Implications for Research and Practice
Forensic, community, and mental health practitioners need research findings for clinical practice. When a sexually assaulted elder is unable to psychologically link ongoing, self-defeating, disrupting cognitions, emotions, and behaviors to the original trauma, there is no resolution or integration, and the underlying fear persists. This leads to an inability to use new experiences to maintain an adaptive and on time trajectory of mental health developmental tasks. Instead, the flexibility of the person to discriminate new information may be lost and the person is either numbed to the new information, hyperalert, or may perceive it as dangerous (Burgess, et al, 1995; van der Kolk, 1989).
As evident in myriad symptoms that can occur after a traumatic event, such as elder sexual assault, the victim is at high risk for PTSD which is typically expressed via disruptive symptoms and behaviors. Although there is a large foundation of literature that examines assessment for PTSD in people who have been exposed to trauma and abuse of various types, there is a paucity of research specific to elders who have been sexually assaulted. That so few symptoms were documented on 284 sexually abused elders indicates a lack of observation by staff and/or family members. Clearly, PTSD symptoms may present in a muted form or as oppositional behavior. Although there is a need for research specific to this type of exposure supported by the pervasive nature of violence in the United States, the forensic nurse is uniquely prepared to provide sensitive and comprehensive intervention and subsequently guide the interdisciplinary treatment team.
Until recently, it has historically and widely been beyond comprehension and belief that elders are victims of sexual assault, and, subsequently, the post-traumatic sequelae were conceivably overlooked or ruled away as medical or psychiatric variants associated with aging. This would be even more likely for elders with significant cognitive disruption as many may have believed it not even possible for them to remember such an event, let alone be affected by it. However, sexual assault is a violent act that inherently exerts an inequity of loss of control, imposition of power, and violation of trust. These facets of trauma directly contribute toward post-traumatic response patterns and behaviors (even if these are manifest without a clear connection to the explicit details of the sexual assault). The historical bias in health care has erroneously posited that the elderly are at low risk for abuse and assault. However, clinical experience and research has now been validated in the extant scientific and anecdotal literature that acknowledges this significant risk for violent injury and death in this vulnerable population.
Forensic nurses, community and health care practitioners, family and other caregivers need to become better informed about interpersonal violence, including sexual assault, perpetrated on elders. In addition, there needs to be education on how to support and provide opportunities for enhanced comprehensive assessment and medico-legal and psychotherapeutic intervention.
This manuscript was supported in part by a grant from the National Institute of Justice (NIJ #2003-WX-1007).
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.