PCAR Technical Assistance Bulletin Supporting Older Adult Survivors of Sexual Violence -------------- Older Adults in PA While Pennsylvania’s overall population is growing rather slowly, the number of Pennsylvanians over the age of 65 is increasing rapidly, at a rate of 20 times the state’s overall population (Pennsylvania State Data Center [PSDC], 2018b). While in 2017, older adults comprised 32% of Pennsylvania’s population (PSDC, 2018a), less than 1% of new clients assisted in rape crisis centers were age 60 or older. Recognizing that Pennsylvania’s rape crisis centers need to be responsive to all members of the communities they serve, it is essential to be prepared to provide effective prevention programming, counseling, and advocacy services to people throughout all the stages of their lives. -------------- Overview of Sexual Victimization of Older Adults The issue of sexual harassment, abuse, and assault of older adults has not received the focus this important topic deserves. Research has been significantly lacking, and of the research that has been done, most has focused on women who identify as white or Caucasian. Additionally, consistent definitions for terms such as “older adult,” “elder abuse,” or “sexual violence” are not used, making it difficult to draw meaningful comparisons or conclusions from the literature (Bows, 2018 a & b). Despite a lack of attention or clarity in the research, it is widely-accepted that the numbers reported in research studies, surveys, or criminal justice statistics vastly underestimate the number of older adults who have experienced sexual harassment, abuse, and/or assault throughout their lifetimes. Acknowledging the discrepancies in the research, existing studies estimated that between 2-8% of older adults had experienced sexual violence within the past year, with lifetime prevalence rates ranging up to 17% (Bows, 2018 a & b). Research has shown that women were more likely to report victimization than people of other genders, with women who have experienced poverty or have less formal education reporting higher incidence rates. It is also noted that older people with disabilities or mental illness are more likely to have experienced some form of sexual victimization during their lives (National Sexual Violence Resource Center [NSVRC], 2013). Despite discrepancies and gaps in the literature, some findings are consistent and important to note. Most commonly, sexual violence is perpetrated where the victim lives, whether it’s a care facility or personal home, and the offenders are usually known by the victim (NSVRC, 2010; NSVRC, 2013). Across age groups, survivors of sexual violence experience a range of emotional, psychological, physical, and spiritual reactions. Some impacts may include increased feelings of shame, anxiety and depression, sleep disturbances, changes in appetite, social withdrawal, substance use and abuse, sexually-transmitted infections, suicidality, or exacerbation of existing medical conditions or diagnoses. Older adults, in particular, are at increased risk of genital trauma and physical injury from sexual abuse or assault (Bows, 2018 a & b; NSVRC, 2010; NSVRC, 2013). -------------- Considerations for Supporting Older Adult Survivors 1. Challenge stereotypes. Many stereotypes exist about older adults that can create or compound barriers for people who are seeking help, and can stand in the way of a rape crisis center’s ability to provide effective services. In addition to challenging these ageist attitudes, it is essential that rape crisis centers make efforts to adapt services and build their capacity to meet the unique needs of individuals who are seeking services, including adults in later life (Bows, 2017b). People of all ages are sexual beings. While the ways people express their sexuality and desire for intimacy may change over time, many older adults enjoy very active sex lives (National Institute on Aging [NIA], n.d.). In light of this fact, primary prevention programs about respectful relationships, healthy sexuality, body autonomy, and consent can be just as important and relevant for people in later life, as they are for children and younger adults (NSVRC, 2010). Many people experience physical and cognitive changes as they age, and while it is important to attend to each individual’s needs, it should never be assumed that a person cannot fully participate in counseling or advocacy efforts for themselves due to their age (NSVRC, 2010). Interestingly, research has shown that potential for post-traumatic growth may be greater in older adults, particularly when survivors are connected to support and empowerment services (Bows, 2017a). 2. Accessibility is key. Accessibility can refer to many aspects of service provision, from ensuring that people with physical disabilities can enter the building with undue burden or that services can be provided regardless of the language the client speaks. Breaking down these and other barriers is essential; it is always important to consider not only a person’s gender, sexual orientation, race, and culture when providing services, but also how their age or life stage, or other aspects of their identity, might impact their experience and healing. Be mindful of how people of different generations might understand or define terms such as sexual harassment, abuse, and assault; sexism; or victimization, for example. Service providers should check in with clients to ensure there is shared understanding. Patronizing speech that disrespects or diminishes a person’s experience or competence should be avoided at all costs (NSVRC, 2010; The Gerontological Society of America, 2012). 3. Create collaborative partnerships. Building relationships with partner organizations and agencies that specialize and focus on working with older adult members of the community is an important first step in building a rape crisis center’s capacity. For example, connecting with medical providers who care for older adults may be a helpful way to learn more about ways to connect and collaborate to meet survivors’ needs and provide services. Reach out to your local Area Agency on Aging and network with professionals who work with Older Adult Protective Services. They can work with you to provide services that help reduce future risk and meet the needs of older adult victims. Not only is it important to know what programs and services are available to older adults for outreach and referral purposes, these partner organizations can provide training to counselor-advocates, develop and review resources, and can serve as advisory group or response team members. As rape crisis centers strive to reflect their communities in staffing and programming, it is important to include older adults from diverse backgrounds on staff, boards, committees, and as volunteers (Bows, 2017a; Olsen, 2017). Strengthening community partnerships helps to build the capacity of rape crisis centers to meet the needs of older adults, but also helps to bring awareness to other organizations about how issues of sexual violence impacts this population. For example, older adults are less likely to be offered forensic rape exams or treatment for sexual transmitted infections, in large part because medical providers may not be trained to identify signs of sexual assault in older adults or to respond effectively (NSVRC, 2013). Community partners should seek to educate each other about their role in preventing and responding to suspicions and/or reports of sexual violence in later life, and to understand how they can work cooperatively and collaboratively to create trauma-informed, survivor-centered policies, procedures, and protocols. 4. Understand confidentiality. While many professionals may be mandated reporters of abuse against older adults, PCAR-funded rape crisis counselor-advocates in Pennsylvania are not. Except in cases of child abuse, or when a client threatens harm to themselves or others, a rape crisis counselor-advocate may only disclose a client’s information with their informed, documented consent (PCAR, 2017; PCAR, 2018 a & b). ----------------------- Additional Resources Lifespan: Sexual Violence Against Adults in Later Life – NSVRC’s on-line resource that includes additional information and links to resources and webinars. https://www.nsvrc.org/lifespan-sexual-violence-against-adults-later-life Additional PCAR/NSVRC Webinars, including: Sexual Violence Against Older Adults: Responding to and Investigation of Cases of Elder Victimization https://campus.nsvrc.org/course/index.php?categoryid=10 Inclusive Services for LGBTQ Older Adults: A Practical Guide to Creating Welcoming Agencies https://www.lgbtagingcenter.org/resources/pdfs/NRC_guidebook.pdf National Clearinghouse on Abuse in Later Life https://www.ncall.us/ ----------------------- References Bows, H. (2018a). Practitioner views on the impacts, challenges, and barriers in supporting older survivors of sexual violence. Violence Against Women, 24(9). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009174/ Bows, H. (2018b). Sexual violence against older people: A review of the empirical literature. Trauma, Violence, & Abuse, 19(5), 567-583. Retrieved from https://journals.sagepub.com/doi/full/10.1177/1524838016683455 The Gerontological Society of America. (2012). Communicating with older adults: An evidence-based review of what really works. Retrieved from https://aging.arizona.edu/sites/aging/files/activity_1_reading_1.pdf National Institute on Aging. (n.d.) Sexuality in later life. Retrieved from https://www.nia.nih.gov/health/sexuality-later-life National Sexual Violence Resource Center. (2010). Sexual violence in later life. Retrieved from https://www.nsvrc.org/sites/default/files/2012-03/publications_SVlaterlife_bulletin.pdf National Sexual Violence Resource Center. (2013). Sexual violence in later life: A technical assistance guide for health care providers. Retrieved from https://www.nsvrc.org/publications/nsvrc-publications-guides/sexual-violence-later-life-technical-assistance-guide-health Olsen, L. (2017). Multi-sector approach to respond to elder sexual violence. Retrieved from https://pcar.org/sites/default/files/resource-pdfs/tab_2017_multi-sector-approach-elder-sexual-violence.pdf Pennsylvania Coalition Against Rape. (2017). Mandated reporting of suspected child abuse: Knowing your role in the protection of children. Retrieved from https://pcar.org/sites/default/files/pages-pdf/mandated_reporting_brochure_2017.pdf Pennsylvania Coalition Against Rape. (2018a). Consent. Retrieved from https://pcar.org/consent Pennsylvania Coalition Against Rape. (2018b). Older adult protective services act: Mandatory reporting and confidentiality requirements. Retrieved from https://pcar.org/sites/default/files/resource-pdfs/older_adult_protective_services_act_factsheet_508d.pdf Pennsylvania State Data Center. (2018a). 2017 state and county detainled population estimates: Growth in the aging, Asian, and Hispanic populations. Retrieved from https://pasdc.hbg.psu.edu/sdc/pasdc_files/researchbriefs/DetailedEstimates_2017.pdf Pennsylvania State Data Center. (2018b). Population characteristics and change: 2010 to 2017. Retrieved from https://pasdc.hbg.psu.edu/Data/Research-Briefs/PA-Population-Estimates ---------------------- © Pennsylvania Coalition Against Rape 2019. All rights reserved. www.pcar.org