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Abuse & Neglect
Around
people 60 years and older experienced some form of abuse in community settings during the past year (World Health Organization, 2020).
1 in
1
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. This type of violence constitutes a violation of human rights and includes physical, sexual, psychological, and emotional abuse; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect.” (WHO, 2020)
Identifying abuse can be difficult. It is important to note that abuse can happen to any older adult, at any time, anywhere.
There are several factors that place older adults at risk (WHO, 2020):
- Individual – poor physical, mental health; gender
- Relationship – shared living arrangements; dependency
- Community – social isolation; lack of social support
- Socio-Cultural – ageist stereotypes; lack of funds; systems of inheritance and land rights;
Service providers working with older adults in potentially abusive situations need to be sensitive to cultural differences and intervene accordingly. Formulating culturally sensitive prevention and intervention efforts requires an understanding of roles and responsibilities within the family. Certain cultural values, beliefs and traditions influence family dynamics, intergenerational relationships and ways in which families define their roles and responsibilities and respond to daily challenges. These differences make some situations difficult to distinguish from abuse or neglect (EAPON, 2020).
This section aims to increase awareness of the possible indicators of abuse and how as service providers you can better screen for and provide support. Additional resources are available:
For Your Clients:
Seniors Safety Line
1-866-299-1011
For Service Providers:
In this section we'll explore the different types of abuse & neglect
Financial
The most common form of elder abuse, financial abuse, is defined as any improper conduct, done with or without the informed consent of the senior that results in a monetary or personal gain to the abuser and/or monetary or personal loss for the older adult (EAPON, 2020).
Financial abuse of an older adult can include (EAPON, 2020):
- Misusing property and/or funds, Power of Attorney
- Theft, forgery
- Sharing their home without paying a fair share of the expenses
- Unexplained disappearance of personal belongings, such as clothes or jewellery
- Unduly pressuring an older adult to relinquish property, sign legal documents without understanding, give money to relatives/caregivers
Possible Indicators of Financial Abuse (EAPON, 2020):
Banking/Legal
- Unexplained or sudden withdrawal of money from accounts
- Suspicious or forged signatures on cheques or other documents
- The older adult is not receiving bank statements
- Transfer or withdrawal of funds without prior permission
- Denial to access or control finances such as credit cards, cheques
Living Status
- Notice of eviction or discontinuation of utilities
- Older adult is unable to pay bills, buy food or pay rent
- Standard of living not in keeping with the older adult’s income or assets
- The older adult’s home is unexpectedly sold
- Power of Attorney refuses to consider moving an older adult to Long-Term Care or Retirement Home in order to gain or retain access to their finances
Financial abuse can be a difficult subject to broach with a family member or older adult. The following are sample questions that may assist service providers in starting the conversation, where financial abuse is suspected. Follow your professional standards when conducting investigative interviews and obtaining client consent (EAPON, 2020).
Questions to ask your clients
- Is there something that you would like to share with me?
- Has there been a recent incident causing you concern?
- Do you make decisions for yourself or does someone else make them for you?
- Does your caregiver depend on you, for shelter or financial support?
- Have you ever felt taken advantage of?
- Do you have any concerns about your money, belongings, property, valuables?
- Has anyone ever asked you to sign papers that you did not understand?
- Does anyone ever take things from you or use your money without your permission?
- Do you manage your own money?
- Has anyone taken anything from your purse/wallet?
- Has anyone taken money from your bank account?
- Have you been pressured to change your Power of Attorney?
- Has anyone pressured you to change your Will?
- Would you like some help with…?
Download this list as a PDF to review with your clients
Financial Abuse Resources & Links
The information provided here has been adapted from EAO’s document (below); For more information about assessment, intervention, the law/reporting, Power of Attorney, Ontario Public Guardian and Trustee, and safety planning for Financial Abuse please read the full guide:
For information on Power of Attorney for Property, Ontario Public Guardian and Trustee, legislation and capacity, please refer to the section on Consent and Capacity.
