Special Populations

Special Concerns Regarding Elderly Patients

• Elderly patients will likely experience extreme humiliation, shock, disbelief and denial just as other patients do, but in addition, usually also must confront an acute awareness of their physical vulnerability, reduced resilience and mortality.
• Fear, anger or depression can be especially severe in older patients who often are isolated, have no support system and live on meager incomes.
• Be aware that elderly patients may be victims of abuse perpetrated by their caretaker(s).
• Because generally the elderly are physically more fragile, in addition to possible pelvic injury and STIs, the elderly may be more at risk for other tissue or skeletal damage and exacerbation of existing illnesses and vulnerabilities. Their injuries also are more likely to be life-threatening.
• Hearing impairment and other physical conditions attendant to advancing age, coupled with the initial reaction to the assault, may render the elderly patient unable to make her/his needs known. Take care not to mistake this confusion and distress for senility.
• Every effort should be made to provide necessary assistance to elderly patients. Medical and counseling follow-up services should be made easily accessible, otherwise older patients may not be willing or able to seek or receive assistance.
• Without encouragement and assistance in locating services, older patients may be reluctant to proceed with the prosecution of their offenders.
• See page 14 and consult your facility guidelines regarding mandatory reporting requirements when the patient is age sixty or older. (See Appendix E for sample forms).

Special Concerns Regarding Patients With Disabilities

• Patients with disabilities may have limited mobility, cognitive problems or difficulties which impair perceptual abilities, impaired and/or reduced mental capacity to comprehend questions, or limited language/communication skills to tell what happened. They may be confused, frightened, unsure of what has occurred, or they may not even understand that they have been victims of crime. Every effort should be made to provide necessary assistance for patients with disabilities.
• If speech problems are evident, ask the patient if s/he has or would like a word board or speech synthesizer, or other assistive device. Provide a sign language interpreter whenever necessary.
• Allow additional time as necessary for evaluation and for the medical and evidence collection examination.
• A patient with physical disabilities may need special assistance to assume the positions necessary for a complete medical and evidence collection examination. Allow the victim to control getting on/off the exam table. Modification of normal procedures may be indicated in some instances.
• The use of anatomically-correct dolls by specially trained personnel has proven to be a successful method of communication for patients with communicative disabilities.
• See page 13 and consult your facility guidelines regarding mandatory reporting requirements when the patient is an adult with mental retardation. (See Appendix E for sample forms).

Special Concerns Regarding Children

• Child victims of sexual abuse/assault present with many special needs.Click herefor a detailed discussion about the care of child and adolescent victims.

Special Concerns Regarding Male Patients

• Male victims of sexual assault present with several needs specific to their gender. Click here for a detailed discussion about the care of male sexual assault patients.