From my experience, older survivors face some particular challenges. Stigma and shame can be very strong barriers to disclosure.

People subjected to sexual violence in general hesitate to talk about it with those closest to them because of fear of not being believed, fear of blame, and other worries.

For older people, especially around anything sexual, that discomfort can be even more pronounced. Talking about sex at all may be taboo, let alone talking about being sexually violated.

Sexual assault is a crime of violence, but because it involves sex, it gets tangled up with the embarrassment and tension of discussing sexual matters, especially in some age groups.

When we look at older women in particular, I think confusion, tension and discomfort about sexual topics play a big role in silencing them. Those layers need to be recognised and unpacked if we want to create space for disclosures and help them feel comfortable about who they can safely tell.

Sexual violence is fundamentally about vulnerability and the exploitation of trust, often in relationships where there is supposed to be safety.

If we focus only on sex rather than on vulnerability and betrayal of trust, we miss what matters in recognising risk.

I’ve seen situations where, once I mentioned my previous work in sexual violence to clients in a generic community role, older women began disclosing childhood sexual abuse. Simply naming the area I worked in opened the door.

That showed me how many older people carry past sexual violence, and how important it is to create openings for them to talk if they want to.

Given the very high prevalence of sexual assault—across women and men and across the lifespan—it makes sense for screening and assessment to assume it could be part of a person’s history. But that needs to be handled with care.

In aged care, for example, we should be considering the possibility of childhood sexual abuse, adult sexual violence, and recent abuse, particularly in light of the inherent vulnerabilities older people often face.

Language is crucial, especially with older women and people from non-English-speaking backgrounds. People vary greatly in how comfortable they are talking about sexual issues and who they feel able to talk to.

The gender of the service provider can matter a lot. If you ask someone directly, “Were you sexually abused as a child?” or “Have you been sexually assaulted?”, the most likely answer is “no”, not necessarily because nothing happened, but because the environment doesn’t yet feel safe.

You have to build trust and then ask more open, gentle questions such as: “Has there ever been anything of a sexual nature that made you feel scared or uncomfortable?” and “Is this something you’d feel comfortable talking with me about, or would you prefer someone else?”

Often people don’t use words like “sexual assault” or “sexual violence” about their experiences. They might not know whether what happened “counts” or meets legal definitions.

I saw that frequently when I worked at a university with younger people, including many international students, who had very different levels of consent education and sexual health knowledge.

You can’t assume shared language or understanding. You have to break things down and explore how they felt—afraid, humiliated, embarrassed—and then help unpack what that was about and what support they might need.

When older women disclose sexual assault to me, what happens next depends a lot on whether the assault is recent or historical.

If it’s recent, I talk with them about the context, any physical injuries or health concerns, and the option of a specialist sexual assault service for forensic and medical care, as well as counselling.

If it’s past abuse and they’re seeking support, the focus is on finding the most appropriate counselling or support service for them, and on understanding their immediate safety concerns and the relationship to the person who harmed them—whether that’s a stranger, partner, family member, friend, or someone else.

I’m careful not to share details that could identify individuals, but I can say that outcomes vary. Stranger assaults reported quickly tend to move more smoothly through the justice system than assaults by known offenders, especially where there are complicating factors like mental health conditions or cognitive impairment.

Specialist sexual assault services are typically very good at meeting medical and counselling needs, but there are limitations, especially around outreach.

Earlier in my career, home visits were more common and older clients really appreciated them. Over time, those services have diminished; now people are generally expected to come to the service or use phone counselling. Many older people are not comfortable or confident with video platforms.

If an assault happens within an aged care facility, the crisis medical/forensic team will usually go to the person, provided there is an appropriate space, but ongoing counselling still generally requires the person to travel to the service or use the phone.

In my own practice, I wasn’t personally called into aged care facilities, but colleagues have been called to hospitals for crisis responses. In some exceptional situations, I’ve advocated for home visiting services—for example, where a person had been raped and had both legs broken and simply couldn’t attend in person.

In terms of what older women need, they need all of the basics—physical care, forensic options where appropriate, and counselling—but beyond that they need choice, flexibility and a sense of empowerment. Services need to work with family members, where appropriate, as they will have their own reactions and need guidance about how to be supportive. Many older women are reluctant to burden their adult children or to discuss sexual violence with them at all, so services need to help navigate those dynamics sensitively. 

Finally, when it comes to older people with cognitive decline, including those in aged care, I don’t think sexual assault counselling services are resourced to provide the kind of outreach and specialised approaches—like music or art-based therapy—that might be most helpful.

Sexual assault services often try to be all things to all vulnerable groups: people with intellectual disability, Aboriginal and Torres Strait Islander communities, people of diverse backgrounds. They are stretched trying to meet multiple complex needs without enough funding to specialise more deeply in areas like cognitive impairment.

At the same time, aged care providers need to assume that many residents will have trauma histories of some kind—sexual violence, other forms of violence, institutional abuse, war, migration trauma, and so on.

Past trauma can surface in later life, sometimes for the first time, as flashbacks or distress. I recall a very elderly woman who was experiencing flashbacks of child sexual abuse at around 96 years old. For her, it felt as if it were happening now, even though the abuse was long in the past. In those situations, the immediate problem is how to help her feel safe in the present.

That raises the question: whose responsibility is it to provide that kind of trauma-informed care? Sexual assault services? Aged care providers? In reality, it needs to be both, working together and sharing knowledge.

We know there are older people—such as care leavers and others with institutional histories—who say they would rather die than enter aged care because of their past experiences. That tells us something about the level of trust (or lack of it) in those systems.

Facilities need to think seriously about what they must do to build trust and genuinely become safe places for older people, especially those with complex trauma histories.