Forms of Abuse

Abuse of older people takes many different forms and is mainly categorized as physical, financial, verbal, sexual and emotional abuse. However, there are others actions that result in abuse such as: Neglect and acts of omission: including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, or the withholding of the necessities of life, such as medication, adequate nutrition and heating; Discriminatory abuse: including racist, sexist, that based on a person's disability, and other forms of harassment, slurs or similar treatment. Institutional abuse: or the failure of an organisation to ensure necessary safeguards and good standards of care are in place to protect and support a vulnerable adult. This may include neglect and poor professional practice and may take the form of isolated incidents through to pervasive ill treatment or gross misconduct at the other. Any or all of these types of abuse may be perpetrated as the result of deliberate intent, negligence or ignorance.

Physical Abuse

Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. Inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind are also examples of physical abuse.

Signs and symptoms of physical abuse may include but are not limited to:

• bruises, black eyes, welts, lacerations, and rope marks;
• bone fractures, broken bones, and skull fractures;
• open wounds, cuts, punctures, untreated injuries in various stages of healing;
• sprains, dislocations, and internal injuries/bleeding;
• broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained;
• laboratory findings of medication overdose or under-utilization of prescribed drugs
• an older person's sudden change in behaviour;
• "doctor-hopping" where an older person frequently changes doctors or other care providers in order to avoid detection of abuse; and
• an older person's report of being physically abused.

Financial Abuse

Financial abuse is the most common form of abuse of older adults. It can involve illegally or improperly using a person's money, assets, or property without the person's permission or knowledge. It is often a form of theft or fraud. Examples of financial abuse include: pressuring for money, goods or property; using property or money without the person's knowledge and consent; and misusing a power of attorney.

Financial abuse is often difficult to detect and frequently occurs over a long period of time. When older adults are financially abused, they are often victims of other forms of mistreatment such as psychological or physical abuse or neglect.

What are the Signs of Financial Abuse?

• Sudden removal of large sums of money from a bank account
• Inability to pay bills, buy food or personal care items
• Fear or anxiety when discussing finances
• Visits by a family member only when check arrives
• Inaccurate knowledge or lack of knowledge of personal finances
• Unexpected revision of a will, or sudden sale of property

How can I Avoid Becoming a Victim of Financial Abuse?

• Maintain a network of friends and acquaintances
• Learn to recognize the signs of abuse
• Be informed of personal assets, including property, bank accounts and possessions
• Keep money in a bank, not in your home
• Have pension cheques deposited directly into bank account
• Insist on a written repayment agreement before lending

What is Emotional Abuse?

There is no universally accepted definition of emotional abuse. Like other forms of violence in relationships, emotional abuse is based on power and control. The following are widely recognized as forms of emotional abuse:

• Rejecting: refusing to acknowledge a person's presence, value or worth; communicating to a person that she or he is useless or inferior; devaluing her/his thoughts and feelings
• Degrading: behaviour which diminishes the identity, dignity and self-worth of the person.
• Terrorizing: inducing terror or extreme fear in a person; coercing by intimidation; placing or threatening to place a person in an unfit or dangerous environment.
• Isolating: physical confinement; restricting normal contact with others; limiting freedom within a person's own environment. Examples: excluding an older person from participating in decisions about her or his own life; refusing access to a person's own money and financial affairs; withholding contact with grandchildren; depriving a person of mobility aids or transportation.

Sexual Abuse

Sexual abuse is the non-consensual sexual contact with an older person. It can mean using coercion such as threats, force, deceptions or contact with elders who are unable to grant consent.

Though older people are at greater risk for abuse due to factors associated with aging, elder sexual assault has not been well researched and is often not recognized or acknowledged. When an older person is a victim of sexual abuse the impact of the assault can also be different.

An older person is more likely to have serious injury such as genital tearing or bruising that may not fully heal. There is also an increased risk of infection because of the increased risk of tearing, and treatment may not be provided for injury and STD's. Because older people have more brittle bones there is a greater chance that bones may be broken by friction or weight. All of these factors can contribute to a longer recovery time in dealing with the abuse.

Identifying and treating elder sexual abuse is difficult because elders are less likely to report it and the symptoms could be the same as other conditions the elderly may be experiencing. Cognitive impairments may make it difficult for the older victim to explain or remember the abuse. It is important that those who are involved with elders are able to recognize signs of sexual abuse to aid in detection and treatment of victims.

The physical signs include:

• Bruising on inner thighs
• Genital or anal bleeding
• Sexually transmitted diseases
• Difficulty walking or standing
• Pain and/or itching in the genital area
• Exacerbation of existing illness

Emotional signs include:

• Scared or timid behavior
• Depressed, withdrawn behavior
• Sudden changes in personality
• Odd, misplaced comments about sex or sexual behavior
• Fear of certain people or of physical characteristics

Verbal Abuse

Verbal abuse is a pattern of behavior that can seriously interfere with the victim's positive emotional well-being and, over time, can lead to significant detriment to the victim's self-esteem, emotional well-being, and physical health.

During intense verbal abuse, the target of the abuse usually suffers by having lower self-worth and low self-esteem. Because of this, victims may fall into clinical depression and posttraumatic stress disorder. Verbal abuse, although not physically harmful and having no visible signs, is damaging nonetheless. Verbal abuse is arguably the most common type of abuse. It often is not taken as seriously as other forms of abuse. However, moderate to severe cases of verbal abuse, and cases in which the victim is under constant attack, may be even more damaging than financial or physical abuse.