As a society, we must be aware that elder abuse exists and is a problem. We must perceive seniors more favourably as positive contributors to society. We must recognize and act on abuse or suspicion of abuse.

The International Network for the Prevention of Elder Abuse (INPEA) with the World Health Organization states that “abuse, neglect and financial exploitation of elders are much more common than societies admit.” (Missing Voices, 2002). The report demonstrates clear links between elder abuse and disempowerment and discrimination. INPEA further states that “ultimately, the challenge for us all is not only to listen to what has been said, but to believe and act upon it.”

Where does abuse take place?

Elder abuse tends to take place where the senior lives. Vulnerable elders in institutional settings such as a long term care facility are particularly at risk . In the home abusers are apt to be adult children or stepchildren, other family members such as grandchildren, or spouses/partners of elders.

At first, you might not recognize or take seriously signs of elder abuse. They may appear to be symptoms of dementia or signs of the elderly person’s frailty — or caregivers may explain them to you that way. In fact, many of the signs and symptoms of elder abuse overlap with symptoms of mental deterioration, but that doesn’t mean you should dismiss them on the caregiver’s say-so. Here is a checklist from NICE (National Initiative for the Care of the Elderly) to help determine if there is mistreatment of a senior.

Types of elder abuse

Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. Such abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement.

Signs and Symptoms

  • Unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two sides of the body
  • Broken bones, sprains, or dislocations
  • Report of drug overdose or apparent failure to take medication regularly (a prescription has more remaining than it should)
  • Broken eyeglasses or frames
  • Signs of being restrained, such as rope marks on wrists
  • Caregiver’s refusal to allow you to see the elder alone

In emotional or psychological senior abuse, people speak to or treat elderly persons in ways that cause emotional pain or distress. It includes intimidation through yelling or threats, humiliation and ridicule, or habitual blaming or scapegoating. Nonverbal abuse can take the form of ignoring the elderly person; isolating an elder from friends or activities; treating an elder person like an infant, and terrorizing or menacing the elderly person. Emotional abuse is difficult to assess.

Signs and Symptoms

  • Being emotionally upset or agitated
  • Being extremely withdrawn, non-communicative, non-responsive
  • Behavior that mimics dementia, such as rocking, sucking, or mumbling to oneself
  • An older person’s report of being verbally or emotionally abused

This type of abuse involves unauthorized use of an elderly person’s funds or property either by a family member, caregiver or an outside scam artist. Examples include cashing an elderly person’s cheque without authorization, forging an older person’s signature,  or deceiving an older person into signing a document such as a will.  Typical rackets that target elders include: announcements of a “prize” that the elderly person has won but must pay money to claim; fraudulent service providers such as contractors and roofers; phone charities, or investment fraud.

Signs and Symptoms

  • Significant withdrawals from the elder’s accounts
  • Sudden changes in the elder’s financial condition
  • Items or cash missing from the senior’s household
  • Suspicious changes in wills, power of attorney, titles, and policies
  • Addition of names to the senior’s signature card
  • Unpaid bills or lack of medical care, although the elder has enough money to pay for them
  • Financial activity the senior couldn’t have done, such as an ATM withdrawal when the account holder is bedridden
  • Unnecessary services, goods, or subscriptions

Elder neglect is a failure to fulfill a caretaking obligation and constitutes more than half of all reported cases of elder abuse. It can be active (intentional) or passive (unintentional) based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does.

“Self-neglect” is characterized as behaviour by an older adult that threatens his or her own health and safety and” usually means that the older adult fails to provide him or herself with the necessities of life.

Signs and symptoms of neglect

  • Unusual weight loss, malnutrition, dehydration
  • Untreated physical problems, such as bed sores
  • Unsanitary living conditions (dirt, bugs, soiled bedding and clothes)
  • Being left dirty or unbathed
  • Unsuitable clothing or covering for the weather
  • Unsafe living conditions (no heat or running water, faulty electrical wiring, other fire hazards)
  • Desertion of the elder at a public place by a caregiver

Sexual elder abuse is contact with an elderly person without the elder’s consent. Such contact can involve physical sex acts, but activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse.

Signs and Symptoms

  • Bruises around breasts or genitals
  • Unexplained venereal disease or genital infections
  • Unexplained vaginal or anal bleeding
  • Torn, stained or bloody underclothing

Systemic abuse refers to system-wide practices that produce neglect, sub standard care, or the violation of dignity and is a form of institutional abuse. Examples include over-medicating, limiting freedoms, or issuing incontinence briefs to all residents as a way of managing residents due to a shortage of staff.

Signs and Symptoms of institutional abuse

  • Neglect (dehydration, malnourishment, poor hygiene, inappropriate clothing, untreated medical problems, poor skin conditions)
  • Physical abuse (unexplained injuries, fractures, bruises, unexplained falls, unauthorized or inappropriate use of restraints)
  • Emotional abuse (feelings of fear/passivity/shame/guilt, extreme passivity and withdrawal, symptoms of depression, the use or talk of punishment)
  • Medical abuse (reduced/absent therapeutic response, poor documentation of medical records, improper administration of drugs,no reasons for treatment given)
  • Violation of rights (difficulty visiting/calling/contacting older person; lack of privacy; resident not allowed to participate in decision making about their own affairs; lack of confidentiality in use of health care records)