For additional resources on Fraud and Scams:
Romance Scams
The Seniors at Risk Network of Guelph Wellington has seen an anecdotal increase in reporting of romance scams with older adults. As such, we have adapted information from Consumer Protection Ontario as a downloadable tipsheet “Are You a Victim of a Romance Scam” for you to support the conversation with your clients.
Physical
Physical abuse is defined as any act of violence or rough handling that may or may not result in physical injury but causes physical discomfort or pain (EAPON, 2020).
Physical abuse may include (EAPON, 2020):
- Physical assault – hitting, shoving, slapping, rough handling
- Pushing, pulling, kicking, beating, twisting, shaking
- Pulling hair, biting, pinching, spitting at someone
- Confinement, inappropriate restraint use
- Overmedicating, withholding necessary medications
Possible Indicators of Physical Abuse (EAPON, 2020):
Physical
- Unexplained injuries such as broken bones, bruises, bumps, cuts, grip marks, welts, lacerations, swelling, fractures
- Internal injuries
- Head or neck injuries
- Signs of being restrained
- Unusual patterns of injuries
- Immobility
- Broken eyeglasses
- Unkempt
- Signs of lethargy, memory problems (under/over medication)
Behavioural
- Discomfort or nervousness around family, friends, caregiver or others
- Unusual withdrawal from family and friends
- Depression
- Discrepancies between injury and explanation from the older adult
- Seen by many different doctors or hospitals
- Reluctance to talk openly; uncommunicative; unresponsive
- Avoidance of physical or eye contact with caregiver and/or health care provider
- Sleep problems
- Self-harming
- Changes in eating patterns
Questions to ask your clients
- Is there something that you would like to share with me?
- Has there been a recent incident (with a family member, friend and/or caregiver) that is causing you concern?
- Is there anyone close to you that makes you feel uncomfortable?
- Is there anyone that you fear being left alone with?
- Are you afraid of any family members and/or caregivers?
- How do family members behave toward you?
- Does your caregiver and/or family member(s) always answer questions that are asked of you? Is there someone in your life who is mistreating/harming you?
- Have you ever been touched in any way you did not want?
- Do you have any bruises, cuts and/or pain in your body that you cannot explain?
- Have you ever experienced physical abuse in the past?
- Are you alone a lot?
- Does your family member/caregiver take you to see a doctor when you have pain or an injury of any sort?
- Do you see different doctors/hospitals every time you are injured?
- Does your family member or caregiver force you to see a different doctor or hospital when you are injured?
- Has anyone tried to harm you while under the influence of alcohol or any other substances?
- Have you ever been forced or tricked to take any substances that may impair your memory or judgment?
Download this list as a PDF to review with your clients
Physical abuse is a difficult subject to talk about with a family member or older adult. It is important to conduct a thorough assessment to identify and intervene appropriately. The following are sample questions that may assist care providers in starting the conversation, where physical abuse is suspected. Follow your professional standards when conducting investigative interviews and obtaining client consent (EAPON, 2020).
Physical Abuse Resources & Links
The information provided here has been adapted from EAO’s document (below); For more information about assessment and intervention (including the law and reporting) please read the full guide:
Intimate Partner Violence
As service providers, you should be aware of the laws around intimate partner violence and what it means for the older adult, partner and/or family when and if a charge is made. Please refer to the section on Support by Sector for more information about how intimate partner violence is defined and how the justice, health, social or other services may impact or support your client.
Intimate Partner Violence in later life may be a continuation of long-term partner abuse or may begin with retirement or the onset of a health condition that leads to a dependency.
Intimate Partner Violence Resources & Links
If Intimate Partner Violence is a concern, a more comprehensive risk assessment of the situation is recommended.
As with many forms of risk and abuse, it may be necessary to complete a safety plan with your client.
Psychological
Emotional and Psychological abuse is any action, verbal or non-verbal, that lessens a person’s sense of identity, dignity and self-worth (EAPON, 2020).
