Sexual Violence Among People Aged 50 Years and Older: Recommendations for Prevention Provided by Direct Survivors of Sexual Violence Past Age 50

Abstract

Sexual violence (SV) is the least acknowledged or reported form of elder abuse, and older adults have been largely excluded from prevention and intervention. Guided by a Critical Feminist Gerontological-Social Ecological framework, a survey was developed to explore knowledge and experiences of SV in later life, and prevention recommendations. Data were collected using Amazon Mechanical Turk, directing participants to a survey on perceptions of SV, involving write-in questions on knowledge and experiences with SV in later life, and needs for prevention. Responses were thematically analyzed. Six themes were identified from 16 survivors of SV since turning 50. These themes include critical needs for knowledge, awareness, and resources for prevention; the rife yet hidden nature of SV; minimization, victim blame, and disbelief of SV in later life; the role of gender-, age-, and work-place-related imbalances of power; needs for greater accountability for people who offend; along with fear, strong emotions and extreme anger among survivors. The results suggest that SV in later life is a complex social problem that must be explored, prevented and addressed at multiple levels, requiring primary, secondary, and tertiary strategies across the lifespan. Timely implications for practice, policy, and research are discussed based on the survivors’ recommendations.

Introduction

Sexual violence (SV) is a preventable public health crisis, resulting in substantive and lasting adverse impacts on the physical and mental health of victims and survivors (Bows, 2018a, 2018b; Hand et al., 2022; World Health Organization [WHO], 2022). In this manuscript, “victims” and “survivors” are used interchangeably, recognizing how people choose to identify. SV in later life is less acknowledged than earlier in life, yet older adults remain vulnerable to SV (Bows, 2018a; Hand et al., 2022). While SV definitions vary, the definition provided by the WHO (2022) is widely accepted, encompassing “any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship,” (para. 1). This includes rape, or “forced or otherwise coerced penetration,” (WHO, 2022, para. 1). Thus, SV can involve a range of non-physical behavior (e.g., unwelcome sexual remarks), and physical behavior, such as rape, which can involve coercion or assault (WHO, 2022). Owing to the limited research on SV in later life, this manuscript focuses on both physical and non-physical SV, that has occurred after turning 50.

SV in later life has been described as elder sexual abuse, defined as unwanted sexual interaction with an adult older than 60 years (Centers for Disease Control and Prevention [CDC], 2022). Yet, definitions of later life differ depending on lived experiences, and some gerontologists are beginning to study adults as young as 50 (National Clearinghouse on Abuse in Later Life [NCALL], 2019), as SV has been linked with greater risks for obesity, poor health (Smith et al., 2010), and accelerated aging (Levine & Crimmins, 2018), suggesting that for some people who have marginalized, later life may begin earlier.

As research on SV in later life is emerging, prevalence estimates still need to be firmly established (Bows, 2018a; Burgess et al., 2008; Hand et al., 2022) despite being studied for over 30 years (Burgess et al., 2008; Hand et al., 2022). Bows (2018b) highlighted that population studies focused on later life report the lowest estimates of SV in later life, ranging from 0.2% to 3.1%. Studies across ages have yielded the highest prevalence rates, ranging up to 17% of all SV cases, and domestic violence (DV) research has identified SV rates in later life of 15% among all DV survivors (Bows, 2018b). More recently, in a Belgian prevalence study on SV in later life, Nobels, Cismaru-Inescu et al. (2021) found a 44% lifetime prevalence of SV among adults who were 70 and older, with a 2.34% reported prevalence within 12 months of the study, noting that older adults may define SV differently than younger adults. Nobels, Keygnaert et al. (2021) also found a life time prevalence of 57% of older patients in three psychiatry wards, with 7% having experienced SV within 12-months of the study. Still, SV is underreported, and its prevalence is likely underestimated (Bows, 2018a; Hand et al., 2022; Nobels, Cismaru-Inescu et al., 2021). In Western nations like the US, SV is even more of socially taboo than physical or psychological abuse, which may impact reporting on SV in later life (Anme et al., 2005; Giannouli, 2022).

While more research on barriers to SV in later life is needed, extant research suggests that another barrier to studying, preventing and addressing SV in later life is that older adults are not widely considered sexual or desirable, due to ageism (Bows, 2018a; Hand et al., 2022). Accordingly, older adults are widely excluded from prevention and intervention. Further research is needed to raise awareness that SV occurs in later life (Bows, 2018a) and qualitative studies are especially needed to understand survivor experiences and their recommendations (Teaster et al., 2015).

