Heather Owen, a SANE registered nurse at Penn State Health St. Joseph Medical Center, demonstrates setting up a room for medical forensic exams after a sexual assault.
An estimated 9 million older adults around the world experience sexual violence or abuse, including rape or other unwanted sexual contact, each year, according to the journal Trauma, Violence, & Abuse.
April 9, 2025
The actual number is likely higher. Many older survivors of sexual violence, especially men, don’t report it. They might fear no one will believe them or people will blame them for what happened, said Vicky Reilly, Sexual Assault Nurse Examiner (SANE) Program co-chair at Penn State Health St. Joseph Medical Center.
“Many times when this happens with the geriatric population, the shame is overwhelming,” Reilly said. “Often the assault is perpetrated by someone they’re related to or relying upon, so speaking up has huge personal and emotional consequences.”
Sexual abuse can have immediate and lasting effects on physical and mental health. During Sexual Assault Awareness Month in April, sexual assault nurse examiners – who have special training to help sexual abuse survivors stay safe – share what you need to know.
Warning signs of sexual abuse
Some older people are not mentally or physically well enough to speak up about sexual abuse or other elder abuse. Watch for:
- unexplained bruising or bite marks on the genital area, thighs, buttocks, breasts, face or neck.
- signs of control and estrangement, like if a caregiver becomes an older person’s spokesperson – even though they’re capable of expressing themselves – and controls everything they do.”Maintaining contact is very important,” Reilly said. “Watch your loved one when they’re in the room with someone. Do they look scared? Are they afraid to talk? Say something like: ‘I noticed you’ve been acting differently when that person comes around. Is everything OK?’”
- situations when strangers might visit your loved one’s home when they’re alone. Offer to stop by and ask for guests’ contact information.
Sexual assault can be emotionally traumatic and physically harmful, especially in older people. “Elderly people more commonly suffer injuries during sexual assault,” said Heather Owen, SANE Program co-chair at St. Joseph Medical Center. Skin loses elasticity and can tear more easily. Bruising and other physical injuries can be more severe in older adults, sometimes requiring hospitalization.
Compassionate care for survivors
At the St. Joseph Medical Center emergency department, survivors can go to the SANE room – a quiet, dedicated area for medical forensic exams after a sexual assault. “The first thing we’re going to do is make sure there are not any immediate medical needs that must be cared for,” Owen said. Some survivors have bleeding, strangulation injuries, brain injuries or broken bones, for example.
The SANE room is staffed by nurses who have taken a 41-hour course approved by the International Association of Forensic Nurses. They then complete a hands-on clinical experience, which includes competency in pelvic examinations. During a SANE exam, the survivor sets the pace
Vicky Reilly, left, and Heather Owen are SANE registered nurses at Penn State Health St. Joseph Medical Center.
and chooses how to proceed. Forensic examination and collection of evidence – commonly known as a rape kit – is secondary to caring for the patient’s health. Every step of a medical forensic exam requires the patient’s consent, which can be withdrawn at any time or for any part of the process.
“Coming to the emergency room isn’t just about collecting evidence of an assault,” Reilly said. “It’s about making sure your body’s healthy. Forensics is part of that. We offer both. But if a person comes in and says, ‘I just want to make sure I’m OK, and I want somebody who’s trained how to do this, but I don’t want to collect a kit,’ that’s fine.”
One thing to know: Health care providers in Pennsylvania are mandated by law to verbally report suspected elder abuse in people age 60 and older and suspected child abuse in people age 18 and under. Between ages 18 and 60, they don’t have to report abuse if the patient doesn’t want them to.
Patients and SANE nurses at St. Joseph Medical Center can access more resources through Penn State Health’s partnership with the Penn State College of Nursing Sexual Assault Forensic Examination Telehealth (SAFE-T) Center. Through this program, another SANE nurse with at least 300 hours of clinical experience can join the exam virtually to provide support to both the on-site nurse and the patient. Penn State Health’s Milton S. Hershey Medical Center, Hampden Medical Center, Holy Spirit Medical Center and Lancaster Medical Center also offer this service.
Ask for help
If an older adult is in immediate danger, call 911. Otherwise, a visit to the emergency department can help ensure they are medically safe. Even if days or weeks have passed since the assault, SANE nurses can test for sexually transmitted infections, refer patients to counseling and primary care providers and more.
“Don’t think there’s no point in going because it happened two weeks ago, and now the nurses won’t be able to do anything for you. That’s not true,” Owen said. “If nothing else, I can speak to them sincerely and let them know they’re heard, they’re believed and that it’s not their fault.”
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