What is Elder Abuse?

What Does Elder Abuse Involve?

What are Common Types of Abuse?

Psychological Abuse
Financial Abuse
Neglect
Physical Abuse
Sexual Abuse
Violation of Rights
Systemic Abuse
Other Forms

What is Elder Abuse? 

In 2002, the World Health Organization defined abuse and neglect of older adults as:

 “...single or repeated acts, or lack of appropriate action, occurring within a relationship where there is an expectation of trust, which causes harm or distress to an older person.”

According to Statistics Canada, as of July, 2005, there were more than 4.2 million people in Canada aged 65 and over. There were approximately 1,834,100 men and approximately 2,383,600 women.

Most Canadian research indicates that between 2 and 10% of older adults experience one or more forms of abuse or neglect at some point in their later years from someone they trust or rely on.  (Stats Canada)

Researchers and those working in the field of elder abuse use different definitions and different age ranges to describe abuse; this helps to explain the wide range of frequency found in the literature. According to experts (Lachs & Pillemer, 2004; Stats Canada, 2000), it is conservatively estimated that 2-10% of older adults will experience one or more forms of abuse at some point during their senior years; this represents between 148,000 and 370,000 older adults in Canada today.

The rate of abuse among certain subpopulations of vulnerable seniors (e.g., among cognitively impaired older adults or physically dependent older adults) may be three to four times higher than the rate found in the general senior population. (Cooney & Mortimer, 1995; Compton, Flannagan & Gregg, 1997).  Sited from ONPEA training Curriculum

Using a figure of 10% for Ontario means that up to 160,000 older adults are suffering some form of abuse in this province.

In total, it is estimated that there are between 168,000 and 421,000 seniors in Canada who are experiencing or have experienced abuse or neglect.
(Statistics Canada)

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What Does Elder Abuse Involve? 

Elder abuse involves doing something that causes harm or distress to an older person.  Elder abuse also includes not doing something (inaction) that the person has a duty to do, such as not providing medications/other essentials of life to an older adult who needs them.

Abuse of older adults usually occurs in relationships where there is an expectation of trust such as:

• in a family, i.e. son, daughter, in-laws, neice, nephew
• between a husband and wife
• between friends
• between an older adult and someone they are relying on such as an accountant or other paid person
• someone who is providing services in an older adults’ home
• staff providing care in an alternate setting to home

Not all abuse is individual actions and not all abuse occurs in a personal relationship. Some abusers actively seek out people that they think will be easier to exploit.

Sometimes, just the "usual way that things are done" can be abusive to older adults.

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What Are Common Types of Abuse?

Psychological Abuse:

This is sometimes called emotional abuse. Some researchers refer to it by formal terms such as "chronic verbal aggression".

Psychological abuse involves actions that diminish a person´s sense of identity, dignity and self-worth. Psychological abuse can make the older person feel "less of a person".  Some abused people state that psychological or emotional abuse is the most hurtful form of abuse. 
 
Psychological abuse may make an older person fearful or cause the person mental anguish. This may be done in several ways, including by :

• Making the people uncertain about themselves and their abilities (lowering their self esteem)
• Threatening some form of violence
• Threatening to abandon or neglect the person

Psychological abuse includes behaviors such as:

• Name calling,
• Yelling,
• Insulting the person,
• Threatening the person or threatening to take away something that is important to them,
• Imitating or mocking the person,
• Swearing at them,
• Ignoring,
• Isolating the person,
• Excluding them from meaningful events or activities.

 Psychological abuse also happens when the older adult is excluded from decision making when the person is capable and wants to be included (in other words, "making decisions for them"), and depriving them of their rights.

Justice Canada includes these as some examples of psychological abuse: 

• Threatening to use violence
• Threatening to abandon them
• Intentionally frightening them
• Making them fear that they will not receive the food or care they need
• Lying to them
• Failing to check allegations of abuse against them
• Insulting, swearing, or name calling
• Making derogative or slanderous statements about them to others
• Socially isolating them, or failing to let them have visitors

It can also include:

• Withholding important information that they have a right to know
• Demeaning them because of the language they speak
• Intentionally misinterpreting their traditional practices
• Repeatedly raising the issue of death with them
• Telling them that they are too much trouble
• Ignoring or excessively criticizing them
• Being over-familiar and disrespectful
• Unreasonably ordering them around
• Treating them like servants
• Treating them like children
  

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Financial Abuse:

This is also known as material abuse. Financial abuse is the misuse of an older adults’  funds and assets, loss of or to damage to an older person’s assets or property, obtaining the person´s property without his or her knowledge and full consent. In the case of an older adult who is not mentally capable, it can also include not representing or acting in that person’s best interests.

Financial abuse can involve the theft or misuse of the older person´s money or property. It includes behaviours such as:

• Misusing a power of attorney,
• Persuading, tricking, or threatening the older adult out of money, property, or possessions (and this includes attempts to do any of these)
• Cashing pension or other cheques without authorization
• Use of the older adult´s money for purposes other than what was intended by the older adult.
   

 Many of these actions are crimes.

Justice Canada points out that financial abuse also includes unduly pressuring* older adults to:

• Move from, sell or relinquish their home or other personal property
• Make or change a will
• Sign legal documents that they do not fully understand
• Change or keep their marital status
• Give money to relatives or caregivers
• Engage in paid work to bring in extra money
• Care for children or grandchildren.
  

