Psychological well being impacts of sexual violence in older adults: a qualitative examine

Sexual violence is prevalent the world over with roughly 30-35% of girls and 10-27% of males experiencing sexual violence at the least as soon as of their lifetime (McLean, 2013; Krahe et al., 2015; WHO, 2013). Sexual violence can have important impacts on each bodily and psychological well being (e.g., Jina & Thomas, 2013; Stein & Barrett-Connor, 2000; Tarzia et al., 2017; 2018). Nevertheless, the expertise of sexual violence is under-researched in older adults, with most proof specializing in youngsters, adolescents and adults of working age.

One instance of sexual violence traditionally being ignored in older adults is the exclusion of older adults within the Crime Survey for England and Wales, the supply of official violence statistics in England and Wales (Workplace for Nationwide Statistics, 2021), resulting in a spot in our understanding of the expertise of violence and abuse on this age group. This can be exacerbated by limitations to disclosure, together with disgrace and guilt, perceptions of sexual violence being socially taboo, issues about being believed, beliefs that they don’t match the perceived sufferer stereotype, and denial (Donne et al., 2018; Goldblatt et al., 2022; Orchowski et al., 2022; Pijlman et al., 2023; Ullman & Relyea 2016).

Collectively, which means our understanding of the psychological well being impacts of such experiences on this age group just isn’t very effectively understood. In 2024, Fadeeva and colleagues demonstrated that older adults who had skilled violence previously 12 months have been extra more likely to dwell with a standard psychological dysfunction than older adults who had not skilled violence (26.4% versus 10.2%), demonstrating the hyperlink between violence and psychological well being points on this age group (Fadeeva et al., 2024; see Carlisle 2024 for an summary). Different quantitative research have equally discovered associations between sexual violence in older adults and PTSD (Prepare dinner et al., 2011; Nobels et al., 2023), despair and anxiousness (Prepare dinner et al., 2013) and persistent sickness and/or incapacity (Nobels et a., 2023).

Nobels et al., (2024) aimed to contribute to this subject by conducting the first qualitative examine to discover the self-perceived psychological well being impression of lifetime sexual victimisation in older victims.

Most analysis on sexual violence victimisation tends to deal with younger individuals or individuals of working age. We don’t but know what the impacts of sexual victimisation are for older adults.

Strategies

Fifteen older adults (outlined as these aged 70 years or older) who had skilled sexual victimisation sooner or later of their lives have been invited to participate in in-depth interviews. Interviews ranged from 15-111 minutes. Individuals have been predominantly feminine (n=12), heterosexual (n=14), and community-dwelling (n=14), with a imply age of 77 (SD 3.9 years, vary 71-85 years). Fourteen contributors had skilled sexual harassment, twelve had experi­enced sexual abuse, and 9 had skilled (tried) rape throughout their lifetime. Two had encountered some type of sexual violence within the 12 months previous to the examine.

Interviews befell primarily on-line or over phone and adopted a structured matter information, which requested about seven key subjects: conceptualising sexual violence, experiences of sexual violence, perceived components contributing to victimisation, penalties of sexual violence, methods for coping and in search of assist, results on familial and peer relationships, transgenerational impression, and recommendations for prevention and help providers following sexual victimisation.

Interviews have been audio recorded and analysed utilizing thematic evaluation in line with Braun and Clarke (2006), utilizing a mixture of deductive and inductive coding.

Outcomes

Evaluation resulted in six key themes:

1. Hurtful recollection – Individuals described unfavorable feelings when recalling sexual violence experiences, and lots of felt that the expertise remained always current within the background. Particular triggers included going to places the place the violence occurred, sexual activity, or information tales of comparable occasions.
2. Many contributors skilled anxiousness within the type of both avoidance or hypervigilance. Avoidance manifested within the type of avoiding particular locations, conditions and folks, in addition to particular ideas or conversations and when not potential resulted in excessive misery. Hypervigilance led to feeling always on guard and alert to ones’ environment, significantly when strolling or biking at night time.
3. Individuals reported experiencing intense emotions of guilt and disgrace all through their lives, typically maintaining their experiences of sexual violence a secret. This additionally impacted their sense of id, resulting in emotions of disappointment in themselves, worthlessness, and low self-confidence.
4. Affect on interpersonal relationships – Some contributors felt anger in the direction of their family members, significantly in the event that they weren’t believed, resulting in emotional distance and mistrust. There was additionally a way of basic mistrust, associated to the necessity to keep on guard. This typically led to loneliness and isolation.
5. It was okay – Whereas many contributors described a spread of psychological well being impacts of their experiences, most reported no long-lasting impression of sexual violence, and didn’t affiliate one with the opposite. Individuals didn’t appear to recognise these contradictions, which can be a real absence of long-lasting psychological well being impacts, a coping mechanism, or acceptance.
6. Some contributors reported posttraumatic progress that emerged from their experiences, comparable to pleasure for stopping the sexual violence, elevated empathy for others, and strengthened resilience. Different examples of constructive impacts included being extra assertive, creating a stronger sense of self-worth, and being extra vital or much less naïve.

