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Elder Mistreatment


Lecturer of Geriatric Medicine
Department of Geriatric and Gerontology
Ain Shams University

Elder mistreatment:
Involves acts of commission or
omission that result in harm or threatened
harm to the health or welfare of an elderly
person by a caregiver or other trusted
Intentional actions that cause harm or
create a serious risk of harm (whether or
not harm is intended) to a vulnerable elder
by a caregiver or other person who stands
in a trust relationship to the elder.
Failure by a caregiver to satisfy the elders
basic needs or to protect the elder from

The definitions exclude violence by strangers.

There must be a trusting relationship between
an older person and the abuser.
Willful (attempts harm) non- willful (lack of
skill, burnt out caregiver)
Who is the abuser?
Partner, adult child or other relative.
Friend, neighbour or visitor
Patient or resident
Health care provider, caregiver or other
social or support worker.
Person managing an older persons affairs
(e.g. Attorney or guardian).
Self (self neglect)

Where does elder abuse take place?

Nursing home.
Increases as world is ageing.
Ranges from 1.5 6% across different
Underreporting ? (only less than 10%
cases are reported)
Abuse is manifested differently in different
culture and ethnic groups.
Barriers to report elderly mistreatment
Lack of awareness (especially among health care professionals).
Health care workers may feel uncomfortable discussing the topic with
their patients or may fear offending their patients caregivers.
Knowing that there are few effective avenues to address the problem once
it is identified. lack of satisfaction with the response by the authorities
Ageism and negative stereotyping of the elderly.
It is often difficult to distinguish subtle symptoms of mistreatment from
symptoms of chronic physical and mental illnesses.
Social isolation of the patient, Cognitive impairment.
The elderly person's fear of threatening the relationship with the
caregiver and feeling that there is nowhere else to go, that nothing can be
done to help.
The shame in admitting abuse by one's own family.

Risk Factors For Elderly Mistreatment
Factors in the victim.
Factors in the abuser.
External factors as living arrangements, external
stress and social isolation

Types of Abuse
Violation of Rights
Financial exploitation

Physical abuse
Physical abuse is the use of force that results
in physical injury, pain, or impairment and
may include hitting, shoving, shaking,
slapping, kicking, pinching, and burning.
Additionally, the inappropriate use of drugs
and physical restraints, force feeding, and
physical punishment.
nonconsensual sexual contact of any kind or
sexual contact with a person incapable of giving
consent. It includes unwanted touching, sexual
assault, and sexual battery.
Primary evidence of sexual abuse includes
bruising of the perineal region or presence of
semen. Secondary evidence includes new onset
of a sexually transmitted disease, blood, or
purulent discharge
infliction of anguish, emotional pain, or
distress through verbal or nonverbal acts.
It includes verbal assaults, insults, threats,
intimidation, humiliation, , name-calling or
harassment, silence treatment.
Psychological abuse also includes
statements that humiliate or infantilize the
elderly person.


Active Neglect: intentional failure of a
care-giver to fulfill his/her caregiving
Passive Neglect: Unintentional failure of a
care-giver to fulfill his/her caregiving
Self Neglect: The older person not
providing his/her own essential needs


Abandonment: desertion of an elderly
person for whom one has agreed to care
for, dumping a cognitively impaired elder
at an emergency room with no
denial of privacy
participation in decision-making.

is the illegal or improper use of an elderly
persons funds, property, or assets.
It may include cashing checks without
authorization, forging an elderly persons
signature, misusing elderly persons
money or possessions, deceiving an
elderly person into signing a document
such as a contract or will, or improper use
of guardianship or power of attorney,
medical fraud.

Is Elder Abuse a Crime?
Physical, sexual, and financial/material
abuses are considered crimes.
Certain emotional abuse and neglect are
subject to criminal prosecution.

