SEXUAL VIOLENCE IN Later Life

Annotated Bibliography

Burgess, A., & Clements, P. (2006). 
Information processing of sexual 
abuse in elders. Journal of Forensic 
Nursing, 2, 113-120. 
doi:10.1111/j.1939-3938.2006.tb00069.x

This paper presents data regarding 
the presence of Post Traumatic Stress 
Disorder (PTSD) symptoms in alleged 
sexual assault victims in later life. 
Symptoms discussed include numbness, 
physiologic upset, startle response, and 
anger. Case studies are provided. The 
lack of training for medical providers in 
evaluating older adults for sexual violence 
is discussed. Research and practice 
implications are provided.

Burgess, A., Dowdell, E., & Prentky, R. 
(2000). Sexual abuse of nursing home 
residents. Journal of Psychosocial 
Nursing, 38(6), 10-18. 

Information concerning the sexual 
assault of 20 nursing home residents is 
provided. Victims were mostly female, 
non-ambulatory, and experienced 
cognitive impairment. Assaults were 
identified when older victims disclosed to 
family members, staff witnessed them, or 
indicators were observed. The collection 
of physical and forensic evidence 
among older victims with dementia and 
communication limitations is discussed. 
Assaulted residents displayed physical 
and psychosocial trauma symptoms. 
Clinical, forensic, and policy implications 
are discussed.

Burgess, A., Hanrahan, N.P., & Baker, T.
(2005). Forensic markers in female 
sexual abuse cases. Clinics of Geriatric 
Medicine, 21, 399-412. 
doi:10.1016/j.cger.2004.10.005

Professionals from health, social service,
law enforcement, and criminal justice 
were brought together to form a work 
group for sexual assault in later life 
research funded by the National Institute 
for Justice. These professionals were 
experienced in handling cases of alleged 
and confirmed sexual assault among older 
adults and contributed 125 cases to
the study that is described in this article. 
Among the alleged victims, about half 
experienced disabilities and a broad 
range of injuries were sustained. 
Information concerning alleged 
victims and perpetrators is presented.

Burgess, A., Prentky, R., & Dowdell, E. 
(2000). Sexual predators in nursing 
homes. Journal of Psychosocial Nursing, 
38(8), 26–35. 

Characteristics of 18 individuals, 
including 15 facility employees and 3 
residents, who sexually assaulted older 
adult residents in care facilities are 
described. Arrest of 11 and conviction of 5 
employees resulted. All perpetrators were 
described as low in social competence 
and all assaulted older victims who were 
incapacitated and defenseless. The assault 
acts included sadistic abuse. Facility 
liability issues are addressed.


2 Sexual Violence In Later Life

Burgess, A., Ramsey-Klawsnik, H., & Gregorian, S. 
(2008). Comparing routes of reporting in elder sexual 
abuse cases. Journal of Elder Abuse & Neglect, 20, 
336-352. doi:10.1080/08946560802359250

This research article presents findings from an 
exploratory study of 284 cases of alleged elder 
sexual abuse reported to either Adult Protective 
Services (APS) or the criminal justice system (CJS). A 
comparison of the two routes of reporting is provided 
along with an analysis of how cases reported to 
either APS or CJS differed. The research addressed 
characteristics of the older victims, forensic markers 
of sexual abuse against older victims, perpetrator 
characteristics, the nature of the alleged abuse, and 
outcomes in terms of arrest and prosecution.

Chihowski, K., & Hughes, S. (2008). Clinical issues 
in responding to alleged elder sexual abuse. 
Journal of Elder Abuse & Neglect, 20, 377 – 400. 
doi:10.1080/08946560802359383

This practice article describes the Massachusetts Sexual 
Abuse Consultation program, an Elder Protective 
Services initiative to train and support elder protective 
services workers and supervisors to effectively respond 
to alleged and confirmed sexual abuse against older 
victims. Challenges to effective investigation and case 
intervention are discussed. Case examples are provided 
to demonstrate casework techniques.

