Risk factors, alert features, signs and symptoms

Risk factors

Risk factors for older people

Older people more at risk of elder abuse are those:

• who are dependent on others for all or part of their care (e.g. due to physical impairments such as a stroke or cognitive impairments such as dementia)
• who are isolated and lack social contacts or support
• with a history of family conflict and tension
• with a history of mental illness
• with low self esteem or feelings of low self worth.

Risk factors for abusers

The Elder Abuse Helpline in Queensland has found that the majority of abusers are close family members, in particular adult sons or daughters, spouses and other close relations.

People more likely to inflict elder abuse are those:

• who are dependent on the older person (e.g. for financial or housing needs)
• experiencing stress from their carer role or who have inadequate support
• experiencing stress in other areas e.g. financial difficulties, health problems
• with a history of family conflict and tension
• with a history of mental illness
• with a history of addictive behaviours e.g. drug or alcohol abuse.

Alert features

The following features should alert health care providers to the possibility of abuse, and the need to expand history taking and assessment procedures.[i]

• There is incongruity between observations and information from the older person, or a discrepancy in perceptions of the older person and the suspected abuser.
• There is any discrepancy between an injury and the history, unexplained injuries, conflicting stories, vague or bizarre explanations, or denial.
• There are frequent requests for care or treatment for comparatively minor conditions.
• There is a delay in seeking care or reporting an injury.
• The older person is described as ‘accident prone’ or has a history of injury, untreated injuries and multiple injuries, especially at various stages of healing.
• There are repeated accident or emergency attendances of the older people from the same care setting.
• There are manifestations of inadequate care, including poor hygiene or nutritional status, poorly controlled medical conditions, frequent falls and confusion.
• A relative or carer appears overly protective or controlling, or the older person displays unexplained anger or fear towards the carer or relative.
• There is an apparent inability to afford food, clothing, housing or social activities, or questionable use of the older person’s possessions/property/funds.

Signs and symptoms of elder abuse

The following signs and symptoms may indicate that someone is experiencing elder abuse.[ii]

Behavioural signs

Behaviours that the older person may exhibit:

• shows signs of being afraid of a particular person/people
• appears worried and/or anxious for no obvious reason
• becomes irritable or easily upset
• appears depressed, withdrawn
• loses interest
• has sleep disturbances
• has changed eating habits
• has suicidal wishes
• has frequent shaking, trembling and/or crying attacks
• has rigid posture
• presents as helpless, hopeless, sad
• uses contradictory statements not resulting from mental confusion
• is reluctant or hesitant to talk openly; waiting for the caregiver to answer
• avoids physical, eye or verbal contact with caregiver or service provider.

Physical abuse

• abrasions
• bed sores
• bleeding
• bruises
• burns
• cuts/lacerations
• dehydration
• direct beatings
• dislocations
• fractures
• grip marks
• hypothermia
• internal injuries
• malnutrition
• over-sedation
• poisoning
• punctures
• scalding
• sprains
• swelling
• welts
• wounds.

Sexual abuse

• bruising or bleeding, pain or itching in the genital area
• sexually transmitted disease
• difficulty in walking or sitting
• recoiling from being touched
• fear of bathing or toileting.

Emotional/psychological abuse

• resignation
• fear
• shame
• depression
• mental confusion
• marked passivity
• anger
• insomnia.

Financial abuse

• failure to pay rent or other bills on behalf of the older person
• sale of property by an older person who seems confused about the reasons for the sale
• lack of money for necessities
• lack of money for social activities
• depletion of savings
• disappearance of possessions
• management of a seemingly competent older person’s finances by another person
• signs of misuse of an Enduring Power of Attorney, with control over an older person’s property/financial affairs for personal gain and to the detriment of the older person’s welfare
• signatures on documents/cheques not resembling the older person’s signature
• reluctance to make a will or have budget advice.

Neglect

• malnourishment or dehydration
• hypothermia
• weight loss with no apparent medical cause
• pallor, sunken eyes, cheeks
• injuries that have not been properly cared for
• poor personal hygiene
• clothing in poor repair; inappropriate for season
• lack of safety precautions, supervision
• absence of appropriate dentures, glasses or hearing aids when these are needed
• abandoned or left unattended for long periods
• medicines not purchased or administered
• no social, cultural, intellectual or physical stimulation.

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[i] New Zealand Ministry of Health (2007). Family Violence Intervention Guidelines: Elder abuse and neglect, Wellington, NZ. Retrieved 10 January 2012, from http://www.health.govt.nz/publication/family-violence-intervention-guidelines-elder-abuse-and-neglect

[ii] As above.