Elder abuse is any behaviour causing harm or distress to an older person by someone they should be able to trust.
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Elder abuse can be physical, emotional (including verbal), financial, sexual, institutional or involve neglect.
It can be one-off, but more often it happens repeatedly over a period of time.
Some people are at greater risk of abuse, due to issues within a family, carers struggling with their role or, in hospital or residential settings, staff training and support issues.
While it's good to not jump to conclusions, signs of abuse may include unexplained behaviours and injuries, confusion and financial issues.
Fortunately, there are ways to prevent elder abuse or get help if you or someone you know is experiencing elder abuse.
Who does elder abuse affect?
Elder abuse is a global problem. International studies suggest that 3–10% of older people experience abuse or neglect each year.
Elder abuse can:
happen to men and women of every religious, cultural, ethnic and income group
occur in any setting, rural or urban
affect older people living on their own or living with others
occur in private homes or within a residential care or health care setting
affect people who are frail and vulnerable, who depend on others to meet their needs.
Sadly, much abuse goes unreported or is only reported after it has escalated to have caused significant harm to an older person.
Who is at risk of elder abuse?
Some older people are more at risk of being abused. This may be due to issues within a family, carers struggling with their role or, in hospital or residential settings, staff training and support issues.
The following signs may raise suspicion of potential elder abuse, but it's important to avoid jumping to conclusions – the whole situation needs to be taken into account:
unexplained behaviour, sleeping or eating habits
confusion, withdrawal and/or edginess
unexplained injuries
drowsiness (due to over-medication)
fear of a particular person or being anxious in familiar situations
recoiling from touch
unusual withdrawals from bank accounts or decisions around property or other assets
unpaid bills and/or not enough money for necessities.
Older people have the right to make their own choices and decisions even if you don’t agree with them. Where older people’s choices are being undermined or over-ridden by others, it is important to question whether their human rights are being upheld.
To help prevent elder abuse, older people should be:
loved and cherished
spoken and listened to respectfully
included in social activities
phoned or visited regularly
supported to spend their money how they wish
encouraged and supported to make their own decisions
enabled to set their own pace.
Where to find help for elder abuse
If you are worried about how you or another older person are being treated, do one of the following:
Talk to someone you trust – a friend or someone in your family/whānau.
Talk to someone you see regularly – a doctor, nurse, member of your church or spiritual leader.
Talk confidentially with a worker from an agency with experience in dealing sensitively with elder abuse, like Age Concern.
Phone 0800 652 105 to ask Age Concern about your nearest elder abuse service.
Hanny Naus is Age Concern New Zealand’s Professional Educator for Elder Abuse and Neglect Prevention. She connects with workers around the country who provide assessment and intervention services to enhance the safety and wellbeing of older people/kaumātua. In previous work roles, Hanny’s focus included social work/counselling practice in community and health care settings with older people, families, and people with disabilities; as well as tertiary social work/counselling student education.
Credits: Health Navigator Editorial Team. Reviewed By: Hanny Naus, Professional Educator for Elder Abuse and Neglect Prevention, Age Concern NZ
Last reviewed: 11 Jun 2020
What are the risk factors for elder abuse?
Elder abuse occurs for many reasons. Sometimes there has been be a background of difficult relationships or family violence. Occasionally carers struggle with their role. The impact of dementia, substance abuse, mental health problems and economic stress can also contribute. These factors can influence those who abuse, but greed and opportunism to exploit older people is also common.
What are the situations that increase risk of elder abuse?
A family undergoes an unforeseen or unfavourable change in circumstances.
Adult children or grandchildren have difficulties in their own living situation and move in with older relatives.
There is a history of tense relationships or abuse between family members.
Difficulties emerge as a result of role reversal (eg, if a father or mother becomes dependent on a son or daughter).
A person appears to befriend an older person and then manipulates them.
Family members are isolated and lack other relationships that give social, physical and emotional satisfaction.
A carer has been forced to change their lifestyle as a result of caring for the older person.
The older person requires a level of care beyond the capacity of the carer.
There are difficulties due to hearing, visual or speech impairments of the older person or of those caring for them.
Older people are required to give money, resources or property to other generations.
The older person is continuing to provide support for younger relatives with disabilities, mental health or addiction issues.
A carer has conflicting responsibilities or financial difficulties and does not adequately support the older person’s needs.
A carer has not received help or support.
The older person refuses adequate support for themselves or their carer.
The older person has an illness or dementia that can cause unpredictable or repetitive behaviour, wandering or aggression, or major changes in personality.
The relative or carer has a disability, mental illness or addiction issue that affects their safe interaction with the older person.
Financial pressures and/or beliefs about rights of inheritance or ownership lead to control of finances, property or resources.
What factors contribute to elder abuse within hospitals or residential care settings?
Staff working in isolation.
Staff inadequately trained to provide care and to respond to challenging behaviour.
Staff poorly supervised.
Staff having inadequate time per patient to provide respectful care.
Low staffing levels and/or frequent use of agency staff.
