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Suspected elder sexual abuse cases investigated by the Massachusetts Elder Protective Services Program between 1993 and 2002 were qualitatively analyzed using clinical consultation records. Cases that involved perpetrators who were family members of their victims inform this discussion of elder sexual abuse within the family. The cases fall into two groups: marital sexual abuse and incestuous abuse. Three patterns of marital cases were observed: (1) long-term domestic violence, (2) recent onset of sexual abuse within a long-term marriage, and (3) sexual victimization within a new marriage. Incestuous elder abuse involved cases perpetrated by adult children, other relatives, and quasi-relatives. Clinical dynamics observed in all types of cases are discussed. Selected cases illustrate abuse dynamics, problems confronting victims, and perpetrator characteristics. The range of abusive behaviors observed, etiological and contributing factors, and forensic markers of elder sexual abuse are discussed.
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