Older Women: Hidden Sexual Abuse Victims
Although other forms of violence within the family have received increasing attention from professionals and the media over recent years, including the physical abuse and neglect of children, child sexual abuse, and domestic violence, elder abuse remains relatively hidden. This is especially true of sexual abuse of older persons. While there are some references to stranger rapes of older women, the topic of elder sexual abuse within the family is rarely addressed in the professional literature, and seldom confronted by social workers, medical personnel or advocates. This is partly true because sexuality is usually associated with younger people. Yet, if sexual abuse is a function of power and control, frail older persons, who often have little power and may be dependent on others for care, can be extremely vulnerable to sexual mistreatment.
Elder sexual abuse is defined as coercing an older person, through force, trickery, threats, or other means, into sexual contact against her or his will. It often begins with covert activities such as inappropriate remarks and threats, and escalates to more severe types of mistreatment, including: the offender forcing the victim to view pornography or to listen to explicit sexual accounts; sexualized kissing and fondling; oral-genital contact; digital penetration; vaginal rape; anal rape; rape by objects; exploitation (e.g., prostituting or swapping the victim); sadistic acts, and ritualistic abuse.1 The prevalence of elder sexual abuse is not known because no systemic study has been done to determine how widespread the problem is. Where it is uncovered, it is usually by adult protective services workers who are called to intervene in other types of mistreatment of older persons, such as physical abuse, neglect or financial exploitation.
In the first study of its kind, Holly Ramsey-Klawsnik, Ph.D. in 1991
examined twenty-eight (28) Massachusetts cases in which sexual abuse was
identified by elder abuse case workers. All the victims resided in the
community (not in nursing homes or other institutional facilities). All
were female, ranging in age from 65 to 101, while all but one of the offenders
was male. Four out of five of the offenders were care givers to the victims,
the vast majority of whom had significant impairments which made them totally
dependent on others for daily assistance.
The offenders were usually relatives of the victim. In 39% of the cases,
an adult son was the abuser; in 29% it was the victim's husband. Over one-third
were elderly themselves, and were the victim's spouse, male friend or brother.
The most frequent form of abuse suffered by the victims in the study was
repeated vaginal rape.2
In a similar study by Malcolm Holt in Great Britain in 1992, 90 elder sexual abuse cases were identified by professionals. Of those, 86% were women, and 14% were men. Almost all the victims of both sexes were over 85 years old and functioned at a poor or very poor level, rendering them totally dependent on others for care. Ninety-eight percent of the abusers of both sexes were male. For the women in the study over half of the abusers were their adult sons while 14% were their husbands; for the men almost two-thirds of the abusers were "friends" and one-third were housekeepers. As in the Massachusetts study, most of the women were vaginally raped; over three-quarters of the men were anally raped.3
In the cases of marital rape, it is not known if the assaults began late in life or were present throughout the length of the marriage. Since 14% of all married women are raped by their husbands,4 it is likely that at least some of the victims were sexually mistreated for most of their adult years. Older women, who may have been socialized to believe that wives must always submit to their husbands' wishes, may continue to suffer sexual mistreatment silently. There are anecdotal data to suggest that some victims are lifelong battered women who not only are repeatedly violated by their husbands for years, but whose sons assume their fathers' abusive behaviors when their mothers are widowed.
It should be noted that 13 of the 44 states which have criminalized marital
rape exclude husbands if their wives have temporary or permanent mental
or physical disabilities, leaving frail and ill older women in those states
extremely vulnerable to such abuse with no legal recourse.5
Data form the Illinois Department of Aging's Elder Abuse and Neglect Program,
which responds to any report of suspected abuse, neglect or financial exploitation
of older persons, show that sexual abuse is the least frequent type of report
received. In FY 1995, only 209 cases (4%) of over 5,000 total reports alleged
sexual abuse. While these figures could mean that elder sexual abuse is
a rare occurrence, it should be noted that other forms of family violence
were also considered rare until they were identified and researched. Sexual
abuse reports to the Elder Abuse Program also had the highest rate of "not
verified" of all the types of mistreatment reported, meaning that after
an investigation not enough credible evidence existed to substantiate sexual
abuse. (It should be noted that most reports of elder abuse allege more
than one type of mistreatment, so that the victims involved may have been
served by the program for other types of abuse.) This points, however,
to the need for more education of case workers on how to identify such abuse
and how to work with victims once it is discovered.6
If, as Groth maintains, it is not the physical attributes of the victim
but rather her/his vulnerability that attracts the sexual offender, then
elders are especially susceptible to such abuse.7 The victims
in the two studies cited here were unable to function independently and
had no choice but to rely on others, usually family members, for daily care
and assistance. In addition, speech and language problems are not uncommon
among older persons with physical problems, such as victims of stroke.
