Elder abuse is any behaviour that causes harm or distress to an older person, inflicted by someone they should reasonably be expected to trust.
Elder abuse can be physical, emotional or financial. It can be a one off occurrence or it can happen repeatedly over a period of time. It includes different forms of abuse, neglect and exploitation, both intentional and unintentional.
Other people may be able to find out that you have been to this or other sites that talk about family violence. If you are a victim of domestic violence or abuse, you can hide your visit.
Who does elder abuse affect?
Elder abuse is a global problem. International studies report that 3% to 10% of older people experience abuse or neglect each year. Elder abuse:
commonly affects people who are frail and vulnerable and who depend on others to meet their most basic needs
happens to men and women of every religious, cultural, ethnic and income group
may occur in any setting, rural or urban
can affect older people living on their own or living with others
can occur in private homes or within a residential care or health care setting.
Sadly, much abuse goes unreported. It has been estimated that only 16% of all abuse incidents come to the attention of service agencies which can assist the older person to live safely.
Institutional abuse is a policy or accepted practice within an organisation that causes harm to, or disregards, a person’s rights. Examples include:
inappropriate rationing of continence products
inflexible routines eg: dress for breakfast before 8am.
Institutional abuse may occur in rehabilitation and continuing care wards, as well as in acute wards, day care, emergency and outpatient departments, and any other area where the care of older people is provided.
What are the signs of elder abuse?
The following are signs that may raise suspicion of elder abuse but it is important to avoid jumping to conclusions – the whole situation needs to be taken into account:
unexplained behaviour, sleeping or eating habits
confusion, withdrawal and/or edginess
drowsiness (due to over-medication)
fear of a particular person
recoiling from touch
unusual withdrawals from bank accounts
unpaid bills and/or not enough money for necessities.
Read more about signs of abuse relating to different types of elder abuse.
How can elder abuse be prevented?
Older people have the right to make their own choices and decisions even if we don’t agree with them. To help prevent elder abuse, older people should be:
loved and cherished
spoken and listened to respectfully
included in social activities
phoned or visited regularly
supported to spend their money how they wish
encouraged and supported to make their own decisions
enabled to set their own pace.
Where to find help
If you or an older person are in danger call the Police on 111.
If you are worried about how you or an older person are being treated:
talk to someone you trust – a friend or someone in your family
talk to someone you see regularly – a doctor, doctor’s nurse, or member of the church or spiritual leader
Elder abuse occurs for many reasons. There may be a background of difficult relationships or family violence, or carers may be struggling with their role. The impact of dementia, substance abuse, mental health problems and economic stress can also contribute.
Examples of situations where the elderly are at increased risk of abuse:
A family undergoes an unforeseen or unfavourable change in circumstances.
There is a history of poor relationships or abuse between family members.
Difficulties emerge as a result of role reversal (eg, if a father or mother becomes dependent on a son or daughter).
Family members are isolated and lack other relationships which give social, physical and emotional satisfaction.
A carer has been forced to change lifestyle as a result of caring.
The older person requires a level of care beyond the capacity of the carer.
There are difficulties due to hearing, visual or speech impairments.
A carer has conflicting responsibilities or financial difficulties.
A carer has not received help or support.
The older person refuses adequate support for themselves or their carer.
The older person has an illness or dementia that can cause unpredictable or repetitive behaviour, wandering or aggression, or major changes in personality.
Financial pressures and/or beliefs about rights of inheritance or ownership lead to control of finances, property or resources.
Factors that can contribute to abuse within hospitals or care settings are:
Staff working in isolation.
Staff inadequately trained to provide care and to respond to challenging behaviour.
Staff poorly supervised.
Low staffing levels and/or frequent use of agency staff.
High staff sickness levels or a rapid turnover of staff.
Staff with low self-esteem, or who are stressed or ‘burnt out’.
Staff who have a criminal history, personality disorder or abuse drugs or alcohol.
Inappropriate/poor staff skill mixes and poor staff/patient ratios.
Inadequate management supports.
Over-cramped or poor working conditions and environment.
Care settings isolated from other parts of the hospital or community.
Attitudes or behaviours that disregard the safety of patients or residents.
Types of elder abuse
There are 5 common categories of elder abuse. You may see signs that may raise suspicion of abuse but it is important to avoid jumping to conclusions. The whole situation needs to be taken into account.
inappropriate use of medicines or physical restraints
physical punishment of any kind.
Multiple injuries, especially of different ages such as bruises, hair loss, fractures, burns or scalding, especially in unusual places, grip marks.
Any forced, coerced or exploitive sexual behaviour or threats imposed on an individual, this includes:
sexual acts imposed on a person unable to give consent
sexual activity that an adult lacking mental capacity is unable to understand
acts such as unwanted touching
all types of sexual assault or battery, such as rape
forced nudity & sexually explicit photography.
Sexually transmitted disease, difficulty walking or sitting, recoiling from being touched, bruising or bleeding, pain or itching in the genital area.
Psychological or emotional abuse
Any behaviour that causes anguish, stress or fear, this includes:
verbal abuse, intimidation, harassment, damage to property, threats of physical or sexual abuse
the removal of decision-making powers
treating an older person like a baby
giving an older person the "silent treatment"
isolating him or her from family, friends, or regular activities
Feelings such as resignation, fear, shame, depression, mental confusion.
Financial or material abuse
This is the illegal or improper use of funds, property, or assets and/or exploitation. This includes:
forging an older person's signature
stealing money or possessions
tricking an older person into signing documents that transfer funds, property, or assets.
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.
This occurs as a result of another person failing to meet the physical and emotional needs of an older person. This includes:
failing to provide an older person with food, clothing, personal shelter, or other essentials, such as medical care or medicines
can also include failing to pay nursing home or assisted-living facility costs for an older person if you have a legal responsibility to do so.
Malnourished or dehydration, hypothermia, weight loss with no apparent medical cause pallor, sunken eyes, cheeks, bedsores or injuries that have not been properly cared for, poor personal hygiene, clothing in poor repair, abandoned or left unattended for long periods, medicines not purchased or administered.
The following features should alert health care providers to the possibility of abuse, and the need to expand history taking and assessment procedures.*
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. 35Elder Abuse and Neglect
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.
*(Levine, 2003; Community Care Access Centre of Waterloo Region, 2001; Bennett, 1994; Cochran and Petrone, 1987;New Mexico Coalition Against Domestic Violence, nd).
Definition of elder abuse
Elder abuse is defined as: "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person."*
However, when defining elder abuse, it is also important to take into consideration the cultural context of what constitutes abuse. Meanings of abuse may include: disrespect, dishonour, lack of esteem shown to kaumätua, or ignoring the needs of older people. It is important to keep in mind the impact abuse has on the older person when determining whether elder abuse has occurred.
*Definition adopted from WHO Toronto Declaration on the Global Prevention of Elder Abuse, 2002.
Regional HealthPathways NZ
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: