Most of the cases did not have adequate data to record SPAN symptoms. The entire record had to be read to determine the presence or absence of the symptom. However, for a small number of cases where nursing home records were available or interviews with family members had been possible, SPAN symptoms were recorded and are reported as follows.
The most frequently reported and observed symptom was numbness, sometimes described by family members as "shock." Elder victims would be described as lying in a fetal position, under their bed, or on the floor. They would be difficult to awaken and would sleep for long periods. One 76-year-old victim of a house invasion, robbery, and sexual assault said 1 year after the crime, "What happened to me is a horror story. My house is boarded up. You kind of become numb."
Symptoms of physiologic upset were also common. There would be symptoms of dysregulation in appetite and eating, sleep patterns, and mood levels. An 83-year-old nursing home victim who was raped at night, told the judge at the offender's trial 14 months after the assault, "I don't sleep nights at all."
The startle reflex is noted frequently in children and adults after a traumatic victimization. With this particular sample of elders, the symptoms were less prominent. This finding is congruent with recent research that after acute exposure to sexual assault, the startle response decreases over time (Morgan, Grillon, Lubin, & Southwick, 1997). Additionally, age differences suggest that older adults have differential reactivity to affective exposure to ongoing stress and crises, particularly related to altered neuropsychological and sociocognitive abilities due to aging (Blanchard-Fields, Stein, & Watson, 2004; Phillips, Maclean, & Allen, 2002; Smith, Hillman, & Duley, 2005).
Elder victims are less likely to verbalize anger. Rather, their behavior is described as agitated, restless, or oppositional. In one case, an 86-year-old nursing home resident acted "very distraught," according to the facility's staff. They said she was slamming doors, yelling loudly in the hallway, getting out of bed and pacing the floor. Although the resident had a history of displaying disruptive behaviors, the behaviors she displayed after the assault were described by staff as "out of character" and they were unable to calm her. She displayed oppositional behavior, refusing to comply with directions or requests such as bathing, eating, and sleeping.
Of note, the group that verbalized the most anger was the family members of victimized elders. One grandson said to the offender at his trial, "The night you raped our grandmother you raped our whole family. I might be on trial right now for what I would have done to you had I been there."
The following two cases present graphic details of the sexual abuse of an elder. The forensic nurse needs such information to be able to interpret post-trauma symptoms and link them to the abuse. Such analyses provide insight for assessment and guidance for intervention for elders with suspected or documented sexual assault. Failure to appreciate the traumatic nature of the abuse in terms of what actually happened will interfere with therapeutic recovery.
J Foren Nurs. 2006;2(3):113-120. © 2006 International Association of Forensic Nurses
Cite this: Information Processing of Sexual Abuse in Elders - Medscape - Oct 01, 2006.