“Too Grey To Be True?” Sexual Violence in Older Adults: A Critical Interpretive Synthesis of Evidence

Abstract

Sexual violence (SV) is an important public health issue with a major impact on victims and their peers, offspring and community. However, SV in older adults is under-researched. This paper aims to establish the prevalence and nature of SV in older adults in Europe, link this with existing policies and health care workers’ response to sexual health needs in older age, and critically revise the currently used frameworks in public health research. To fill this gap in the literature, we applied a Critical Interpretative Synthesis (CIS) approach. The CIS approach uses techniques from grounded theory and processes from systematic review. It allows to critically interpret key findings from both academic as well as grey literature, engendering theory refining. In the first phase of purposive sampling, we conducted a systematic review of academic sources and included 14 references. The cut-off age used to define old age varied between 60 and 70 years old among the included studies. Subsequently we added another 14 references in the second phase of theoretical sampling. We ultimately included 16 peer-reviewed articles and 12 documents from the grey literature. The CIS results demonstrate that knowledge of SV in older adults is still limited. The current research suggests that SV in older adults rarely occurs, however, prevalence rates are likely to be underestimated because of methodological shortcomings. The complexity of SV in older adults is not acknowledged in ongoing research due to the conflation of SV with other types of violence. Information on specific risk factors and about assailants committing SV in old age is absent. Policy documents dealing with sexual and reproductive health, rights and ageing make no mention of SV in older adults. In clinical practice, the sexual health needs of older adults often remain unmet. In conclusion, our findings suggest that older adults are forgotten in prevention and response to SV. Greater awareness about this topic could contribute to a revision of current policies and health care practices, leading to more tailored care for older victims of SV.

Measuring Sexual Victimization and Perpetration in Today’s Society: Modifications to the Sexual Experiences Survey

“…Depending on the level of physical contact and the objective of the sexual act, five distinct forms can be identified (items 1 till 5) (Keygnaert, 2014). One additional items was added based on the revised definition of elder abuse and neglect (CIUSS, 2017), (items 6) and broadened for applicability to the entire research population (Nobels et al, 2020): 1) sexual harassment, including forms of sexual violence without physical contact; 2) sexual abuse, including forms of sexual violence with physical contact but without penetration; 3) (attempted) rape, including forms of penetration with an object or body part; 4) sexual exploitation, including any abuse of a position of vulnerability, differential power or trust for sexual purposes (e.g., forced prostitution, gang rape, forced marriage); 5) sexual assault as a weapon of war/torture, including crimes against humanity such as sexual slavery, forced abortion, forced childbearing; 6) sexual neglect, including disrespect of a person's sexual privacy, sexual orientation or gender identity, treating people as asexual beings and/or preventing them from expressing their sexuality.…”

“…Other aspects of sexual neglect include not treating people as sexual beings (item 5) and disrespect of sexual intimacy (e.g., touching during care; item 7). This is particularly relevant for older adults who are often considered as people without any sexual needs (Kessel, 2001;Nobels et al, 2020; but also among people who need care due to a disability (Basile et al, 2016;Shaqiri et al, 2018). Additionally, not explaining the sexual side-effects of a treatment (item 6) can be considered as a form of denying one's sexual needs.…”

“…Scholars showed that sexual side effects are often minimized among older patients compared to younger patients (Schroyen et al, 2018) and older patients often feel too embarrassed to discuss loss of sexual function because they believed they would be considered as 'too old' to worry about this (O'Brien et al, 2011). While research has already examined attitudes of caregivers regarding sexual health among older adults (e.g., Gott et al, 2004;Saunamäki & Engström, 2014), the prevalence of sexual neglect remains largely under-researched (Nobels et al, 2020). Generally, sexual neglect was recently added to the definition of mistreatment of older adults by the Research Chair on Mistreatment of Older Adults (CIUSSS, 2017).…”

“…Research has namely shown that sexual victimization is prevalent within this population (Basile et al, 2016;Nobels et al, 2018;Shaqiri et al, 2018). Yet risks factors and prevalence rates of sexual neglect among older adults remain unknown (Nobels et al, 2020). Especially among older adults, measuring unwanted sexual contact during care is considered to be of utmost importance (Nobels et al, 2020;Nobels et al, 2018).…”

“…Yet risks factors and prevalence rates of sexual neglect among older adults remain unknown (Nobels et al, 2020). Especially among older adults, measuring unwanted sexual contact during care is considered to be of utmost importance (Nobels et al, 2020;Nobels et al, 2018).…”