Unit 4: Sexual violence against older people

Older people, particularly those with dementia or those living in assisted care facilities can be particularly vulnerable to sexual violence. Problems with detecting sexual violence against older people and issues of under-reporting of sexual assault generally mean that this is a much under-researched area. The World Health Organisation defines sexual violence as: ‘any act, attempt to obtain a sexual act, unwanted sexual comments or advances...against a person’s sexuality using coercion, by any person...in any setting’ (WHO, 2015, p. 35).

  Introduction

Older people, particularly those with dementia or those living in assisted care facilities can be particularly vulnerable to sexual violence. Problems with detecting sexual violence against older people and issues of under-reporting of sexual assault generally mean that this is a much under-researched area. The World Health Organisation defines sexual violence as: ‘any act, attempt to obtain a sexual act, unwanted sexual comments or advances...against a person’s sexuality using coercion, by any person...in any setting’ (WHO, 2015, p. 35).

  Key message

  • Older adults can be especially vulnerable to sexual violence and abuse, especially those who have a cognitive condition
  • There is a general low level of reporting in this area, which can contribute to abusive situations or relationships going undetected

  Learning outcomes

  1. Be aware that sexual violence and abuse may be largely under-recognised in older populations
  2. Be aware of the types of abuse and potential indicators
  3. Understand strategies to assist health and social care practitioners to respond to incidents or signs of sexual violence or abuse

 

  Content

Acts of sexual violence against older people can include:

  • Rape- including penetration by non-bodily objects
  • Assault- including unwanted touching of the genitals and forced masturbation and/or oral sex
  • Taking sexual photos of the older person without their consent
  • Intrusive and unnecessary procedures involving the rectum or genitals
  • Exhibitionism and/or voyeurism- i.e., masturbating in front of or exposing oneself to the older person and/or watching an older person in a state of undress without their consent
  • Any unwanted touching that is sexual in nature
  • Threats of sexual abuse and sexual harassment

             (Chihowski & Hughes, 2008; Ramsey-Klawsnik, 2004).

 

Sexual violence or sexual abuse of older people can be perpetrated by partners, family members, strangers and care-givers. Older people living with dementia and women are especially vulnerable to sexual abuse (Burgess & Phillips, 2006). Sexual violence and sexual abuse of older people can lead to significant psychological and emotional problems for the victim, as well as having an adverse impact on their physical health and well-being. Moreover, older people are more likely than younger victims of sexual violence to require hospitalisation and to suffer serious injury and genital trauma (Burgess & Philips, 2006; Burgess, Hanrahan & Baker, 2005; Eckert & Sugar, 2008). For patients with dementia, especially those with limited verbal abilities, detection of sexual abuse can be problematic and often as low as only one in eight are able to self-report abuse (Burgess & Philips, 2006).

 

Recognising the signs

In the absence of victim disclosure, a health and social care practitioner should be on the lookout for physical signs of sexual abuse. While patients with dementia are more likely to be physically coerced than patients without dementia, any signs of physical trauma in a patient should be thoroughly investigated. Possible physical signs of sexual abuse may include:

  • Bruising on the arms and wrists from being forcible restrained
  • Bruising or tenderness of the genital area
  • Vaginal or rectal bleeding
  • Abrasions, swelling, redness or tears in the perianal area

Many older patients who are cognitively impaired with dementia and/or Alzheimer’s disease may communicate their distress through behavioural cues if unable to communicate verbally (Benbow & Haddad 1993).

Such behavioural disclosure can occur in a number of ways 

  • Indirect statements (as in, for example, “don’t let that man near me!”)
  • Sudden behavioural change, including becoming withdrawn, refusing personal care, or retreating into the foetal position
  • Displaying a fearful or an ambivalent response towards a suspected abuser
  • Displaying a guarded response when asked about abuse
  • Becoming upset or distressed while receiving personal care

Strategies for addressing potential abuse

As many older people, particularly those with cognitive impairments, are frequently accompanied by a care-giver it can be especially challenging for health and social care practitioners who may be suspicious that abuse is taking place, to raise the issue. In such circumstances, assessing the suspected victim on their own is advised (O’Connor et al., 2009). In cases where an older person has a cognitive impairment, health and social care practitioners should be conscious to:

  • Use clear, direct and non-emotive language
  • Speak slowly and clearly
  • Use non-leading questions
  • Ask one question at a time
  • Ask questions about who, what, where and when, but not why
  • Be patient in tone and demeanour
  • Use language and terminology appropriate to the person
  • Employ visual aids, where possible

(Downes et al., 2013: 16). 

Conclusion

Sexual violence and abuse of older people is frequently under-reported. This contributes to the incorrect notion that older people are at less risk of sexual violence or abuse. Moreover, this view is often prevalent amongst older people, as well as health and social care practitioners. Regardless of such common misconceptions, older people are at risk from sexual violence and abuse, with individuals with cognitive impairments more so. Indeed, it is frequently the case that perpetrators will seek out such individuals, precisely because they are more vulnerable and less likely to report incidents of abuse.

Health and social care practitioners therefore need to be acutely aware of the possibility of sexual violence or abuse against older people. In cases where an individual may have a cognitive impairment, health and social care practitioners should be mindful of behavioural cues that can indicate that abuse may be occurring. Older people with a cognitive impairment are frequently accompanied by carers, who may be an abuser. This can make raising suspicions of abuse more difficult for health and social care practitioners. Where possible, health and social care practitioners should conduct assessments with suspected victims independent of carers and should employ direct, sensitive and appropriate questioning of the older person.

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This project has been funded with support from the European Commission. This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein