Download sexual_assault_in_later_life_may_2017

Elder Sexual Abuse:
It is REAL.
It does happen.
N O R T H C A R O L I N A PA R T N E R S H I P TO A D D R E S S A D U LT A B U S E , 2 0 1 7 A N N UA L C O N F E R E N C E
B E T T Y N A N C E - F LOY D, P H D, R N , C N E , C N L
M AY 1 7 , 2 0 1 7 .
Learning outcomes
1.
Identify physical, social, economical, and psychological outcomes for elders after a sexual
assault.
2.
Analyze common risk factors among elderly sexual abuse offenders.
3.
Discuss the importance of interprofessional and paraprofessional teamwork regarding sexual
assault.
THE UNIVERSITY of NORTH CAROLINA at CHAPEL HILL SCHOOL of NURSING
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What is sexual violence ?
“any sexual act, attempt to obtain a sexual act, unwanted sexual comments or
advances, or acts to traffic or otherwise directed, against a person’s sexuality
using coercion, by any person regardless of their relationship to the victim, in
any setting, including but not limited to home and work”
World Health Organization
http://www.who.int/violence_injury_prevention/violence/global_campaign/en/chap6.pdf
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Elderly Sexual Assault study
https://www.youtube.com/watch?v=07CQwYdSZuw
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Inter-relationships
elderly
family
Health care
Law
enforcement
Judicial
system
Judicial
system
police
Health
care
Positive elderly/family
outcome
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In her words…..
https://www.youtube.com/watch?v=LABQPBjife8
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The majority of sexual assaults are not
reported to the police
ONLY 28% of elderly sexual assaults are reported to the police
https://www.rainn.org/statistics/criminal-justice-system
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What makes the elderly more
vulnerable?
Lack of a support system
Generational beliefs about sexual
violence – may not report.
Rigid gender roles
Anything sexual should not be discussed
Domestic or child sexual abuse
Altered mental status
Isolation
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Living arrangements: Advantage or
Disadvantage?
HOME WITH FAMILY OR
CAREGIVERS
INSTITUTIONS
A more regulated environmentmandatory reporting laws, protective
services, Department of Health
licensing, etc.
Limited contact with others
Family
Contact with other residents
Contact with long term care facility
staff
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Nursing Assistant arrested for sexual abuse
https://www.youtube.com/watch?v=uctf6QKcZvY
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Senior Home Sexual Scandal
https://www.youtube.com/watch?v=F79Eiinvxus
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CNA sexually abuses elderly man
https://www.youtube.com/watch?v=ZD5kz61YbAc
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During the assault
Most women do not fight back
Fight, Flight, or Freeze response kicks in
Bodies may be physiologically responsive
The victim may “tune out” or only notice specific details of the event or the
perpetrator
Survivors are likely to be re-victimized
◦ Re-victimization is not well understood
◦ Women who were abused as children are more likely to be abused or
assaulted as an adult
(Mullen, 1994; Cunningham, 1994; Widom, 1996)
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Our elderly sexual
abuse victims are
often overlooked
September 2004, first National Protocol for Sexual
Assault Medical Forensic Examinations released by the
U.S. DOJ, Office of Violence Against Women
Updated 4/2013
https://www.ncjrs.gov/pdffiles1/ovw/241903.pdf
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Why do people not report sexual assault
to the police?
Fear that they will be charged with a crime – negative experience with police in past
Fear of physical examination
Uncertainty regarding what happened/memory loss (freeze effect)
Excessive questioning by police or in accusatory manner
Fear that they have no proof
Want to avoid criminal trial
Want to “move on” and not think about it or upset family.
Dissuaded from reporting by friends/family/offender
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Why are our elderly overlooked – your
thoughts?
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Of the sexual violence crimes not reported to
police from 2005-2010, the victim gave the
following reasons for not reporting
20% feared retaliation
13% believed the police would not do anything to help
13% believed it was a personal matter
8% reported to a different official
8% believed it was not important enough to report
7% did not want to get the perpetrator in trouble
2% believed the police could not do anything to help
30% gave another reason, or did not cite one reason
https://www.rainn.org/statistics/criminal-justice-system
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What happens if the assault is not
reported – your thoughts?
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Recovery time in the elderly
Exacerbation of existing illnesses
never fully heal
Longer recovery times
Brittle pelvis or hip bones can be broken by
friction or weight
Increased change of sustaining serious
injury
Increased vaginal or anal tearing and
bruising that may
Increased risk of infections
STIs (STDs)
What happens if the assault is not reported?
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Potential Social outcomes
Survivor may receive unwanted attention
Survivor may receive unwanted media exposure.
