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Report reveals prevalence of sexual assault in nursing homes

April 12, 2017

A new paper in The Gerontologist examined sexual assault in nursing homes. The report finds that the most vulnerable residents are likely to become victims; legal examinations were infrequent due to administration complexities and training and institutional policy, and nursing homes are not adequately equipped to deal with sexual assault cases.

Although sexual assault is among one of the most shocking types of assault, it is also the least acknowledged, detected and reported type of assault against nursing home residents. This systematic review examined 15 studies published in peer-reviewed journals to characterize sexual assaults among nursing home residents.

The aim of this paper was to examine victim/perpetrator relationship characteristics and the forensic characteristics of sexual assaults occurring in nursing homes comprising assault type, examination process, legal outcomes, and preventive measures. Victims of sexual assault were likely to be females with cognitive or physical impairments. Perpetrators were likely to be male residents, although sexual assault by staff members was also substantial. Forensic characteristics and investigative data were limited.

This review surveyed original research published in peer-reviewed, English-language journals between January 1949 and October 2015. The combined searches yielded 2,291 articles, of which 15 were eligible for inclusion. Eleven studies reported the number of nursing home sexual assault victims with eight studies focusing on nursing homes and/or other facilities. The number of nursing home sexual assault victims from these ranged from 20 to 50 victims. The number of victims in mixed settings (for example, community, nursing homes, and assisted living) ranged from 46 to 127 victims. Isolated incidents were most commonly observed.

Victims of sexual assault were predominately Caucasian females with a form of mental and physical impairment and perpetrators were predominately Caucasian males. Perpetrator information was limited, with the majority of research studies failing to identify characteristics beyond race and gender.

Nine studies described victims' socio-demographic characteristics, who were most often female, Caucasian, widowed, required assistance in all activities of daily living, required financial assistance had difficulties with orientation, communication, or ambulation were disabled mentally impaired or suffered from a number of illnesses.

Seven studies reported on perpetrators, who most often were male, Caucasian, had a criminal or sexual assault history abused substances, were low in social competence exploited frail and defenseless victims, had an untreated psychiatric illness, and were financially dependent on the victim or unemployed. Accused direct care staff were typically male, between 19 and 65 years, and with criminal histories. Accused residents were typically male, between 21 and 96 years, substance abusers, with criminal histories and/or a form of disability.

A definitive estimate of prevalence of sexual assaults in nursing homes is not possible to ascertain, however, staff-to-resident sexual assault was than 1% (per 1,000 residents per year). The challenges of ascertaining rates of sexual assaults are hampered due to underreporting and the inability to confirm reported incidents. While sexual assault is perceived to be the least common form of elder abuse, it is also likely to be greatly underreported. Within a year of being assaulted, 50% of victims died.

One study identified barriers to reporting sexual assault incidents occurring in healthcare facilities. Over 50% of investigative personnel reported sexual assault as more challenging than any other form of assault to investigate due to state investigation regulations, limited resources (staff, training and power), limited forensic evidence and victim deliberating conditions. Facility limitations to the investigative process (untrained staff or failing to follow protocols) and enhancing factors (person-centred, healthcare provider, reporting and examination) were also discussed.

"Much more needs to be done for this vulnerable group of people as the nursing homes," said lead author Daisy Smith. "Regulatory investigative personnel remain poorly equipped to appropriately identify and respond to sexual assault"
The paper "A systematic review of sexual assaults in nursing homes" is available at:

Direct correspondence to:

Joseph E. Ibrahim
Head, Health Law and Ageing Research Unit, Department of Forensic Medicine
Monash Univeristy
Southbank, Victoria 3006, Australia

To request a copy of the study, please contact:
Daniel Luzer ( or 212-743-6113)

Sharing on social media? Find Oxford Journals online at @OxfordJournals

Oxford University Press USA

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