Critical risk factors for elder abuse include societal perceptions, ageism, sexism, and other forms of prejudice (WHO, 2009). Older adults have long been regarded as fragile, incompetent and less valuable than younger adults (Bows, 2018a). Public perceptions can impact policies and may be internalized (Hand et al., 2022; WHO, 2009). Social acceptance of SV as a private issue can also promote silence, which can limit resource expansion and development (Hussain & Khan, 2008).

What follows is inadequate education on social issues that are not understood as problems, like SV against adults who are not understood as sexual (Terry, 2014). Perceptions have strong potential to impact prevention and intervention at micro-to-macro levels (Hussain & Khan, 2008). An understanding of the impacts of rape myths on perceptions can help advance prevention (Bows, 2018a; Hand et al., 2022).

These constructs informed the framework that guided this study, the purpose of which was to explore knowledge and experiences with SV in later life, barriers to, and recommendations for prevention, according to people who have survived SV after turning 50. As such, the research question for this study is “what (if any) barriers may exist, to preventing SV in later life, according to the knowledge and lived experiences of survivors of SV that has occurred after turning 50?”

This research question attends to a gap in current research on barriers to and recommendations for preventing SV in later life (Bows, 2018a; Hand et al., 2022) from the perspectives of survivors of SV in later life (Hand et al., 2022; Teaster et al., 2015). At present, to the authors’ knowledge, no other articles have been published on primary research with survivors of SV in later life, as most of the existing limited research on SV in later life are based on adult protective services (APS) and police reports and on interviews or focus groups with practitioners who serve older adults (Hand et al., 2022).

Methods

Theoretical Framework

An integrative theoretical framework, incorporating the Critical Feminist Gerontological Framework and the Social Ecological Model (SEM), guided this study. Feminist research seeks to explore social constructs, values and meanings that disproportionately impact older women by examining cultural and societal norms stemming from sexual differences as well as their impacts on older women (Freixas et al., 2012). Critical gerontology focuses on political and socioeconomic aspects of growing older, which can include exploring gender-based stereotypes and discrimination as well as racism, ethnocentrism, and other forms of discrimination and particularly how discrimination and harmful stereotypes can impact how older adults live their lives (Freixas et al., 2012) As Bows (2018a) has suggested, beyond offering a greater understanding of the unique impacts and needs of older adults, combining these frameworks to apply a critical feminist gerontological lens to explore how ageism and sexism intersect can offer valuable implications for future research, policy and practice that can directly impact at-risk older adults. Using a critical feminist gerontological lens emphasizes power dynamics (e.g., based on age) and is suitable for exploring factors linked to both male and female survivors of SV, although women are primarily impacted (Bows, 2018a).

Thus, power dynamics, between men and women and among older and younger adults, and intersectional discrimination were explored, relating to SV in later life (Bows, 2018a). This attended to a key study aim, to offer a new understanding of SV in later life and what is needed for prevention from the perspectives of survivors, to prioritize their wisdom, offering a timely contribution to the limited knowledgebase in this area.

Considering the aims of our study and research that suggests multi-level prevention strategies are needed (Anme et al., 2005; Bows, 2018a; Brozowski & Hall, 2010; Hand et al., 2022), the Social Ecological Model (SEM) was also used to guide this study, in following recommendations to use the SEM to guide primary SV prevention and SV research (CDC, 2022). The SEM transcends focus on micro level change only for victims or perpetrators in favor of promoting prevention at several levels by calling for changes in existing social norms, perspectives and social systems (Men Can Stop Rape, 2011). In particular, the SEM encourages an exploration of links between individuals, relationships, communities or organizations and society as well as how they impact wellness (Socio-Drama Tackling Ageism, Preventing Abuse, STAGE, 2016) and several researchers have used it to explore violence against women (Terry, 2014).

Using the SEM, SV was explored at individual and societal levels with potential to explore inter-relational-, communal-, and organizational-level responses, as most SV research has focused largely at the individual level only (Du Mont et al., 2022). Thus, this research chiefly focused on experiences with and knowledge of SV after turning 50, in consideration older adults being left out of prevention and intervention, and of the possible impacts of relational, communal, or societal responses on prevention and on SV experiences after turning 50.

These frameworks were also integrated and used to guide the study prior to data collection, as to participate in the study, the survivors had to be at least 50 years of age and it was anticipated that the majority of the survivors would identify as female. While the majority of the survivors in this study did identify as female, as will be discussed later in the results section, it is noteworthy that several male survivors of SV since turning 50 participated in this study. Still, a critical gerontological perspective and the SEM are relevant to older men, who also experience ageism and can benefit from multi-level prevention. As we will discuss in our Results section, the gendered nature of SV, including in later life, was discussed by both male and female participants as well, who noted that most perpetrators are men, which was attributed to societal norms that afford men more privilege and with this, more power to control women. We believe this supports the need for a Critical Feminist Gerontological-Social Ecological framework.

