A Systematic Scoping Review of Perceptions of Sexual Violence in Later Life and Approaches to Prevention

Background:

Older adults are not viewed as sexual or sexually desirable due to intersectional ageism and sexism, and are largely excluded from sexual violence (SV) prevention and intervention (Bows & Westmarland, 2015). Accordingly, little is known about SV among elders, also identified as elder sexual abuse (ESA) or what is needed to prevent it. Thus, a Critical Feminist Gerontological -Social Ecological framework was used to explore (a) perceptions of ESA, (b) potential barriers and (c) solutions to prevention at individual, relational, organizational, and societal levels, to offer an understanding of influences of ageism and sexism on how ESA is perceived and prevented.

Methods:

A systematic scoping review was conducted, on perceptions of ESA, barriers and solutions to prevention, which included: (a) peer-reviewed and grey sources (b) published since 2010 (c) in English, (d) supported by primary research, on (e) perceptions of ESA and its prevention. Excluded sources consisted of those focused on (a) non-sexual abuse (e.g. financial abuse), (b) on elder abuse overall, without substantial attention ESA, or (c) solely on individuals younger than 50 years.

An eight database search returned 148 potentially relevant sources, 53 of which were excluded on title and abstract screening, 76 upon full text reading, and one article that was excluded upon critical appraisal, yielding 18 articles for thematic analysis, using NVivo qualitative analysis software, to uncover themes from the literature.

Findings:

Seven overarching themes were identified from the 18 scholarly articles on perceptions of ESA, barriers to and solutions for prevention. These surrounded (a) needs for knowledge and awareness, (b) research, and (c) policy development, (d) influences of agism and sexism, (e) SV being a taboo involving limited support, and a need for exploration of (f) sociocultural differences, to address (g) confusion about SV and how it is defined, including when it involves elders.

Implications:

Various implications for practice, research, policy, and education were discussed in the reviewed articles. For example, further interdisciplinary collaboration is needed in practice and research to influence policy and education surrounding gerontology and SV. Thus, increased knowledge and awareness are needed, including on ESA involving dementia, particularly through trainings for practitioners in long-term care, general healthcare, domestic violence and SV arenas, informal caregivers and society members.

Discomfort with sexuality among elders owing to ageism, sexism and rape stereotypes was widely cited as presenting substantial barriers to prevention. Thus, further research on how to increase comfort with discussing ESA is needed, among caregivers, family, friends and community members, at organizational and societal levels. Future interdisciplinary research should also underscore power imbalances influenced by ageism and sexism, unmet needs of individuals who perpetrate SV, related barriers and solutions to prevention.

Moreover, the need for ESA education has implications for policy; expressly in terms of increasing support for caregivers of individuals with dementia. Further funding, resources and training are especially needed in social work, law enforcement, and SV agency settings. Additionally, policymakers are encouraged to use a clear and widely accepted definition of SV to shift paradigms surrounding SV, particularly involving elders.