Those who are vulnerable, like the elderly are more likely to be a victim of abuse, however abuse can happen to anybody, by anyone, at any time. This is why it is important to know the different types of abuse and the possible signs of it, as it can help provide them with safety and protection. Although if somebody is exhibiting these signs it does not automatically mean they are a victim of abuse as there may be a good explanation. For example those of a more elderly age has skin that bruises much easier so bruised skin may be from where they accidentally banged themselves.
This shouldn’t be assumed however and deciding if someone is being abused or not is usually a difficult and lengthy process that may not be found out for years, it is usually a combination of factors that gives more of a clue to the whole situation. Elder abuse can be defined as “‘A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person”(who. int/ageing/projects/elder_abuse/en, 08/03/12).
There are many types of abuse and some of these are usually combine together, some ways in which older service users can be abused include, physically, verbally, emotionally, sexually and financially. Physical abuse is probably the most often thought of abuse when someone is asked about elder abuse. This may because physical injuries are sometimes easier to identify and most people don’t like the idea that someone that is stronger or in a position of trust can assault someone of a venerable position.
Physical abuse is causing someone pain or injury, for example by hitting, pushing, slapping, shaking, striking, beating, shoving, kicking and/or using an item as a weapon towards somebody. Also physically restraining somebody in an inappropriate manner is also counted as physical abuse. This can include tying them down, this can lead to bruising. “Freedom of movement becomes limited, and over a period of time the use of restraints may result in deconditioning and muscle atrophy” (Falls in the Nursing Home, Ann Intern Med 1994 Sep 15; 121(6):442-51).
Likewise an elderly person should not be given medication in a means to restrain them, unless these medications are needed to treat symptoms. Medicating an elderly person in a way that is of benefit staff or careers is physical abuse, for example giving them extra medication to make them sleep longer or to discipline them. Likewise withholding medication that is prescribed to them, for example not letting them have pain relieve medication when they are in a lot of pain, is also elder abuse, this can come under both physical abuse and neglect. The prescription or administering of medication that is not licensed for the purpose used, often described as the ‘soft cosh’ because of the impact that it can have. ” (elderabuse. org. uk, 08/03/12) There can be many signs of physical abuse, however these can sometimes be covered by the abuser or victim and any injuries that go unexplained should be investigated fully.
These may also be called indicators, there can be physical signs or indicators, such as bruises or behavioral indicators such as the victim changing in the way they act or interact with other people, especially in the way that the victim and abuser are towards one another. Signs should not be taken as conclusive proof and instead patterns or someone with many signs may be more of an indicator. Sometimes signs of physical elder abuse may go on noticed, “They may appear to be symptoms of dementia or signs of the elderly person’s frailty – or caregivers may explain them in that way. and it is true that some signs and symptoms are similar as those of mental deterioration; however this doesn’t mean that they should be ignored. Some signs that someone has physically abusing an elderly person can be malnourishment or dehydration without any other ill related causes. Also prove of medication that has been over or under dosed, been given inappropriately or not been given at all.
There may be laboratory evidence of this, or there may be a report of a drug overdose or care workers may say that the service user failed to take their medication as they refused it, this may happen on an often occurrence, and although the service user may be doing this if they seem to take it fine with other service user’s that it may be a sign that that particular care worker may be withholding the prescribed drugs. Another sign that this is happening is that there may be more prescribed drugs remaining than there should be even though the care worker hasn’t said the service user refused to take them.
These signs sometimes come under medication abuse which “may include withholding medication, over-medicating or not complying with prescriptions refills. ” (edmontonpolice. ca/communitypolicing/familyprotection/elderabuse. aspx, 08/03/12) Physical signs such as bruises and scars can also be a sign of physical abuse; however this may be from an accident. This can especially be a sign if they seem to be on two sides of the body in a symmetrical way or if they appear in regular patterns or clusters in areas such as the groin or neck.
Although the elderly are usually fragile, broken bones, sprains and fractures can also be a sign of physical abuse. Any other signs of physical abuse can include things such as cuts, open wounds, black eyes, welts and any other injuries at any stage of healing or that haven’t been treated properly. Burns can also be a sign of physical abuse, these are most commonly around the palms, soles or buttocks, but can be in any other place, they may appear as cigarette burns or larger burns.
Signs of being restrained can also be a sign of physical abuse, such as rope marks on the wrists, restraint is “any manual method, physical or mechanical device, or equipment that immobilizes or reduces the ability of the person to move his or her arms, legs, body or head freely (Centers for Medicare and Medicaid, Effective 1-1-08) this can include medicine used to restrain people. Physical restraint can be used in care settings, however this needs to be at a last resort and only if someone or the person themselves is going to come to harm if the restraint isn’t used.
Even with expectable restraints there is a lot of controversy as they are believed to be unnecessary and sometimes cause further problems of distress in the service user. In most cases good care workers try and find alternatives and they may first of all discuss the use of restraint with the service user or an advocate. In the UK it is unlawful to use restraining belts, cuffs and vests that are designed to keep the service user restrained to a bed or chair; however in other countries this may be accepted.
Broken frames or eyeglasses can also be a sign of physical abuse as they may have become broken due to physical abuse; however they could have broken for other reasons. Poor skin hygiene or conditions lost of weight and a solid bed or clothing can also be signs, as well as being in pain. There may also be a change in the service users behavior, for example they may become withdrawn and act differently, this is even often the case for service users that are less able to communicate their feelings, it may still be shown that they have a change in their behavior.
