How do we protect elders and the impaired, or more personal, our family members, from sexual abuse? We interview caregivers and review references for someone to provide assistance while we are working or we trust an assisted living facility to care for our loved ones. Concurrently, we worry about vulnerability and find the progression to our own future frail, vulnerable state to be terrifying and depressing.
Elder sexual abuse is under reported and under diagnosed. It is difficult to detect in many cases because the victim cannot articulate or clearly remember what happened. One strategy, however, in the detection of elder sexual abuse is to identify at-risk elders and concentrate efforts with this population.
Social isolation of the elder may account for a barrier in detecting sexual abuse. But even the most isolated elder will visit a health care provider at some point which on average is about five times a year. Nevertheless, health care providers percentages of reported abuse cases is small-about 20% or less.
For a frail, dependent elder, the primary care provider may be the only opportunity for abuse detection and yet, many primary care givers believe the symptoms are related to aging and disease rather than abuse. Researchers analyzed a set of State of Michigan records of reported cases of elder abuse for the years 1989-1993 and noted that physicians reported an average of only 2% of all cases reported. It was suggested that increasing physicians and nurses awareness of the problem of elder sexual abuse could increase the number of cases screened for potential abuse and as such increase the number of elder sexual abuse reports to responsible agencies.
All suspected cases of elder sexual abuse should to be reported for two reasons. The first reason is to provide for the safety and protection of the elder and the second reason is to prevent further victimization by the perpetrator. Cases need a rapid and immediate report to those in charge of their care, to the physician (if an institution case) and a complete physical examination by a qualified sexual assault forensic examiner. The absence of such reporting and documentation in a nursing home places the facility at risk for negligent protocol.
Within the care providing role, observations of the vulnerable elder are very important in verifying on going abuse. Although specific evidence may be difficult, home care providers can increase their visits and observations as a strategy to increase the body of evidence.There is a reporting hesitance in family cases of elder abuse. Elder abuse laws are designed and intended to protect vulnerable citizens and to punish violators. But people are concerned about and investigations and repercussion if they are wrong.
Barriers identified to detecting elder abuse include: families/patients resistance to intervention once elder abuse is identified, families/patients denial of abuse, fear of reprisal by the abuser towards the elder, lack of professional protocols for responding to elder abuse, lack of clear guidelines about confidentiality in elder abuse situations, difficulty in determining what constitutes elder abuse, and the lack of knowledge about the prevalence of elder abuse.
Recommendations include an elder abuse package for education, detection and management of elder abuse with a website as well as professional guidelines for detection and management.
How do we identify when sexual abuse may have occurred versus the normal personality changes when the person has dementia or Alzheimers? It’s the focus of the next blog.
Sources: “Elderly Victims of Sexual Abuse and Their Offenders”, Ann W. Burgess, U.S. Department of Justice, December 2006. “Elder Abuse,” National Institutes of Health.
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