Older adults with physical and cognitive impairment are at higher risk for sexual abuse. Risk factors include dependency on caregivers, social isolation, prior history of abuse and physical and mental impairments.(Cannell et al., J Elder Abuse Negl 26:398–413, 2014) Most sexual abuse is predicated on power and control rather than sexual gratification. Ageist attitudes that view older adults as either asexual or cognitively impaired may cause victims to not be believed when they report to authorities. Although the overall approach to evaluation of an older adult victim of sexual assault is similar to that of younger victims, special consideration should be given to physical changes of aging during the examination. Equally important is being aware of the emotional trauma this age cohort may experience after a sexual assault and how that might impair reporting and affect their overall health. A trauma informed approach is critical to avoid causing victims any further distress.