Study Design

Given the sensitive nature of SV in later life, an anonymous online survey was conducted, with open text questions to collect qualitative data on experiences with SV in later life, barriers to and solutions for prevention as part of a cross-sectional mixed methods dissertation study. The larger dissertation study, upon which this manuscript was based, involved data collection through a survey that was provided via Amazon MTURK. Participants in this study were directed to a Qualtrics link to an informed consent page and then the survey, where they were asked up to 27 open-text questions to gather qualitative data on their response to a randomized SV vignette, and to explore their perceptions of SV, needs for prevention, personal beliefs related to SV, their personal resource knowledge, and personal experiences with SV past 50 years. The survey also included quantitative questions on individual participant responses to the SV vignettes to examine how victim age and SV type may possibly impact the perceived seriousness, culpability, reportability, and personal knowledge of SV. Following the quantitative questions that were asked as part of the larger dissertation study, open-text, or write-in questions were included for thematic analysis, on personal experiences with SV in later life, barriers and recommendations to prevention.

Survey responses provided by participants in the larger dissertation study who indicated that they were 50 years or older and were survivors of SV past the age of 50 years were thematically analyzed, and will be described in this manuscript. Survivors who were 50+ were included owing to impacts of oppression on aging (NCALL, 2019).

Researchers have begun gathering qualitative data online, via Amazon Mechanical Turk (MTURK), to explore sensitive topics that are complex or difficult to discuss in-person (Maszak, 2018). (See Appendix 1 for the survey questions). MTURK surveys transcend mobility constraints that are common in later life. Data were collected through a survey via MTURK, an online platform for recruiting “high-quality convenience samples,” (Chandler & Shapiro, 2016, p. 56) through anonymous surveys through offering tasks by crowdsourcing, or open invitation (Rubenstein, 2016). MTURK has been used to explore sensitive issues, while posing minimal distress, and a credit card is required to create a MTURK account, limiting potential for multiple survey attempts (Rubenstein, 2016).

Ethical Issues

The Institutional Review Board (IRB) at The Ohio State University issued approval for the study. Informed consent was obtained from all subjects involved in the study through an online consent form that participants were directed to read and agree to prior to proceeding with the online survey, indicating that they read the consent form or someone read it to them, and that they freely give their consent to participate in the study. Still, all results are presented anonymously, in order to protect the identity and privacy of the participants. A trigger warning was also provided prior to participants beginning the survey, along with the contact information for the research team and select mental health resources, to prioritize a trauma-informed approach to research. Participants were also provided an overview of study and the nature of the questions they would be asked. (See Figure 1, Figure 2, and Table 1 for further information).

Inclusion Criteria

Individuals who agreed to proceed with the survey, who were at least 18, and lived in the US, were eligible for the larger dissertation study, in efforts to gather data on SV perceptions and knowledge, as part of a larger dissertation study. Responses from participants who reported experiencing SV past age 50 (in Appendix 1) are explored in this manuscript. Thus, the survivors in this study, that was conducted as part of a larger dissertation, were identified through a convenience sample of survey respondents, considering the sensitive, socially taboo nature of the research topic, and to minimize potential distress.

Exclusion Criteria

The responses of participants in the larger dissertation study who did not indicate that they had survived SV past the age of 50 or who indicated that they may have survived SV past the age of 50 but then described learning of SV past 50 years but not personally experiencing it were excluded from the thematic analysis of survivors’ experiences.

Open-Text Questions to Garner Qualitative Data

Participants were asked up to 27 open-text questions to gather qualitative data on personal experiences with, knowledge and beliefs about SV across the lifespan, as well as knowledge of related SV resources for older adults, and needs for prevention. (See Appendix 1, Figure 1 for the specific questions that were asked, as well as Figure 2, and Table 1 for further information).

Compensation and Further Recruitment Information

Participants were offered $1.65 for beginning the survey, paid by the first author, from a teaching and research award. All participants were compensated, regardless of age or experience with SV, as the aim of the larger dissertation study was to explore societal perceptions and knowledge of SV, and within this aim, to explore recommendations for prevention, offered by older victims within the sample. Compensating all participants, regardless of SV experience, may have minimized malingered responses.

