The case analysis explores an emergency department visit by a 67-year-old female with early dementia post-brain attack, with complaints of possible sexual assault or abuse. This patient resides in a long-term skilled nursing facility. The case outlines the forensic care provided by the Advanced Practice Forensic Nurse (APFN) once medically cleared by the emergency department Advanced Practice Nurse (APN). The case discussion includes issues related to sexuality in aging populations, consent, sexual abuse or assault in institutions, and forensic care of older persons. Expected genital injuries in older women that result from sexual assault and abuse are also explored. The case discussion will analyze the key elements for critical thinking and clinical reasoning and demonstrate standards of care for the APFN and APN practice. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.