Prostitution in the shadow of life-long sexual abuse: Arab women's retrospective experiences.

The present study uses the life-course and intersectionality perspectives to explore the meaning that aging Arab women attribute to their lived experiences of life-long sexual abuse in the shadow of engaging in prostitution. Interpretive phenomenological analysis was used to analyze the narratives of 10 older Arab women in Israel who were engaged in prostitution. Four themes emerged: experiencing childhood in the shadow of sexual abuse, becoming a prostitute, being entrapped in prostitution, and settling accounts with the native culture. Women aging in prostitution experience a harsh reality of abuse and loss. The present study points to multiple channels of abuse throughout the life course, from childhood until old age.

From a humble identity to an identity of respect: lifetime abuse among Arab Israeli older women.

This study addresses the retrospective experiences of older Arab Israeli women after a lifetime of living in the shadow of intimate partner violence. Qualitative research was conducted, using in-depth, semi-structured interviews of 15 Arab Israeli older women. Underlying this study is a feminist perspective and a life course perspective. Two main themes emerged: (1) socially endorsed violence against Arab Israeli women. This took several forms: men's dominant position and women's dependence, sources of violence used against women before and after marriage, and the social education of women to accept their fate. (2) The construction of a multifaceted survival identity throughout Arab Israeli women's life and old age. This identity has a variety of dimensions, including: a submissive victim identity, a rehabilitative identity of respect in old age, and a form of split identity that combines both the rehabilitative social identity and the marginal identity still experienced within the home.

Is lifetime abuse forgivable in old age?

Old age is characterized by reflection and a retrospective examination of the multiple meanings of various life experiences, including lifelong abuse. Forgiveness is found to have a salutary effect, especially for older adults. To understand the place and role of forgiveness in the reflective process during aging, we performed a secondary analysis of in-depth, semi-structured interviews (N = 78) with older women survivors of abuse. Inductive thematic analysis was based on concepts developed deductively from the literature review. The findings include three main themes: (1) The dimensions of forgiving: The victim as subject; (2) Being forgiven: Between lost forgiveness and hope; and (3) Self-forgiveness and the aging self. Despite the known salutary effect of forgiveness, we must consider that this is not a universally desirable process. We included the dimension of forgiveness in the study of abuse throughout the older person's life course and identified further complexities in addition to the "forgiveness"/"unforgiveness."

The Multiple Punishment of Being an Older Adult Coping With Health Problems in Prison.

BACKGROUND AND OBJECTIVES: Studies have examined the vulnerabilities and the extent of health problems experienced by the older adult population in prison. However, reports about the subjective experiences of incarcerated older adults who are coping with health problems are scarce. This is alarming since older adults comprise the fastest-growing demographic in the prison systems of the United States and Europe. The aim of the current study was to bring forth the voices of older adults who are living with diseases in prison and to outline the landscape of struggling with everyday health care management. RESEARCH DESIGN AND METHODS: An interpretive phenomenological analysis was used to analyze the narratives of 23 individuals aged 60-88 who were coping with health problems in prison. RESULTS: The narratives revealed 3 major themes: (1) living day to day with illness in prison: fighting prison bureaucracy and public humiliation; (2) coping with complex medical issues: lack of professional medical care and cumulative problems, and (3) what does the future hold? Fear of living with illness out of prison. DISCUSSION AND IMPLICATIONS: Intersectionality was used as a conceptual framework for understanding the participants' narratives. The cumulative effect of belonging to systematically oppressed and marginalized groups is discussed. The research findings point to issues and experiences that are unique to older adults coping with health problems in prison and can serve as a framework for developing tailored interventions for these individuals.

Constructing Professional Intervention with IPV Across Generations in a Faith-Based Society: An Intersectional Perspective.

The intersectionality between the social and personal dimensions influencing the construction of intimate partner violence in the ultra-Orthodox Jewish community is examined by studying attitudes toward professional intervention among community members coping with IPV. Semi-structured interviews were conducted among 38 information-rich participants coping with IPV, from three generations in the ultra-Orthodox community. Three themes emerged: "Don't think you can do it alone": Professional intervention as a preferred option; "I did everything to hide the situation": The end of the era of shame?;"If it's not his problem, then it's my problem": Professional intervention as a concept of reference. The study findings indicate the ways in which professional intervention among ultra-Orthodox couples coping with IPV is affected and affects the community.

"I Do Not Think She Will Understand, This is Not a Situation for a Girl Like Her:" Disenfranchised Grief Among Adults with Intellectual and Developmental Disabilities in the Ultra-orthodox Jewish Society.

This article examines the experience of aging ultra-Orthodox families alongside a person with intellectual and developmental disabilities (IDD) in relation to parents' illness and death, followed by grief. In-depth interviews were conducted with 14 family units. Each family unit included the person with IDD, a parent, and a sibling-a total of 43 participants. Three main themes emerged: A. The difficulty in confronting illness and dying of parents alongside a family member with IDD in an Ultra-Orthodox Context. B. Exclusion of the person with IDD from parents' memorial events. C. Religious ceremonies as a strategy for coping with mourning among persons with IDD. The discussion focuses on the concept of disenfranchised grief in a religious context and its impact on the family support system. Culturally sensitive therapeutic recommendations are made for professionals working with older ultra-Orthodox Jewish families alongside a person with IDD in the context of the subject.

Juggling between caregiving and self-actualization: Older parents' lifelong experience of caring for an adult child with developmental disabilities.

Recently, the number of adults with Developmental Disabilities (DD) who live with their parents has increased. This study aims to explore how parents report retrospectively and interpret their experience in the context of self-actualization in the long-term care of a child with a developmental disability. Four forms of parents' experiences emerged from the analysis: "This child is my whole world"-Total devotion; "I Can Do Both"-Actualizing personal and familial goals as well as caregiving issues; "It's a mission, it's a calling, it's a full-time job"-Self-actualization through caregiving; and "Disability will not stop me"-Emphasizing self-actualization. While prior studies have created a distinct separation between caregiving and self-actualization, the current study focuses on the complex dynamics of lifelong parental caregiving for a child with DD, illustrating the parents' ways of actualizing their life goals in the context of caregiving over the years.

PROTOCOL: Global elder abuse: A mega-map of systematic reviews on prevalence, consequences, risk and protective factors and interventions.

This is the protocol for a Campbell systematic review. The objectives are as follows: to produce a mega-map which identifies, maps and provides a visual interactive display, based on systematic reviews on all the main aspects of elder abuse in both the community and in institutions, such as residential and long-term care institutions.

Forms of sexual assault against older women in the context of acquaintance relationships: An intersectional perspective.

This study addresses forms of sexual assault against women in late life (SAWLL) from an intersectional perspective, focusing on acquaintance relationships. Qualitative research was conducted, using in-depth interviews with 18 welfare and healthcare professionals who treated sexual assault survivors. Five forms (themes) emerged, relevant to the identification of SAWLL: (1) Coercive sexual assault in the context of changes brought on by old age, (2) contempt and sexual humiliation based on ageist and sexist social constructions, (3) violation of the older women's dignity in the multigenerational context, (4) life-long incestuous relationships and sexual assault against older women and (5) erotic touching and exhibitionism in caregiving relationships. The revealed forms emphasise the vulnerability of older women who are sexually assaulted in domestic relationships by perpetrators whom they know. These forms can contribute to filling the existing gap in knowledge on SAWLL and promote the visibility of sexually assaulted older women in the justice system. In addition, they can aid law enforcement, health and welfare professionals and policymakers to advance the general understanding of SAWLL as well as improve the response to this phenomenon.

The Interplay Between Poly-Victimization and Sexual Assault in Late Life in the Context of Life Course Perspective.

The aim of this article is to explore the interplay between poly-victimization and sexual assault against women in late life (SAWLL) according to the life-course perspective. Two themes emerged from qualitative interviews with 18 experienced welfare and health care professionals who intervened in cases of SAWLL: sexual assault by a spouse co-occurring with other types of abuse within marital relationships, and sexual assault and other types of abuse by two or more perpetrators along the life course. In many cases, SAWLL is an expression of a broader experience of poly-victimization, which relates to vulnerability in old age.