In total, 783 participants were recruited via MTURK, 567 of whom answered all survey questions. Of these larger dissertation study participants, 16 reported surviving SV since turning 50, resulting in 16 written responses for thematic analysis. (See Appendix 1 for the survey questions). Responses were qualitatively analyzed to probe survivors’ knowledge, lived experiences of SV, and recommendations for preventing SV in later life.

Thematic Analysis

Thematic analysis was used to explore the survivors’ responses and to provide an in-depth overview of their recommendations for prevention. The purpose of thematic analysis is to identify answers to questions through analytical themes (Braun & Clarke, 2006). Using and following the steps for thematic analysis that were outlined by Braun and Clarke (2006), the survivors’ open-text responses were thematically analyzed. Themes from these survivors’ responses were identified by the first author as part of a dissertation study, by closely reading the survivors’ written responses first individually, and then across the dataset, to promote familiarization with the data, then conducting initial coding using in vivo, descriptive and values codes, in a Microsoft Excel coding spreadsheet. These initial codes were reviewed, revised to closely reflect the language of the survivors, and were then combined and refined, to yield additional themes, which were then further refined and combined, yielding higher level themes that reflected the survivors’ words (Braun & Clarke, 2006). These themes will be further discussed in the next section, along with direct quotes from survivors that reflect these resulting themes.

With regard to trustworthiness, credibility was ensured through an iterative coding process, following thematic analysis, by gathering information from a diverse sample of survivors (Sikolia et al., 2013), who shared their experiences with SV in later life, with several commonalities identified, supporting each other’s stories and the resulting themes. This suggests congruency between their stories and the themes that were iteratively identified by the first author as part of the larger dissertation study. Member checking did not occur, owing to participation being anonymous. However, transferability was strengthened by thoroughly describing the research context and providing a clear audit trail (Bruce, 2007), both in Microsoft Excel and in the write-up of this manuscript. Dependability and confirmability were also increased through providing a detailed audit trail of the thematic analysis that was conducted of the survivors’ responses, and in turn, by including direct quotes throughout coding, analysis, and writing (Bruce, 2007).

Results

Of the 783 participants recruited through MTURK, 567 answered all survey questions, 104 (18.3%) of whom were older than 50 years. Sixteen of these participants, aged 50+ years, reported experiencing “unwanted sexual touch” since turning 50. All 567 completed survey responses were analyzed as part of a larger dissertation study, in part for a quantitative analysis (Hand, 2020). The written responses of the 16 survivors who experienced SV past 50 years were qualitatively (or more specifically, thematically) analyzed however; these results and survivor demographic information are provided in this manuscript. Most of these survivors were female (n = 10); six were men. Appendix 2 (See Table 2 and Figure 3) for a table of the demographic characteristics of the survivors.

All survivors were older than 50, and some were in their 80s, with a median age range of 50 to 59 years (mean age = 57.63 years). The older survivor sample was diverse with regard to race and sexual orientation. Still, most survivors (n = 10) were White, although two were Indigenous or Native American, three were Black or African American, and one was Latino or of Spanish origin. While most (n = 11) identified as heterosexual, four identified as bisexual, and one identified as pansexual.

All 16 survivors reported experiencing unwanted sexual touch (otherwise known as SV). Of these survivors, 11 (68.75%) told someone about the SV (e.g., a spouse, partner, family member, friend, colleague, religious official, or supervisor). Still, only seven (43.75%) officially reported the SV (e.g., to the police, a hospital and/ or to one or more agency), reflecting research that suggests most SV cases in later life remain unreported (Bows, 2018a). Reasons for not reporting included not wanting to involve authorities, the SV being “minimized,” not wanting to worry others, fearing “repercussions,” “embarrassment,” and receiving an apology from the offender.

Six key themes were identified. These included (a) critical needs for knowledge, awareness, and resources, (b) the rife yet hidden nature of SV, (c) minimization, victim blame, and disbelief, (d) imbalance of power; (e) needs for greater accountability and (f) fear, strong emotions and extreme anger.

Critical Needs for Knowledge, Awareness, and Resources

The survivors in this study stressed multi-level needs for awareness, which is consistent with the SEM that was used to guide this study, and highlighted how these needs for awareness impact understandings of SV in later life, and resources to prevent and address it. Lack of awareness, education and training were identified as substantial barriers to prevention. One survivor, in his 50s, noted, “awareness [of] resources [needs] to be everywhere,” adding, “there are materials and resources for. . . not being ‘scammed’. . . but I do not know [of] ones specifically related to unwanted touching or behavior.” In sum, as another survivor, in her 50s, suggested, “awareness and education are vital.”

