Identifying Elder Abuse Types & Signs

Risk factors for elder abuse

The following are known indicators/precursors to abuse:

  • Social and geographical isolation
  • Confusion regarding property, belongings or surroundings
  • Older people who do not have the ability to self-advocate
  • Families that take advantage of the older person or their assets
  • Domestic and family violence
  • Carer stress - please see the Carergiver Strain Index at the bottom of this page

Elder abuse signs and behaviours

The NSW Helpline recognises five (5) forms of abuse. These are as follows:

Financial abuse

Financial abuse is the illegal or improper use of an older person’s property or finances.

Signs

  • Unexplained disappearance of belongings
  • Unexplained or inability to pay bills
  • Significant bank withdrawals and/or changes to wills
  • Inability of an older person to access bank accounts or statements
  • Stockpiling of unpaid bills or an empty fridge
  • Disparity between living conditions and money
  • No money to pay for essentials for the home including food, clothing, and utilities

 Behaviours

  • Threatening, coercing re: assets or wills
  • Taking control of the older person’s finances against their wishes and denying access to their own money
  • Abusing Powers of Attorney
  • Stealing goods, e.g. jewellery, credit cards, cash, food, and other possessions
  • Unauthorised use of banking and financial documents
  • The recent addition of a signature on a bank account

Psychological abuse

(including social isolation; this is sometimes referred to as emotional abuse)

Psychological abuse is the infliction of mental stress involving actions and threats that cause isolation, fear of violence, deprivation and feelings of shame and powerlessness.

Signs

  • Resignation, shame
  • Depression, tearfulness
  • Confusion, agitation and social isolation
  • Feelings of helplessness
  • Unexplained paranoia or excessive fear
  • Disrupted appetite or sleep patterns, such as insomnia
  • Unusual passivity or anger
  • Sadness or grief at the loss of interactions with others
  • Withdrawal or listlessness due to people not visiting
  • Changes in levels of self-esteem
  • Worry or anxiety after a visit by specific person/people
  • Appearing ashamed
  • Social isolation

Behaviours

  • Pressuring, intimidating or bullying
  • Name calling, and verbal abuse
  • Treating an older person like a child
  • Threatening to harm the person, other people or pets
  • Engaging in emotional blackmail such as threatening to withdraw access to grandchildren, family, friends, services, telephone or placement in an aged care facility
  • Preventing contact with family and friends, or denying access to the phone or computer
  • Withholding mail
  • Preventing an older person from engaging in religious or cultural practices
  • Moving an older person far away family or friends

Neglect

(either intentional or unintentional)

Neglect is a term used to describe the failure of a carer or responsible person to provide the necessities of life to an older person.

Signs

  • Inadequate clothing, complaints of being cold or too hot
  • Poor personal hygiene, unkempt appearance
  • Lack of medical or dental care, or injuries that have not been properly cared for
  • Absence of required aids
  • Exposure to unsafe, unhealthy, and /or unsanitary conditions
  • Unexplained weight loss, dehydration, poor skin integrity, malnutrition

 Behaviours

  • Failure to provide basic needs, i.e. food, adequate or clean clothing, heating, medicines
  • Under- or over-medication
  • Exposure to danger or lack of supervision, such as leaving the older person in an unsafe place or in isolation
  • An overly attentive carer in the company of others
  • Refusal to permit others to provide appropriate care

Physical abuse

Physical abuse involves the infliction of physical pain or injury, or physical coercion.

Signs

  • Internal or external injuries (sprains, dislocations and fractures, pressure sores, unexplained bruises  or marks on different areas of the body, pain on touching)
  • Broken or healing bones
  • Lacerations to mouth, lips, gums, eyes or ears, missing teeth and/or eye injuries
  • Evidence of hitting, punching, shaking, pulling, i.e. bruises, lacerations, choke marks, hair loss or welts
  • Burns, e.g. rope, cigarettes, matches, iron, and/or hot water

Behaviours

  • Pushing, shoving, or rough handling
  • Kicking, hitting, punching, slapping, biting, and/or burning
  • Restraining: physical or medical
  • Locking the person in a room or home or tying to a chair or bed
  • Intentional injury with a weapon or object
  • Overuse or misuse of medications

Sexual abuse

Sexual abuse is a broad term used to describe a range of sexual acts where the victim’s consent has not been obtained or where consent has been obtained through coercion.

Signs

  • Unexplained STD or incontinence (bladder or bowel)
  • Injury and trauma, e.g. scratches, bruises etc. to face, neck, chest, abdomen, thighs or buttocks
  • Trauma including bleeding around the genitals, chest, rectum or mouth
  • Torn or bloody underclothing or bedding
  • Human bite marks
  • Anxiety around the perpetrator and other psychological symptoms

Behaviours

  • Non-consensual sexual contact, language or exploitative behaviour
  • Rape and sexual assault
  • Cleaning or treating the older person’s genital area roughly or inappropriately
  • Enforced nudity of an older person against their consent

See the pdf attached – Abuse types – for a comprehensive overview.

Points to consider when identifying abuse

  • More than one indicator may be present, as well as more than one abuse type. For example, psychological abuse can underpin multiple abuse types
  • The presence of one or more of abuse indicators does not necessarily indicate abuse is occurring, but it does require you to be attentive of the older person
  • Indicators of abuse are often subtle and can vary from person to person, but the relationship between yourself and the older person means that you are best placed to recognise changes that may suggest your patient or client is being abused
  • You should remain observant and aware of the abuse indicators, especially where there is no disclosure or witnessing of the abuse
  • Discussing what you observed with a colleague can help determine the health and safety of the older person

The Elder Abuse Suspicion Index (EASI)

(see PDF attached below)

Future research is needed to provide appropriate and validated tools useful across various fields that play a role in identifying abuse of older people in NSW where abuse is suspected. One such validated tool promoted by the Royal Australian College of General Practitioners is the Elder Abuse Suspicion Index (EASI), which was developed for ise in general practice.

'The EASI was developed to raise a doctor’s suspicion about elder abuse to a level at which it might be reasonable to propose a referral for further evaluation by social services, adult protective services, or equivalents. While all six questions should be asked, a response of "yes" on one or more of questions 2 to 6 may establish concern. The EASI was validated for use by family practitioners of cognitively intact seniors seen in ambulatory settings.' (National Initiative for the Care of the Elderly NICE)

Yaffe M.J., Wolfson C., Lithwick M., Weiss D., Development and validation of a tool to improve physician identification of elder abuse: The Elder Abuse Suspicion Index (EASI) © Journal of Elder Abuse and Neglect 2008; 20(3) 276-300.

Caregiver Strain Index

(see PDF attached below)

This easy-to-use tool looks at areas that may impact a carer's wellbeing.