About Senior Abuse

A very real social problem, abuse of older adults is a very complex issue and may involve physical abuse, emotional/psychological abuse, neglect, financial abuse, violation of rights, and sexual assault.

Any senior can be abused, despite her or his age, living arrangements or conditions, physical or mental health, sexual orientation, financial status, education, culture, or social status.

FREQUENTLY ASKED QUESTIONS (FAQs)

1. What is senior abuse?
2. What causes senior abuse?
3. What are the different types and signs of senior abuse?
4. What role does culture play?
5. How many older people are abused?
6. Why isn’t it reported?
7. What makes an older person vulnerable to abuse?
8. Who abuses older people?
9. Are there criminal penalties for the abusers?
10. What legislation exists in Nova Scotia to protect seniors from abuse?
11. How can senior abuse be prevented?
12. What is being done to stop senior abuse?
13. How can I help stop senior abuse?

1. What is senior abuse?

FAQs

The Nova Scotia Elder Abuse Strategy: Toward Awareness and Prevention (2005) states “elder abuse is the infliction of harm on an older person”. Abuse is any act or failure to act that endangers the health and/or well being of the older person. Such action or inaction is especially harmful when it occurs within a relationship where there is an expectation of trust.

Abuse may be:

Physical—inflicting, or threatening to inflict, physical pain, injury, or discomfort on an older adult.

Sexual—any form of sexual activity with a person without the consent of that person.

Emotional / Psychological—inflicting mental pain, anguish, or distress on an older person through verbal or nonverbal acts.

Financial—the unethical or illegal misuse of the money, property, or other assets of an older adult, including placing inappropriate pressure on an older person in order to gain access to her or his assets.

Violation of Human / Civil Rights—the unlawful or unreasonable denial of fundamental rights and freedoms normally enjoyed by adults.

Neglect—the failure to provide the necessities of life such as proper food, fluids, suitable clothing, a safe and sanitary place of shelter, proper medical attention, personal care, and necessary supervision. There are several forms of neglect, including active neglect, passive neglect, self-neglect, and abandonment.

Much abuse occurs within relationships where there is an expectation of trust. Some of these relationships include:

• in a family,
• between a husband and a wife,
• between friends,
• between an older adult and someone they rely on such as an accountant, care worker, or other paid person,
• when someone is providing services in an older adult’s home.

Not all abuse is a result of individual action and not all abuse occurs within a personal relationship. Sometimes older adults are targeted because the abusers think they will be easier targets.

Sometimes abuse is a result of how older people are treated at a societal level. Systemic abuse, for example, can happen when policies or practices take away a person’s independence and dignity. This sometimes happens when other people are making decisions for the older person and may be rooted in ageism (see Question #2 - What causes senior abuse?).

2. What causes senior abuse?

FAQs

The causes of senior abuse are extremely complex. Abuse generally does not occur because of only one factor but is a combination of circumstances that can be intensified and complicated by particular life events.

Poor or negative attitudes about aging and the resulting behaviours are a form of discrimination called ageism, which is frequently the root of disrespectful and abusive behaviours toward older persons. An inaccurate understanding of the needs and capabilities of older persons, insensitivity to the wishes of the older person, and additional stressors in one’s life can also lead to a variety of abusive behaviours.

Oftentimes, people who exercise power over others by pressuring, threatening or taking advantage of vulnerable older persons don’t know that their behaviour or attitudes are wrong or considered abusive.

Senior abuse is sometimes a continuance of existing abuse and violence which can be present in families and other relationships. This abuse can be intensified by a variety of risk factors such as a change in lifestyle (like retirement); employment or financial difficulties; disputes over property/money; physical illness; mental/psychiatric illness; addictions; lack of additional supports; isolation; changing relationships with family and/or friends; and declining lack of independence due to increasing physical frailty. Beliefs about the role and expectations of women and men, disability, race or homophobia are also causes of violations of older persons.

While opinions vary on whether caregiving by a partner, relative or friend causes abuse, there is little evidence to support this notion. Lack of awareness and education about the role and expectations of caregiving as well as an inability to access or the lack of community services and supports is a significant issue for many persons giving and receiving care. The additional stresses of providing care coupled with any of the above factors may make already unhealthy relationships more strained and difficult. This creates a greater risk of abuse. Dependency can contribute to increased feelings of guilt, resentment or obligation by the person receiving care. There are also circumstances where the caregiver is dependent on the person requiring care which can affect the relationship and lead to abuse of the caregiver by the care recipient.

3. What are the different types and signs of senior abuse?

FAQs

This section provides more information on the different forms of abuse and how you might recognize whether abuse is occurring. While some of these signs and symptoms may be a result of other issues, they may alert you to the possibility of abuse. Consider these signs if you suspect someone is being abused. Also keep in mind that many older adults will experience more than one type of abuse at the same time.