Older adults didn’t are likely to affiliate psychological well being difficulties with their expertise of sexual violence, reporting no long-lasting impression of the trauma.

Conclusions

This examine is the primary to qualitatively assess the impression of sexual violence on psychological well being in older adults. The authors concluded that:

many older victims report psychological well being challenges, together with anxiety-related signs, profound emotions of guilt and disgrace, which incessantly result in a disrupted sense of id, and elevated mistrust towards oth­ers.

Older adults typically have problem articulating the direct impression of their experiences on their psychological well being or relationships, and this can be associated to avoidance associated coping methods, or an issue in seeing themselves as victims.

Many contributors discovered it troublesome to speak about their experiences, which can be reflective of the time these adults grew up in, the place sexuality was seen as taboo, sufferer blaming was widespread, and males have been inspired to be robust and “man up”.

Older adults discovered it troublesome to speak about their experiences of sexual violence which can be reflective of the time these adults grew up in, the place sexuality was seen as taboo and sufferer blaming was widespread.

Strengths and limitations

This is a crucial examine, addressing a transparent hole within the proof by shedding gentle on the experiences of an often-overlooked group. In doing so, this paper offers this subset of sexual violence victims a voice, one thing that many might have been beforehand unable to do.

The authors are clear about their analysis goals, and use acceptable methodology, which is effectively described and justified, to handle these. Given the delicate nature of the subject of the analysis, the authors took moral concerns under consideration, guaranteeing that contributors have been comfy with the method and had help afterwards if wanted. In addition they used an acceptable and pragmatic method to recruitment, figuring out potential contributors who have been already collaborating in one in every of two present research on sexual violence in older adults. This method was delicate and unobtrusive, and a great way to determine those that could also be much less more likely to entry or reply to different recruitment methods (e.g., social media commercials). Lastly, the evaluation seems to be rigorous and findings are express, though there could possibly be extra info offered on the evaluation course of comparable to how the chosen quotes have been chosen.

Nevertheless, the authors didn’t appear to think about the connection between the researcher and contributors, and didn’t focus on reflexivity or consideration of the affect or impression of the researcher on the analysis course of and findings. Moreover, the authors acknowledge that, as nearly all of interview contributors have been feminine, outcomes are restricted when it comes to their generalisability to male victims of sexual violence, and should not seemingly consultant given proof suggesting that just about one in three older males (aged 70 and above) had skilled sexual victimization of their lifetime (Nobels et al., 2021).

The vast majority of contributors on this examine have been feminine – what concerning the experiences of male older adults who’ve skilled sexual violence?

Implications for observe

This examine has a number of key takeaways for healthcare professionals:

1. Whereas a minority of contributors had skilled sexual violence in older grownup age, most mentioned psychological well being and interpersonal challenges of their previous experiences that persevered over time into older age. Due to this fact, healthcare professionals want to concentrate on and look out for indicators of doubtless unresolved and protracted trauma.

2. Regardless of reporting signs per trauma and different psychological well being and interpersonal challenges, older adults who’ve skilled sexual violence might really feel disgrace, guilt and a basic mistrust of others. Collectively, these might act as limitations to in search of assist for these challenges. The authors suggest routine enquiry about sexual violence to determine those that might profit from therapeutic assist. In addition they suggest doing so in a delicate, trauma-informed manner, to construct belief and create secure areas for disclosure.

3. Additional, healthcare professionals ought to recognise and respect any boundaries asserted by this affected person group, which can replicate post-traumatic progress and be key to attaining belief.

4. Healthcare professionals might profit from the event of specialized screening instruments for trauma in older adults to facilitate the identification of sexual violence victims in a structured and delicate manner. This could possibly be paired with protocols for age-appropriate referral routes for help, and specialised coaching in sexual violence throughout the lifespan.

Moreover, the authors determine a number of avenues for additional analysis, together with:

1. Understanding males’s experiences of sexual violence particularly. The authors recognised the limitation of their principally feminine pattern and recognized addressing this as a future avenue for analysis.

2. Exploring the experiences of older adults with cognitive impairments or different vulnerabilities. Whereas this proof hole might not be potential to handle as a result of moral concerns, almost all contributors of the current examine have been group dwelling, so one potential avenue for additional analysis could possibly be to research experiences of adults residing in care houses, who’re more likely to be frailer and should have completely different experiences or impacts, and usually tend to expertise violence (Yon et al., 2019).

Healthcare professionals working with older adults ought to look out for indicators of doubtless unresolved and protracted trauma arising from earlier sexual violence victimisation.

Assertion of pursuits

Sophie Carlisle – No conflicts of curiosity.

Edited by

Laura Hemming.

Hyperlinks

Major paper

Anne Nobels, Mona Biebuyck, Ines Keygnaert. (2025). ‘Did it go away scars? It did, then and now’–older adults’ perceived psychological well being impression upon sexual victimization throughout their lifetime. Growing older & Psychological Well being, 1-11.

Different references

Aakvaag, H. F., Thoresen, S., Wentzel-Larsen, T., Dyb, G., Røysamb, E., & Olff, M. (2016). Damaged and responsible because it occurred: A inhabitants examine of trauma-related disgrace and guilt after violence and sexual abuse. Journal of affective problems, 204, 16-23.

Carlisle S. Violence in opposition to older individuals is strongly related to poor psychological well being #16DaysOfActivism2024. The Psychological Elf, 10 Dec 2024.

Prepare dinner, J. M., Pilver, C., Dinnen, S., Schnurr, P. P., & Hoff, R. (2013). Prevalence of bodily and sexual assault and psychological well being problems in older ladies: Findings from a nationally consultant sample. The American Journal of Geriatric Psychiatry, 21(9), 877-886.

Donne, M. D., DeLuca, J., Pleskach, P., Bromson, C., Mosley, M. P., Perez, E. T., … & Frye, V. (2018). Limitations to and facilitators of help-seeking habits amongst males who expertise sexual violence. American journal of males’s well being, 12(2), 189-201.

Fadeeva, A., Hashemi, L., Cooper, C., Stewart, R., & McManus, S. (2024). Violence in opposition to older individuals and associations with psychological well being: A nationwide chance pattern survey of the overall inhabitants in England. Journal of affective problems, 363, 1-7.

Goldblatt, H., Band-Winterstein, T., Lev, S., & Harel, D. (2022). “Who would sexually assault an 80-year-old girl?”: Limitations to exploring and exposing sexual assault in opposition to ladies in late life. Journal of interpersonal violence, 37(5-6), 2751-2775.

Jina, R., & Thomas, L. S. (2013). Well being penalties of sexual violence in opposition to ladies. Finest observe & analysis Medical obstetrics & gynaecology, 27(1), 15-26.

Krahé, B., Berger, A., Vanwesenbeeck, I., Bianchi, G., Chliaoutakis, J., Fernández-Fuertes, A. A., … & Zygadło, A. (2015). Prevalence and correlates of younger individuals’s sexual aggression perpetration and victimisation in 10 European international locations: a multi-level evaluation. Tradition, well being & sexuality, 17(6), 682-699.

McLean, I. A. (2013). The male sufferer of sexual assault. Finest Observe & Analysis Medical Obstetrics & Gynaecology, 27(1), 39-46.

Nobels A, Cismaru-Inescu A, Nisen L, Hahaut B, Beaulieu M, Lemmens G, Adam S, Schapansky E, Vandeviver C & Keygnaert I. (2021). Sexual violence in older adults: A Belgian prevalence examine. BMC Geriatrics, 21(1), 601. https://doi.org/10.1186/s12877-021-02485-3

Nobels, A., Meersman, C., Lemmens, G., & Keygnaert, I. (2023). “Simply one thing that occurred?”: Psychological well being impression of disclosure and framing of sexual violence in older victims. Worldwide journal of geriatric psychiatry, 38(12), e6036.

Orchowski, L. M., Grocott, L., Bogen, Ok. W., Ilegbusi, A., Amstadter, A. B., & Nugent, N. R. (2022). Limitations to reporting sexual violence: A qualitative evaluation of# WhyIDidntReport. Violence in opposition to ladies, 28(14), 3530-3553.

Pijlman, V., Eichelsheim, V., Pemberton, A., & de Waardt, M. (2023). “Typically it appears simpler to push it away”: A examine into the limitations to help-seeking for victims of sexual violence. Journal of Interpersonal Violence, 38(11-12), 7530-7555.

Stein, M. B., & Barrett-Connor, E. (2000). Sexual assault and bodily well being: Findings from a population-based examine of older adults. Biopsychosocial Science and Medication, 62(6), 838-843.

Tarzia, L., Maxwell, S., Valpied, J., Novy, Ok., Quake, R., & Hegarty, Ok. (2017). Sexual violence related to poor psychological well being in ladies attending Australian basic practices. Australian and New Zealand journal of public well being, 41(5), 518-523.

Tarzia, L., Thuraisingam, S., Novy, Ok., Valpied, J., Quake, R., & Hegarty, Ok. (2018). Exploring the relationships between sexual violence, psychological well being and perpetrator id: a cross-sectional Australian main care examine. BMC public well being, 18(1), 1410.

Tarzia, L. (2021). “It went to the very coronary heart of who I used to be as a lady”: The invisible impacts of intimate companion sexual violence. Qualitative well being analysis, 31(2), 287-297.

Ullman, S. E., & Relyea, M. (2016). Social help, coping, and posttraumatic stress signs in feminine sexual assault survivors: A longitudinal evaluation. Journal of traumatic stress, 29(6), 500-506.

World Well being Group. (2013). World and regional estimates of violence in opposition to ladies: Prevalence and well being results of intimate companion violence and non-partner sexual violence. Retrieved from http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/

Yon, Y., Ramiro-Gonzalez, M., Mikton, C. R., Huber, M., & Sethi, D. (2019). The prevalence of elder abuse in institutional settings: a scientific evaluate and meta-analysis. European journal of public well being, 29(1), 58-67.

Photograph credit