Such problems may make it virtually impossible for the victim to disclose
the abuse to outsiders. Also, a number of older persons suffer form dementia
and other mental impairments. While only about 5% of all persons over age
60 have such problems, the percent increases as age increases, and such
symptoms may be present in as many as half of all persons who are 85 years
of age or older. Cognitive impairments mean that victims will have little
or no credibility if they report sexual abuse. According to Ramsey-Klawsnik,
"Females are predisposed to victimization due to the greater physical,
social, political and financial power generally held by males. Old age
and impairment decrease personal power and hereby increase the risk of abuse...Consequently,
elderly, disabled females make excellent sexual abuse victims."8
Persons working with older sexual abuse victims should recognize that,
as with many victims of family violence, the victim may have ambivalent
feelings toward the abuser which include love and loyalty as well as fear
and revulsion.
Older sexual assault victims need many of the same services and interventions
younger victims need: non-judgmental emotional support; medical care; protection
form unsupervised access by the abuser; legal interventions where appropriate
and desired; it is essential that anyone working with elder abuse victims
recognize that competent older persons have the right to refuse any and
all interventions, even those that are "for their own good."
Persons with cognitive impairments, however, may need others to take steps
to protect them and to provide needed services.
Adult protective services programs should consult with rape crisis center
staff to learn more about the dynamics of sexual abuse and how to effectively
intervene with victims. In return, APS supervisors can educate the sexual
assault network about working with vulnerable adults and about the assistance
available through APS programs.
Any suspected or confirmed victim of elder sexual abuse should be referred to an Adult Protective Services Program, even if the person is also being served by a rape crisis center. The referral means that the older person can be linked up to a wide array of services available through the aging network, including in-home services such as cleaning, meal preparation or delivery, or home health care. These services will reduce the victim's dependence on the abuser and will also reduce her isolation, both of which contribute significantly to vulnerability to abuse. The rape crisis center and local adult protective services programs should cooperate on other interventions such as legal remedies in order to avoid duplication of effort and to reduce the confusion to the client. Vulnerable older persons need and deserve the skilled attention of all those with whom they come into contact in order to reduce their vulnerability to sexual abuse.
By Kathleen Quinn, Bureau Chief of Elder Rights, Illinois Department on Aging.
1994-ICASA Coalition Commentary. Reprinted with permission, June 5, 1997, Illinois Coalition Against Sexual Assault. Linda Schneider, editor.
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1 Ramsey-Klawsnik, Holly, Ph.D. "Elder Sexual Abuse:
Preliminary Findings." Journal of Elder Abuse and Neglect. Vol. 3(3),
1991.
2 Ibid.
3 Holt, Malcolm G., CSS "Elder Sexual Abuse in Britain: Preliminary Findings." Journal of Elder Abuse and Neglect. Vol.5(2), 1993.
4 Russell, Diane E. Rape in Marriage. Indianapolis: Indiana University Press, 1990.
5 Ramsey-Klawsnik.
6 Illinois Department on Aging, Elder Abuse and Neglect Program: FY 1995 Annual Report. Springfield, Illinois, 1996.
7 Groth, A.N., "The Older Rape Victim and Her Assailant." Geriatric Psychiatry, 203-215, 1978, as cited in Ramsey-Klawsnik.
8 Ramsey-Klawsnik
