Sexual violence is prevalent across the world with approximately 30-35% of women and 10-27% of men experiencing sexual violence at least once in their lifetime (McLean, 2013; Krahe et al., 2015; WHO, 2013). Sexual violence can have significant impacts on both physical and mental health (e.g., Jina & Thomas, 2013; Stein & Barrett-Connor, 2000; Tarzia et al., 2017; 2018). However, the experience of sexual violence is under-researched in older adults, with most evidence focusing on children, adolescents and adults of working age.
One example of sexual violence historically being overlooked in older adults is the exclusion of older adults in the Crime Survey for England and Wales, the source of official violence statistics in England and Wales (Office for National Statistics, 2021), leading to a gap in our understanding of the experience of violence and abuse in this age group. This may be exacerbated by barriers to disclosure, including shame and guilt, perceptions of sexual violence being socially taboo, concerns about being believed, beliefs that they do not fit the perceived victim stereotype, and denial (Donne et al., 2018; Goldblatt et al., 2022; Orchowski et al., 2022; Pijlman et al., 2023; Ullman & Relyea 2016).
Together, this means that our understanding of the mental health impacts of such experiences in this age group is not very well understood. In 2024, Fadeeva and colleagues demonstrated that older adults who had experienced violence in the past year were more likely to live with a common mental disorder than older adults who had not experienced violence (26.4% versus 10.2%), demonstrating the link between violence and mental health issues in this age group (Fadeeva et al., 2024; see Carlisle 2024 for an overview). Other quantitative studies have similarly found associations between sexual violence in older adults and PTSD (Cook et al., 2011; Nobels et al., 2023), depression and anxiety (Cook et al., 2013) and chronic illness and/or disability (Nobels et a., 2023).
Nobels et al., (2024) aimed to contribute to this field by conducting the first qualitative study to explore the self-perceived mental health impact of lifetime sexual victimisation in older victims.
Most research on sexual violence victimisation tends to focus on young people or people of working age. We don’t yet know what the impacts of sexual victimisation are for older adults.
Methods
Fifteen older adults (defined as those aged 70 years or older) who had experienced sexual victimisation at some point in their lives were invited to take part in in-depth interviews. Interviews ranged from 15-111 minutes. Participants were predominantly female (n=12), heterosexual (n=14), and community-dwelling (n=14), with a mean age of 77 (SD 3.9 years, range 71-85 years). Fourteen participants had experienced sexual harassment, twelve had experienced sexual abuse, and nine had experienced (attempted) rape during their lifetime. Two had encountered some form of sexual violence in the year prior to the study.
Interviews took place primarily online or over telephone and followed a structured topic guide, which asked about seven key topics: conceptualising sexual violence, experiences of sexual violence, perceived factors contributing to victimisation, consequences of sexual violence, strategies for coping and seeking help, effects on familial and peer relationships, transgenerational impact, and suggestions for prevention and support services following sexual victimisation.
Interviews were audio recorded and analysed using thematic analysis according to Braun and Clarke (2006), using a mix of deductive and inductive coding.
Results
Analysis resulted in six key themes:
- Hurtful recollection – Participants described negative emotions when recalling sexual violence experiences, and many felt that the experience remained constantly present in the background. Specific triggers included going to locations where the violence occurred, sexual intercourse, or news stories of similar events.
- Many participants experienced anxiety in the form of either avoidance or hypervigilance. Avoidance manifested in the form of avoiding specific places, situations and people, as well as specific thoughts or conversations and when not possible resulted in extreme distress. Hypervigilance led to feeling constantly on guard and alert to ones’ surroundings, particularly when walking or cycling at night.
- Participants reported experiencing intense feelings of guilt and shame throughout their lives, often keeping their experiences of sexual violence a secret. This also impacted their sense of identity, leading to feelings of disappointment in themselves, worthlessness, and low self-confidence.
- Impact on interpersonal relationships – Some participants felt anger towards their loved ones, particularly if they were not believed, leading to emotional distance and distrust. There was also a sense of general distrust, related to the need to stay on guard. This sometimes led to loneliness and isolation.
- It was okay – While many participants described a range of mental health impacts of their experiences, most reported no long-lasting impact of sexual violence, and did not associate one with the other. Participants did not seem to recognise these contradictions, which may be a genuine absence of long-lasting mental health impacts, a coping mechanism, or acceptance.
- Some participants reported posttraumatic growth that emerged from their experiences, such as pride for stopping the sexual violence, increased empathy for others, and strengthened resilience. Other examples of positive impacts included being more assertive, developing a stronger sense of self-worth, and being more critical or less naïve.