High staff sickness levels and/or a rapid turnover of staff.
Staff with low self-esteem or who are stressed or burnt out.
Staff who have a criminal history, personality disorder or who abuse drugs or alcohol.
Inappropriate or poor staff skill mixes and poor staff to patient ratios.
Inadequate management supports.
Ways of working that disregard the social and cultural needs of residents.
Over-cramped or poor working conditions and environment.
Care settings isolated from other parts of the hospital or community.
Attitudes or behaviours that disregard the safety of patients or residents.
What are the types of elder abuse?
There are 5 common categories of elder abuse. You may see signs that may raise suspicion of abuse, but it is important to avoid jumping to conclusions. The whole situation needs to be taken into account.
inappropriate use of medicines or physical restraints
force-feeding
physical punishment of any kind.
Multiple injuries, such as bruises, hair loss, grip marks, fractures, burns or scalding, especially if these are of different ages and in unusual places.
Psychological or emotional abuse
Any behaviour that causes anguish, stress or fear, including:
verbal abuse, intimidation, harassment, damage to property, threats of physical or sexual abuse
the removal of decision-making powers
treating an older person like a baby
giving an older person the "silent treatment"
isolating them from family, friends or regular activities.
Feelings such as resignation, fear, shame, depression or mental confusion.
Financial or material abuse
This is the illegal or improper use and/or exploitation of funds, property or assets. This includes:
forging an older person's signature
stealing money or possessions
tricking an older person into signing documents that transfer funds, property or assets.
Failure to pay rent or other bills on behalf of the older person, sale of property by an older person who seems confused about the reasons for the sale, lack of money for necessities, lack of money for social activities, depletion of savings, disappearance of possessions.
Neglect (including self-neglect)
This occurs as a result of an older person themselves or another person failing to meet the physical and emotional needs of an older person. This includes:
failing to provide an older person with food, clothing, personal shelter, or other essentials, such as medical care or medicines
can also include failing to pay nursing home or assisted-living facility costs for an older person if you have a legal responsibility to do so.
Malnourished or dehydration, hypothermia, weight loss with no apparent medical cause pallor, sunken eyes, cheeks, bedsores or injuries that have not been properly cared for, poor personal hygiene, clothing in poor repair, abandoned or left unattended for long periods, medicines not purchased or administered.
Sexual abuse
Any forced, coerced or exploitative sexual behaviour or threats imposed on an individual. This includes:
sexual acts imposed on a person unable to give consent
sexual activity that an adult lacking mental capacity is unable to understand
acts such as unwanted touching
all types of sexual assault or battery, such as rape
forced nudity and sexually explicit photography.
Sexually transmitted infection, difficulty walking or sitting, recoiling from being touched, bruising or bleeding, pain or itching in the genital area.
Institutional abuse
Any policy or accepted practice within an organisation that causes harm to, or disregards, a person’s rights. It may occur in hospital and residential care facilities, but also in community settings.
Examples include:
inappropriate rationing of continence products
inflexible routines eg, all dressed for breakfast before 8 am.
The older person does not receive the care or support that is promised, eg, written documentation (such as a needs assessment) does not result in adequate care provision. Repeated incidents of an older person’s physical and emotional needs being inadequately resolved by an organisation. An older person being neglected until an advocate or an audit highlights the gaps.
To find an abuse service for elderly within your area, use the location filter under the map (mobile view) or at the bottom of the search results (computer view).
Source: HealthPoint services directory used with permission.
Information for healthcare providers on elder abuse
The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.
Definition of elder abuse
Elder abuse is defined as "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person" (Adopted from the World Health Organisation Toronto Declaration on the Global Prevention of Elder Abuse, 2002).
This definition is the basis for working with older people about elder abuse and neglect. However, when defining elder abuse, it is also important to take into consideration each cultural context of what constitutes abuse. Meanings of abuse may include disrespect, dishonour, lack of esteem shown to older people/kaumātua or ignoring the needs of older people. It is important to keep in mind the impact abuse has on the older person when determining whether elder abuse has occurred.
The following features should alert healthcare providers to the possibility of abuse, and the need to expand history taking and assessment procedures.
There is incongruity between observations and information from the older person, or a discrepancy in perceptions of the older person and the suspected abuser.
There is any discrepancy between an injury and the history, unexplained injuries, conflicting stories, vague or bizarre explanations, or denial.
There are frequent requests for care or treatment for comparatively minor conditions.
There is a delay in seeking care or reporting an injury.
The older person is described as ‘accident prone’ or has a history of injury, untreated injuries and multiple injuries, especially at various stages of healing. 35Elder Abuse and Neglect
There are repeated accident or emergency attendances of the older people from the same care setting.
There are manifestations of inadequate care, including poor hygiene or nutritional status, poorly controlled medical conditions, frequent falls and confusion.
A relative or carer appears overly protective or controlling, or the older person displays unexplained anger or fear towards the carer or relative.
There is an apparent inability to afford food, clothing, housing or social activities, or questionable use of the older person’s possessions/property/funds.
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