Friends/Family/Acquaintances may be judgmental, blaming, “side” with
perpetrator
Families may “split” when the perpetrator is a family member
Survivor may feel distant from others or emotionally numb
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Potential Social outcomes
Survivor may experience changes with significant other or in intimate
relationships
Difficult for survivor to be sexually or emotionally intimate
Difficult for survivor to trust others
Survivor’s partner may have difficulty alleviating their own feelings of
hurt, guilt, blame, fear, outrage, sadness, etc.
Survivor may experience irritability, anger, nightmares, or flashbacks that can be
difficult for others to cope with
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Potential financial outcomes
Medical cost
Legal cost
Psychiatric/psychological cost
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Potential psychological and behavioral
outcomes
Posttraumatic Stress Disorder (PTSD)
or acute stress
Disorder
Sexual dysfunction
Feelings of guilt and shame
Anxiety (including panic attacks)
Depression
Substance use and abuse
Low self-esteem
Suicidal ideation
Fear
Eating disorders
Sleep disorders
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Who are the offenders?
What do they look like? Where do they work? How do we recognize
them?
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Offender
Risk factors: Individual
Exposure to sexually explicit media
Alcohol and drug use Delinquency
Hostility towards women
Empathic deficits
Adherence to traditional gender role
norms
General aggressiveness and acceptance of
violence
Hyper-masculinity
Early sexual initiation
Suicidal behavior
Coercive sexual fantasies
Prior sexual victimization or perpetration
Preference for impersonal sex and sexual-risk
taking
http://www.cdc.gov/violenceprevention/sexualviolence/ri
skprotectivefactors.html
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Offender
Risk Factors: Relationships
Family environment characterized by physical violence and conflict
Childhood history of physical, sexual, or emotional abuse
Emotionally unsupportive family environment
Poor parent-child relationships, particularly with fathers
Association with sexually aggressive, hypermasculine, and delinquent peers
Involvement in a violent or abusive intimate relationship
http://www.cdc.gov/violenceprevention/sexualviolence/riskprotectivefactors.html
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Offender
Risk Factors: Community
Poverty
Lack of employment opportunities
Lack of institutional support from police and judicial system
General tolerance of sexual violence within the community
Weak community sanctions against sexual violence perpetrators
http://www.cdc.gov/violenceprevention/sexualviolence/riskprotectivefactors.html
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Offenders
Risk Factors: Societal
Societal norms that support sexual violence
Societal norms that support male superiority and sexual entitlement
Societal norms that maintain women's inferiority and sexual submissiveness
Weak laws and policies related to sexual violence and gender equity
High levels of crime and other forms of violence
http://www.cdc.gov/violenceprevention/sexualviolence/riskprotectivefactors.html
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What are the common themes? – your
thoughts?
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Time is of the essence
We must work together to protect our elderly
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Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
Beginning in 1992, JCAHO has required health care facilities
1. to establish policies and procedures for training staff to identify crime victims
2. work with abuse survivors
ASK for the SANE trained nurse.
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Sexual Assault Nurse Examiner (SANE)
Adult/Adolescent/Pediatric
1976 First SANE program in Tennessee
1991 recognized as a specialty by the American Academy of Forensic Sciences
Mid-1990s programs began to develop rapidly
Role: Caring for Sexual Assault Patient Populations
Provide Compassionate and competent patient centered care
Collect evidence in a thorough and appropriate manner
Testify in legal proceedings (US Department of Justice: Office on Violence Against Women,
2013).
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SANE training programs in North Carolina
For a list of approved SANE programs offered in NC.
http://www.ncbon.com/myfiles/downloads/sane-program.pdf
UNC CLL SANE Resources: http://nursing.unc.edu/lifelong/sane/
Next training schedule
http://www.cvent.com/events/pediatric-adolescent-sexual-assault-nurse-examiner-trainin
g/event-summary-d3254f69f2cd4dd1bc25f73f4268aec1.aspx
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How can we work together better – your
thoughts?
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A Few Extra Resources …..
International Association of Forensic Nurses http://www.forensicnurses.org/?
International Sexual Assault Resources https://www.rainn.org/international-sexual-assaultresources
WomensLaw.org http://www.womenslaw.org/gethelp_national_type.php?type_id=1056
for Multiple links for sexual assault and for survivors
Office for Victims of Crime https://www.ovc.gov/help/international.html
End Violence Against Women International http://www.evawintl.org/Resources.aspx
NC Board of Nursing http://www.ncbon.com/dcp/i/nursing-practice-sexual-assault-nurse-examiner
UNC CLL SANE Resources: http://nursing.unc.edu/lifelong/sane/
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References
Available upon request
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