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Abuse and Neglect of Older Adults
Is This Overview Paper for You?
This fact sheet provides information on abuse and neglect
of older adults living in the community. It updates the 1990
fact sheet, Elder Abuse. The information will be of greatest
interest to professionals and community service providers who
want to learn more about abuse and neglect of older adults.
Materials written for seniors and their families may be obtained
from seniors' centres and other community resource centres. Information
on abuse in institutions is the subject of Abuse of Older Adults
in Institutions, another fact sheet available from the Clearinghouse.
What Is Abuse of Older Adults?
Abuse of older adults is also called elder abuse or abuse of seniors.
One of the simplest definitions is "mistreatment of older people
by those in a position of trust, power or responsibility for their
care."1 Neglect is commonly associated with abuse.
Different forms of abuse are most commonly grouped into four categories:
Physical abuse involves inflicting physical discomfort,
pain or injury. It includes behaviours such as slapping, hitting,
punching, beating, burning, sexual assault and rough handling.
Psychological abuse diminishes the identity, dignity and
self-worth of the older person. Examples are name calling, yelling,
insulting, threatening, imitating, swearing, ignoring, isolating,
excluding from meaningful events and deprivation of rights.
Financial abuse, also known as material or property abuse,
involves the misuse of money or property. Examples include stealing
money or possessions, forging a signature on pension cheques or
legal documents, misusing a power of attorney, and forcing or tricking
an older adult into selling or giving away his or her property.
Neglect is the failure of a caregiver to meet the needs
of an older adult who is unable to meet those needs alone.
It includes behaviours such as denial of food, water, medication,
medical treatment, therapy, nursing services, health aids, clothing
and visitors.
Specialists in the field of abuse of older adults also recognize
other forms of abuse, including medical, systemic, sexual, civic
and human rights abuse. An abused older adult may experience more
than one type of abuse at any given time.
How Widespread Is the Problem?
Findings differ regarding the number of abused older adults, and
regarding who is abused and who abuses. Studies vary in the definitions
of the age group and the behaviours labelled as abuse. These inconsistencies
make it impossible to compare findings across provinces or among
social agencies in any one region.
Available information on prevalence is likely understated
because abused older adults are reluctant to identify themselves.
They often take no action against their abusers. They may be embarrassed,
unsure that any good will result, unwilling to risk rejection by
loved ones, or afraid of having to leave their home.
The Canadian study most often quoted on prevalence of abuse of
older adults is the 1990 national telephone survey of 2,000 older
adults in private dwellings.2 The findings are comparable
to those found in other countries:
- Approximately 4 percent of older adults living in private homes
reported experiencing abuse or neglect.
- The most prevalent mistreatment reported was material abuse,
most often involving widowed older adults living alone and perpetrated
by a distant relative or a non-relative rather than by a close
family member.
- Chronic verbal aggression, a component of psychological abuse,
ranked as the second most prevalent form of abuse. Victims were
usually abused by their spouse.
- Physical abuse ranked third. Again, in the majority of cases
the abusers were spouses of the victims.
Explaining Abuse of Older Adults
In the past, the most popular explanation for abuse of older adults
was that it was provoked by stress on the person providing
long-term care for the older adult. Recent research shows that the
dynamics between dependent individuals and their caregivers are
much more complex.
The most common explanations of abuse of older adults focus on
the following:3
- A web of dependent relationships - physical, emotional
and financial, between the victim and abuser. Research findings
are inconsistent. Not all dependent seniors are abused. Some studies
even suggest that abusers are more likely than non-abusers to
be dependent on their victims.
- Traits of the abusive caregiver. An impressive amount
of research has linked mental health problems and social characteristics
of caregivers to abuse. One example is that abusers are more likely
than non-abusers to have alcohol or other substance abuse problems.
- Situational stress. Caregiver stress related to long-term
care of an older adult sometimes leads to abuse. The failure
of stress-reducing interventions (e.g., home care assistance,
respite care) to reduce abuse has led to less emphasis on the
singular importance of caregiver stress.
- Transgenerational family violence - children from a
long history of family violence "getting back at" a
parent. The limited research on this theory suggests that it explains
child abuse much more than senior abuse.
- Social isolation. Isolation has not been established
as a cause of abuse, but abused older adults are more likely to
have fewer contacts with friends and family members than are non-abused
older adults.