Indicators for elder mistreatment
Physical Signs:-
Multiple injuries, especially of different ages; bruises,
welts, cuts, abrasions;
Scalds & burns, especially sock & glove patterns;
Genital Injuries
Poisoning especially if recurrent
Sexually transmitted diseases;
Patterned bruising;
Unexplained failure to thrive;
Poor hygiene;
Dehydration or malnutrition;
Fractures, especially if in specific patterns;

Behavioral Indicators

Fear of particular person
Appears worried and/or anxious
Becomes easily irritable or upset
Appears depressed or withdrawn
Avoids physical eye or verbal contact with carer
or service provider.
Difficulty in walking or sitting
Pain or itching in genital area
Recoiling from being touched
Fear of bathing or toileting

Indicators of Financial Abuse

Lack of money for necessities
Depletion of savings
Disappearance of possessions
Sale of property by older person who
seems confused about the reasons for the

Indicators of Neglect & Acts of Omission

Malnourishment or dehydration
Poor personal hygiene
Clothing in poor repair
Absence of appropriate dentures, glasses
or hearing aids
Left unattended for long periods
Medicines not purchased or administered

Indicators of Self Neglect

Reclusive, filthy and unhealthy living
Collecting and/or hoarding rubbish
Poor personal hygiene
Inappropriate or unusual clothing
Menagerie of pets


failure of an organization to provide an
appropriate and professional service.
Low staff morale
High staff turnover
High sickness rates
Excessive hours worked and frequent use of agency staff
Lack of consideration for Privacy
Lack of care with personal clothing (including loss of clothes,
being dressed in other peoples clothes, dirty or unkempt,
spectacles not clean, wearing other peoples spectacles,
hearing aids or teeth)

Poor hygiene with noticeable smell of
Residents in dirty clothing and/or bed linen
Inappropriate use of equipment
Over reliance on sedating medication,
catheterisation and enemas
Lack of communication between staff, staff
and residents and staff and relatives

Effective management requires a
multidisciplinary approach that covers
broad areas of
medical treatment,
mental health care,
social services, and
legal assistance.

Education is the cornerstone of preventing elder
Respite care essential in reducing caregiver stress
Social contact & support the elderly, family members
& caregivers.
Counseling for behavioral or personal problems in
the family play a significant role.
If there is a substance abuse problem, treatment is
first step in preventing violence against older family

Identification of suspected
Physicians should learn to recognize the
common signs and symptoms of elder abuse,
many of which can be subtle.
Health care provider may be the only contact of
the elder other than the abuser.
When the physician suspects a problem, he
should conduct a thorough history and physical
exam, and the caretaker should be asked to
leave the examining room during the interview.

Victims may not expose truth immediately,
instead asking directly, physician should
begin with questions about nature of
relationship with the caregiver, conditions
of the home, and circumstances
surrounding her physical signs and
Assess patient safety , if unsafe hospital
admission is warranted.
Develop a plan-of-care to promote
functional independence


Decision making capacity.
Home assessment
Documentation of signs of abuse
Community services
Provide the Pt:
Education: Promote the social attitude that no one should be subjected to
violent, abusive, humiliating, or neglectful behavior. Educate about the special
needs and problems of older adults and about the risk factors for abuse.
Provide resources accessible for geographic areas and on-going and emergent
Respite care: Temporary rest and time off is essential in reducing caregiver
stress, a major contributing factor in elder abuse.
Social contact and support: Encourage being part of a social circle or
support group. Having other people to talk to is an important part of relieving
tensions. Many times, families/ friends can share solutions and provide informal
respite for each other. Abuse is less likely to go unnoticed when there is a
larger social circle, more eyes on the Pt.
Counseling: Encourage changing lifelong patterns of behavior and finding
solutions to problems emerging from current stressors. If there is a substance
abuse, behavior problem in the family, treatment is the first step in preventing
violence against the older family member. Address mental illness issues.
Professionals and Community should:
Keep a watchful eye out for family, friends, and neighbors who may be
Get educated and understand that abuse can happen to anyone.
Speak up if you have concerns. Trust your instincts! Know what to look for.
Keep reporting any suspicions you have of abuse to helping agencies.
Spread the word. Share what youve learned to friends, family and people you
work with.
Instructions to a caregiver:-
If the caregiver overwhelmed by the demands of caring for
an elder, instruct (he /she ) to do the following:
Request help, from friends, relatives, or local respite care agencies, so you
can take a break, if only for a couple of hours.
Find an adult day care program.
Stay healthy and get medical care for yourself when necessary.
Adopt stress reduction practices.
Seek counseling for depression, which can lead to elder abuse.
Find a support group for caregivers of the elderly.
If caregiver is having a problems with drug or alcohol abuse, get help.

The Right to Refuse Help
Despite your best efforts to identify elder
abuse and offer assistance, the suspected
victim may refuse help.
Whether abused or not, competent adults
have the legal right to refuse medical and
social services.