In particular, the survivors stressed the importance of a more widespread understanding of why SV is a relevant problem in later life through training, mandatory education, and public SV awareness for older adults and organizations that serve them. For example, one survivor suggested, “to prevent unwanted sexual touch/behavior in people over 50 there needs to be more educational outlets,” to raise public awareness at the societal level of the SEM, such as through organizations “like AARP” as well as “through the media.” He added, “the way to prevent and address [this] is through awareness and showing through action that there are people and systems to help,” reflecting needs for a multi-level approach to prevention, which is consistent with the SEM that was used to guide this study. He concluded, “awareness and facts are the best preventive measures.” Another survivor noted needs for “better screening of employees who work with older people” as a primary organizational-level strategy to prevent SV in later life.

Some survivors also expressed gratitude for the study, and for the hope it provided for improved future awareness of SV in later life and survivor support.

The Rife Yet Hidden Nature of SV

The survivors routinely mentioned that when they consider what is known about SV, what first comes to mind are thoughts of violence, including physical violence, forced sex, and unwanted sexual touch. SV was described as pervasive. For example, when asked what comes to mind when reflecting on SV in later life (see Appendix 1 for the survey questions), one survivor, in her 50s, commented, “it is a pervasive problem” adding, “every adult woman I know has experienced sexual abuse.” Another survivor, in her 50s, noted that SV in later life “happens more often than we know.”

While SV is rife across the lifespan, the results suggest it is particularly hidden in later life. A survivor in her 80s shared that when she told colleagues about enduring SV that was perpetrated at work, her “superiors at work” and the “police” who “worked in the building” she worked in were “shocked” upon learning that she had been sexually violated. Consistent with the Critical Feminist Gerontological-Social Ecological Model (CFG-SEM) that guided the development of this study, the shock practitioners frequently experience upon learning of SV in later life and the barriers this presents to prevention have been underscored in research, owing to rape stereotypes involving younger victims, and these stereotypes influencing responses to SV, which can be internalized by survivors (Bows, 2018a). For example, in response to being asked why she did not report the SV she experienced after turning 50, another participant shared, “at the time [I] didn’t understand how wrong it was.” Another participant suggested, “people have to know about. . . behavior of the people around us,” adding, “there should be an awareness among all of us.” When asked what may be needed to address SV toward people ages 50 and older, a participant in her 50s similarly stressed “there is lot of unwanted sexual touch happening in front of us.”

Thus, the participants’ responses reflect extant research, that SV is occurring in plain sight (Burgess et al., 2008), as witnesses commonly do not report SV in later life, because SV against older adults is generally not anticipated owing to beliefs that older adults are not sexual, desirable, or victimized at the societal, organizational, relational, and individual levels of the SEM (Bows, 2018a; Hand et al., 2022). To address the hidden nature of SV in later life and challenges with reporting it, another participant suggested, “I think researchers should focus on. . . awareness and educational aspects. . . as well tools,” noting, “steps should be clear on what to do before (training, education, facts) during, and after (reporting, details about how people might respond, as well as getting proper care after.” These recommendations highlight needs for enhanced primary, secondary, and tertiary strategies to prevent and address SV in later life.

Minimization, Victim Blame, and Disbelief

Several survivors expressed strong concerns that SV is not perceived as a serious problem, especially in later life. One survivor, in her 50s, highlighted that SV in later life is not even understood as violence. Another survivor in her 50s observed, a barrier to preventing SV among adults aged 50 and older is that “people believe that older people are not sexual,” which reflects the need for the critical gerontological lens that was used to guide this study. Another survivor who was also in her 50s shared that upon learning about her surviving SV, her family members “minimized the importance and impact” of the SV she experienced, indicating relational-level barriers to preventing and addressing SV in later life. Further, “denial that such a thing exists” was noted as a barrier to prevention, including among older survivors themselves, aligning with the CFG-SEM integrative framework that was used to guide this study and supporting research that suggests people do not believe SV is a problem for older adults (Bows, 2018a, 2018b; Hand et al., 2022).

Victims were described as largely held resposible according to the participants’ personal knowledge and experiences, because SV is understood as potentially preventable at the individual level (e.g., through self-defense). For example, a surivvor in her 50s who was victimized by an acquaintance, shared that a common belief she has encountered about SV in later life in general that also applies after turning 50 is that “the victim somehow provoked the attack and/or deserved it.” Ageism was also identified as a barrier to prevention. The survivors highlighted that victims are not believed owing to their age, thus, they experience age-based stigma. Further, shame, embarrassment, and denial were identified as individual-, relational, and societal-level barriers to prevention, consistent with the integrative CFG-SEM framework that was used to guide this study. For example, one survivor shared that she did not want to report the SV that she experienced in her early 50s due to “embarrassment.” Similarly, another survivor identified “shame, embarrasment, denial by the offender(s)” as key barriers to preventing SV in later life.