Between sexual assault and compassion: The experience of living with a spouse's dementia-related hypersexuality-A narrative case-study.

BACKGROUND: Hypersexuality is one of the behavioral and psychological symptoms of dementia. This symptom can lead to poor quality of life for the person who lives with dementia, as well as for his or her caregiver, who might be exposed to sexual assault. AIM: This study aimed to highlight the experience of an older woman living and coping with a spouse who exhibits dementia-related hypersexuality. METHOD: A narrative case-study of a single case was designed, composed of four semi-structured interviews conducted over a 10-month period. The data were analyzed through thematic, structural, and performance analysis. FINDINGS: Four phases were revealed, depicting the experience of being a partner and caregiver of a spouse with dementia-related hypersexuality: a) "I need help": A distress call; b) "It depends how long I agree to go on with it": Living with the ambiguous reality of dementia-related hypersexual behavior within an ongoing intimate relationship; c) "It's as if I'm hugging someone who's no longer alive": The transition from the previous couplehood identity to a new couplehood identity; and d) "I am just taking care of him as if he is a child": A compassionate couplehood identity construction. CONCLUSIONS: Living with a partner with dementia-related hypersexuality is a distressing experience for the caregiver-spouse. Yet, positive memories from a long intimate relationship can lead to the creation of a compassionate identity, which supports the caregiving process, and creates a sense of acceptance and meaning making. This, in turn, enables a positive aging experience. These finding have some practical implications for supporting and intervening in such cases.

"Who Would Sexually Assault an 80-Year-Old Woman?": Barriers to Exploring and Exposing Sexual Assault Against Women in Late Life.

The phenomenon of Sexual Assault against Women in Late Life (SAWLL) has received increasing research attention in recent years. Yet, there is still only scant knowledge on it, compared with research on the sexual assault of younger women. Sexual assault is considered a sensitive topic, generally characterized by a conspiracy of silence. The aim of this article is to explore the barriers that hinder the identification and exposure of SAWLL, as reported by professionals. The research question was as follows: How do welfare and health care professionals present the motives and processes that obstruct exploring, exposing, and intervening in cases of SAWLL? A qualitative research design was used. Participants were 18 experienced welfare and health care professionals engaged in intervention with sexual assault in late life victims as well as offenders. Data were collected through in-depth, semi-structured interviews, which were later transcribed and thematically analyzed. Four themes emerged from the data analysis: (a) Leading Negative Emotions, (b) Lack of Language, (c) Implications of Cumulative and Complex Trauma, and (d) Social Exclusion. Women and professionals alike undergo complementary processes involving silence and silencing. These processes construct a "wall" of barriers, requiring professionals' sensitivity and awareness to deconstruct these barriers. Professional intervention through open discourse with the abused women can break this conspiracy of silence. We recommend that training programs for professionals intervening in cases of elder abuse and neglect will be directed along two paths: The first path should focus on professionals' competence and skills, and the second path should address the women's specific needs. These programs will include a particular module that will specifically address SAWLL. This module should comprise knowledge on typical emotional reactions to SAWLL, the use of language in creating reality, cumulative and complex trauma, and the social construction of ageism and sexism, which lead to social exclusion.

The Lived Experience of Older Women Who Are Sexually Abused in the Context of Lifelong IPV.

The present study explores the lived experience of older women who are sexually abused in the context of lifelong intimate partner violence (IPV). An interpretive phenomenological analysis was used, and semi-structured interviews were performed with 19 older women survivors of lifelong IPV and sexual violence. Three themes emerged: sexual violence shaping lifelong IPV, the occurrence of sexual violence in old age in the context of lifelong IPV, and cumulative insights and reflections on being a survivor of lifelong IPV and sexual violence. The transition to aging has a profound impact on the violent relationship dynamics and this should be considered in practical interventions.

Growing Older in the Shadow of Childhood Intrafamilial Sexual Abuse: Women's Reflections on Parenthood Experiences Throughout the Life Course.