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.

Sexual Abuse

Sexual abuse is defined as non-consensual sexual contact of any kind with a person. Sexual contact with any person incapable of giving consent is also considered sexual abuse. It may include unwanted touching, all types of sexual assault or battery (such as rape, sodomy, coerced nudity), sexually explicit photographing, the forcing or coercing of degrading, humiliating, or painful sexual acts.

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

• bruises around the breasts or genital area;
• unexplained venereal disease or genital infections;
• unexplained vaginal or anal bleeding;
• torn, stained, or bloody underclothing; and
• an older person’s report of being sexually assaulted or raped.

Emotional or Psychological Abuse

Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse may include verbal assaults, insults, threats, intimidation, humiliation, and harassment. Treating an older person like an infant or child; isolating an older person from her/his family, friends, or regular activities; actively withholding access to grandchildren; giving an older person the "silent treatment;" and enforced social isolation are also examples of emotional/psychological abuse.

Signs and symptoms of emotional/psychological abuse may include but are not limited to:

• being emotionally upset or agitated;
• being extremely withdrawn and non-communicative or non-responsive;
• unusual behaviour usually attributed to dementia (e.g., sucking, biting, rocking); and
• an older person’s report of being verbally or emotionally mistreated.

Financial Abuse

Financial abuse (sometimes referred to as financial or material exploitation) is defined as the illegal or improper use of an older person’s funds, property, or assets. Examples include cashing an older adult’s cheque(s) without authorization or permission; forging an older person’s signature; misusing or stealing an older person’s money or possessions; coercing or deceiving an older person into signing any document (e.g., contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.

Signs and symptoms of financial or material exploitation may include but are not limited to:

• sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the older adult;
• the inclusion of additional names on an older person’s bank signature card;
• unauthorized withdrawal of the older person’s funds using her or his ATM card;
• abrupt changes in a will or other financial documents;
• unexplained purchases or abuse of funds by persons appointed as Power of Attorney;
• unexplained disappearance of funds or valuable possessions;
• substandard care being provided or bills unpaid despite the availability of adequate financial resources;
• discovery of an older person’s signature being forged for financial transactions or for the titles of her/his possessions;
• sudden appearance of previously uninvolved relatives claiming their rights to an older person’s affairs and possessions;
• unexplained sudden transfer of assets to a family member or someone outside the family;
• the provision of services that are not necessary; and
• an older person’s report of financial exploitation.

Neglect

Neglect is the refusal or failure to provide an older person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an older person. Neglect may also include failure of a person who has fiduciary/ management responsibilities to provide care for an older person (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care.

The intentional withholding of the necessities of life is referred to as active neglect; and the unintentional failure to provide proper care is referred to as passive neglect. Passive neglect is often a result of lack of knowledge, experience, or ability to provide care.

Signs and symptoms of neglect (whether active or passive) may include but are not limited to:

• dehydration, malnutrition, untreated bed sores, and poor personal hygiene;
• unattended or untreated health problems;
• hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water);
• unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing); and
• an older person’s report of being neglected.

Self-neglect involves the behaviour of an older person that threatens her/his own health or safety. Self-neglect generally is observed in an older person as a refusal or failure to provide herself/himself with adequate food, water, clothing, shelter, personal hygiene, medication, and safety precautions. The definition of self-neglect does not include a situation in which a mentally competent older person, who understands the consequences of her/his decisions, makes a conscious and voluntary decision to engage in acts that threaten her/his health or safety as a matter of personal choice.

Abandonment is the desertion of an older person by an individual who has assumed responsibility for providing care for that person, or by someone with physical custody of an older adult. This is a form of neglect and can include deserting an older adult at a hospital, a nursing facility (or other similar institution), deserting an older adult at a shopping centre or other public location.

4. What role does culture play?

FAQs

Behaviours considered to be abusive in any given society can vary. Certain behaviours may not be considered inappropriate or a violation of rights. For example, if there are specific cultural expectations of children regarding the ownership of property or money belonging to the parent, this may be thought to be acceptable and proper. In some societies, abuse is not discussed or considered a concern. Most cultures regard disrespect and poor treatment of older persons to be unacceptable but there can be many complicating factors.

It is important when dealing with any individual from another culture to learn about their beliefs, practices and understandings about aging and abuse.

Consider these questions:

• What language do people understand? Do they nod in agreement or do they in fact realize what is being said?
• What are commonly accepted gender roles (men and women) of a particular culture?
• Does any cultural practice violate rights or prevent individuals from living as they wish?
• Is there a clear understanding of the Canadian concept of human rights?
• Are there differences in how families and generations relate to one another in a particular culture? What are attitudes regarding behaviours of various generations toward one another?
• Who makes decisions in the family?
• What role do older persons play in the family or in their community?
• Are there religious beliefs that influence how family members regard or treat one another?
• How does this cultural group respond to having resources or support provided from those in the dominant culture/ society?
• Do they look to their own cultural group to address concerns or seek support?
• Does the older person have associations with other seniors in the community to discuss or compare experiences?

5. How many older people are abused?

FAQs

It is difficult to say how many older persons are abused, neglected, or exploited, in large part because of a lack of awareness and understanding of senior abuse. Situations of abuse are frequently not reported and the problem remains greatly hidden.

The best information available indicates that between 4% and 10% of older adults experience abuse. This means that in Nova Scotia approximately 5,000 to 13,500 older people experience harm and poor health or well-being because of abuse. Because abuse is severely underreported, it is believed that this number is far greater.

This number is also known to be higher in certain settings such as institutions, including long-term care facilities.

Because women live longer than men and there are more older women than there are older men, senior abuse is and will continue to be a significant women’s issue. More older women are abused than men, however, even when adjusted for their greater numbers.

6. Why isn’t it reported?

FAQs

There are a number of reasons why abuse of older adults may not be reported. Embarrassment, shame, and fear are big obstacles to overcome for many people to reach out for support or assistance. Because violence or deception is increasingly regarded by our society to be disturbing and wrong, many abused persons do not reveal their experience due to fear of the consequences to the person who has victimized them.

Older adults may not report abuse because they:

• fear more abuse
• want to protect family honour and/or consider family break-up to be unacceptable
• fear losing their independence
• fear losing financial, physical, and/or emotional support provided by the abuser
• lack self-esteem and assertiveness; believe “I deserve what I get” and accept abuse as “normal”
• fear institutionalization (being placed in a facility against their will)
• fear being denied access to grandchildren
• feel hopeless about finding solutions
• love the abuser and do not want to see her/him criticized, particularly if it is their own child who is abusing them
• may experience language difficulties
• don’t know or understand their rights, including how to act on them
• don’t know what services are available to them
• may be depressed due to loneliness or lack of proper nutrition.

We sometimes don’t see it because:

• attitudes, behaviours, and institutionalized practices in our society promote ageism and devalue older persons
• it is simply not reported and may be well hidden
• there is a lack of awareness about abuse of older adults
• society believes in sanctity of the family and the family’s right to privacy
• use of force in certain circumstances is seen as okay
• there are lack of options for dealing with an abused older person
• we just don’t know what to do.

7. What makes an older adult vulnerable to abuse?

FAQs

Some seniors are more at risk than others. Those who are older, socially isolated, have reduced cognitive capacity, have disabilities and are dependent, and those cared for by people with an addiction (such as alcohol, drugs or gambling) are at higher risk.

Social isolation and mental impairment (such as dementia or Alzheimer’s Disease) are two factors that may make an older person more vulnerable to abuse. But, in some situations, studies show that living with someone else (a caregiver or a friend) may increase the chances for abuse to occur. A history of domestic violence may also make a senior more susceptible to abuse. Families that have a history of poor relationships or mental health problems may also be at higher risk.

Senior abuse affects people of all education levels, sexual orientation, ability, and social, economic and ethnic backgrounds and cultures. It affects both men and women.

8. Who abuses older people?

FAQs

Most abuse is committed by someone the senior knows, such as a family member, friend, caregiver, landlord, (paid) care provider, or a person who provides a service (e.g. financial advisor or home maintenance person).

Abusers of older adults are both women and men. Family members are more often the abusers than any other group. For several years, data showed that adult children were the most common abusers of family members. Recent information, however, indicates spouses are the most common perpetrators when data concerning older adults and vulnerable adults is combined.

9. Are there criminal penalties for the abusers?

FAQs

Some abusive actions are defined as crimes, but not all abuse is considered criminal. The Criminal Code of Canada describes the different offences that someone can be charged with if they are accused of abusive actions toward older adults. The relevant provisions relate to physical and sexual abuse, chronic psychological abuse, neglect, loss of rights (as under the Canadian Charter of Rights and Freedoms), property theft, breach of trust and breach of power of attorney, extortion, fraud and false pretences, and intimidation.

Because not all behaviour believed to be abusive falls under the Criminal Code, a range of resources and supports are necessary to be able to respond to cases of abuse. It is also important to note that while there are commonly accepted definitions of abuse, the way abuse is defined in legislation may vary. This becomes important when one looks to available legal responses, and it emphasizes the need for a range of resources and supports.

10. What legislation exists in Nova Scotia to protect seniors from abuse?

FAQs

Nova Scotia has two specific pieces of legislation of direct relevance to preventing and responding to abuse of older adults: the Adult Protection Act and the Protection of Persons in Care Act.

Adult Protection

Reporting known or suspected cases of abuse against a vulnerable adult is mandatory in Nova Scotia. The Adult Protection Act serves to protect people aged 16 years or older who are abused or neglected and cannot physically or mentally protect or care for themselves. It creates an obligation and legal responsibility for any person to report suspected abuse or neglect. The Act protects the person who reports abuse unless the information is given maliciously or without reasonable and probable cause.

If financial abuse occurs at the same time as other forms of abuse, Adult Protection workers may be able to intervene and offer services to help those in need of protection. In cases where the situation only involves financial abuse, Adult Protection workers can refer individuals to an authority that can help safeguard his/her financial interests.

The Nova Scotia Department of Health administers Adult Protection Services within the Continuing Care Branch. About 75% of persons assisted under the Act are seniors. More information on Adult Protection Services can be found at www.gov.ns.ca/health/ccs

If you know or suspect an adult is need of protection, call Adult Protection Services at 1-800-225-7225.

Protection of Persons in Care

The Protection of Persons in Care Act aims to protect individuals in care and applies to hospitals, residential care facilities, nursing homes, homes for the aged or disabled persons under the Homes for Special Care Act, and any other institution or organization deemed a “health facility”. The act creates a duty for those employed in the administration of a health facility to protect patients and residents from abuse or neglect. It includes a mandatory reporting provision for service providers and a voluntary reporting provision for all others.

This act came into effect on October 1, 2007. You can report known or suspected cases of abuse or neglect in any of these facilities to the Protection of Persons in Care office at the Department of Health at 1-800-225-7225.

11. How can senior abuse be prevented?

FAQs

As with all forms of violence, abuse of older adults can be prevented.

We must:

• Challenge ageist attitudes and beliefs that devalue older adults.
• Treat older adults with the respect and dignity they deserve.
• Work with older adults to empower them to make healthy relationship choices.
• Offer alternatives to remaining in abusive situations.
• Enhance informal support networks.
• Ensure seniors retain as much power and control over their own lives as possible.
• Provide information on services and programs available to assist.
• Encourage caregivers to access support available to them.
• Educate ourselves and others about senior abuse.

We must also foster positive relationships between generations and provide support to those caring for and supporting seniors.

For seniors, some simple but essential steps you can take to reduce the risks include:

• Maintain as much control and power of your life as possible.
• Stay active in the community and connected with friends and family. This will decrease social isolation, a known risk factor for senior abuse.
• Plan for your future. With a power of attorney and a health care directive / living will, health care decisions can be addressed to avoid confusion and family problems, should you become incapacitated.
• Make arrangements with someone you trust who understands your wishes.
• Seek independent advice from someone you trust and who has correct information before signing any documents.
• Know your rights. For example, if you engage the services of a paid care provider or family caregiver, you have the right to voice your preferences and concerns. If you live in a nursing home or board and care home, you still have rights. There may be a resident/patient advocate who has knowledge and skills to mediate and assess the situation and who has the power to intervene.
• Take care of your health.
• Seek professional help for drug, alcohol, and depression concerns. Encourage family members to get help for these problems.
• Attend support groups for spouses and learn about domestic violence services.

Educating seniors, professionals, caregivers, and the public about abuse is critical to prevention. It is important that the issue of abuse is understood, discussed by both professionals and the public and confronted in our communities.

There are numerous brochures, videos and other publications available that provide information on abuse. See the Links to Education and Awareness Resources section for more information.

12. What is being done to stop senior abuse?

FAQs

Many organizations and communities across the province are working towards ending senior abuse. The Department of Seniors is leading the implementation of the Nova Scotia Elder Abuse Strategy: Towards Awareness and Prevention. This includes working with our many partners in carrying out the priority actions.

One such action is to explore the development of networks as a mechanism for increasing awareness and responding to senior abuse at the community level. Senior abuse coalitions/networks are one approach being used in other provinces as a means to make life safer for seniors. For example, community response networks bring together individuals and groups such as social workers, nurses, lawyers, community organizations, individuals and others, including older adults. These community efforts can play an increasingly important role in educating the public and professionals.

Community responses can focus on education and awareness programs as well as develop tools for communities to use in detecting abuse and to apply coordinated procedures to address abuse (e.g. protocols).

No matter how communities work towards ending senior abuse, it is important to involve seniors and seniors’ organizations to ensure success.

13. How can I help stop senior abuse?

FAQs

Know what senior abuse involves... be aware of the warning signs and know what services are available.

Some specific tips:

• Be aware of support services in your community. This includes social service agencies, seniors’ centres, legal services, clergy, transition houses or shelters, health centres, etc.
• Become a community "watchdog". Keep a watchful eye out for loved ones, friends, or neighbours who may be vulnerable.
• Speak up if you have concerns. That means even if you are not sure. You have a right and responsibility to question.
• Become involved. Find out what is being done to prevent abuse. Volunteer with older adults in your community
• Support efforts and programs to increase and strengthen services in your community.