How to spot and challenge elder abuse

It is estimated that over 500,000 older people are abused in the UK every year. Elder abuse causes severe humiliation, suffering, and emotional scars to already vulnerable people nearing the end of their lives. The victims are primarily women over the age of 70, often with long-term illnesses or disabilities. They are some of the most vulnerable, dependent and isolated people in our society.

Who and where are the abusers?   

Abuse can be perpetrated by anyone, whether that is in an older person’s own home by a relative, friend or neighbour, or in a care setting by a volunteer worker, health or social worker. Abuse also occurs within institutional settings. Here there is more at issue because of the organisational context of the delivery of care, as abuse may occur because of inadequate systems or lack of financial control around resident’s personal allowances.

Why do people abuse the elderly?

The causes of abuse are not yet understood, however there are risk factors that can help identify situations in which abuse may occur within the home, these include where the elderly person is socially isolated; where there has been a poor quality long term relationship between the abuser and abused; where the abuser is dependent upon the person they abuse for accommodation, financial or emotional support and where the abuser has a history of alcohol, drug and mental health problems.

How to spot abuse

Indicators include difficulty getting access to the older person, or interviewing them alone; a history of unexplained or repeated falls or minor injuries; repeated visits to the GP, or A&E department, especially when there is no obvious medical reason; requests for help from many different agencies, or frequent transfers from one agency to another and refusal of support services.

What are the main types of elderly abuse?

There are five main types of elder abuse: physical abuse, psychological abuse, financial abuse, sexual abuse and neglect, details of which are provided below. It is important to note, however, that the following are indicators that abuse may be occurring, and that there may be other reasons for the behaviour or injuries stated.

1. Physical abuse is the injury or mistreatment of an older person; it may be deliberate or accidental and can be inflicted directly with a punch or a kick, or through a weapon, such as a cigarette or hairbrush. Signs of physical abuse are cuts, burns, bruises and scratches that may have been left untreated; injuries and wounds in concealed places or protected areas such as the underarm; injuries that do not match the explanation given for them or under or overuse of medication.

2. Psychological abuse can take the form of threatening, bullying, isolating, shouting, blackmailing or blaming, also deliberately ignoring and depriving an elderly person of their basic needs and pleasures. This can be recognised through unexpected or unexplained changes in the behaviour of an elderly person, or the older person appearing isolated, depressed, withdrawn, frightened, agitated, anxious or aggressive.

3. Financial abuse is the most commonly reported form of abuse against the elderly. It can be identified as theft, fraud, forgery and embezzlement. Signs of this type of abuse are a lack of money for basic necessities, such as food despite an adequate income, or the reluctance to pay for such by the person controlling their funds; disappearance of possessions and bank statements; unexplained changes in withdrawals from a person’s bank account and an older person’s inability to explain what is happening with their income.

4. Sexual abuse is forcing an older person to take part in a sexual activity without their consent. This includes sexual assault, rape, sexual harassment and the use of sexual language. Signs include pain, itching or injury in the anal, genital or abdominal area, or difficulty sitting and walking due to discomfort in those areas; bite marks or bruises on the breasts, neck or face; torn, stained or bloody underclothing; venereal disease or recurrent bouts of cystitis and unexplained problems with catheters.

5. Neglect is failing to provide basic necessities such as food, clothing, hygiene and mental stimulation. Signs include deterioration in appearance and personal hygiene; rashes, sores and ulcers and unexplained weight loss; inadequate food, drink or medical care; a lack of social stimulation and an unhygienic and unsafe environment.

 What to do if you suspect abuse of an older person

If you suspect that abuse is occurring, try to speak to the older person about what you have noticed, being as open and honest as possible. Give them the opportunity to talk and listen carefully to what they tell you, offering to seek help if appropriate. Some people may be worried about how you react so it is important to stay calm if they tell you they have been abused. Some people may ask you to promise not to tell anyone about the abuse. Whether you are a practitioner, friend or relative, you should always be honest and never make false promises – sometimes the abuse might affect more than one person and you will have a responsibility to other people too.

You must remember that an older person is an adult and should never be treated like a child, even if they appear confused and disoriented (he or she can still react to what you are saying and how you say it). Try not to take over or be over-protective and remember that you should not lead someone into saying something. Try to balance the need of the older person to be heard with the need to ensure you do not prejudice future action, such as a police or disciplinary investigation.

If it is appropriate, try to explain simply the sort of people who might be able to help e.g. health or social care professionals (such as a GP), police, home carers, care-home employees, volunteers and advocates. Perhaps offer to approach one of these on the person’s behalf. Ask what they want you to do. Do not discuss the subject with or challenge the abuser.
Action on Elder Abuse (Registered Charity No: 1140543)was established in 1993 as a specialist organisation focusing exclusively on issues relating to the abuse of older people. For more information on elder abuse and how it can be prevented please visit our website