Each person’s experience of elder abuse will be different, so it doesn’t always look the same on the outside. And because the abuse is often being carried out by someone the older person trusts – and might rely on for care – they may be reluctant to talk about what’s happening.
However, there are likely to be some signs that indicate something might be wrong – in particular, an unexplained change in an older person’s behaviour or demeanour.
Signs to look out for
All of these signs could have an innocent explanation – but they could also indicate an older person is experiencing elder abuse.
Psychological abuse and coercive control
Unhappiness, loneliness or expressions of fear, unusual worry or anxiety may indicate that someone is experiencing psychological abuse or coercive control. A person who stops going to their usual social activities, answering calls or seeing friends might be being pressured by a family member who wants to keep them isolated.
Expand and read this dropdown list for more warning signs that a person might be experiencing psychological abuse.
Displaying any one or more of the following: resignation, shame, depression, tearfulness, confusion, agitation - or an increase in these behaviours
Expressing feelings of helplessness
Showing unexplained paranoia or excessive fear
Having a change in appetite or sleep patterns, such as insomnia
Expressing unusual passivity or anger
Showing sadness or grief at the loss of interactions with others
Withdrawing or seeming listless due to a lack of visitors
Displaying changed levels of self-esteem
Worrying or being anxious after a visit by a specific person or people
Being socially isolated
Neglect
Neglect might be indicated by an older person appearing unkempt or wearing the wrong clothing for the weather, being particularly hungry or thirsty, losing weight or becoming unwell, or their home being unusually chaotic or dirty.
Expand and read this dropdown list for more warning signs that a person might be experiencing neglect.
Failing to provide the older person’s basic needs, such as food, adequate or clean clothing, heating and medicines
Under- or over-medicating
Exposing the older person to danger or not supervising them, such as leaving them in an unsafe place or aloneActing overly attentive when other people are around
Acting overly attentive when other people are around
Denying others the opportunity to provide appropriate care
Having poor personal hygiene or an unkempt appearance
Not receiving enough medical or dental care
Having injuries that haven’t been properly cared for
Lacking necessary aids, such as a walking frame
Being exposed to unsafe, unhealthy or unsanitary conditions
Developing unexplained weight loss, dehydration, poor skin condition or malnutrition
Financial abuse
Money worry and anxiety, along with not being able to buy groceries or everyday items, might indicate financial abuse. There might also be unusual activity in the person’s bank account, changes to online passwords, or requests to visit a lawyer or bank to make sudden changes to a will.
Expand and read this dropdown list for more warning signs that a person might be experiencing financial abuse.
Experiencing blocks in access to their bank accounts or statements
Accumulating unpaid bills
Having an empty fridge
Experiencing a difference between their living conditions and the money they have
Having no money to pay for home essentials like food, clothing, and utilities
Physical abuse
Unexplained injuries and pain – or not being able to remember how an accident or bruise occurred – might be an indication of physical abuse, particularly if the person is expressing fear and anxiety.
Expand and read this dropdown list for more warning signs that a person might be experiencing physical abuse.
Sustaining internal or external injuries, including sprains, dislocations and fractures, pressure sores, unexplained bruises or marks on different areas of the body
Feeling pain when touched
Having broken or healing bones
Suffering lacerations to the mouth, lips, gums, eyes or ears
Experiencing missing teeth and/or eye injuries
Displaying evidence of hitting, punching, shaking or pulling, such as bruises, lacerations, choke marks, hair loss or welts
Getting burns from things like rope, cigarettes, matches, an iron or hot water
Sexual abuse
It’s not often talked about, but older people can experience sexual abuse – from long-term or more recent partners, or from another individual. Pain, fear and anxiety, as well as injuries to breasts and chest or genitals, could indicate the person is experiencing sexual abuse.
Expand and read this dropdown list for more warning signs that a person might be experiencing sexual abuse.
Some characteristics, situations or risk factors can be common among older people who experience abuse. Understanding common risk factors can help us to recognise elder abuse when it occurs.
These risk factors don’t mean that a person is definitely experiencing abuse, and they aren’t the cause of the abuse. They simply indicate that at a population level, there is a statistical association between the risk factor and the occurrence of abuse.
For example, an older person who has some dependence on others for care may not experience abuse. However, if we were to group all the people who are experiencing abuse, a high proportion of them would be dependent on others for care. This means we can identify dependency as a risk factor, and it encourages us to pay more attention to it when we have some concerns.
Understanding risk factors also helps us decide how to support people and how to build and encourage protective factors.
This includes being depended on for care and being dependent on others. An older person may look after or provide a home for someone else, including an intellectually, emotionally or mentally ill adult or a partner experiencing cognitive impairment. They might worry about who would provide that care if they stop doing so, and therefore don’t complain about any abusive behaviour.
An older person who needs help with day-to-day tasks might feel they have to put up with some level of abuse in order to stay living in their own home or with family and receive that help.
A co-dependent relationship is one that works both ways. For example, the older person might be providing a home or financial support to an adult child in return for some care. However, although the adult child might be looking after the older person in some ways, they could be abusing them in others.
Regardless of the situation, if a person is unhappy or being disrespected, pressured or neglected, it might be elder abuse, and help is available.
There is a correlation between elder abuse and older people who have poor health or a disability. In some situations poor health or age-related illnesses may lead to someone requiring more care, and abuse happens in the context of that care relationship.
