Describe Sexual Abuse, Trauma and Dementia in the Elderly: A Retrospective Study of 284 Cases.

Victims and Offenders, 1:193–204, 2006Copyright © Taylor & Francis Group, LLCISSN: 1556-4886 print/1556-4991 onlineDOI: 10.1080/15564880600663935193UVAO1556-48861556-4991Victims and Offenders, Vol. 01, No. 02, March 2006: pp. 0–0Victims and OffendersSexual Abuse, Trauma and Dementia in the Elderly: A Retrospective Study of 284 CasesSexual Abuse, Trauma and Dementia in the ElderlyA. W. Burgess and S. L. PhillipsAnn W. BurgessWilliam F. Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USASteven L. PhillipsUniversity of Nevada School of Medicine, Reno, Nevada, USAAbstract: The study objective was to compare elders with a dementia with thosewithout a dementia as to method of disclosure of sexual abuse, forensic markers ofsexual abuse and legal outcome of cases. A convenience sample was obtained of 284forensic cases known to a multidisciplinary group of professionals who investigated,examined or consulted on elder sexual abuse victims. The Comprehensive SexualAssault Assessment (CSAAT) was used to enter data from case files. 60 percent of the284 elders were diagnosed with some degree of dementia. Elders with dementia, com-pared 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, pre-sented behavior cues of distress rather than verbal disclosures, were easily confusedand verbally manipulated, and were beaten. Suspects who were identified whomabused elders with dementia had less chance of being arrested, indicted or plea bar-gained. All reported suspected cases of elder sexual abuse need a complete physicalexamination as well as a sexual assault evidence kit. Patterns of verbal, behavioral orphysical changes of elders can be used to support an allegation of sexual assault.Keywords: elders, dementia, sexual abuse, trauma, criminal justice systemSEXUAL TRAUMA AND DEMENTIAAttention to sex crimes against the elderly is slowly increasing despite the factthat sexual victimization in all age groups is underreported. The threshold forolder people reporting sexual victimization is estimated to be lower than in theAddress correspondence to Ann W. Burgess, DNSC, APRN, BC, Boston College,Connell School of Nursing, Chestnut Hill, MA 02465. E-mail: burges@bc.edu

194A. W. Burgess and S. L. Phillipsyounger cohort. Fear of retaliation, shame and asexual stereotypes of older adultsprevent detection and reporting (Acierno, Gray, Best, Resnick, Kilpatrick, Saun-ders & Brady, 2001). The few studies on elder rape describe the location, victim-offender relationship and injuries. For example, Muram, Miller & Cutler (1992)compared sexual assault victims over age 55 with those under age 55 and notedthat the majority of elder assaults occurred in the victim’s residence, often by anunknown assailant, genital injuries were more severe in elders, and intimidationby physical force was all that was necessary to subdue the victim in most cases.Post-trauma response has been reviewed in studies of older adults whoexperienced rape as well as combat, natural and man-made disasters (Falk,Hersen & Van Hasselt, 1994; Averill & Beck, 2000). However, the clinicalliterature is vague about any impact from the physiological and psychologicalaspect of a sexual assault on an elder, especially if he or she has dementia.This paper reports on a cohort of elder sexual abuse cases and reviews theneuroscience on trauma, the aging brain and its interface with elder sexualabuse.METHODOLOGYThe StudyThe study was a retrospective record review of 284 cases of elder sexualabuse that were sent to law enforcement for investigation, to sexual assaultforensic examiners for a rape exam, or to adult protective services for consul-tation regarding a suspected sexual assault. Data from these cases weretransferred to the Comprehensive Sexual Assault Assessment Tool (CSAAT)for data analysis (Hanrahan, Burgess & Baker, 2005). Specific variables rela-tive to behaviors previously noted in distressed elders were included (Burgess,Hanrahan & Baker, 2005).The definition of elder sexual abuse, for this study, included cases ofperson’s age 60 and older whereby there was a physical sexual relationshipwithout the elder’s informed consent and including sexual assaults by strang-ers. A physical sexual relationship referred to not only intercourse but to otherforms of intimate sexual contact, such as touching the genital area or breastswhen not associated with a defined nursing care plan. This is an arbitrarydefinition but is similar to the Benbow & Haddad, 1993 study.Data sources included clinical reports from sexual assault forensic exam-iners, investigative reports, photographs and/or colposcopy slides, and reportsfrom law enforcement and/or the prosecutor’s office on the outcome of the case.The variables related to a physical or cognitive limitation required there be amedical and nursing diagnosis to confirm the presence of immobility and/ora dementia. Names were redacted and a coded number given to each case. IRBapproval was secured from Boston College Institution Review Board.