Detecting sexual abuse in elders

Over the past year, the news has been filled with tragic stories about children who have been sexually abused. The fact is that the number of children being sexually molested, assaulted and raped in this country and abroad is appalling — and growing. It is estimated that one in four girls and one in six boys will experience sexual abuse before their 18th birthday.

Unbeknownst to them, their grandparents might know of their pain because they, too, are quietly suffering from sexual abuse themselves.

Elderly sexual abuse

Sexual abuse of the elderly is one of the most underreported crimes of all. It’s easy to ignore; the victim often depends on the perpetrator for care, and might suffer from mild dementia and become confused — which means they may not be able to fully recall what occurred. The victim could be fearful that saying something will lead to being institutionalized. Also, given the older generation’s view on sexual behavior, victims could quietly blame themselves and be ashamed of what they think they’ve caused.

Victims of sexual abuse often live alone and have no peers. If a victim lives in a facility, he or she could fear some sort of reprisal for reporting the abuse. The victims often doubt anyone will believe them, so see no sense in telling.

Sexual molestation or rape could also occur from another resident who, in the fog of dementia, thinks he’s having relations with his deceased wife or, in the throes of Alzheimer’s, has lost all sense of sexual boundaries as he wanders the halls during sleepless nights.

Sexual abuse defined

The Older Adults Protective Services Act defines sexual abuse as “Intentionally, knowingly or recklessly causing or attempting to cause rape, involuntary deviate sexual intercourse, sexual assault, statutory sexual assault, aggravated indecent assault, indecent assault or incest on persons 60 years and older.” Besides sexual abuse, the Protective Services Act also covers sexual harassment whereupon a person is forced, tricked, coerced or manipulated into any unwanted sexual contact.
 

Spotting the abuse

Despite the silence among the victims, a more educated professional community of nurses, direct care workers, physicians, social workers and police are detecting elder sexual abuse and enabling those affected to safely come forward to end their plight.

“We’ve been seeing an increase each year in total elder abuse allegations, sexual allegations reported and substantiated cases of sexual abuse,” said Denise Getgen, chief of the Pennsylvania Department of Aging’s Division of Consumer Protection. “Among those cases we’re witnessing a greater incidence of resident-to-resident sexual harassment in facilities and sexual abuse by family members or paid caregivers in the community.”

If you work in the health care field, visit with older people who are dependent upon others, know of an older person who lives alone or volunteer in long-term care or assisted living facilities, take a moment to familiarize yourself with the signs of potential sexual abuse among older people. According to experts and the Pennsylvania Coalition Against Rape, these are signs to look for:

Physical Signs

• Bruising on inner thighs
• Genital or anal bleeding
• Sexually transmitted diseases or infections
• Difficulty walking or standing
• Pain and/or itching in the genital area
• Worsening of existing illness(es)
• Lack of appetite or other eating disorder

Emotional signs

• Scared or timid behavior
• Withdrawal and wanting to be alone
• Any sudden change in personality
• Acting overly compliant
• Suicidal thoughts and/or attempts
• Odd comments about sex or sexual behavior
• Agitation or aggression
• Confusion

Older people who have been sexually abused are more likely to suffer broken bones and soft tissue injury, so don’t overlook a broken limb if it occurred under suspicious circumstances.

   
“There’s a double tragedy with sexually abused older adults because there is a higher rate of physical injury and fear that the perpetrator, who often is a caregiver, will abandon the older adult with no one left to meet their basic survival needs,” said attorney Ron W. Costen, Ph.D., professor of social work and director of the Protective Services Institute at Temple University. “The choice often appears to the older adult to be basic survival versus tolerating the sexual assaults. We must be more aggressive at finding these perpetrators and removing them from society.”

If you suspect sexual abuse, place a call to the local elder abuse hotline; a directory of state-by-state numbers can be found by clicking here. If you need to report a rape, call the Rape Crisis Helpline at 888.772.7227. If someone is in immediate danger, call 911 or the local police for immediate help. If you aren’t sure that an older person is being sexually abused, but your instincts tell you something is off, call either helpline for advice on what to do and how to approach the potential victim so they might feel safe enough to break their silence. 

The bottom line

• Sexual abuse among the elderly is more common than we’d like to think – and goes largely unreported because the victims might be confused, feel ashamed or be afraid of possible repercussions of reporting the abuse.
• The Older Adults Protective Services Act defines sexual abuse as “Intentionally, knowingly or recklessly causing or attempting to cause rape, involuntary deviate sexual intercourse, sexual assault, statutory sexual assault, aggravated indecent assault, indecent assault or incest on persons 60 years and older.”
• There are both physical and emotional signs of abuse. Older people who have been sexually abused are more likely to suffer broken bones and soft tissue injury, so don’t overlook a broken limb or a bruise if it occurred under suspicious circumstances.
• If you suspect sexual abuse, place a call to your state’s elder abuse hotline, and if you need to report a rape, call the Rape Crisis Helpline at 1.888.772.7227. They can also help you approach a potential victim who you think might be suffering from abuse.
• If someone is in immediate danger, call 911 or the local police for immediate help.