Elder abuse can also cause poor health in the older person, particularly if they are neglected, stressed or not being taken to appointments, exercise and social activities.
People with cognitive impairment, including dementia, have a higher risk of experiencing abuse and may face difficulties seeking help, particularly if they are not believed.
Observations of family violence, in all its forms, have shown that people who have experienced previous trauma, including in childhood, are at increased risk of experiencing violence and conflict in later life.
Women are at higher risk of experiencing elder abuse and other forms of family violence. Patriarchal beliefs about gender roles within families and marriages can lead to men’s violence against women.
People from the LGBTIQA+ communities are more likely than others to experience abuse relating to their gender identity or sexual orientation.
People who experience elder abuse are more likely to experience poor mental health. In some situations it may be the effects of the abuse that lead to mental distress. In others it might be that poor mental health makes people more isolated and vulnerable to abusive behaviour.
A person who is facing challenges with substance abuse or is engaging in problem gambling may be at risk of elder abuse through others taking advantage of their situation.
Social and cultural factors
Social and cultural factors are those related to a person’s cultural environment and social networks. These factors can contribute to the type of abuse a person experiences, and they might also make it more difficult for them to stop the abuse or seek help.
People can be socially isolated as well as physically or geographically isolated. Older people with few friends or close family, limited opportunities for social participation, or trouble accessing transport can easily be exploited. There might be no-one to ask for help and no-one to witness the abuse.
While some people are happy alone or with little company, others develop loneliness. This might make a person more vulnerable to a friend or family member who offers some company but is also abusive.
A person’s culture, faith or ethnicity does not make them more likely to experience abuse, but it might influence their experience of abuse or perceptions of it. Generational attitudes and social norms can differ between cultures, particularly regarding roles and responsibilities within a family and community expectations. These beliefs and perceptions might make it more difficult to recognise abuse and seek help for it.
Responses and services are not always culturally safe and appropriate, which may inhibit a person from seeking help. Older people may feel reluctant to seek help if they fear racism or discrimination, or if assistance is not available in their language.
An older person living alone may need more help from outsiders, which can increase the risk of abuse. On the other hand, an older person living with family (particularly if they have little choice about this) may be at risk of abuse if a family member takes advantage of or neglects them.
Financial pressures and worries about income can influence a person’s decision-making and lead them to accept behaviours or situations that become abusive. Some people might have had little experience managing money throughout their life and, as a result, have low financial literacy, which can increase their risk of abuse.
Providing ongoing care for an older person can be stressful, particularly if there are existing tensions or conflict in the relationship. Sometimes a stressed carer can be abusive or hurtful. An overwhelmed carer may not be able to provide the necessary level of care, which can lead to neglect.
Families can sometimes be complicated. Those with a history of intergenerational violence might experience ongoing tension and conflict. Older family members may be punished as ‘payback’ or be caught within sibling rivalry.
Relationship breakdowns and separations can sometimes add to tensions and conflicts, particularly as family members make changes to living arrangements or care roles. Blended and step-families can sometimes be sites of complex family dynamics and conflict that can lead to abuse.
Some people may not know that the behaviour they are exposed to is abusive or that there are services available to help. Perhaps they are unaware of the services or don’t believe their problems are serious enough to warrant getting help. Some perpetrators of abuse will deliberately isolate the older person or keep information and aged care services from them as part of the pattern of abusive behaviour.
Factors affecting the perpetrator
It’s hard to work out for certain why people perpetrate elder abuse, because very few people own up to doing so. But listening to older people who have experienced abuse and looking at the context in which the abuse occurred has helped to identify some common factors among perpetrators of abuse.
The National Elder Abuse Prevalence Study includes more detail about how different risk factors can relate more significantly to particular types of abuse.
The most common perpetrators of elder abuse are the adult children of the older person. Sons and daughters commonly look after ageing parents, so it can be hard for others to recognise that the relationship might have become abusive.
The spouse or partner of an older person may engage in coercive control or abusive behaviour. Sometimes this is an extension of longstanding intimate partner violence, or it might be happening in a new relationship. It can also be conflict that has arisen from recent changes such as relationship breakdown, illness and dependency.
Other family members, such as grandchildren and sons- or daughters-in-law, can also be responsible for abuse towards an older person, sometimes while also providing some level of care.
A significant number of older people who experience abuse indicate that the person responsible is an adult child who is living with them and dependent on them for housing. This living situation may have arisen because the son or daughter is also affected by mental or physical health issues, disability or financial problems.
An older person who moves in with a family member for care can also be at risk of abuse, particularly if they are isolated.
In the National Prevalence Study and when accessing services, a significant number of older people report that the person perpetrating abuse has a mental health issue.
A significant number of perpetrators of abuse are reported to have physical health problems, including long-term disability. This could indicate that for some situations of neglect, the abuse isn’t deliberate but results from the carer being unable to provide the right care due to their own disability or poor health.
Financial abuse often occurs in situations where the perpetrator is experiencing financial stress. This might be unemployment or housing stress, or it may be related to a failed business or a relationship breakdown.
Some perpetrators are impatient to receive the money they think of as their inheritance, or they wrongly believe their ageing parent no longer needs as much money as they have and should help struggling family members.
Who commits elder abuse?
A 2021 national survey found that family members are the most likely group of people to commit elder abuse.
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