Imbalance of Power

The survivors shared that individuals who are afforded greater power can influence how SV is understood, through their greater influence the narrative. Men were identified as having more power in this regard by the survivors, although work-based power-imbalances were also noted. For example, one survivor, in her 80s, who was raped by her boss, highligthed, “He was the powerful one as he could take away my job, withhold my monies, and researchers need to understand that the more ‘powerful’ person can put a person through hell on a daily basis.” This same survivor added, “Unwanted sexual touch should not happen no matter what age!”

The survivors observed that culture and power can influence policy, support, prosecution, and public responses. As one survivor suggested, further work to decrease SV “may [impact] of the attitudes and behavior.” Another noted, “some cultures view things as ‘these types of things happen’. . .. many just live with the silence. . . power is a heavy weight against victims,” as “often community leaders or relatives that control things are abusers, and. . . victims feel there is nothing they can do. They feel trapped or hopeless.” Another survivor, in her 50s, who experienced acquaintance-perpetrated SV, highlighted “some cultures are more accepting of touch than others, men tend to be more powerful than women which puts women in a vulnerable position.”

Similarly, another survivor in her 50s observed, “a patriarchal society condones treating women as property,” and added, “men are in charge and men are the primary offenders.” Another survivor concluded, “I think as with all ages. . . feeling vulnerable makes people not report or properly seek help when it takes place.” Thus, the survivors stressed that women are uniquely vulnerable and older adults often fear disbelief that they are not sexual, as discussed earlier. This reflects the CFG-SEM framework that was used to guide this study as well as recent research that has emphasized intersectional risk factors for SV owing to both gender and age, which has underscored that older adults are often discounted as not sexual, and as not being actively targeted for SV (Bows, 2018a, 2018b; Hand et al., 2022).

Needs for Greater Accountability and Prevention

The prosecution of offenders and stricter sentencing were suggested by the survivors in this study, to more effectively prevent SV. For example, one survivor, in her 50s, suggested “drag men’s aberrant [behavior] into the spotlight and prosecute them. . . stop letting society treat women and children as property.” This same participant recommended “a zero tolerance policy for offenders.” This sentiment was echoed by a separate survivor in her 50s, who suggested, “penalties for offenders need to be tougher.” Another survivor who was also in her 50s shared, “[I] am very angry. . . this kind of activity should be strictly punished.” A separate survivor, in her 50s, noted, “it is violence and the violator should go to prison,” adding, “It shouldn’t matter the age. Prosecute.” These recommendations suggest the need for stronger tertiary prevention responses to SV in later life.

The survivors also recommended stricter enforcement of policies to prevent SV in later life. For example, to enforce policies designed to prevent SV in later life, another survivor, in her 80s, recommended, “Have more seminars that can be attended by all to enforce the saying ‘no means NO’.” A different survivor, in her 50s, concluded, “education is needed regarding appropriate versus nonappropriate touching, victims need to be encouraged to report and perpetrators need to be held accountable for their actions.” Another survivor in her 50s shared she wished that she “had the courage to see to it that he served prison time” upon reflecting on what she may do differently in response to the SV she survived, adding, “It’s important to educate young people before they become victim(s).” As such, she recommended prevention education initiatives “as early as middle school and continue through college and into the work environment.” It is noteworthy that this recommendation moves beyond the SEM that was used to guide this study by also emphasizing the need for further outreach and prevention across the lifecourse along with stronger primary, secondary, and tertiary prevention responses to SV in later life.

Fear, Strong Emotions and Extreme Anger

The survivors frequently highlighted the fear and strong emotions SV in later life subsequently evokes, including long after it occurs. One survivor underscored the lasting impacts of SV since turning 50, sharing, “my colleague became so bad. . .he misbehaved with me. . .I feel so worried about the situation and many things got changed in my life. So I [can’t]. . . trust anyone,” adding that fear of SV results in “[loss] of freedom” for women, highlighting the gendered nature of SV, including in later life, in alignment with the critical feminist lens that was integrated into the framework that was used to guide this study. Another participant, in her 60s, shared, “now know that I need to be very watchful.”