Emotional Abuse may present as the following (EAPON, 2020):
- Words that are hurtful make the older adult feel unworthy
- Not considering a person’s wishes. Removal of decision-making powers
- Not respecting a person’s belongings or pets
- Threatening an older adult
- Treating an older adult like a child
- Shunning, ignoring or lack of acknowledgement
- Verbal intimidation, being forced into making decisions against their will
- Threats of institutionalization
- Not allowing the older adult to socialize, including access to telephone, friends, neighbours, or attending social gatherings
- Withholding of affection, such as refusing access to grandchildren
Possible Indicators of Psychological Abuse (EAPON, 2020):
- Low self-esteem, withdrawal
- Tearfulness
- Lack of eye contact with health care providers
- Fearfulness – Nervous around caregiver or other persons
- Reluctance to talk openly, waits for caregiver to respond to questions asked of them
- Helplessness
- Insomnia/sleep deprivation/fatigue, listlessness
It is important to be aware of sudden changes in the older adult’s behavior as emotional abuse can be difficult to determine. Asking questions to start the conversation and get a better understanding of their situation and feelings is a good place to start. This, along with noted behavioural changes can form part of your assessment in order to help guide your plan of support for the older adult (EAPON, 2020).
Questions to ask your clients
- Is there anyone close to you that makes you feel uncomfortable?
- Is there anyone that you fear being left alone with?
- Are you afraid of family members and/or caregivers?
- How do family members behave towards you? Are they verbally abusive?
- Do your caregiver and/or family member(s) always answer questions that are asked of you?
- Can you tell me about a time recently when someone talked to or yelled at you in a way that made you feel bad about yourself?
- Does anyone ever scold or threaten you? Can you give me an example?
- Does anyone ever tell you that you’re sick when you know you aren’t? Can you give me an example?
- When was the last time you got to see relatives or friends?
- Do you have any access to a telephone? If not, why not?
- Are you by yourself a lot?
Download this list as a PDF to review with your clients
Psychological Abuse Resources & Links
The information provided here has been adapted from EAO’s document (below); For more information about assessment and intervention of Emotional Abuse please read the full guide:
With many forms of risk and abuse, it may be necessary to complete a safety plan with your client.
Sexual
Sexual abuse is any sexual behaviour directed toward an older adult without that person’s full knowledge and consent; it includes coercing an older person through force, trickery, threats or other means into unwanted sexual activity.
Sexual abuse also includes sexual contact with seniors who are unable to grant consent and unwanted sexual contact between service providers and their elderly clients. Sexual abuse can be very difficult to identify as embarrassment and shame may prevent the issue from being talked about or reported (EAPON, 2020).
Sexual abuse can include (EAPON, 2020):
- Unwanted sexual contact such as touching, sexualized kissing
- Making sexual remarks and/or suggestions to another person
- Forcing a person to perform a sexual act
- Inappropriate touching
- Fondling a confused senior
- Forced intercourse/rape
- Coerced nudity and sexually explicit photographing
Possible Indicators of Sexual Abuse (EAPON, 2020):
- Bruising around the breasts, inner thighs or genital area
- Unexplained venereal disease or genital infections
- Torn, stained, or bloody underclothing
- Difficulty in walking or sitting
- Inappropriate sexual comments
Sexual abuse can be a very difficult conversation to have with a family member or older adult client. The following sample questions may assist care providers, to start the conversation with the older adult, about their concerns of suspected sexual abuse (EAPON, 2020).
Sexual assault and harassment are a crime in Canada. Even when you are married, it is a crime to force any sexual conduct on another person. If a sexual act is committed while the victim is physically or mentally unable to consent, that is sexual assault (EAPON, 2020).
Questions to ask your clients
- Is there anyone close to you that makes you feel uncomfortable?
- Does anyone speak to you in a sexual nature that makes you feel uncomfortable?
- Has your partner ever made inappropriate or aggressive sexual remarks towards you?
- Is there anyone that you fear being left alone with?
- Have you ever been touched in any way you did not want?
- Has anyone forced you to watch pornographic material or pictures?