Financial or material abuse against older adults may also include family or friends:

• Refusing to move out of the older adult´s home when asked
• Sharing their home with an older adult without paying a fair share of the expenses
• Unduly pressuring the older adult to buy alcohol or drugs.

The abuser in financial abuse situations is commonly a trusted person in the senior’s life (such as a spouse or partner, family member (often an adult child, caregiver, or friend). Financial abuse is often accompanied by other forms of abuse, such as psychological abuse, physical abuse or denial of rights.

* Encouraging people of any age to make choices or plan for their future is not the same as unduly pressuring them.

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Neglect:

Some people have a legal or social responsibility to care for and support an older adult who is unable to meet those needs himself or herself. "Neglect" occurs when the other person fails to live up to that responsibility. Neglect has two forms.

• Active neglect which is the intentional withholding basic necessities of life (including care).
• Passive neglect is not providing basic necessities of life because of lack of experience, information, or ability. 

Neglect can be physical, psychological, or financial in form.

Neglect includes denying the older person any of the things that are essential to life, such as food, water, medications, medical treatment, therapy, nursing services, therapeutic and equipment aids, clothing, visits from people important to the older person, and rights. 

Justice Canada includes these as some examples of neglect. Failing to provide:

• Adequate nutrition, clothing and other necessities
• Adequate personal care, e.g. failing to turn a bedridden older adult frequently
• Safe and comfortable conditions
• A clean environment
• Prerequisites for personal cleanliness
• Sufficient bathroom space for privacy
• Sufficient space for personal privacy
• Transportation to necessary appointments
  (At least occasional) outings.

It may also include:

• Leaving mentally incapable older adults alone too long or failing to remain with those who need help
• Abandonment.

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Physical Abuse:

This refers to the non-accidental use of physical force to coerce or to inflict bodily harm.  It often causes physical discomfort, pain or injury, but the person doesn´t have to have an injury to have experienced physical abuse.

Physical abuse may include, for example:

• Beating 
• Punching
• Burning or scalding
• Pushing or shoving
• Hitting with a hand or instrument or slapping
• Rough handling  or physical coercion
• Stabbing
• Tripping
• Spitting

Physical abuse against older adults may also include:

• Tying them to furniture
• Using or misusing physical restraints
• Restraining them through the use of alcohol, tranquillizers or other medication
• Forcing them to remain in beds or chairs
• Forcing them to remain in rooms (including locking them in)
  

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Sexual Abuse:

Sexual abuse is any kind of sexual behaviour directed towards an older adult without the person’s full knowledge and consent. It includes sexual assault, sexual harassment, and rape. Sexual abuse can happen to mentally capable seniors by their spouse, partner, a family member or trusted people in their lives. It can also happen to mentally incapable older adults.

Sexual abuse is different than physical abuse. It has both a physical and psychological component, and its purpose is often to exert power and control over the adult or to demean the person.

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Violation of Rights:

This refers to denial of a senior´s fundamental rights as an adult. It includes the negation or disregard for the human and legal rights of an individual. For example, common examples of rights violations include:

• withholding information
• mail censorship (going through their mail)
• denying the person privacy
• denying the person visitors
• restricting the person´s liberty and freedom

 
 
Unless the older adult has agreed to the restrictions, or has been found at law to be mentally incapable, no one has the right to deny the human rights of another person. When someone is denied their human rights, it affects their self-esteem and confidence, and demoralization sets in.

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Systemic Abuse:
 
This refers to rules, regulations and policies that significantly harm or discriminate against older adults, or undermine their dignity and autonomy. These rules or policies are often developed for an apparently neutral purpose but it is the disproportionate negative effect on the individual or group that is important.
 
It also refers to when social responsibility to older adults is not being met. 

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Other Forms:

There are other forms of abuse or neglect that are being recognized. Spiritual abuse or neglect may include:

• Using their religious or spiritual beliefs to exploit, manipulate, dominate or control them
• Ridiculing their beliefs
• Preventing them from engaging in spiritual or religious practices
  Acting in a disrespectful way toward their spirituality.

 Each of these types of abuse or neglect hurt the older person.

 Is "Self Neglect" a Form of Abuse or Neglect?

Self neglect refers to a person’s inability to provide care and support to himself or herself. Self neglect can happen as a result of an individual’s choice of lifestyle, or the person may

• be depressed,
• have poor health,
• have cognitive (memory or decisionmaking) problems, or
• be physically unable to care for self.

Conceptually, self neglect is different than someone else harming the older adult.

Do Older Adults Define Abuse the Same Way that Others Do?

Yes and no     

According to the international publication “Missing Voices”, older adults around the world tend to think of  "abuse" in terms of three different categories:

• neglect (where older people are isolated, abandoned, being excluded from society or not being treated as a valued member of society)
•  violation of rights that other people take for granted (e.g. privacy, non-discrimination, control over their health care and treatment, as well as lack of access to appropriate care and support, not having their legal rights respected)
•  being deprived of choices, personal decisions, status, finances, and respect

Many older adults who have lived with family violence note that attitudes to family violence have changed over the past forty years. Compared to the social attitudes that were common when they were younger, older adults may find abuse is less likely to be treated as a private matter and kept hidden.  

Many older adults find it is safer today than previously to acknowledge that abuse has been happening in their lives; others still find it difficult to share this intimate information.


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