Del Bove, G., Stermac, L., & Bainbridge, D. (2006). 
Comparisons of sexual assault among older and 
younger women. Journal of Elder Abuse & Neglect, 
17(3), 1-18. doi:10.1300/J084v17n03_01

This study examined the nature and extent of coercion, 
violence, and physical injury among older victims of 
sexual assaults (55 years and older) and compared these 
with the sexual assault victims of mid-age (31-54 years) 
and younger women (15-30 years). The results of this 
investigation reveal that older victims of sexual assault 
are more likely to be living alone at the time of the attack. 
In addition, older victims of sexual assault tended to 
report higher rates of vulnerabilities such as psychiatric 
and cognitive disabilities than did younger female 
victims. In contrast to younger victims, elder sexual 
assault victims are also more likely to be assaulted in 
their own home and one-quarter of older victims require 
ambulance involvement. Although the use of weapons 
was most likely in the sexual assaults of younger women, 
the use of physical violence and restraint was common 
and equally likely among all three groups. Similarly, 
vaginal penetration and the presence of physical trauma 
were just as likely in elder victims as in younger victims 
of sexual assault. These results reveal new information 
about the nature and extent of violence and coercion in 
elder female sexual assaults. The vulnerability of the older 
victims illustrated in this investigation raises a number of 
research questions about these women’s prior history of 
victimization and future safety.

Eckert, L., & Sugar, N. (2008). Older victims of sexual 
assault: An underrecognized population. American 
Journal of Obstetrics & Gynecology, 198, 688.e1-688.
e7. doi:10.1016/j.ajog.2008.03.021

A study undertaken to determine if sexual assault 
characteristics differ in older verses younger female 
victims is described. Data were analyzed regarding 
adult females evaluated at a hospital emergency 



Annotated Bibliography 3

department during a nine-year period. Characteristics 
of 102 female alleged victims over the age of 55 are 
provided. The older women were more commonly 
assaulted in their own homes or care facilities than 
were younger women. Compared to younger female 
victims, older women were also more commonly 
assaulted by a service provider or stranger, impaired 
at the time of assault, admitted to a hospital following 
assault, and incurred genital trauma.

Hanrahan, N. P., Burgess, A. W., & Gerolamo, A. M. 
(2005) Core data elements tracking elder sexual 
abuse. Clinics in Geriatric Medicine, 21, 413-427. 
doi:10.1016/j.cger.2004.10.008

Sexual abuse in the older adult population is an 
understudied vector of violent crimes with significant 
physical and psychological consequences for 
victims and families. Research requires a theoretical 
framework that delineates core elements using a 
standardized instrument. To develop a conceptual 
framework and identify core data elements specific to 
the older adult population, clinical, administrative, and 
criminal experts were consulted using a nominal group 
method to revise an existing sexual assault instrument. 
The revised instrument could be used to establish a 
national database of elder sexual abuse. The database 
could become a standard reference to guide the 
detection, assessment, and prosecution of elder sexual 
abuse crimes as well as build a base from which policy 
makers could plan and evaluate interventions that 
targeted risk factors.

Hodell, E. C., Golding, J. M., Yozwiak, J. A., Bradshaw, 
G. S., Kinstle, T. L., & Marsil, D. F. (2009) The 
Perception of Elder Sexual Abuse in the Courtroom. 
Violence Against Women, 15, 678-698. 
doi: 10.1177/1077801209332294

This study examines juror perceptions of elder sexual 
abuse. In one study, 118 subjects read a fictional 
criminal trial summary of an elder sexual abuse case 
in which 76 year-old woman was reportedly abused by 
either her son or her neighbor. In a second study, 360 
participants read a fictional trial summary in which 
elder sexual abuse took place in either a nursing home 
or the victim’s home. Conviction rates were low in both 
experiments (25% and 33%, respectively), suggesting 
that mock jurors may doubt the credibility of older 
victims in elder sexual abuse cases.

Holt, M. (1993). Elder sexual abuse in Britain: 
Preliminary findings. Journal of Elder Abuse & 
Neglect, 5: 64-71. doi: 10.1300/J084v05n02_06

This early study utilized a convenience sample to 
survey health and social service personnel about 
suspected elder sexual abuse cases they had 
encountered. Information about 90 suspected 
cases is provided, including victim characteristics, 
relationships between them and the alleged 
perpetrators, and types of assaults.