- Pervasive societal power imbalances. Individual experience
is inseparably linked to social forces and institutional practices
that may support power imbalances in families (e.g., ageism or sexism).4
Several of these models may be required to explain abuse of
older adults. Service providers and professionals need to explore
all of these possible explanations to determine what intervention
is most likely to succeed.
Who Are the Abused and the Abusers?
The persons at greatest risk for being abused or for abusing, and
the conditions which put them at risk, vary with the types of abuse.5
The Abused Older Adult
Few consistent differences have been found between abused and non-abused
older adults. The age, gender, marital status, ethnicity and income
level of older adults who are abused do not differ significantly
from those who are not abused. Consistent differences that do exist
include the following:
- Older adults who live with someone are more likely to be abused
than those who live alone.
- Older adults who live with grown offspring or other caregivers
are more likely to be abused than those who live with a spouse.
The Abuser
- Males are more likely to be perpetrators of physical abuse.
Women are more likely to be perpetrators of neglect and financial abuse.
- A large-scale study in the United States6 found
that family members were suspected in two thirds of reported abuse cases,
most often adult children and then spouses. Except for the
financial category, abuse by non-family members is rare in private
dwellings.
- Abusers have been characterized in various studies as
having other problems, including financial difficulties, recurring
mental health problems, limited social supports, substance (alcohol)
abuse, police arrests and poor employment records.
- To prevent repeat offences in cases of serious abuse,
changing the living arrangements is usually more effective than
giving caregiving assistance to the abuser.7
Detection and Management
Potential indicators of abuse have been documented on the
basis of the behaviours and appearance of both victims and perpetrators
in known abuse cases.8 Recently, more attention is being
paid to characteristics of caregivers. New, simple screens of caregivers
are now available for identifying situations of high risk for abuse
of older adults.9
However, decisions about how and when to intervene are
still among the most difficult that service providers face. Ethical
dilemmas are common.10 Knowledge about successful interventions
is growing but is slow to reach the practice level.11
Interventions are shifting to approaches that are more respectful
of the rights of older persons to make their own choices.12
These approaches are based on increased understanding
of help-seeking behaviours and the power of social support. Each
intervention must be unique to the situation and to the mental competency
of both the abused and abuser.
Existing domestic violence programs need to consider special approaches
for older adults because:
- older adults tend to be more isolated than women or children,
- neglect is generally not part of domestic violence programs,
and
- unlike the situation for children, societal norms do not give
responsibility for the care of older adults to any particular
individual or agency.
A Team Approach
Awareness is growing among various disciplines about the critical
role each can play, as well as the importance of a team approach,
in the detection, assessment and treatment of abuse of older adults.
Treatment teams often include the client, a nurse, physician,
social worker, geriatrician, and psychiatrist or mental health worker.13
Other team members may include the client's dentist, lawyer and
bank manager, a representative from a housing placement service
and a human rights advocate. Older professionals are valuable
members on the treatment team.
Community committees14 focus on activities such as:
- an assessment of the need for professional education, protocols,
policies and procedures,
- education and awareness programs for professionals and the
public,15
- consistent tools for detection and protocols for what to do
and who to contact if abuse is suspected,
- standard record-keeping and tracking of referrals,
- additional opportunities to enhance social support networks
for all seniors, and
- processes for reviewing and changing programs.
Involving seniors and seniors' organizations in local initiatives
is critical for success.16 A Canadian network of seniors'
organizations has identified 10 broad areas requiring action: justice,
isolation, attitudes, empowerment, education and training, support
services, housing, cultural sensitivity, research and responsibilities
of governments.17
Professionals and service providers need more training about abuse
of seniors and increased awareness of available local community
supports.18,19,20
Legislation
Mandatory reporting of abuse of older adults in the United States
has not proved successful in reducing abuse because the resources
to act on reports have not been provided.
In Canada, many believe that laws intended for the general public
are adequate for cases of abuse of older adults (i.e., family law
and laws dealing with physical assault, financial abuse, neglect,
mental cruelty, consumer protection and housing).
New Canadian laws for adult guardianship and adult protection support
models in which consumer and service providers make treatment
decisions together.
