| By Ann Wolbert Burgess
Journal of Psychological Nursing
Vol. 38, No. 6 (June 2000)
Reviewed by Loree
Cook-Daniels
Even nursing home residents who cannot verbalize their victimization
often show signs they’ve been sexually assaulted, say
researchers Ann Wolbert Burgess and colleagues.
Their article, “Sexual Abuse of Nursing Home Residents”
was published in the Journal of Psychological Nursing, Vol.
38, No. 6 (June 2000), pages 10 – 18. The researchers
examined extensive records on twenty sexual assault cases
that had been involved in civil suits. Four of the victims
were under 65, and two were older men. Five of the residents
could ambulate on their own; the rest used a wheelchair or
were bedbound. Twelve had a primary diagnosis of dementia
or Alzheimer’s disease.
In all 20 cases, someone other than the victim was involved
in reporting the rape to nursing home administration. Seven
of the victims informed a family member, and three informed
a staff member. Six incidents (three perpetrated by staff
members, three by other residents) were witnessed by staff,
and staff suspected a seventh. In four cases, staff or family
members detected physical “clues”: pregnancy,
venereal warts, and serious pelvic bruising with reports of
pain.
In only three cases did the perpetrator remain unidentified.
In half the cases, there were no forensic rape examinations,
“usually because of delayed reporting, not believing
the resident, or failing to follow protocol.” Of the
ten examinations that were done, six produced positive evidence;
two had vaginal bleeding but no sperm; and two revealed no
physical or forensic evidence.
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Victims frequently showed trauma-related symptoms related
to the assault. These included:
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Expressions of fear of male staff;
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Avoidant behavior with male staff;
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Withdrawn behavior (cessation of usual activities);
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Staying near the nurses station or lying in bed in a
fetal position;
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Repeating statements made during the assault;
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Sexualized behaviors;
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Wearing two or three layers of clothing to bed;
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Persistent requests to go home and leaving the nursing
home;
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Statements such as believing one’s marriage is
over, newly-initiated calling for one’s dead sibling,
talk of “carrying a baby”, and talk of being
caught and displeasing parents;
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Refusal to sleep in bed, either hiding on the floor
or curling up under the bed;
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Refusal to take medications, eat, have vital signs taken,
or allow medical treatments;
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Refusal to wear usual makeup and costume jewelry; and
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New complaints of feeling cold (made by more than half
of the victims).
The researchers noted that rape trauma syndrome has two distinct
variations, both of which were shown by these sexual assault
victims. One type is compounded rape trauma, in which “victims
have a past and/or current history of psychiatric, psychosocial,
or physical problems that compound the effects of the sexual
assault.” The second is silent rape trauma, in which
“expression of assault-related symptomatology is muted,
undetected, or absent.”
However, because so many of the residents did show trauma-related
symptoms, the researchers concluded “staff must be trained
to detect the emergence of symptoms, including noteworthy
changes in baseline behavior in victims who are likely to
exhibit symptoms in a muted or ‘silent’ fashion.”
A single copy of this article (File No. K4285-8) can be obtained
from the Clearinghouse of Abuse and Neglect of the Elderly.
Send a check for $1.60 made out to CANE-UD to:
CANE
Dep’t. of Consumer Studies
University of Delaware
Newark, DE 19716
302-831-3525
CANE-UD@udel.edu.
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