A/81/133 stigma and dependence on family members or caregivers may make rural older women less likely to report violence or seek assistance. Distance from services, transport barriers, limited access to information and digital exclusion frequently restrict access to services. G. Women in institutional care 48. More older women than men reside in long-term care settings, and the majority suffer from some kind of cognitive impairment. 134 An official investigation in Australia estimated the prevalence of abuse in residential aged care at 39.2%. 135 Police data from Canada further indicates that women accounted for 66% of victims in nursing and retirement homes and were four times more likely than men to experience sexual assault. 136 Their privacy, autonomy and ability to escape abusive environments are severely limited, especially when they feel isolated and do not have contact with the outside world. H. Women with disabilities 49. Older women with disabilities experience some of the highest levels of exposure to violence, due to the cumulative and intersecting effects of ageism, sexism and ableism. Physical, sensory, intellectual and psychosocial disabilities may increase dependence on family members, intimate partners, caregivers or institutions, creating conditions in which coercive control, neglect, economic exploitation and abuse can occur, with limited possibilities for escape or disclosure. 137 Violence may include the withholding of medication, assistive devices, food or personal care, denial of autonomy in medical and financial decisions, involuntary institutionalization and the use of physical or chemical restraints in care settings. In the c ase of the oldest women with profound cognitive disabilities, sexual abuse is often wrongly perceived as causing little or no harm to them. 138 They also face significant barriers in accessing justice and support, including inaccessible reporting mechanisms, communication barriers, a lack of reasonable accommodation and a dependence on perpetrators to reach services or pursue complaints. 139 I. Incarcerated women 50. Older female prisoners have heightened health, mobility and care needs, which prison systems frequently fail to meet. 140 Basic conditions in cells, inaccessible sanitary facilities, wards located on higher floors and common areas spread across multiple levels may significantly impede mobility and increase the risk of falls and injuries. 141 The confiscation of personal belongings, including eyeglasses, makes it impossible for older prisoners to read documents. 142 Incarceration spaces are often noisy and lack privacy, particularly affecting women struggling with sleep during __________________ 134 Submission by the Feminist Legal Clinic. Submission by Relationships Australia. 136 Submission by Canada. 137 Submission by Alliance internationale pour la défense des droits et des libertés. 138 Submission by Collective Shout. 139 Submission by Ontario, Canada. 140 See https://pubmed.ncbi.nlm.nih.gov/30943874/. 141 Confidential submission. 142 Submission by Legal Initiative. 135 26-09992 13/26