Older adults did not tend to associate mental health difficulties with their experience of sexual violence, reporting no long-lasting impact of the trauma.
Conclusions
This study is the first to qualitatively assess the impact of sexual violence on mental health in older adults. The authors concluded that:
many older victims report mental health challenges, including anxiety-related symptoms, profound feelings of guilt and shame, which frequently lead to a disrupted sense of identity, and increased distrust toward others.
Older adults sometimes have difficulty articulating the direct impact of their experiences on their mental health or relationships, and this may be related to avoidance related coping strategies, or a difficulty in seeing themselves as victims.
Many participants found it difficult to talk about their experiences, which may be reflective of the time these adults grew up in, where sexuality was seen as taboo, victim blaming was widespread, and men were encouraged to be strong and “man up”.
Older adults found it difficult to talk about their experiences of sexual violence which may be reflective of the time these adults grew up in, where sexuality was seen as taboo and victim blaming was widespread.
Strengths and limitations
This is an important study, addressing a clear gap in the evidence by shedding light on the experiences of an often-overlooked group. In doing so, this paper gives this subset of sexual violence victims a voice, something that many may have been previously unable to do.
The authors are clear about their research aims, and use appropriate methodology, which is well described and justified, to address these. Given the sensitive nature of the topic of the research, the authors took ethical considerations into account, ensuring that participants were comfortable with the process and had support afterwards if needed. They also used an appropriate and pragmatic approach to recruitment, identifying potential participants who were already taking part in one of two existing studies on sexual violence in older adults. This approach was sensitive and unobtrusive, and a good way to identify those who may be less likely to access or respond to other recruitment strategies (e.g., social media advertisements). Finally, the analysis appears to be rigorous and findings are explicit, although there could be more information provided on the analysis process such as how the selected quotes were chosen.
However, the authors did not seem to consider the relationship between the researcher and participants, and did not discuss reflexivity or consideration of the influence or impact of the researcher on the research process and findings. Additionally, the authors acknowledge that, as the majority of interview participants were female, results are limited in terms of their generalisability to male victims of sexual violence, and are not likely representative given evidence suggesting that nearly one in three older men (aged 70 and above) had experienced sexual victimization in their lifetime (Nobels et al., 2021).
The majority of participants in this study were female – what about the experiences of male older adults who have experienced sexual violence?
Implications for practice
This study has several key takeaways for healthcare professionals:
- While a minority of participants had experienced sexual violence in older adult age, most discussed mental health and interpersonal challenges of their past experiences that persisted over time into older age. Therefore, healthcare professionals need to be aware of and look out for signs of potentially unresolved and persistent trauma.
- Despite reporting symptoms consistent with trauma and other mental health and interpersonal challenges, older adults who have experienced sexual violence may feel shame, guilt and a general distrust of others. Together, these may act as barriers to seeking help for these challenges. The authors recommend routine enquiry about sexual violence to identify those who may benefit from therapeutic help. They also recommend doing so in a sensitive, trauma-informed way, to build trust and create safe spaces for disclosure.
- Further, healthcare professionals should recognise and respect any boundaries asserted by this patient group, which may reflect post-traumatic growth and be key to achieving trust.
- Healthcare professionals may benefit from the development of specialised screening tools for trauma in older adults to facilitate the identification of sexual violence victims in a structured and sensitive way. This could be paired with protocols for age-appropriate referral routes for support, and specialised training in sexual violence across the lifespan.
Additionally, the authors identify several avenues for further research, including:
- Understanding men’s experiences of sexual violence specifically. The authors recognised the limitation of their mostly female sample and identified addressing this as a future avenue for research.
- Exploring the experiences of older adults with cognitive impairments or other vulnerabilities. While this evidence gap may not be possible to address due to ethical considerations, nearly all participants of the present study were community dwelling, so one potential avenue for further research could be to investigate experiences of adults residing in care homes, who are likely to be frailer and may have different experiences or impacts, and are more likely to experience violence (Yon et al., 2019).
Healthcare professionals working with older adults should look out for signs of potentially unresolved and persistent trauma arising from previous sexual violence victimisation.
Statement of interests
Sophie Carlisle – No conflicts of interest.
Edited by
Laura Hemming.
Links
Primary paper
Anne Nobels, Mona Biebuyck, Ines Keygnaert. (2025). ‘Did it leave scars? It did, then and now’–older adults’ perceived mental health impact upon sexual victimization during their lifetime. Aging & Mental Health, 1-11.
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