BACKGROUND AND OBJECTIVES: The long-term effect of intrafamilial sexual abuse for the survivors' parenting rarely focuses on older women who are mothers of adult children. The aim of this study was to explore the parenthood experiences of aging women survivors of intrafamilial sexual abuse, using the life course perspective as a conceptual framework. RESEARCH DESIGN AND METHODS: Interpretive phenomenological analysis was used to analyze the narratives of 19 older women survivors of intrafamilial sexual abuse. RESULTS: The narratives revealed 4 themes: (a) "How did I raise those kids? I really do not know": Early parenthood experiences of aging women incest survivors; (b) "This is a true gift they are giving me now": Revealing the intrafamilial sexual abuse secret to the adult children; (c) "Is it possible to say that something good came out of it?": Adult children as a victory over incest experiences; and (d) "When my granddaughter was born, I suddenly felt that I could not go near her": Grandparenting in the shadow of incest memories. DISCUSSION AND IMPLICATIONS: Aging seems to open up a new avenue for parent-child relationships in the shadow of the parent's traumatic past, allowing reframing of parenthood in later life and demonstrating the power of parenthood as a source of healing in the lives of sexual abuse victims.

Breaking the Taboo: Sexual Assault in Late Life as a Multifaceted Phenomenon-Toward an Integrative Theoretical Framework.

Sexual assault (SA) in late life has been receiving growing attention over the past two decades. It is directed primarily against older women and has been the least frequently reported form of abuse. Despite the growing awareness and body of knowledge on this phenomenon, the theoretical framework is still limited. Therefore, the aim of the present article is to suggest a theoretical conceptualization of the multifaceted phenomenon of sexual assault against women in late life (SAWLL). This conceptualization has been developed through several stages: (a) identification of three grounded fields of inquiry that are relevant to SAWLL: SA, elder mistreatment, and intimate partner violence; (b) classification of SAWLL along four paths: (1) ongoing SA in the context of lifelong IPV; (2) SA beginning in old age in the family within the community, involving spouses, family members, caregivers, dating mates, and so on; (3) ongoing SA, continuing in institutions, perpetrated by family members; and (4) SA in institutions, beginning in old age, relating to staff, residents, and family members; (c) We suggest three additional theoretical perspectives: trauma, a life-course perspective, and social constructionism, which provide further in-depth knowledge for understanding SAWLL. The combination of the three abovementioned stages composes an integrative theoretical framework, addressing SAWLL as a multifaceted phenomenon.

Women Coping With a Partner's Dementia-Related Violence: A Qualitative Study.

PURPOSE: The aim of the present study was to differentiate between the lived experience of two groups of women caregiving for a partner with dementia. One group was coping with lifelong intimate partner violence (IPV) and dementia-related violence (Group 1); the other group was coping with dementia-related violence only (Group 2). DESIGN: An interpretive phenomenological analysis perspective was used. Data collection was performed through in-depth, semistructured interviews with eight female spouses of men with dementia from each of the two above-mentioned groups, followed by a content analysis. FINDINGS: Comparing the narratives of the aging women revealed their different experiences over several dimensions: (a) the identification of violence as a symptom of dementia; (b) the use of past couplehood memories; (c) feelings over time; (d) willingness to care for the partner with dementia; and (e) a prospective view of life. CONCLUSIONS: The complexities of being old and having to cope with caregiving responsibilities for a spouse with dementia, accompanied by violent behaviors, emphasize the significance of the couple's past relationship. This notion should be taken into account in practical interventions. CLINICAL RELEVANCE: As part of the aging process, there is an increase in people who are engaged in dementia-related violence. Nurses' education and practice should focus on the dynamics of dyads coping with violence and identify the particular needs of the caregiver spouse in this context.

The health care aide position in nursing homes: A comparative survey of nurses' and aides' perceptions.

