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Profile or Behavior Patterns in the Abused Older Adult and in the Abuser

This information is based on material obtained from the Brandon Manitoba Senior Resource Center


Confidentiality/Privacy
Older individuals have the right to privacy.

Freedom of choice
Older individuals have the right to make decisions and live their lives as they wish provided they do not infringe on the rights or safety of others. This includes the right to refuse assistance and intervention. There may be instances where an individual’s ability to make decisions is in question. These situations should be referred to the Doctor.

Safety
Older individuals have the right to live in safety and without fear. This includes the right
to be free from physical, emotional, and financial abuse as well as from neglect.

Information
Older individuals have the right to information required to make meaningful and informed choices. This includes information about their legal and civil rights, resources and the range of service options available to them to address their needs.

The Basic Necessities of Life
Older individuals have the right to basic requirements of life: food, clothing, shelter, medical care, etc...

(Source: The Direct Services Committee, Age and Opportunity Elder Abuse Resource Centre; Age and Opportunity Elder Abuse Resource Centre Assessment Protocol December 1992; Winnipeg, Manitoba.)

DEFINITIONS AND TYPES OF ABUSE:
Definition of Elder Abuse: Is any action/inaction by a person in a position of trust that results in harm to or jeopardizes the well being or safety of an older person. (See Elder Abuse Decision Tree – Appendix A)

Note:

No single characteristic automatically points to abuse or neglect of the older adult. One should look for multiple factors that might indicate mistreatment. Some adults may have severe physical or emotional problems resulting from disease or the aging process. Indicators that trigger further investigation may include the following:

Types of Abuse:

1) Physical:
• Any unwanted physical and/or sexual contact.
• Any act of violence or rough treatment.

Possible Indicators of Physical Abuse: Unexplained:
• baldness
• burns
• bumps
• falls
• cuts, lacerations
• fractures, broken bones
• marks
• infections
• internal injuries
• pain
• fearfulness

• bed sores
• scars
• punctured ear drums
• sore throat
• tenderness
• black eye
• broken teeth
• scratches
• bite marks
• confusion
• grip marks
• swelling
• torn, stained, bloody clothing
• difficulty walking or sitting
• hypothermia (lowered body temperature, blue lips, cold hands, shivering)

Any unusual pattern or location of injury such as clustered bruises or welts, or bruising along the inner arm or thigh, or any other soft body parts such as abdomen, buttocks.

2) Financial Abuse 

Any situation involving the dishonest or illegal use of an adult’s personal money or property and/or possessions. This includes: - fraud, force, misrepresentation, theft, “conning”, extortion, withholding, forced changes of will or property titles, misuse of power of attorney.

Possible Indicators of Exploitation/Financial Abuse:


• signed over power of attorney against own will
• forced to change will or sell house
• used as a babysitter/house sitter
• inadequate living environment
• unable to afford social activities
• possessions disappear such as artwork, jewelry, furs, silverware, vehicles, equipment...
• unexplained or sudden withdrawal of money from accounts
• unexplained or sudden inability to pay bills

• lack of money for food, appropriate clothing, glasses, hearing aid, cane or other walking aids, dentures, or other                   necessities when income appears potentially adequate

• indicates papers were signed but doesn’t know what for
• rent or mortgage in arrears
• bills unpaid (particularly if paying these bills is the responsibility of the alleged abuser)
• pension cheque withheld

3) Emotional Abuse 

Any behaviour which provokes fear of violence or isolation, emotional stress or mental anguish. Any behaviour which diminishes a person’s sense of identity, dignity, or self-worth. This includes: threatening, name calling, humiliating, withholding affection, social isolation, removal of decision making rights, insulting, harassment, intimidation, coercion.

Possible Indicators of Emotional Abuse:
• appears ashamed
• low self-esteem
• withdrawn, passive
• appears to recoil (flinching, cringing)
• fearful, anxious
• feels guilty without cause

• excluded from family gatherings
• loss of self determination
• does not make decisions
• “baby talk”
• depressed, hopeless, helpless
• agitated
• difficulty sleeping or needs excessive sleep
• tearfulness
• restricted access to: telephone, food, bathroom facilities, family, service providers...
• not permitted to have friends, visitors, go to church or outings

4) Neglect 

Withholding any basic needs of life.. This includes: abandonment, confinement, lack of attention, withholding food, hygiene or medical care, denial of clothing, heat, and shelter.

Possible Indicators of Neglect:
• malnourished, overly thin
• no dentures
• dehydration
• mouth sores
• bed sores
• poor skin condition
• poor hygiene
• unpleasant odor
• soiled linen, clothing
• unkempt appearance
• clothes in poor repair or inappropriate for season
• urine burns
• confusion
over sedation - reduced physical/mental activity
• reduced/absent therapeutic response
• no glasses, hearing aid, cane, walker
• dangerous environment

• unattended, tied to chair or bed
• cancellation of or not taken to doctor/dentist/therapy
• immobility, weakness
• deserted
• home in disrepair
• lack of required safety features in home
• presence of untreated injuries
• medication problems


The ABUSED OLDER ADULT may exhibit any of the following:

• history of repeated incidents of unexplained accidents or injuries
• medical history does not coincide with presenting injuries
• seek medical attention from a variety of doctors - “doctor shopping”
• postpone seeking medical attention
• frequent use of Emergency Department
• prolonged delay between time of injury and presentation for treatment
• has physical/mental limitations affecting ability for self-care
• gives information reluctantly: waits for caregiver to answer
• avoids physical, verbal, eye contact with caregiver or professional
• hesitant, inaudible, loud, rapid, slow speech
• agitated, anxious, excited, discouraged, fearful, humiliated, overly quiet, resigned, unresponsive, passive
• clenched hands
• rigid
• rocking
• suicidal thoughts or attempts
• crying

• complaints of insomnia
• cringing, flinching
• may indicate a fear of being left alone with the alleged abuser
• drug/alcohol abuse

The ALLEGED ABUSER may exhibit any of the following:
• refuse to permit hospitalization/diagnostic tests
• ignore victim’s hospital admission - doesn’t visit
• refuse to participate in discharge planning or take elder home
• be impatient with victim/staff/procedures
• appear fatigued
• respond defensively when questioned
• make excuses
• be hostile, suspicious, irritable, demanding, angry and impatient
• not want victim interviewed alone
• lack remorse
• be depressed
• have erratic behaviour
• abuse substances
• have employment difficulties
• have agist attitudes
• feel excessively burdened by care giving role
• have feelings of anger/frustration
• deny that caregiving has changed lifestyle in any way
• have unrealistic expectations of victim’s limits and abilities

• lack understanding of aging process
• intimidate, threatens, insults, or is indifferent to victim
• be reluctant to touch, make eye contact, face or speak directly to the victim
• speak for victim
• be excessively involved with victim or not involved at all
• ignore needs and rights of victim
• make decisions without consulting victim
• treat victim like a child or non- person
• blame victim for problems which are not within the victim’s control

• be unwilling or reluctant to comply with service provider when planning for care
• isolate the victim by denying access to friends, visitors, monitoring all social interactions
• use finances
• be caregiver based on financial need

SOME FACTORS CONTRIBUTING TO THE RISK OF ABUSE:

Intergenerational family violence


• If violence is a typical pattern of family behaviour, abusers may learn to be violent by witnessing it.


Personality traits of abusers


• Studies show that abusers are more likely to have psychological or substance abuse problems than people who are not abusive. Alcohol consumption has also been associated with severe and frequent abuse.

Social Isolation

• As with other forms of family violence, some studies have shown that many abused older people have fewer social contacts than their peers who are not abused. However, it is not clear whether social isolation causes abuse or results from it – both victims and abusers may feel that isolation is necessary to keep the abuse hidden.

Ageism

• Because of the negative stereotypes and attitudes toward aging and older people, some strains of our culture can appear to dehumanize older adults. As a result, it is easier for some to abuse seniors without feeling guilt or remorse. Some older people hold many of these same negative stereotypes themselves. They may think that the abuse is deserved, unavoidable, or not significant enough to warrant help; it is accepted or expected that older people lose power and control over their lives.

Reacting to stress in violent or abusive ways.

• Caring for an older relative can be stressful for families. Caregivers may become angry and frustrated due to a limited understanding of the aging process, a lack of caregiving skills, and inadequate supports or resources. However, caregiver stress does not necessarily lead to violence or abuse.

Spousal abuse.

• Research suggests that older people are frequently abused by their spouses. According to a large national study, 40% of older men and 28% of older women who were abused by a family member were victimized by their spouses – Statistics Canada, 1999). Until recently, spousal abuse among older adults has been largely ignored, even though the number of injuries and level of violence are considered as serious as they are in cases of abuse by adult children toward their parents.

Tolerance of violence in this society.

• The abuse and neglect of older adults does not occur in a vacuum. Rather, it is a product of society’s general tolerance and acceptance of violence, demonstrated by the toys children play with, the content of many movies and sports, and the methods used by nations to solve conflicts. This acceptance of violence contributes to the abuse and neglect of older people.

(Source: Abuse and Neglect of Older Adults: Community Awareness and Response, Health Canada, 2002).


INTERVENTION

There may be opportunities for you to assist individuals in accessing available community services. If you suspect abuse in a situation, you can refer to the Elder Abuse Decision Tree, Appendix A, for assistance.

Develop a trusting relationship You can be supportive when talking to the abused person by reminding them of the following:

• it’s not their fault.
• they are not alone.
• help is available.
• it is abuse; they don’t have to put up with it.
• something can be done
If an individual does disclose abuse to you:
• take the report seriously the first time
• believe the individual
• identify your role as someone who can help
• be non-judgmental – avoid victim blaming
• support the individual:
1) listen and let them talk about their feelings
2) respect their feelings and concerns
3) help them find the good things about themselves

Give clear messages:

• abuse is never okay or justifiable
• personal safety is always the most important issue
• assault is a crime
• they do not cause the abuse
• they are not to blame for the abuser’s behaviour
• they cannot change the abuser’s behaviour
• apologies and promises will not end the violence
• they are not alone
• they are not crazy
• abuse is not loss of control, it is a means of control

Present options:

• talk about what they can do to plan for their safety
• encourage them to make their own decisions.
• Ask the individual what they want
• Know the key resources in the community and how to contact them (see Appendix B)
• Respect the individual’s right to confidentiality and the right to seek or not to seek treatment.



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