Criminal, physical, psychologic or financial abuse of older persons is becoming an increasing public health problem. Previously the focus was on abuse in residential care, but now focus is on abuse in the family home. The true prevalence is unknown as it is poorly reported, but could be as high as affecting 5-10% of older persons significant problem. It has been shown that there is an increased mortality in those with corroborated mistreatment
Abuse may include:
• Physical abuse – acts of violence or use of force causing injury, pain, disease – could be pushing, striking, punching, slapping, hair pulling, throwing objects, coercion, confinement, force feeding or use of restraints
• Financial abuse/exploitation – misuse of older persons money/assets for personal gain; the pressuring to distribute assets; denial of access to personal funds; forging of signatures
• Psychological/emotional abuse mental anguish – eg threats of physical violence or institutionalisation, verbal abuse (shouting and screaming), degradation, humiliation, intimidation, restricting access to activities
• Neglect – failure to provide for basic needs (could be financial, physical or emotional)
• Sexual abuse – any sexual act to which consent is not given (ranges from rape to sexual harassment)
Those with dementia are more likely to be abused due to confusion and also their manifestation of aggressive behaviour. Claims of violence by these older persons may also be easily dismissed as a sign of their confusion, especially if there is a lack of corroboration.
Most of those responsible for the abuse are close family members. There seems to be a greater risk in those with cognitive impairment or those who need assistance with the activities of daily living. Many cases may be related to caregiver strain, frustration and burnout, psychiatric disorder, dependence on the victim or breakdowns in family interactions. Substance abuse by the caregiver may also be a major risk factor.
Many cases go undetected by health professionals – they have little or no training in recognition; may have ageist attitudes; very little information in the medical literature on the problem; victim is unwilling to discuss it; may be disbelieving; signs may be subtle; fear of confrontation with offender or jeopardising other relationships; reluctance to report if its only a suspicion; victim may request the abuse not be reported; do not know about reporting procedures. Health care professionals have a responsibility to reported suspected cases of elder abuse to the relevant authorities.
Intervention will be interdisciplinary (health professionals, social services, legal agencies). The principles of intervention should ensure that the safety of the abused person is paramount, that individuals are encouraged to make their own decisions, that the least restrictive intervention is used, that the interests of the abused person takes precedence over those of their family or other members of the community, and that the person subject to the abuse be offered protection through legal avenues.