What type of abuse to elderly is characterized by threats of harm or humiliation?

Introduction

Abuse can take place in any situation and any person is at risk. A vulnerable person is someone who may be restricted in capacity to guard themself against harm or exploitation or to report such harm or exploitation.

Abuse can be perpetrated (carried out) by a range of people, such as strangers, institutions, or family members. It may happen when an older person or a person with a disability lives alone or with a relative. It may also happen in residential or day-care settings, in hospitals, home support services and other places assumed to be safe, or in public places.

Elder abuse is the abuse of someone aged 65 or over and it happens in a relationship where there is an expectation of trust. Elder abuse can be a single or repeated act, or a lack of action, which causes harm or distress to the older person, or that violates their human and civil rights.

Find information on recognising the signs of child abuse, and the protection of vulnerable children, in our page Child abuse and child protection.

Types of elder abuse

There are different types of elder abuse. The abuse may be carried out deliberately (on purpose), or through negligence (not doing what it is your duty to do) or ignorance (not knowing something you should know). An older person may experience more than one form of abuse at any given time.

Types of abuse include:

Psychological abuse: this includes emotional abuse, threats of harm or abandonment, deprivation of contact (taking away or preventing all contact), humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks

Physical abuse: this includes slapping, pushing, hitting, kicking, misuse of medication, inappropriate restraint (including physical and chemical restraint) or sanctions

Financial or material abuse: this includes theft, fraud, exploitation, pressure in connection with wills, property or inheritance, or financial transactions, or the misuse or misappropriation of property, possessions or benefits

Neglect: this includes self-neglect and acts of omission including ignoring medical or physical care needs, the withholding of the necessities of life, such as medication, adequate nutrition and heating

Discriminatory abuse: this includes ageism, racism, sexism, that based on a person’s disability, and other forms of harassment, slurs or similar treatment

Institutional abuse: this may occur within residential care, nursing homes, acute hospitals and any other in-patient settings, and may involve poor standards of care, rigid routines and inadequate responses to complex needs

Sexual abuse: this may include rape and sexual assault or sexual acts to which the older adult has not consented, or could not consent, or into which they were forced to consent

You can get information on the various forms of elder abuse, and how to recognise the signs of abuse, on hse.ie.

Reporting a concern

The HSE has Safeguarding and Protection Teams in place in every region of the country. These teams are responsible for adult safeguarding within services for older persons and services for people with disabilities.

If you suspect someone you know may be a victim of abuse, or if you are a victim of abuse yourself, you should contact your local health centre, your GP, public health nurse or the Garda Síochana.

You can also contact the HSE Information Line on 1850 24 1850.

In an emergency, where a person is at immediate risk, you should contact the Garda Síochana or Emergency Services on 999 or 112.

Further information on safeguarding of older people

You can visit the HSE website for information on how to protect yourself or protect someone else you are concerned about.

The HSE also has a series of short films called ‘Open Your Eyes to Elder Abuse in Your Community’ that you can watch online and a booklet (pdf) on elder abuse.

Banking and Payments Federation Ireland has published a Guide to Safeguarding your Money Now and in the Future (pdf). It has information to help older people recognise the signs of elder financial abuse and keep control of their affairs.

Safeguarding Ireland was established by the HSE to raise awareness of and tackle abuse of vulnerable adults. Visit the Safeguarding Ireland website for more information on its policies and publications.

You can get more information on help and support services available from the HSE Information Line (see below).

Types of Abuse

Elder abuse is a growing problem. While we don't know all of the details about why abuse occurs or how to stop its spread, we do know that help is available for victims. Concerned people, like you, can spot the warning signs of a possible problem, and make a call for help if an elder is in need of assistance.

• Physical Abuse
• Sexual Abuse
• Emotional or Psychological Abuse
• Neglect
• Abandonment
• Financial or Material Exploitation
• Self-neglect

Physical Abuse

Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include but is not limited to such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse.

Signs and symptoms of physical abuse include but are not limited to:

• bruises, black eyes, welts, lacerations, and rope marks
• bone fractures, broken bones, and skull fractures
• open wounds, cuts, punctures, untreated injuries in various stages of healing
• sprains, dislocations, and internal injuries/bleeding
• broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained
• laboratory findings of medication overdose or under utilization of prescribed drugs
• an elder's report of being hit, slapped, kicked, or mistreated
• an elder's sudden change in behavior
• the caregiver's refusal to allow visitors to see an elder alone

Sexual Abuse

Sexual abuse is defined as non-consensual sexual contact of any kind with an elderly person. Sexual contact with any person incapable of giving consent is also considered sexual abuse. It includes, but is not limited to, unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.

Signs and symptoms of sexual abuse include but are not limited to:

• bruises around the breasts or genital area
• unexplained venereal disease or genital infections
• unexplained vaginal or anal bleeding
• torn, stained, or bloody underclothing
• an elder's report of being sexually assaulted or raped

Emotional or Psychological Abuse

Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant; isolating an elderly person from his/her family, friends, or regular activities; giving an older person the "silent treatment;" and enforced social isolation are examples of emotional/psychological abuse.

Signs and symptoms of emotional/psychological abuse include but are not limited to:

• being emotionally upset or agitated
• being extremely withdrawn and non communicative or non responsive
• unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking)
• an elder's report of being verbally or emotionally mistreated

Neglect

Neglect is defined as the refusal or failure to fulfill any part of a person's obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care.

Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder.

Signs and symptoms of neglect include but are not limited to:

• dehydration, malnutrition, untreated bed sores, and poor personal hygiene;
• unattended or untreated health problems
• hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water)
• unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing)
• an elder's report of being mistreated

Abandonment

Abandonment is defined as the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.

Signs and symptoms of abandonment include but are not limited to:

• the desertion of an elder at a hospital, a nursing facility, or other similar institution
• the desertion of an elder at a shopping center or other public location
• an elder's own report of being abandoned

Financial or Material Exploitation

Financial or material exploitation is defined as the illegal or improper use of an elder's funds, property, or assets. Examples include, but are not limited to, cashing an elderly person's checks without authorization or permission; forging an older person's signature; misusing or stealing an older person's money or possessions; coercing or deceiving an older person into signing any document (e.g., contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.

Signs and symptoms of financial or material exploitation include but are not limited to:

• sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder
• the inclusion of additional names on an elder's bank signature card
• unauthorized withdrawal of the elder's funds using the elder's ATM card
• abrupt changes in a will or other financial documents
• unexplained disappearance of funds or valuable possessions
• substandard care being provided or bills unpaid despite the availability of adequate financial resources
• discovery of an elder's signature being forged for financial transactions or for the titles of his/her possessions
• sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions
• unexplained sudden transfer of assets to a family member or someone outside the family;
• the provision of services that are not necessary
• an elder's report of financial exploitation

Self-neglect

Self-neglect is characterized as the behavior of an elderly person that threatens his/her own health or safety. Self-neglect generally manifests itself in an older person as a refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions.

The definition of self-neglect excludes a situation in which a mentally competent older person, who understands the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her health or safety as a matter of personal choice.

Signs and symptoms of self-neglect include but are not limited to:

• dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene
• hazardous or unsafe living conditions/arrangements (e.g., improper wiring, no indoor plumbing, no heat, no running water)
• unsanitary or unclean living quarters (e.g., animal/insect infestation, no functioning toilet, fecal/urine smell)
• inappropriate and/or inadequate clothing, lack of the necessary medical aids (e.g., eyeglasses, hearing aids, dentures)
• grossly inadequate housing or homelessness

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