As legislation changes, continuous monitoring is needed to guarantee
that decisions do not rely on the same solution for all
cases. Also, the approaches supported by the law must not be so
expensive that they disappear in times of funding cuts (e.g.,
specific advocacy services).21
Research
Research provides information that guides decisions about interventions,
staffing needs and legislation. Multidisciplinary research is needed
to advance knowledge in the following key areas:22
- standardization of definitions and measures
- trends in prevalence and incidence of abuse
- prevalence and incidence studies in institutions and home care
services
- the nature of financial abuse and neglect
- other research methodologies (e.g., first person accounts to
develop knowledge about how abuse happens, continues and ends)
- the staffing and training implications of prevalence trends
- refinement of available screening and assessment instruments
- evaluation of existing intervention programs (e.g. practices,
costs, outcomes of treatment programs)
- the effects of recent changes in community support systems
- evaluation of education of primary health care providers and
other service providers and professionals
- monitoring and evaluation of legislative changes.
Support Services
If you or someone you know has been abused or is experiencing abuse,
you are not alone; help is available. Emergency telephone
numbers can be found at the front of your phone book. You can also
contact your local:
Social service agency
Seniors' centre
Distress centre
Doctor or health care practitioner
Hospital or health agency
Independent living centre
Transition house or shelter
Legal agency
Bank or financial institution
Senior citizen home or daycare centre
Spiritual advisor or organization
Immigrant service centre
Ethnocultural community or organization, or
Community resource centre.
Suggested Resource Materials
Abuse and Neglect of Older Adults: Awareness Information for
People in the Workplace. (1994). National Clearinghouse
on Family Violence and Mental Health Division, Health Canada, Ottawa.
A guide for people interested in meeting to discuss family violence
issues.
Elder Abuse Protocol. (1997). CLSC René-Cassin, University
Institute of Social Gerontology of Quebec, Montreal.
Intergenerational Conflict and the Prevention of Abuse Against
Older Persons. (1994). Ottawa: National Clearinghouse on Family
Violence, Health Canada.
"Not in Our Community" - Preventing Mistreatment
of Seniors: A Guide for Ethnocultural Communities. (1997). CLSC
René-Cassin, University Institute of Social Gerontology of Quebec,
Montreal.
Preventing Family Violence, 7th Edition. (1998). National
Film Board of Canada, Ottawa. A catalogue of Canadian videos on
family violence for the general public, professionals and service
providers. Includes 10 videos on abuse of older adults.
MacLean, M.J. (ed.) (1995). Abuse and Neglect of Older Canadians:
Strategies for Change. Ottawa: Canadian Association on Gerontology.
Pittaway, E. et al. (1995). A Guide to Enhancing Services for
Abused Older Canadians. British Columbia Interministry Committee
on Elder Abuse.
Working with Mistreated Seniors from Ethnocultural Communities
and Their Families: A Guide for Service Providers. (1977). CLSC
René-Cassin, University Institute for Social Gerontology of Quebec,
Montreal.
Quinn, M.J. & Tomita, S.K. (1997). Elder Abuse and Neglect:
Causes, Diagnosis, and Intervention Strategies. 2nd ed. New
York: Springer Publishing Company.
Spencer, C. (1996). Diminishing Returns. Vancouver, British
Columbia: Gerontology Research Centre, Simon Fraser University.
An examination of financial responsibility, decision making and
financial abuse among older adults.
Agencies in many communities have materials on abuse of older
adults for seniors and their families. Contact your local seniors'
centre, Council on Aging, public health or social services department.
Related Overview Papers in This Series
The following fact sheets are available in English and French from
the National Clearinghouse on Family Violence.
Emotional Abuse. 1996.
Family Violence and People with a Mental Handicap. 1993.
Family Violence and Substance Abuse. 1994.
Financial Abuse of Older Adults. 1999.
Abuse of Older Adults in Institutions. 1999.
References
Toronto Mayor's Committee on Aging. (1984). Elder Abuse: Report by
the Crimes and Abuse Subcommittee to Toronto City Council.
Toronto: City of Toronto.
Podnieks, E., Pillemer, K., Nicholson, J.P., Shillington, T.
& Frizzel, A.(1990). National Survey on Abuse of the
Elderly in Canada. Toronto: Ryerson Polytechnical Institute.
McDonald, P.L., Hornick, J.P., Robertson, G.B. & Wallace,
J.E. (1991). Elder Abuse and Neglect in Canada. Toronto:
Butterworths, p. 27-33.
