Elder abuse for healthcare providers

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" (Adopted from the World Health Organisation Toronto Declaration on the Global Prevention of Elder Abuse, 2002).

This definition is the basis for working with older people about elder abuse and neglect. However, when defining elder abuse, it is also important to take into consideration each cultural context of what constitutes abuse. Meanings of abuse may include disrespect, dishonour, lack of esteem shown to older people/kaumātua 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.

The following features should alert healthcare 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. 
• 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.

From Family violence intervention guidelines: Elder abuse and neglect(external link) Health New Zealand | Te Whatu Ora, 2007.

Abuse - elder
Abuse and safety