Analysis of Possible Sexual Assault or Abuse in a 67-Year-Old Female With Early Dementia Post–Brain Attack

Abstract

The case analysis explores an emergency department visit by a 67-year-old female with early dementia post-brain attack, with complaints of possible sexual assault or abuse. This patient resides in a long-term skilled nursing facility. The case outlines the forensic care provided by the Advanced Practice Forensic Nurse (APFN) once medically cleared by the emergency department Advanced Practice Nurse (APN). The case discussion includes issues related to sexuality in aging populations, consent, sexual abuse or assault in institutions, and forensic care of older persons. Expected genital injuries in older women that result from sexual assault and abuse are also explored. The case discussion will analyze the key elements for critical thinking and clinical reasoning and demonstrate standards of care for the APFN and APN practice.

Sexual Assault and Justice for Older Women: A Critical Review of the Literature

“…Developing a more thorough understanding of the ways in which older individuals with dementia communicate and disclose sexual assault may assist in gaining access to justice for these victims (see, e.g., Speck et al, 2013).…”

“…Abuse between residents typically takes the form of indecent exposure and unwanted discussion of sexual activity, while sexual abuse involving penetration or oral contact is comparatively rare (Castle, 2012). In contrast, Payne’s (2010) analysis of sexual abuse cases in nursing homes identified staff, and specifically nursing aides, as the most prevalent group of offenders, and offenders may seek out environments where they have access to vulnerable individuals (Speck et al, 2013).…”

“…Thus, the impacts of sexual violence can vary depending upon when it occurs across the life course (Ullman & Brecklin, 2003). Most notably, older women are more likely to sustain genital injury during a sexual assault due to the physiological and anatomical changes that accompany menopause and aging (Burgess & Phillips, 2006; Eckert & Sugar, 2008; Morgan et al, 2011; Poulos & Sheridan, 2008; Ramin, 1997; Speck et al, 2013). As a result, older women are likely to have different support and treatment needs in the aftermath of sexual assault.…”

“…The impacts and trauma of sexual assault can be more severe for women who have been victimized multiple times across their life course or who have experienced both sexual and physical abuse (Cook et al, 2013; Speck et al, 2013; Ullman & Brecklin, 2003), and Bright and Bowland argue that this may result in “a complicated pattern of symptoms” (2008, p. 377). Burgess and Morgenbesser (2005, p. 196) suggest that the impacts of sexual assault can be heightened for elderly victims, as they may not be “equipped—physically, constitutionally, or psychologically—to defend against and cope with the proximal effects of sexual assault” (see also, Burgess et al, 2000; Groth, 1978).…”

Sexual assault can happen in your facility

“…3 Many sexual assaults go unreported; reasons a victim may not report a sexual assault include personal beliefs, fear, embarrassment, mistrust of the justice system, or an inability to report due to a physical or cognitive disability. 3 Many sexual assaults go unreported; reasons a victim may not report a sexual assault include personal beliefs, fear, embarrassment, mistrust of the justice system, or an inability to report due to a physical or cognitive disability.…”