SV in later life was described as contributing to increased anxiety, fear, humiliation, and shame. When asked why she decided not to report the SV that occurred since turning 50, a survivor, in her 50s, divulged, “I was scared of the repercussions.” A different participant in his 50s explained, “While 50 is still young and many still very physically capable, active and confident, there is still fear present when it happens,” cautioning that SV in later life “changes a [person’s] life dramatically.”

Extreme anger was commonly shared as well. Still, anger is a normal response to SV across the lifecourse; it can be used to mask fear and vulnerabillity, enabling survivors to feel in control (Petersson & Plantin, 2019). While this was captured by younger survivors in the overall dissertation study sample, the strongest reactions came from the 16 older survivors whose responses are explored in this manuscript.

Discussion

In this study, 16 SV survivors shared their experiences with SV after turning 50, contributing to limited research on SV in later life; research with older survivors themselves is also extremely limited. Still, their narratives are vital, as vulnerable and impacted individuals may understand and describe SV in later life differently than researchers or practitioners (Walsh & Yon, 2012), offering invaluable insights on the nature of SV in later life and what is needed to prevent it. The results suggest SV is a common yet hidden, socially taboo and complex issue with lasting impacts on survivors that warrants much more research and awareness raising efforts to enhance primary, secondary, and tertiary responses to SV in later life. The findings also draw attention to the critical importance of gathering data from diverse survivors themselves, across age groups, owing to longstanding youth-focused SV stereotypes and subsequent youth-focused prevention and intervention initiatives (Bows, 2018b; Hand et al., 2022), which aligns with the integrative CFG-SEM-based framework that was used to guide this study.

The workplace SV the survivors described was a form of SV in later life that has not previously been studied (Hand, 2020). While workplace SV earlier in life has been established (Gravelin et al., 2019), this distinct finding offers implications for policymakers; needs for training on SV in later life were identified, in the workplace, community, and social service, educational and healthcare institutions, to enhance primary, secondary, and tertiary organizational strategies to prevent SV in later life.

Efforts to increase awareness of resources that are inclusive of older adults were strongly recommended by the survivors as well, along with improved resources and greater support, to meet the unique needs of older potential victims and survivors, which will be further discussed.

Practice Implications

The findings demonstrate that older survivors are often disbelieved, and experience stigma, at individual, relational, organizational, and societal levels, supporting earlier research and the use of the CFG-SEM (Bows, 2018a; Brozowski & Hall, 2010; Hand et al., 2022). While disbelief occurs across the lifespan, younger adults are acknowledged as vulnerable to SV, in contrast to older women, who encounter disbeleif about their desirability, sexual activity, and SV risks (Bows, 2018a, 2018b; Hand et al., 2022).

These stereotypes must be challenged through early and ongoing practitioner training, such as through bystander interventions (an evidence-based method of encouraging individuals, agencies, and communities to alter harmful social norms that hinder prevention and intervention, Basile et al., 2016). Bystander strategies focused on SV almost exclusively focus on younger adults, on college campuses (Bows, 2018b). Bystander trainings in long-term care facilities, for example, could yield a greater understanding of risk factors for SV across the lifespan, addressing the disbelief older women encounter (Kleinsasser et al., 2015). It is critically important for such trainings to explore how awareness and victim blame may be promoted or discouraged, especially among at-risk older adults (Bows, 2018a; Hand, 2020). Further, some survivors suggested SV education should begin in grade school to address ageist rape myths that chiefly impact older women.

Workplace SV in later life was described as a substantial problem. To the authors’ knowledge, the only published discussions on SV against older adults at work involve older perpetrators rather than older victims. Harmful and misleading SV stereotypes should be addressed in workplace discussions, and workplace violence and harassment prevention efforts should be inclusive of older adults.

The results challenge perceptions that SV is strictly a gendered issue. Six (37.5%) of the 16 survivors were men, highlighting the importance for trainings to meet the needs of older male and transgender survivors. The majority of the limited research on SV in later life is based on White, cis-gender, female, and heterosexual samples (Hand et al., 2022).

While only 4.5% of the US identify as LGBTQ+ (McCarthy, 2019), five (31.25%) survivors were LGBTQ+, reflecting risks for the LGBTQ community (Cook-Daniels & Munson, 2010; Hand, 2020). Limited studies exist on SV among LGBTQ+ elders (Cook-Daniels & Munson, 2010; Hand, 2020). More attention is expressly needed on older LGBTQ+ adults in practice, research, and policies focused on prevention and intervention.