Aronson, J., Thornewell, C. & Williams, K. (1995). Wife Assault
in Old Age: Coming Out of Obscurity. Canadian Journal on Aging,
14: suppl. 2, 73-88.
Vida, S. (1994). An Update on Elder Abuse and Neglect. Canadian
Journal of Psychiatry, 39, S34-S40.
Barnett, O.W., Miller-Perrin, C.L. & Perrin, R.D. (1997).
Family Violence Across the Lifespan: An Introduction. California:
Sage Publications.
Barnett, O.W. et al. (1997).
Pittaway, E., Gallagher, E., Stones, M., Kosberg, J., Nahmiash,
D., Podnieks, E., Strain, L., & Bond, J. (1995). A Guide
to Enhancing Services for Abused Older Canadians. British
Columbia: Interministry Committee on Elder Abuse.
Reis, M. & Nahmiash, D. (1995). Validation of the Caregiver
Abuse Screen (CASE). Canadian Journal on Aging, 14: suppl.
2, 45-60.
Spencer, C. (1996). Rights and Responsibilities: Ethical Dilemmas
in Suspected Abuse and Neglect Cases. Vancouver: Gerontology
Research Centre, Simon Fraser University.
Canadian Task Force on the Periodic Health Examination (1994).
Periodic Health Examination, 1994 Update: 4. Secondary Prevention
of Elder Abuse and Mistreatment. Canadian Medical Association
Journal, 151, 1413-1420.
Quinn, M.J. & Tomita, S.K. (1997). Elder Abuse and Neglect:
Causes, Diagnosis, and Intervention Strategies. 2nd ed. New
York: Springer Publishing Company.
Vida, S. (1994). An Update on Elder Abuse and Neglect. Canadian
Journal of Psychiatry, 39, S34-S40.
Carson, M., Brammer, A., Kartes, L., Hall, B., Ashton, D., &
Ross, M. (1996). Breaking the Silence on Elder Abuse. The Canadian
Nurse, September, 1996, 31-35.
Kemsley, H. (1998). Elder Abuse Takes Centre Stage. The Ottawa
Citizen, February 7, p. K3.
National Clearinghouse on Family Violence (1994). Older Canadians
and the Abuse of Seniors: A Continuum from Participation to Empowerment.
Health Canada.
One Voice. (1995). National Action Plan to Reduce the Abuse
of Older Adults in Canada. Ottawa: One Voice, The Canadian
Seniors Network.
Krueger, P. & Patterson, C. (1997). Detecting and Managing
Elder Abuse: Challenges in Primary Care. Canadian Medical Association
Journal, 157, 1095-1100.
Mayer, L. & Galan, D. (1993). Elder Abuse and the Dentists'
Awareness and Knowledge of the Problem: A National Survey, Journal
of the American Medical Association, 59: 11, 921-926.
Trevitt, C. & Gallagher, E. (1996). Elder Abuse in Canada
and Australia: Implications for Nurses. International Journal
of Nursing Studies, 33(6), 651-659.
Gordon, R.M. (1995). Adult Guardianship and Adult Protection
Legislation in Canada: Recent Reforms and Future Problems. Canadian
Journal on Aging, 14: suppl. 2, 89-102.
McDonald, L. & Wigdor, B. (1995). Editorial: Taking Stock:
Elder Abuse Research in Canada. Canadian Journal on Aging,
14: suppl. 2, 1-6.
This document was prepared by Susan M. Swanson.
For further information on family violence, contact:
The National Clearinghouse on Family Violence
Family Violence Prevention Unit
Health Issues Division
Public Health Agency of Canada
Health Canada
Address Locator: 1909D1
9th Floor, Jeanne Mance Building
Tunney's Pasture
Ottawa, Ontario, K1A 1B4, CANADA
Telephone: 1-800-267-1291 or (613) 957-2938
Fax: (613) 941-8930
Fax Link: 1-888-267-1233 or (613) 941-7285
TTY: 1-800-561-5643 or (613) 952-6396
Web site: www.phac-aspc.gc.ca/nc-cn
This publication may be provided
in alternate formats upon request.
Ce feuillet de renseignements est également
disponible en français sous le titre
Mauvais traitements et négligence à l'égard des aînés.
The opinions expressed in this report are those of
the authors and do not necessarily reflect the views of Health
Canada.
March 1999 (revised)
Our mission is to help the people of Canada maintain
and improve their health.
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