Alternative Names elderly abuse, institutional abuse, domestic abuse
Definition Elderly abuse is the mistreatment of an older person. It may occur while the person is living alone, with others or in an institution.
Domestic elderly abuse refers to mistreatment by someone who has a special relationship with the elder. This person could be a spouse, sibling, child, friend, or other caregiver.
Institutional abuse refers to mistreatment of a resident in a facility for older persons. This includes nursing homes, foster homes, group homes, or board and care facilities where staff is paid to provide care.
Self-neglect occurs when the behaviour of an older person living alone threatens his or her own health or safety.
There are four common types of elderly abuse.
Physical abuse is pain or injury inflicted intentionally by a caregiver. It may include slapping, beating, physical restraint, or sexual assault.
Psychological or emotional abuse is mental suffering inflicted intentionally by a caregiver. It may include humiliation, intimidation, threats, and destruction of belongings.
Financial abuse is improper or illegal use of the resources of an older person without consent. It may include the sale of a home or belongings.
Neglect is failing to provide reasonable care. A person may be denied food or health care, for example, or abandoned.
Only a very few Australian studies have been conducted on the prevalence of elderly abuse. Overseas studies indicate that between 2% to 5% or older people are victims of abuse. A study in NSW confirmed this and found 4.6% had experienced physical, psychological and financial abuse or neglect. (1992 figures)
What are the signs and symptoms of the injury? Elderly abuse takes many forms. It may leave visible injuries, such as cuts and bruises, or emotional scars.
Signs and symptoms of mistreatment vary with different types of abuse.
With physical abuse, a person may:
have bruises, black eyes, cuts, and rope marks
have broken bones
have injuries on different parts of the body in various stages of healing
have sprains, dislocations, and internal injuries
have broken eyeglasses
have laboratory findings of a medication overdose
report being hit, slapped, kicked, or mistreated
show a sudden change in behaviour
have a caregiver who refuses to let visitors see an elderly alone
With emotional abuse, a person may:
be emotionally upset or agitated
be very withdrawn, uncommunicative, and unresponsive
behave in unusual ways, such as by sucking, biting, and rocking
report being verbally or emotionally mistreated
With financial abuse, there may be:
a sudden change in a bank account
new names added to the elder's bank signature card
unauthorized withdrawal of the elder's funds using an ATM card
changes in a will or other financial document
unexplained disappearance of funds or valuable possessions
be living in conditions that are not safe, sanitary, or clean
wear inappropriate or inadequate clothing
lose weight
What are the causes and risks of the injury? A combination of psychological, social, and economic factors contribute to elderly abuse. One or more of these issues may trigger it:
caregiver stress. Caring for older, frail people can be time consuming and very stressful. The stress is greater when the elderly person is mentally or physically impaired.
cycle of violence. Some families act more violent than others. Violence is a learned behaviour that spreads from one generation to another. In these families, abusive behaviour is the normal response to tension or conflict.
poor health or impairment. Elders in poor health are more likely to be abused than those in good health. Abuse tends to occur when an elderly person's mental or physical health worsens and stress rises.
personal problems of the abuser. Adult children who abuse their parents may suffer from mental disorders, alcohol dependence, drug abuse or addiction, and financial problems. They may have just finished raising their children and now find themselves tied down again taking care of a parent.
The typical victim of elderly abuse is a widowed, white woman. In her mid-70s or older, she lives on a fixed income. However, it is important to remember that victims do not have to "fit" the typical picture. Elderly abuse happens in all ethnic groups, races, and economic groups.
The abuser is usually a member of the household, often a spouse or adult child. Two-thirds of the abusers are family members. Often, the victim does not report the abuse. He or she may:
fear revenge by the abuser
feel embarrassed
worry about being put into an institution
What can be done to prevent the injury? Campaigns and education to raise awareness of the problem and its warning signs may help prevent elderly abuse.
People can help by:
asking directly about signs of possible abuse
talking to the victim and being supportive. This can make him or her feel less isolated.
showing concern, so that the person knows there is someone to turn to if he or she wants help
How is the injury recognised? Elderly abuse is usually recognised by the signs listed above.
What are the treatments for the injury? Treatment depends on the type of abuse. Any physical injuries should be treated. If possible, the victim needs to be separated from the abuser. Emergency care is provided when physical injuries have occurred.
When suspected abuse is reported to the appropriate government agency, they will arrange for services to help protect the victim. Many different programs and services are available, including:
Untreated elderly abuse may continue and grow worse. If the abuse is severe, it can lead to death.
What are the side effects of the treatments? In cases of domestic abuse, an elderly may need to leave home. He or she may have to live with someone else or in a nursing home to be safe.
What happens after treatment for the injury? Once the abuse has been stopped, ongoing care of the elderly person continues in a safe environment. Ongoing monitoring by the elderly person's healthcare doctor and the appropriate government agency should continue.
Author: Gail Hendrickson, RN, BS Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 25/04/2005 Contributors Potential conflict of interest information for reviewers available on request