Jones, H., & Powell, J. L. (2006). Old age, 
vulnerability and sexual violence: Implications 
for knowledge and practice. International 
Nursing Review, 53, 211-216. 
doi: 10.1111/j.1466-7657.2006.00457.x

This paper seeks to offer further analysis on the 
relationship between abuse of power, elder abuse 
and sexual violence. Through the analysis of available 
literature it is possible to observe which and how older 
people have been marginalized both in particular 
disciplines of study and policy spaces. The authors 
conclude that marginalization results in inadequate 
redress to issues of violence and power that may 
manifest against the older person, and which leads to 
feelings of vulnerability.

Lingler, J. H. (2003) Ethical issues in distinguishing 
sexual activity from sexual maltreatment among 
women with dementia. Journal of Elder Abuse & 
Neglect, 15, 85-102. doi:10.1300/J084v15n02_05

The purpose of this paper is to examine the ethics 
of nonconsensual sexual intercourse among women 
with dementia. The author proposes a paradigm 
for contextual ethical analyses, rooted in feminist 
bioethical approaches, for distinguishing between 
sexual activity and sexual maltreatment among 
persons with dementia who cannot consent. This paper 
ultimately argues that while women with dementia 
are particularly vulnerable to sexual maltreatment, 
certainly some, if not most, sexual activity between 
loving spouses may be morally permissible even when 
one partner has dementia and cannot consent.

Payne, B. K. (2010) Understanding elder sexual 
abuse and the criminal justice system’s response: 
Comparisons to elder physical abuse. 
Justice Quarterly, 27, 206-224. 
doi:10.1080/07418820902763087

This article reviews literature on elder physical and 
sexual abuse and examines patterns in reported cases 
of elder abuse. Researchers analyzed 314 cases of elder 
physical abuse and 127 cases of elder sexual abuse 
between 1993 and 2003 from the Medicaid Fraud 
Reports. Results showed a pattern of repeat offenses, 
as nearly one-third of cases involved either an offender 
victimizing multiple victims or victimizing one victim 
on multiple occassions. Elder sexual abuse cases were 
more likely than elder physical abuse cases to involve 
cognitively impaired victims. Finally, witnesses were 
crucial to successful prosecution of elder abuse cases 
involving cognitively impaired victims.

Poulos, C., & Sheridan, D. (2008). Genital injuries 
in post-menopausal women after sexual assault. 
Journal of Elder Abuse & Neglect, 20, 323 – 335. 
doi:10.1080/08946560802359243

A literature review conducted to examine known 
physical findings regarding older women who have 
been sexually assaulted is described. Only seven 
studies addressing the issue were found. Most found 
that older women are more likely than younger women 
to sustain genital injuries.

Ramsey-Klawsnik, H. (1991). Elder sexual abuse: 
Preliminary findings. Journal of Elder Abuse & 
Neglect, 3, 73-90. doi:10.1300/J084v03n03_04

A study of 28 cases of suspected elder sexual abuse 
conducted in 1989 using a survey methodology of 
Elder Protective Services workers is described. Data 
presented include victim characteristics, indicators 
of sexual assault, relationships of elders to the 
alleged perpetrators, and types of assaults. Sexual 
victimization of people in later life is discussed, 
including policy and practice.

Ramsey-Klawsnik, H. (2003). Elder sexual abuse 
within the family. Journal of Elder Abuse & Neglect, 
15(1), 43 – 58. doi:10.1300/J084v15n01_04

This article describes a qualitative analysis of 100 cases 
of elder sexual abuse handled by the Massachusetts 
Elder Protective Services Program between 1993 and 
2002. Marital sexual assault of older victims and incest 
are discussed. The following are described: clinical 
dynamics observed in cases, problems confronting 
victims, perpetrator characteristics, range of abuses, 
etiological factors, and forensic markers.

Ramsey-Klawsnik, H. (2004). Elder sexual abuse 
perpetrated by residents in care settings. Victimization 
of the Elderly and Disabled, 6(6), 81, 93 – 95. 

This article provides a discussion of the sexual 
victimization of older victims in care facilities by fellow 
residents. It addresses etiological factors, impact on 
victims, and facility staff mishandling instances of 
resident sexual assault. Guidelines for appropriate staff 
response and education are provided.

Ramsey-Klawsnik, H. (2008). Introduction. Journal 
of Elder Abuse & Neglect, 20, 301-305. 
doi:10.1080/08946560802359227 

This brief article describes the content of a special 
edition of the Journal of Elder Abuse & Neglect 
devoted exclusively to the topic of sexual violence 
against people in later life. An historical overview of 
the “discovery” and initial research into the topic is 
provided. The need for interdisciplinary collaboration 
to insure that older victims are well-served and 
perpetrators are held accountable is addressed.

Ramsey-Klawsnik, H. (2009). Elder sexual abuse. 
National Association of Social Workers MA Chapter 
Focus Newsletter, 36(4), 7-10, 15-17. 

Sexual abuse against people in later life in domestic and 
institutional settings is discussed and a compilation of 
clinical and research findings is provided. Professional 
roles and responsibilities are delineated. Types of cases 
confronted in clinical practice are discussed, including 
intimate partner violence, incest, other community 
cases, and assault in institutions. Documented cases 
illustrate frequently observed clinical dynamics, 
including problems confronting victims. Findings are 
presented regarding victims and perpetrators, forensic 
markers, abuse acts, and harm incurred by victims. 
Primary prevention, responding to indicators, reporting 
alleged cases, and complying with other legal and 
ethical requirements are discussed with a focus on the 
social worker’s role in intervention and treatment. (This 
article is available as an on-line continuing education 
course at www.naswma.org.)

Ramsey-Klawsnik, H., & Brandl, B. (2009, July/
August). Sexual abuse in later life. Sexual Assault 
Report, 12, 81, 83-85, 91-93. 

This article addresses sexual assault in later life 
focusing on intimate partner violence, incest, and 
assault in care facilities. Prevalence, incidence, and 
dynamics of sexual assault against older adults 
are discussed, illustrative cases are provided, and 
relevant literature is reviewed. Tips for practitioners 
encountering possible sexual violence against older 
adults are provided, including how to screen for 
possible assault, avoiding the contamination of forensic 
evidence, responding to victim needs, and mandatory 
elder abuse reporting.

Ramsey-Klawsnik, H., Teaster, P., & Mendiondo, M. 
(2007). Researching clinical practice: The study of 
sexual abuse in care facilities. Victimization of the 
Elderly and Disabled, 10, 49-50, 58, 61-63. 

The process of developing a research project to study 
sexual abuse of vulnerable adults, including older 
adults, living in care facilities is described. The project 
sought to collect data about victims, perpetrators, 
facilities in which sexual assault occurs, abuse acts, the 
investigation process, and case outcomes. Challenges 
faced and how they were handled are described 
including creating a research design that would enable 
the investigation process to be studied, gaining access 
to and protecting highly confidential information, 
securing funding, building a research team, and 
defining study questions.

Ramsey-Klawsnik, H., Teaster, P., & Mendiondo, M. 
(2008). Researching clinical practice: Findings from the 
study of sexual abuse in care facilities. Victimization of 
the Elderly and Disabled, 11, 17-18, 24, 28, 31. 

Findings from the study of sexual abuse of vulnerable 
adults in care facilities are provided. Addressed are both 
the alleged cases and those that were substantiated at 
the conclusion of investigations conducted by either 
Adult Protective Services or state licensing/regulatory 
staff. Data discussed include victims, perpetrators, 
involved facilities, abuse acts, and forensic markers. 
Among the findings: 429 alleged sexual assault cases 
were analyzed and 78 were substantiated. Alleged 
victims ranged from age 18 to 101 and 42% of the 
confirmed victims were elders. The most common 
trigger for the reports of alleged assault to state 
officials was victim statement and the most common 
assault location was nursing homes. The 463 alleged 
perpetrators ranged in age from 16 to 96 and the 
largest group was facility employees followed by facility 
residents. Only 9% of the accused staff was confirmed 
as sexual perpetrators while 44% of the accused 
residents were and this discrepancy is discussed.

Ramsey-Klawsnik, H., Teaster, P., Mendiondo, M., 
Abner, E., Cecil, K., & Tooms, M. (2007). Sexual 
abuse of vulnerable adults in care facilities: Clinical 
findings and a research initiative. Journal of the 
American Psychiatric Nurses Association 12, 332-339. 
doi:10.1177/1078390306298576

Sexual abuse of vulnerable adults (ages 18 – 59 with 
significant disabilities and/or older adults) living in care 
facilities is explored. Clinical findings, including case 
examples, are provided along with practice implications 
for nurses and other professionals who are responsible 
for the care of vulnerable adults living in facilities. A 
literature search is provided and the study of sexual 
abuse of vulnerable adults in institutions is described.

Ramsey-Klawsnik, H., Teaster, P., Mendiondo, M., 
Marcum, J. & Abner, E. (2008). Sexual predators 
who target elders: Findings from the first 
national study of sexual abuse in care facilities. 
Journal of Elder Abuse & Neglect, 20, 353-376. 
doi:10.1080/08946560802359375

This article reports research findings concerning 
119 alleged sexual perpetrators reported to state 
abuse authorities for abusing older victims in facility 
care settings. Most of the alleged perpetrators were 
employed by the facilities, and the next largest group 
was comprised of facility residents. Perpetrator 
characteristics, victim vulnerabilities, abuse acts, 
locations of assaults, and available case outcomes 
are provided. While state officials confirmed 32 of 
the alleged perpetrators as having sexually assaulted 
elders, other cases remained highly suspicious for 
sexual assault but unconfirmed. None of the identified 
perpetrators were arrested. Practice implications 
are discussed, including the need for increased law 
enforcement involvement in facility sexual assault 
cases and the need for collaboration between civil and 
criminal investigators.

Roberto, K. A., & Teaster, P. B. (2005) Sexual 
abuse of vulnerable young and old women: A 
comparative analysis of circumstances and 
outcomes. Violence Against Women, 11, 473-504. 
doi:10.1177/1077801204274329

Aggregated data from 125 substantiated Adult 
Protective Services cases of sexually abused women 
were collected during a 5-year period. Women older 
than 59 years represented 63% of the cases. Regardless 
of age, the most common types of abuse involved 
sexualized kissing and fondling and unwelcome 
sexual interest in the women’s body. Most identified 
perpetrators were older males. Family members were 
most likely to abuse women living in the community, 
whereas women living in facilities usually experienced 
abuse by another resident. Perpetrators were 
prosecuted and convicted in six cases. About 12% of the 
women continued to be at risk of further sexual abuse.

Roberto, K. A., Teaster, P. B., & Nikzad, K. A. (2007) 
Sexual abuse of vulnerable young and old men. 
Journal of Interpersonal Violence, 22, 1009-1023. 
doi:10.1177/0886260507302997

During a 4-year period, aggregated data from Adult 
Protective Services case files in Virginia revealed 
17 cases of sexually abused young, middle-age, and 
old men. The most common types of sexual abuse 
across age groups involved instances of sexualized 
kissing and fondling and unwelcome sexual interest 
in the individual men’s bodies. The majority of 
alleged perpetrators were male; they typically were 
similar in age to the men and resided in the same 
residential facility. In none of the cases was the alleged 
perpetrator prosecuted. Only two of the men continued 
to be at risk of further sexual abuse by the alleged 
perpetrator. Implications of these data for future 
research and practice include a need for studies that 
focus on differences between male and female victims, 
especially concerning investigations and interventions, 
and for training on reporting and intervention for 
facilities and agencies and organizations working with 
victims and alleged perpetrators.

Teaster, P., Ramsey-Klawsnik, H., Mendiondo, M., 
Abner, E., Cecil, K., & Tooms, M. (2007). From behind 
the shadows: A profile of the sexual abuse of older 
men residing in nursing homes. Journal of Elder 
Abuse & Neglect 19, 29 – 45. 
doi:10.1300/J084v19n01_03

Described are 26 cases of alleged sexual assault of men 
aged 50 and over residing in nursing homes. A review of 
the scant literature on the sexual abuse of older men is 
provided. Six of the cases were substantiated for sexual 
abuse at the conclusion of investigations conducted by 
civil authorities. Molestation was the most common form 
of alleged and confirmed assault, although rape was also 
substantiated. While the majority of alleged perpetrators 
were facility employees (75%), most (67%) of the 
confirmed perpetrators were facility residents.

Teaster, P., & Roberto, K. (2004). The sexual 
abuse of older adults: APS cases and outcomes. 
The Gerontologist, 44, 788-796. 
doi:10.1093/geront/44.6.788

Described is a study of sexual abuse cases involving 
adults over the age of 60 that were handled by Virginia 
Adult Protective Services from 1996 – 2001. Among 
the 82 victims, most were women in their 70’s or 80’s 
residing in nursing homes who had major limitations 
in self-care ability. Most perpetrators were older male 
adult nursing home residents. Only 4 perpetrators 
were prosecuted.

Teitelman, J. (2006). Sexual abuse of older adults: 
Appropriate responses for health and human services 
providers. Journal of Health and Human Services 
Administration, 29, 209-27. 

The purpose of this paper is to provide an introduction 
to the concept, scope and dynamics of elder sexual 
abuse and to offer suggestions for appropriate 
responses that are applicable across a wide range of 
health and social services. Definitions, demographic 
aspects and proposed causes of elder sexual abuse are 
discussed. Risk profiles for both community-dwelling 
older adults and those living in facilities are presented 
as a guide for professionals, followed by a discussion 
of physical and psychological signs of sexual abuse, 
and approaches for determining a client’s capacity to 
consent to sexual activity Finally, recommendations for 
appropriate responses once it is determined that abuse 
is likely to have occurred, including meeting obligations 
as a mandated reporter and providing effective 
communication and support to victims, are provided.

Vierthaler, K. (2008). Best practices for working with 
rape crisis centers to address elder sexual abuse. 
Journal of Elder Abuse & Neglect, 20, 306-322. 
doi: 10.1080/08946560802359235

An historical perspective on social and professional 
reaction to sexual assault in general and to sexual 
assault against older adults in particular is provided. 
An analysis of rape myths and the rape crisis 
movement is provided to help explain why older adults 
have been overlooked as victims of sexual assault. A 
Pennsylvania project designed to enhance response to 
victims of elder sexual violence is described.

Wisconsin Coalition Against Sexual Assault. (1998). 
Widening the circle: Sexual assault/abuse and people 
with disabilities and the elderly. Madison, WI: Author. 

This manual was written to assist sexual assault 
service providers, human services personnel, and 
others to effectively serve victims and survivors of 
sexual violence who are elderly or have disabilities. 
Information is provided about making services 
accessible to people with special needs and informing 
older adults and people with disabilities and their 
support systems about sexual assault services. 
Developmental, psychiatric, physical, and sensory 
disabilities and aging issues are discussed along 
with dynamics of sexual assault against people with 
disabilities and people in later life.

Zink, T., Fisher, B. S., Regan, S., & Pabst, S. (2005). 
The prevalence and incidence of intimate partner 
violence in older women in primary care practices. 
Journal of General Internal Medicine, 20, 884-888. 
doi:10.1111/j.1525-1497.2005.0191.x.

The purpose of this study was to determine the 
prevalence and incidence of intimate partner violence 
(IPV) among women age 55 and older who visit 
primary care offices. In a telephone survey of 995 
women over the age of 55, researchers found that 
1.52% reported intimate partner physical abuse since 
age 55, and 0.41% in the past year. Additionally, 2.14% 
reported intimate partner sexual assault since age 
55, and 1.12% in the past year. Victims of IPV were 
more likely to report chronic pain and depression than 
patients who did not report IPV.


This bibliography was compiled by Holly Ramsey-
Klawsnik, PhD, and is part of a Sexual Violence in Later 
Life Information Packet, which includes the following: 
fact sheet, technical assistance bulletin, technical 
assistance guide, resource list, and research brief. 
Further discussion and additional information about 
sexual violence against people in later life and its 
prevention can be found in those materials. Contact 
the National Sexual Violence Resource Center for more 
information: www.nsvrc.org or 877-739-3895. 


This document was supported by Cooperative Agreement #1VF1CE001751-01 from the Centers for Disease Control and Prevention.

© 2010 National Sexual Violence Resource Center. All rights reserved. 

NSVRC • 123 North Enola Drive, Enola, PA 17025 • Toll free: 877-739-3895 • www.nsvrc.org • resources@nsvrc.org