Sexual Aggression Between Residents in Nursing Homes: Literature Synthesis of an Underrecognized Problem

Abstract

Evidence exists suggesting that most sexual aggression against older adults occurs in long-term care facilities. Fellow residents are the most common perpetrators, often due to inappropriate hypersexual behavior caused by dementing illness. This resident-to-resident sexual aggression (RRSA) is defined as sexual interactions between long-term care residents that in a community setting would likely be construed as unwelcome by at least one of the recipients and have high potential to cause physical or psychological distress in one or both of the involved. Although RRSA may be common and physical and psychological consequences for victims may be significant, this phenomenon has received little direct attention from researchers to date. We review the existing literature and relevant related research examining elder sexual abuse and hypersexual behavior to describe the epidemiologic features of this phenomenon, including risk factors for perpetrators and victims. Preventing and managing sexual aggression in nursing homes is made more challenging due to the legitimate and recognized need for nursing home residents, even those with advanced dementing illness, to sexually express themselves. We discuss the ethical dilemma this situation creates and the need to evaluate the capacity to consent to sexual activity among residents with dementing illness and to re-evaluate capacity as the diseases progress. We offer suggestions for managing RRSA incidents and for future research, including the importance of designing effective interventions.

Elderly Sexual Offenders

“…Among these elderly individuals, inappropriate sexual behavior could be dealt with in very different ways depending on the jurisdiction. Sexual aggression within the nursing home setting is a relatively new issue that come to attention [56]. As with older offenders who commit general offences, older sexual offenders could be prosecuted criminally found incompetent to stand trial or not guilty by reason of insanity-though these outcomes may be less likely if a sexual offence is involved as there is often a Brational motive^(i.e., sexual gratification) for their offending.…”

“…Indeed, fronto-temporal dementias may disproportionately put an individual for criminal behavior including inappropriate sexual behavior [61,62]. There have also been a number of case studies of new onset inappropriate sexual behavior signaling the onset of new dementia [56,63,64]. Among elderly individuals referred for sexual behavior and mental health issues, the unrecognized prevalence of neurocognitive dysfunction was nearly 60 % [65•].…”

Violence in the Nursing Homes: Understandings, Management, Documentation and Impact of Resident to Resident Aggression

“…Still more recently, the works of Rosen and his colleagues that have drawn attention to RRA. (Rosen et al, 2010 and This author having consulted to long-term care facilities for over a decade has found that staff were much more attentive and more concerned about resident aggression toward staff than RRA. In discussions and training sessions with line staff in over one hundred nursing homes, when asked who is the greatest victim of resident aggression, their answer was staff.…”

“…Similarly sexual violations range from a brief fondling to rape. (Rosen et al, 2010) This paper focuses on physical encounters. It should be remembered that the actual aggression spectru m r a n g e s f r o m y e l l i n g , v e r b a l a s s a u l t s , offensive gestures, pinching, throwing objects, hitting, punching, assaults to homicide .…”

How organizational factors interact to influence the quality of care of older people in the care home sector

“…Physical abuse of older people resident in nursing homes has been associated with cognitive and behavioural difficulties and previous victimisation. (2) Residents can also be at risk of abuse by other residents (16,17) .…”