Prevalence and impact of sexual violence in older adults

Abstract

Sexual violence is increasingly recognised as an important public health problem of major societal and judicial concern. Although research has shown that sexuality and sexual health remain important in old age, research on sexual violence in older adults is scarce. Knowledge on the prevalence and nature of sexual violence, its mental impact and help-seeking behaviour upon sexual victimisation in older adults remains limited. Moreover, despite the knowledge that people with severe mental illness have an increased risk of sexual victimisation compared to people who do not suffer from severe mental illness, the extent of sexual victimisation in old age psychiatry patients remains unknown. In order to develop preventive measures and to provide tailored care for older victims of sexual violence, a revision of current policies and healthcare practices regarding sexual violence seems of the utmost importance. Hence, the general objective of this dissertation was to contribute to a better understanding of the nature, magnitude, mental health impact and help-seeking behaviour upon sexual victimisation in older adults in Belgium. To this end, we conducted a mixed methods study comprising a Critical Interpretive Synthesis, a population based-study in which we administered a survey through face-to-face interviews with 513 randomly selected older adults across Belgium, the same questionnaire-based study in 100 old age psychiatry patients admitted to three old age psychiatry departments across Flanders, and 15 in-depth interviews with older victims of sexual violence. This dissertation shows that sexual victimisation appears to be common in older adults and old age psychiatry patients in Belgium. More than 44% of older adults living in Belgium (55% of women, 29% of men) and 57% of the old age psychiatry patients (65% of women, 42% of men) were sexually victimised during their lifetime, respectively 8% (9% of women, 7% of men) and 7% (6% of women, 9% of men) in the past 12-months. Nevertheless, older adults remain neglected in policies and healthcare practices on prevention of and response to sexual violence. Moreover, sexual victimisation in older adults stays largely undetected. Despite the important association of lifetime exposure to sexual violence with adverse mental health outcomes in old age, the vast majority of victims never disclosed their sexual violence experiences nor sought professional help. Older victims seem willing to discuss their sexual victimisation with healthcare workers, but expect health care workers to initiate the conversation. Our results highlight the importance of recognising older adults as a risk group for sexual victimisation and indicate a need to sensitise society about positive sexuality and respect for sexual intimacy in older adults as well as the prevention of sexual victimisation against older adults. In addition, tailored, accessible, acceptable and affordable mental health care for older victims of sexual violence is needed. In this regard, healthcare professionals need to be educated through training, detection tools and care procedures to initiate conversations about sexual victimisation, to better detect signs of sexual violence, and to prevent, mitigate and respond to sexual victimisation in older adults.