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Elder abuse just next door! Part 2: What are the risk factors and types of elder abuse?

The Bottom Line

  • Risk factors help us to identify elders who are vulnerable or caregivers/family members more likely to abuse. Several important risk factors have been identified for the:
    • elder being abused (i.e. history of abuse or trauma, mental illness, low income),
    • person inflicting the abuse (i.e. stressed or overburdened caregiver, history of mental illness)
    • relationship between elder and person inflicting abuse (family relationships are difficult, low social support)
  • There are 5 different types of abuse
    • Physical abuse
    • Psychological or emotional abuse
    • Sexual abuse or abusive sexual contact
    • Financial abuse
    • Neglect (abandonment)
  • Older adults have a right to live their lives free of abuse, so take action to increase awareness and prevent it from happening. If you observe any of these indicators of abuse speak to the person experiencing the abuse and assist them in changing their situation.

In Part 1 of this 4 part series we defined elder abuse and how the definitions of abuse have changed over time. In Part 2, we expand upon the different types of elder abuse. We also examine important risk factors that may help to identify people who are vulnerable to abuse, as well as, people who are more likely to commit the abuse.

In Part 3, we look at the views of Canadians on elder abuse compared to the evidence on the size of this problem. In Part 4, we examine the benefits and harms of interventions to help those experiencing elder abuse.

What are important risk factors for elder abuse?

In general, risk factors are circumstances that may increase the chances of developing a disease or sustaining an injury. Researchers seek to evaluate risk factors that may be changed or modified, in the hope that the chances of illness or injury may be reduced. Sometimes risk factors cannot be altered but they may still serve as signs for potential problems that require our attention. In the case of elder abuse, there are risk factors associated with 1) the person who is the victim of the abuse, 2) those who are more likely to commit the abuse (the perpetrator), 3) the relationship between the abused person and the perpetrator, and 4) the living circumstances of the person being abused.

What is the scientific evidence about risk factors for elder abuse?

A well-conducted systematic review(1) evaluated the scientific evidence identifying different risk factors for elder abuse. This systematic review examined 25 studies in the general population of community-dwelling seniors (those not living in institutions), 13 studies in older people requiring assistance with their activities of daily living (ADL), and 11 studies in elders with dementia. The review showed that only half the studies (27 from 49) adequately evaluated risk factors for elder abuse. Some important risk factors identified in this systematic review can be grouped into four categories:

  1. The person experiencing abuse (the victim),
    • Has experienced trauma or past abuse
    • Has mental health problems
    • Has low income
    • Needs help with activities of daily living
  2. The person committing the abuse (the perpetrator),
    • Caregiver feels stressed or overburdened
    • Has mental health problems
  3. The type of relationship between the elder (victim) and the perpetrator,
    • Has family conflict or difficult relationships
  4. The environment or circumstances of the elder being abused
    • Living with others
    • Low social support (few people or resources to help with their needs (physical, emotional, financial, social)

Detecting and preventing elder abuse needs to be considered in the context of the culture where it is occurring. Most of the research done on elder abuse is from developed countries. As such, identifying risk factors reflects the cultural context of the countries where the studies took place. There is a need for more research in this area generally and this should include the study of risk factors in different cultures.

What specific actions are considered elder abuse?

Recall that any action or lack of action that brings harm to an older person can be considered elder abuse. It can be a single event or done repeatedly. Since most of the current research (and reporting) on elder abuse has been conducted in developed nations, the actions labelled as abuse reflect the culture and context of these countries.

We generally understand abuse to be classified into five types:

  1. Physical abuse (Table 1)
  2. Psychological or emotional abuse (Table 2)
  3. Financial abuse (Table 3)
  4. Sexual abuse or unwanted sexual contact (Table 4)
  5. Abuse related to neglect and abandonment (Table 5)

The tables below provide a definition and description of the actions associated with the different types of elder abuse.

Table 1: Actions associated with physical abuse

Definition of physical abuse What does it include?
  • Actions or behaviours that result in bodily injury, pain, impairment or physical distress (2)
  • Striking, hitting, pushing, shaking, burning, shoving (3)
  • Pinching, slapping, scratching, biting (4)
  • Inappropriately physical or chemical restraints (3)
  • Harm created by under or over medicating (3)
  • Assaulted or threatened with a weapon (e.g., knife, gun, or other object) (5)
  • Rough transfers (from bed to chair, from chair to chair, etc.) (6)

Table 2: Actions associated with psychological abuse

Definitions of psychological or emotional abuse
What does it include?
  • Severe or persistent verbal/non-verbal behaviour that results in emotional or physical harm (2)
  • Insults, intimidation, humiliation, harassment, treating them like a child (3) and verbal assaults (4)
  • Threats (3) or threatening acts (5)
  • Isolating them from family, friends or regular activities (3) or social isolation (5)
  • Controlling behavior (e.g., prohibiting or limiting access to transportation, telephone, or money or other resources) (5)
  • Disregarding or trivializing needs (5)
  • Damaging or destroying property