- Have you ever been forced to watch someone else take part in any sexual act without your consent?
- Have you ever felt pressured to take part in a sexual act with your partner because they threatened you?
- Do you feel coerced to participate in sexual acts with your partner for fear of physical harm being done to you if you do not?
- Has anyone forced you to touch them?
- Have you experienced sexual abuse or any other type of abuse in the past?
- Has a family member tried to harm you while under the influence of alcohol or drugs?
- Does your partner force you to take any substances which may impair your memory or judgment?
- Have you been forced or tricked to take any substances that may impair your memory or judgment?
Download this list as a PDF to review with your clients
Sexual Abuse Resources & Links
The information provided here has been adapted from EAO’s document (below); For more information about assessment, intervention, reporting of Sexual Abuse please read the full guide:
Reporting instances of sexual abuse is mandatory in Long Term Care and Retirement Homes, for more information refer to Privacy and Reporting.
With many forms of risk and abuse, it may be necessary to complete a safety plan with your client.
Neglect
Neglect is not meeting the basic needs of the older person (EAPON, 2020);
- Active (intentional) neglect: the deliberate withholding of care or the basic necessities of life to an older adult for whom they are caring
- Passive (unintentional) neglect: the failure to provide proper care to an older adult due to lack of knowledge, experience /ability or unaware of how to access local resources
Neglect can be (EAPON, 2020):
- Withholding care or denying access to necessary services (home care, nursing) or medical attention
- Leaving a person in an unsafe place
- Improper use of medication – over/under medicating
- Not providing food or liquids, proper clothing or hygiene
- Failure to assist with activities of daily living
- Abandonment
- Denial of a senior’s basic rights
Possible Indicators of Neglect (EAPON, 2020):
- Signs of malnourishment
- Missing or broken dentures, walkers, hearing aids, glasses
- Unsafe and/or unclean living conditions
- Non-compliance/withholding of medical prescriptions and/or treatments
- Insect and pest infestation
- Presence of urine and/or fecal smell
- Being left alone/isolated and/or unattended for long periods of time
- Unkempt appearance (unshaven, matted hair) or dirty clothing
- Soiled bedding and linens
- Inappropriate or inadequate clothing for weather/season
- Lack of contact with healthcare practitioners such as doctor/dentist
- Untreated pressure ulcers
Questions to ask your clients
- Do you have anyone who spends time with you, takes you shopping or to the doctor?
- Is there someone who helps you with personal needs such as taking medicine, getting to the bathroom, getting out of bed, getting dressed or getting food?
- Can you take your own medication or get around by yourself?
- Who makes decisions about your life – how you should live or where you should live?
- Do you have enough privacy at home?
- Do you trust most of the people in your family?
- Are you uncomfortable with or afraid of anyone in your life?
- Are you sad and lonely often?
- Do you feel like no one wants you around?
- Does anyone in your family drink a lot?
- Does someone in your family make you stay in bed or tell you are sick when you are not?
- Has anyone taken things that belong to you, without your approval?
- Does anyone tell you that doing things for you is too much trouble?
- Has anyone close to you tried to hurt you or harm you in any way?
Download this list as a PDF to review with your clients
Considerations
- Caregiving for mental or physical impairments is highly stressful and families are not trained for the job. Unintentional though it may be, abuse and neglect is sometimes perpetrated by people who had previously acted loving, supportive and caring. For more information about screening for caregiver burnout refer to the section on Social.
- The likelihood of abuse and neglect increases with age. As people get older, especially those more dependent, the likelihood of being taken advantage of increases (EAPON, 2020).
Victims of neglect may feel ashamed of their experiences. Those who consider reporting often choose not to because, in the majority of cases, they are abused by a family member, loved one, or trusted caregiver. It can be extremely difficult to tell others that someone you trust and love is abusing or neglecting you. Consider how your communication strategies impact your assessment of the facts (EAPON, 2020).
Neglect Resources & Links
The information provided here has been adapted from EAO’s document (below); For more information about assessment, intervention, safety planning and reporting please read the full guide:
