Elder neglect and abuse are poorly understood. This post is part of my effort to help change that.
The Royal Canadian Mounted Police (RCMP) defines elderly abuse thus:
“Elder Abuse refers to the violence, mistreatment or neglect that older adults living in either private residences or institutions may experience at the hands of their spouses, children, other family members, caregivers, service providers or other individuals in situations of power or trust.”
Elderly people who live with dementia are particularly susceptible to abuse because they may be less able to identify it or report it when it happens. They are extremely vulnerable, and we must be extra vigilant to ensure they do not fall victim to abuse, particularly by those who are meant to be caring for them.
Here are the forms elder abuse may take (compiled based information from the Canadian Network for the Prevention of Elder Abuse, the Royal Canadian Mounted Police and my own observations), and some of the signs to look for so you can take action to stop it:
What to look for: untreated or unexplainable injuries in various stages of healing, limb and skull fractures, bruises, sores, cuts, punctures, sprains, internal injuries/bleeding, dislocations, black eyes, welts and signs of being restrained.
Forcing an older adult to engage in sexual activity is sexual abuse. It may include verbal or suggestive behaviour, not respecting personal privacy, sexual touching, or sex without the person’s consent (rape).
What to look for: venereal disease, genital infections, torn, stained, or bloody underclothing, vaginal or anal bleeding, bruising around the breasts or genital area.
Threatening, insulting, intimidating, humiliating and treating an older adult like a child are all forms of emotional abuse, as is preventing them from seeing their family members and friends. Emotional abuse may be difficult to identify and prove and it can devastate a person’s sense of identity, dignity, or self-worth.
What to look for: changes in behaviour such as emotional upset/agitation, biting, rocking, lashing out, repetitive movement. Emotionally abused people may become withdrawn, non-responsive, and/or verbally and/or physically aggressive. In the case of people who live with dementia, this kind of behaviour may wrongly be attributed to the disease.
Tricking, threatening, or persuading older adults out of their money, property, or possessions is financial abuse. Misusing a power of attorney is a common form of financial abuse; it is often perpetrated by family members and/or legal guardians. Failing to provide elders with the care they need, deserve and can afford in order to preserve their estates for inheritance is a form of financial abuse.
What to look for: sudden changes in bank account or banking practice (unexplained withdrawals of large sums of money by a person accompanying the elderly person), signs that an elderly person has been coerced into signing a document (i.e. contracts, wills, mandates in case of incapacity, powers of attorney), someone is using an elderly person’s cheques without authorization, forging their signature, or misusing their money or possessions. Money and personal effects missing from their home.
Violation of rights and freedoms
It is a violation of rights and freedoms if somebody interferes with an older adult’s ability to make choices, especially when those choices are protected under the law.
What to look for: the the person stops going to church, temple, mosque or is prevented from engaging in their spiritual practices or traditions; mail or similar information is redirected; privacy is denied; family and friends are prevented from visiting; someone else dictates how they can spend their own money; institutionalization without a legitimate reason. This kind of abuse also includes restricting liberty, as well as denying rights to privacy, access to information, and available community supports.
Failing to provide an elder person the necessities of life, such as food, clothing, a safe shelter, medical attention, personal care, and necessary supervision is neglect, which may be intentional or unintentional. Sometimes the people providing care do not have the necessary knowledge, experience, or ability, and are unintentionally neglectful.
What to look for: unkempt appearance, broken glasses, shoes and clothes that don’t fit, lack of appropriate clothing, lack of eyewear, missing hearing aids, dentures and other necessities; weight loss, malnutrition, dehydration, poor personal hygiene, frequent urinary tract infections (UTIs), untreated sores, hazardous or unsafe living condition or arrangements (dirt, fleas, lice, soiled bedding, fecal/urine smell); substandard or inappropriate medical care.
Systemic / institutional abuse
Systemic / institutional abuse refers to rules, regulations, policies, or social practices that harm or discriminate against older adults. Systemic abuse includes rules that are developed for an apparently neutral purpose, but that hurt elderly people. Some institutions operate to meet personal or financial goals that conflict with meeting residents’ health and environmental needs.
What to look for: use of physical restraints as an easy way to prevent falls; or diapering a person instead of helping them to the washroom, to save time or effort; staff shortages lead; overcrowding, mealtimes in shifts; low staff to resident ratios; substandard and/or unsanitary living environments; inadequate care and nutrition; inadequate activity; forced inactivity; no access to outdoors; aggressive / inappropriate staff–client relations; use of chemical restraints such as antipsychotic medications and physical restraints to exert control over the elderly for the sake of convenience and cost saving.
What to do if you see persistent signs of elder abuse:
- Report what you see and hear to the elderly person’s family.
- If the elderly person’s family members are the perpetrators, report to the appropriate authorities or ombudsmen. Finding the right people and places to report elder abuse in your area is relatively simple using the internet. Search: reporting elder abuse. I’ve included a couple of links below.
- Do something. DO NOT REMAIN SILENT.
I believe the abuse of elderly people, particularly those living with dementia, is far more widespread than statistics indicate. Elderly people who live with dementia are still frequently chemically restrained using antipsychotic medication such as quetiapine (Seroquel) and risperidone (Respirdal); they are also physically restrained, and suffer all manner of systemic / institutional neglect.
Eldercare is in a state of crisis in North America and many other parts of the world, and it’s only going to get worse if we don’t wake up and make massive changes. Awareness is great, but a lot more action is required.
Here are some action-oriented links:
- World Elder Abuse Awareness Day PDF.
- How and where to report elder abuse in Canada.
- How and where to reporting elder abuse in the United States
Copyright: lopolo / 123RF Stock Photo