual assault in the postmenopausal population.
Sexual violence perpetrated on elders is a significant problem. Elder sexual assault victims often need more assistance than younger victims, yet they typically receive fewer services. Rape crisis centers have faced a multitude of barriers in addressing elder sexual abuse. This article provides an overview of the rape crisis movement and discusses why elders have been both overlooked as potential targets of sexual assault and underserved as victims. Recommendations are made to encourage collaboration between elder and rape crisis advocates. This article describes a Pennsylvania project to cross-train Department of Aging protective service workers and rape crisis advocates.
Although sexual interests in institutionalized elderly patients have long been recognized (Comfort, 1974; Wasow & Loeb, 1974), guidelines to help determine patients' competencies to participate in intimate relationships are not delineated in the literature. This paper describes the assessment technique used by an interdisciplinary staff on a coed Alzheimer's disease unit. Two case studies are presented to highlight how the assessment led to the treatment decisions.