Research concerning elder sexual abuse is scant and in fact includes only four previous studies. Five types of elder sexual abuse have been identified within the literature based on who perpetrates the abuse: (1) stranger or acquaintance assault; (2) abuse by unrelated caregivers; (3) incestuous abuse; (4) martial or partner abuse; and (5) resident-to-resident abuse in residential facilities. The current study examined cases of incestuous sexual abuse and marital or partner sexual abuse in a sample of 100 cases investigated between 1993 and 2002 by the Protective Services (PS) Program of the Massachusetts Executive Office of Elder Affairs. Data were drawn from consultation/investigation files and were qualitatively analyzed for this article. Quantitative analysis is ongoing and will be reported in a separate paper. Three main patterns of marital/intimate partner sexual abuse were discovered: (1) abuse occurring within a long-term domestic violence situation; (2) recent onset of abuse within a long-term marriage; and (3) abuse within a new marriage. Each is examined in turn with illustrative case accounts. One case is offered illustrating a rare case of an elderly wife sexually abusing her elderly husband. Incestuous sexual abuse fell into three categories according to the relationship between the offender and the victim: (1) abuse by adult child perpetrators; (2) other relatives as perpetrators of abuse; and (3) quasi-relatives, such as in-laws, as perpetrators of abuse. Each is examined in turn with illustrative case examples. One case example is offered that involved a juvenile offender. The analysis of elder sexual abuse goes on to describe the range of behaviors discovered in the sexual abuse of elders, the etiological and contributing factors of such abuse, and forensic markers signaling symptoms of elder abuse. The most frequently observed type of marital elder sexual abuse occurs within a context of long-term domestic violence and involves sexual abuse perpetrated by a male partner. In incestuous cases, perpetrators are most often adult sons. Familial elder abuse most often occurs within a pattern of multifaceted abuse involving many forms of victimization and exploitation. Given the gravity of sexual abuse and its deleterious outcomes on any age group, further research into this topic is more than warranted. References