Table 3:  Financial abuse

Definition of financial abuse
What does it include?
  • "An action or lack of action with respect to material possessions, funds, assets, property, or legal documents, that is unauthorized, or coerced, or a misuse of legal authority” (2)
  • Improper use of an elder’s resources for monetary or personal benefit, profit, or gain (5)
  • Misusing or stealing a senior's assets, property, or money (3)
  • Not repaying a loan, overcharging, unauthorized withdrawals (4)
  • Exchanging care for financial control (4)
  • Cashing an elderly person’s cheques without authorization (3)
  • Forging an elderly person’s signature (3)
  • Unduly pressuring seniors to make or change a will, or to sign legal documents that they do not fully understand (3)
  • Use of deception to surrender finances or property (5)
  • Sharing an older person’s home without paying a fair share of the expenses when requested (3)
  • Improper use of guardianship or power of attorney (5)

Table 4:  Actions associated with sexual abuse

 Definition of sexual abuse or abusive sexual contact
What does it include?
  • Direct or indirect sexual activity without consent (2)
  • This includes acts in which the elderly person is unable to understand the act or is unable to communicate (5)
  • Unwanted sexual innuendo, unwanted sexual touching or fondling, inappropriate sexual remarks, lewdness (4)
  • Abusive sexual contact is defined as intentional touching (either directly or through the clothing) of the genitalia, anus, groin, breast, mouth, inner thigh, or buttocks (5)

Table 5:  Actions associated with abuse related to neglect

 Definition of abuse related to neglect
What does it include?
  • Repeated deprivation of assistance needed by an older person for activities of daily living (2)
  • It includes “not acting” and this results in harms for the older person or not protecting them from harm (5)
  • The willful desertion of an elderly person by a caregiver or other responsible person (5)
  • Not providing appropriate water or food, shelter, clothing, medication or medical attention, assistance with basic necessities (3)
  • Not providing hygiene, clothing, shelter, or access to necessary health care, or failure to prevent exposure to unsafe activities and environments (5)
  • Deserting when the senior needs assistance (5)

As we noted in Part 1, there are different definitions of abuse that often reflect the laws of a region or country, or definitions that change over time. The actions described in the tables may not reflect all aspects of elder abuse that occur in cultural contexts where elder abuse has not been studied. For example, in some traditional cultures older widows may be forced to marry against their consent. Although, this may appear to be a private matter, it may reflect psychological and financial abuse.

What is the bottom line about elder abuse?

Elder abuse can happen to people of all backgrounds, races, religions, and ages. It can happen in any family or relationship. Elder abuse may be difficult to talk about especially if it is being committed by a family member. However, there is nothing to be embarrassed about; it is important to get help.

It is critical that we become aware of the signs of elder abuse. No one should have to experience any type of abuse. If you notice any of the signs associated with elder abuse (described in the tables above) take action and speak to someone. You may want to contact family or friends, members of your local faith community, health-care providers, social services, the police, or members of the legal profession. Help is available so donít delay in moving forward to stop abuse. In some provinces it is mandatory to report elder abuse.

Here are a few steps to help you report elder abuse.

  1. If you think someone you know is being abused, at risk for serious harm and the situation is an emergency, call 911.
  2. If you suspect someone you know is abused but they are not in any immediate risk, consider speaking with them to get more information. If your discussion verifies your concerns, then you can inform them of their rights. If they are not ready to deal with the abuse, offer your personal support until they are ready to take action.
  3. If the older person is confused and doesn't seem to be able to understand their situation, you may have to contact the local Office of the Public Guardian and Trustee or the local police. They will investigate further.

In this four-part series of blog posts we discuss several aspects of elder abuse:

  • In Part 1 we examine the general definition of elder abuse
  • In Part 2 we look at important risk factors associated with elder abuse and different types of abuse
  • In Part 3 we compare what Canadians believe about abuse and the evidence on the size of this health problem in Canada and around the world
  • In Part 4 we discuss the benefits and possible harms of elder abuse interventions


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Author Details

References

  1. Johannesen M, LoGiudice D. Elder abuse: a systematic review of risk factors in community-dwelling elders. Age Ageing 2013 May;42(3):292-8.
  2. National Initiative for the Care of the Elderly. Defining and Measuring Elder Abuse (NICE). 2014. http://www.nicenet.ca/tools-dmea-defining-and-measuring-elder-abuse.
  3. Elder Abuse it's time to Face the Reality. 2014. http://www.seniors.gc.ca/eng/pie/eaa/elderabuse.shtml.
  4. MacDonald L. Synopsis Report: Defining and Measuring Elder Abuse and Neglect - Preparatory Work Required to Measure the Prevalence of Abuse and Neglect of Older Adults in Canada. HRSDC: NICE; 2012.
  5. Centre for Disease Control. Definitions of Elder Abuse. 2014. http://www.cdc.gov/violenceprevention/elderabuse/definitions.html.
  6. Yaffe MJ, Tazkarji B. Understanding elder abuse in family practice. Can Fam Physician 2012 Dec;58(12):1336-8.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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