Information for health professionals
Health professionals are in an important position to help identify elder abuse and to support patients who may be experiencing it.
The following 6-step approach, helps health professionals assess and respond to elder abuse.[i]
1) Identify the abuse
- Include general questions during an assessment to help identify elder abuse.
- Use direct questions for older adults who present with signs or symptoms of elder abuse.
- Consider using direct questions where there is an increased risk of elder abuse.
Older people are more at risk of elder abuse when they:
- are dependent on others for their care (e.g. due to physical impairments such as a stroke or cognitive impairments such as dementia)
- are isolated and lack social contacts or support
- have a history of family conflict and tension
- have a history of mental illness
- have low self-esteem or feelings of low self-worth.
The majority of abusers are close family members, in particular adult sons or daughters, spouses and other close relations.
Signs of abuse
The following signs and behaviours should alert health professionals to the possibility of abuse, and the need to expand history taking and assessment procedures.[ii]
- There is inconsistency 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 accidents or emergency attendances of the older people from the same care setting.
Behaviours that the older person may exhibit: [iii]
- being afraid of a particular person/people
- appearing worried and/or anxious for no obvious reason
- becoming irritable or easily upset
- appearing depressed or withdrawn
- loses interest in their usual activities
- changing their sleeping or eating habits
- expressing suicidal wishes
- frequent shaking, trembling and/or crying attacks
- rigid posture
- presenting as helpless, hopeless or sad
- using contradictory statements not resulting from mental confusion
- being reluctant or hesitant to talk openly; waiting for the caregiver to answer
- avoiding physical, eye or verbal contact with caregiver or service provider
- recoiling from being touched
- being afraid of bathing or toileting.
Physical signs of abuse: [iv]
- cuts, abrasions, bruises, burns, dislocations, bed sores, broken bones and internal injuries
- dehydration, hypothermia, malnutrition, over-sedation
- bruising or bleeding, pain or itching in the genital area
- sexually transmitted disease
- difficulty in walking or sitting
- fear, shame, depression, resignation, anger, mental confusion, marked passivity
- weight loss with no apparent medical cause
- pallor, sunken eyes, cheeks
- injuries that have not been properly cared for
- poor personal hygiene
- clothing in poor repair; inappropriate for season
- absence of appropriate dentures, glasses or hearing aids when these are needed
- medicines not purchased or administered.
Other signs of abuse: [v]
The older person:
- seems confused about the sale of a property and the reasons for the sale
- lacks money for necessities or social activities
- has savings and/or possessions that are disappearing
- is reluctant to make a will or receive budget advice
- lacks safety equipment or supervision
- is abandoned or left unattended for long periods
- has no social, cultural, intellectual or physical stimulation.
- failing to pay rent or other bills on behalf of the older person
- managing the finances of a seemingly competent older person
- misusing an Enduring Power of Attorney (with control over an older person’s property/financial affairs) for personal gain and to the detriment of the older person’s welfare
- forging the older person’s signature on documents/cheques.
Questions for older people who may be at risk of abuse [vi]
- How are things going at home/in residential care?
- How are you spending your days?
- How are you feeling about the amount of help you are getting at home/in residential care?
- How do you feel your (husband/daughter/other caregiver) is managing?
- Do you have everything you need to take care of yourself?
Direct questions for use when signs of abuse are present
- Has anyone at home ever hurt you?
- Has anyone ever taken anything that was yours without your consent?
- Has anyone ever made you do things you didn’t want to?
- Has anyone ever touched you without consent?
- Has anyone ever scolded or threatened you?
- Have you ever signed any documents that you didn’t understand?
- Are you afraid of anyone at home?
- Are you alone a lot?
- Has anyone ever failed to help you to take care of yourself when you needed help?
2) Provide emotional support
- Listen to the person’s story.
- Acknowledge what they tell you.
- Validate their experience.
3) Assess risk
- Determine the level and urgency of safety concerns.
- Identify if the risk is life threatening (including risk of homicide).
- Identify the risk of suicide or self-harm.
4) Safety planning
- If the older person is at risk of serious harm or death, advise them of your concerns and contact the police. Contact the Elder Abuse Helpline and relevant agencies such as social workers and mental health services.
- For all other safety concerns, ask for the person’s consent to refer them for support and discuss a safety plan and referral options.
- Educate and support the person whatever their choices, and provide contact information for services.
- Record the action you have taken and document any current or past injuries.
- Refer the person experiencing abuse to the Elder Abuse Helpline, a Seniors Legal and Support Service, other social and/or legal services and health services.
- If the person refuses intervention, let them know they may talk to you or other support agencies in the future and give them contact details for support.
- Where the older person has impaired capacity, talk with the formally appointed decision maker if appropriate or refer the matter to the Office of the Public Guardian for investigation.
- Ensure procedures are in place for intervention, and follow up as required.
[i] New Zealand Ministry of Health (2007). Family Violence Intervention Guidelines: Elder abuse and neglect, Wellington, NZ. Retrieved 10 January 2012, from http://www.health.govt.nz/publication/family-violence-intervention-guidelines-elder-abuse-and-neglect
[ii] As above.
[iii] As above.
[iv] As above.
[v] As above.
[vi] As above.