BACKGROUND: The health care aide position embodies one of the most basic paradoxes of long-term care for older adults: those who have the most contact and most intensive interaction with nursing-home residents are also those having the least training, authority, and status within the system. They therefore hold one of the keys to quality care in many settings, especially nursing homes. In the absence of agreement on the position's roles, responsibilities, and authority, it is important to examine how the position is perceived by the key members in the long-term-care framework. OBJECTIVES: The current study examined and compared health care aides' and nurses' perceptions of the position in nursing-home settings in Israel, using a standardized tool developed for this inquiry. The comparison accounted for potential intervening factors that may help better understand the job requirements and boundaries. DESIGN: A comparative survey design. SETTINGS: 30 nursing homes (of at least 20 beds) in northern Israel. PARTICIPANTS: We used convenience sampling to recruit 369 health care aides and 261 nurses (a total of 630 participants). METHODS: The main instrument of data collection was specially designed and validated for this study. It was based on a qualitative study that defined basic content units representing tasks importance, knowledge, and personal characteristics for the job. RESULTS: Participants found it difficult to prioritize the job components or to differentiate between core tasks and characteristics and the secondary aspects of their job. General care, profession-specific knowledge, and emotional abilities were endorsed the most by participants. Cleaning, communication, and safety were ranked lower (although rankings were still considerably high). However, previous experience as a health care aide undermined incumbents' perceptions of their own responsibilities and professionalism. Incumbent health care aides rated most factors higher than nurses did, with the exception of the importance of communication. CONCLUSION: Our results may help decision makers understand the complexity around the health care aide position, manage and develop it more effectively while setting standards (training and certification, performance appraisal, and more) for professionalization processes and better defining the division of nursing work between health care aides and nurses.

Sibling Relationships Over the Life Course: Growing Up With a Disability.

The research explores sibling relationships, and the ways in which they are shaped over the life course by family members, in families with a lifelong disability. In-depth, semistructured interviews were conducted with 15 family units including a parent, a sibling, and an adult sibling with a disability. The content analysis revealed five sibling relationship patterns: (a) "Not a child, but a parent caretaker"-the parent-surrogate sibling; (b) "We somehow grew apart"-the estranged sibling; (c) "It is important for me to maintain some kind of distance"-the bystander sibling; (d) "When there's something they want to tell him, they always send me"-the mediator sibling; and (e) "I love him to death"-the friend sibling. These patterns of adult sibling relationships are discussed in relation to family dynamics, values, and legacies; recommendations for practice and research are made.

The meanings of the unlicensed assistive personnel role in nursing homes: A triadic job analysis perspective.

AIM: This study described and analyzed how older residents, professional nurses and unlicensed assistive personnel (UAP) perceive the meaning and content of the job carried out by UAP in nursing homes (NHs), as a basis for job analysis. BACKGROUND: Increasing numbers of NH beds and financial restraints have led UAP to become a significant part of the long-term care service system, yet in numerous contexts, the UAP job remains misunderstood and underexplored. METHOD: The research employed a qualitative phenomenological methodology. Data were collected from 50 semi-structured in-depth interviews with 18 UAP, 15 certified nurses and 17 older NH residents. RESULTS: We identified six content dimensions in the participants' descriptions regarding the meanings of the roles and duties of the UAP: (a) care for the physical environment, (b) bodily-physical care, (c) psycho-social interpersonal care, (d) professional hierarchy and boundaries, (e) UAP personal traits and (f) UAP skills, or the need for training and professional education. CONCLUSIONS: Future job definition and formal regulation of UAP should place more focus on the personal characteristics of UAP, as a prerequisite to enter the job. IMPLICATIONS FOR NURSING MANAGEMENT: The study takes a step forward toward better defining the professional boundaries delineating the meaning of the UAP position.

Social Workers' Attempts to Navigate Among the Elderly, Their Families, and Foreign Home Care Workers in the Haredi Community.

BACKGROUND: The study's aim is to examine social workers' experience in facilitating the integration of foreign home care workers (FHCWs) into the ultraorthodox Jewish (UOJ) community for the purpose of treating older adults. METHOD: Using the qualitative-phenomenological approach, semistructured, in-depth interviews were conducted with 18 social workers in daily contact with UOJ older adult clients in the process of integrating FHCWs. RESULTS: Data analysis revealed three central themes-integrating FHCWs into the aging UOJ family: barriers and challenges in the interaction between the two worlds; "even the rabbi has a FHCW": changing trends in caring for older adults; and the social worker as mediator and facilitator of a successful relationship. DISCUSSION: Social workers play a central role, serving as a cultural bridge in the process of integrating FHCWs, as a way of addressing the needs of ultraorthodox elderly and their families, while also considering the needs of the foreign workers.