Policy Implications

The survivors underscored urgent needs for resources for prevention and intervention, and needs for raising community awareness of resources that are inclusive of older survivors, as most current resources are tailored for younger adults (Bows, 2018a; Hand et al., 2022). Future funding is needed to develop and promote such resources, which could be prioritized by legislators as well as by federal, state and local organizations that offer grants to prevent violence or to address the needs of older adults.

Prioritizing older survivor-identified policy recommendations could offer at-risk older adults more control over policies that impact them. The survivors highlighted needs for policies to ensure safety, through improved screening in long-term care agencies and in the workplace. Legislators, long-term care administrators, and administrators in violence prevention agencies (e.g., focused on preventing and addressing domestic violence and/or SV) should support efforts to promote an accurate, widespread, and multi-level understanding of SV in later life. This could potentially be achieved by mandating trainings focused on preventing and addressing SV in later life and through including older adults in agency mission statements focused on violence prevention and including the prevention of SV in long-term care agency mission statements for example, which could inform enhanced community outreach. Community members could benefit from organizational web pages and social media pages including information on SV in later life, how to recognize signs of it, how and where to report it, and how to best support the unique needs of older survivors.

Research Implications

The gratitude expressed by the survivors highlights the value of research on SV in later life, to increase awareness and offer validation and hope for opportunities to impact change. Considering that racially non-dominant groups remain at greater risk for SV (Basile et al., 2016), research is needed on the influence of power imbalances and culture on prevention and intervention among older non-dominant populations. As discussed in the Results section, power imbalances were frequently discussed by the survivors when describing SV in later life and barriers to preventing it.

Namely, further research is needed on cultural aspects that influence how SV among individuals living with dementia is prevented, as dementia remains a key risk factor, owing to intersectional prejudice and heightened vulnerability (Bows, 2018a; Hand et al., 2022). Future research should also explore workplace-related SV in later life, as this is the only known study that highlights workplace SV in later life, despite workplace SV being well-established among younger populations (Hand, 2020).

Limitations

The sample size was small, at 16 participants, highlighting a need for larger scale future research with survivors. Consideration for best practices for recruiting larger samples of older survivors is warranted.

It is noteworthy that the decision to use an online survey excludes what may be a significant number of older adults, such as those who do not own and/or do not use a computer, for example. Although participants could be any age over 18 years to participate in the larger dissertation study and participants did not have to be survivors for the larger dissertation study and thus, there was little known motivation to falsify age or SV experiences, verifying age is a unique challenge presented by online survey data collection. While SV in later life is socially taboo, supporting the decision to garner qualitative data using online surveys, the appropriateness of online (vs. in-person) data collection should also be explored in consideration of the above discussed challenges that come with online survey data collection. The preferences of this current older adult cohort (e.g., for online vs. in-person) data collection should also be prioritized.

Moreover, the questionnaire that is shared in this manuscript was comprehensive because this manuscript summarizes findings from a larger dissertation study that focused on answering other research questions in addition to those that are presented in this paper. Future qualitative research with survivors of SV in later life could be improved by collecting as little data as possible (e.g., for less comprehensive studies that are not conducted as part of a doctoral dissertation to demonstrate rigor) to collect only the data that is needed from participants.

It is possible that the recall of participants may be not be completely accurate as well, potentially making a case for future research with and possibly recruitment through APS and other practitioners (e.g., in long-term care facilities) who have recently received reports of SV in later life).

Conclusions

The findings demonstrate that SV in later life is a complex social issue that must be further explored, prevented and addressed using primary, secondary and tertiary prevention strategies across the life course. Needs for more comprehensive efforts to prevent address the hidden nature of SV in later life were highlighted, through establishing and promoting greater knowledge about SV in later life through organizational and community trainings, along with increased societal, organizational, relational and individual awareness of SV in later life, and resources to enhance reporting and to address the unique needs of older survivors. In particular, further work is needed to attend to responses of dismissal, disbelief, blame and stigma, and to inequality and imbalance of power; to ensure greater accountability for people who offend according to the recommendations of the survivors, while addressing the lasting impacts of SV in later life that were described by the survivors in this study.

Needs for further research with older survivors were highlighted by the survivors to advance multi-level prevention as well, by ensuring that policies can adequately address their distinct needs, based on their input, while collaboratively advancing agency among older survivors, especially for women who disproportionately experience SV across the lifespan, as well as for men, who made up 37.5% of the study population (n = 6). The timely prevention recommendations that were emphasized by the survivors were numerous, yet all of their recommendations are feasible and all have strong potential to advance prevention at multiple levels. This will require further collaboration among researchers, policymakers, and practitioners across disciplines, with at-risk older adults and with older victims.