There are a number of signs and symptoms that can warn you that an elderly person is being abused. This section discusses a number of important areas:
Characteristics of Elder Abuse Victims
Many victims of elder abuse and neglect tend to minimize or deny the mistreatment they are receiving. Some do this out of fear of rejection and disruption of their lives; some out of pride, embarrassment or shame; some out of concern about their family's privacy and some out of concern that legal action might be taken against the alleged abuser. Others feel that they deserve the mistreatment and resign to it. For the mentally infirm, they may not even be able to report abuse.
Elderly abuse victims are typically characterized by experts as being:
- Vulnerable
- Exploitable
- Socially isolated
- Physically/Cognitively impaired
- Have thwarted many attempts for help in the past
- Ready to adopt a dependent role - be it economically, physically, socially or emotionally.
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Characteristics of Abusers of Elderly Persons
Abusers can be family members or someone outside the family. Elder abuse may involve multiple offenders. Most elderly victims are abused by their caregivers or relatives, with adult children and spouse believed to be the most frequent abusers. Abusers tend to rationalize and justify their actions and deny harming the elderly person. They give excuses for their behaviour, such as losing their self-control, and blaming it on the victim for provoking them.
Abusers often tend to have the following characteristics:
- Stress
- Social isolation
- History of family violence
- Alcohol and/or drug addiction
- Poor communication between parties
- Mental illnesses/Mental health problems
- Financial dependency on the elderly victim
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Recognition and Assessment of Abuse Signs and Symptoms
The various types of elder abuse and neglect have their own indicators.
In addition, the physiological changes caused by aging and disease also create difficulties in the recognition and assessment procedures for elder abuse. The assessment procedure for possible abuse must therefore be as holistic as possible.
Purely physical signs should be interpreted with much caution, and professional opinion and assessment should be sought.
Indicators of possible neglect/inadequate care:
- Unexplained abrasions
- Body odour
- Dehydration
- Unexplained fractures
- Unexplained sprains
- Malnutrition
- Poor hygiene
- Unexplained rashes
- Overgrown nails
- Deprived behaviour of elderly person
- Soiled/inappropriate clothing
- Misuse of medication/over-sedation
- Unattended medical needs/physical problems
- Pressure sores
- Lost or non-functioning aides (e.g. glasses)
- Poor maintenance of house
- Consistent lack of supervision, especially in dangerous activities or for long periods
Indicators of possible psychological abuse:
- Anxiety
- Aggression
- Agitation
- Ambivalence
- Confusion
- Cowering
- Depression
- Drug/alcohol abuse
- Headaches, chest pain, palpitation
- Neurotic traits (e.g. sleep disorders)
- Non-responsiveness
- Restlessness
- Social withdrawal or isolation
- Suicidal behaviour/tendency
- Psychoneurotic behaviour (e.g. hysteria, obsession, hoarding food)
- Isolation of the elder from his family or relatives by the caregiver, saying that they do not care about him/her
- Nervous breakdown
Indicators of possible financial abuse:
- Blocked access to property
- A disparity between elder's assets and living conditions
- Unexplained withdrawal of money from elder's account
- Signing of documents without the elder person understanding what they mean
- Unusual activities in bank account (e.g. bank statements no longer come to the elder's house)
- An unusual interest by family members in the elder's assets
- An implausible explanation on the elder's finances by the caregiver, elder or both
- Caregiver has no visible financial support
- Caregiver refuses to spend money on the care of the elder
- A promise to care for the elder in exchange of the elder's property and monies to the caregiver, but a failure to do so
Indicators of possible physical abuse not shared with neglect:
- Evidence of non-accidental past injuries
- Deformities
- Contractures resulting from restraint/delay in seeking treatment
- Dislocation, pain, tenderness and swelling
- Unexplained bruises and welts:
- Face, lips and mouth
- Torso, back, buttocks, thighs
- Bite and teeth marks
- Clustered, forming regular patterns
- Reflecting shape of article used (e.g. cords, buckle, belt)
- In various stages of healing
- On several different surface areas
- Regularly appear after absence, weekend or holidays
- Unexplained burns:
- Cigar, cigarette, especially on soles, palms, back or buttocks
- Immersion burns (sock-like on feet, glove-like on hands, doughnut shaped on buttocks or genitalia)
- Patterned like electric burner, iron, etc
- Rope burns on arms, legs, neck or torso
- Unexplained fractures:
- To skull, nose, facial structure
- In various stages of healing
- Multiple breaks or spiral fractures
- Unexplained hair loss
- Haemorrhaging beneath scalp
- Possible hair pulling, self or other
- Possible evidence of underlying severe head injury
- Unexplained lacerations or abrasions:
- Injuries to mouth, lips, gums or eyes
- To external genitalia
- Sexual abuse:
- Difficulty in walking or sitting
- Torn, stained or bloody underclothing
- Pain or itching in the genital or urinary area
- Scarring, bruises or bleeding in external genitalia, vaginal or anal areas
- Any newly acquired sexually transmitted disease
- Unexpected and unreported reluctance to cooperate with toileting and physical examination of genitalia
- History of the abuser denying access to the elderly person or having a history of sexual offending.
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