They may act in a distressed, anxious way and become angry and upset, or becoming more angry then usual, for example they may shout and/or cry. They may tell someone that they have been a subject to abuse or complain via written or verbal communications. If a service user does do this then it should be taken seriously, the steps on what to do if this does happen are detailed later on. Unaccountable injuries and/ or “the refusal of the caretaker to allow visitors to see the elder alone” elder-abuse-(information. om, 09/03/12) can also be a sign of physical abuse as the care giver may not want others to see the proof or may not want the victim to tell others. The victim may also wince away when someone goes to touch them as they may think they are going to get harmed so they become extra fearful. Another type of abuse is verbal abuse, this can take on many forms and is usually linked to emotional abuse due to the way it can make people feel about their self’s. Such as critizing, degrading, insulting, calling names, threatening, screaming, and making people feel bad about themselves by belittling them.
This can also include racial, sexist and ageist comments. Verbal abuse usually involves the abuser judging the victim and the abuser may put the victim down even for something the victim is proud of doing. This can make the victim feel down about their self’s and lower their self-esteem and confidence. They may stop doing an activity they enjoy because of what an abuser has said. “Disparaging comments disguised as jokes and withholding communication are also examples of verbal abuse” (troubledwith. om, 09/03/12), this type of abuse can lead to a service user feeling worthless, like they deserve it, especially if the abuser is using degrading comments. It can also lead the victim to believe it is true, they may feel it is their fault why they are being treated that way. They may feel they are a burden and are causing stress towards their care givers and that they deserve to be spoken to in that way. However that is not true and this can be also counted as emotional abuse. They may believe as there are no visual scars it can’t count as abuse, but this is also untrue.
Abusers may also verbally harass an elder to gain financially; they may use their account details, steal money or even partake in identity theft. This can also come under financial abuse but sometimes verbal abuse is included to belittle the victim or confuse them. “The abuser might tell the elder that he’s won a prize and that he must pay in order to claim, create a phony charity for the senior to donate money to or engage in investment fraud” (ehow. com, 09/03/12). Verbal abuse does not always have to be done via oral communication, it can also be done by written communication or the use of hand signals.
For example by writing threatening letters or using hand gestures to offend someone. Verbal abuse is usually a pattern of behavior from the abuser and it can interfere with the victim’s positive emotional development and can be detrimental to their physical state, allowing the abuser to take and feel as though they are in control. One of the problems with verbal abuse is that sometimes the abuser may not realize they are doing it, sometimes the victim may laugh along, when really they are hurt. This is why people should be careful about what they say and how they say it.
In some cases jokes may be all right if the people have formed a good relationship and know where each other stand and have spoken properly about it. However friendly jokes are best avoided in care settings. Care workers can also verbally abuse someone by talking as if they are not there, for example yelling down the corridor ‘she’s wet the bed again’ As this is inappropriate and doesn’t provide the service user with dignity of care. There can be many signs that an elder person is or has been verbally abused and these signs are usually similar to emotional abuse. They may behave differently and be upset, agitated or angry.
They may become withdrawn and non-communicative and want to be isolated from family and friends. They may have a change in behavior or unusual behavior such as biting, rocking and sucking. They may become hostile to others and be insulting and threatening family and friends. In most situations verbal abuse comes along with emotional abuse, however other types of abuse are very likely to affect an elder emotionally and psychologically.
A definition of both verbal and emotional abuse can be “discrimination on the basis of age, insults and hurtful words, denigration, intimidation, false accusations, psychological pain and distress. (ageuk. org. uk, 10/03/12) Another form of abuse is emotional abuse; the main means of this is for the abuser to gain control. Emotional abuse can be anything from subtle words to being physically abusive and dominating. Emotional abuse can also include manipulation. The abuser can be “insulting, threatening, devaluing, mocking, controlling, critical, and undermining of self-esteem and worth” (everydayhealth. com, 10/03/11). The abuser may also withhold things from the victim, for example they may not allow them to see their family or friends.
Emotional abuse can occur in many ways and this is why it can be hard to tell if someone is being emotionally abused. Even the abuser may not realize that they are causing someone else emotional pain. Sometimes the abuser may also brainwash the victim to thinking it is their fault or/and that the carer does really care for them they are just taking things out of proportion. This can lead to the victim to not saying anything as they may not realize that they are being emotionally abused as they have been tricked into accepting it.
This may cause the victim to become ashamed, especially if the abuser repeats the same hurtful words many times. The victim begins to believe it and they may feel that they are a burden and their career is just stressed. “Their abuser has often isolated them through intimidation. They are reluctant to trust others because they fear angering their abuser” (David Sack, MD, the CEO of Promises Treatment Centers in California and the author of many journal articles on depression). As said under verbal abuse (which is closely linked to emotional abuse) the abuser may ridicule or humiliate the victim, calling them hurtful names.
This can make a service user to become annoyed and they may show this through a change of behavior, such as becoming more angry and hostile towards others. So this can be a sign of emotional abuse. Emotional abuse is increasing towards the elderly and this may be due to people living to older ages which is causing the amount of dependent elderly to go up so the prevalence of emotional abuse towards the elderly is also rising. Emotional (or psychological) abuse towards the elderly causes them emotional pain and distress, it may make them feel inadequate and lead to them having less confidence and a low-self esteem.
This can cause them to blame them self for things, for example they may say ‘I’m a nuisance aren’t I’. A career can also cause emotional abuse in other non-verbal ways, for example they may ignore them or deliberately isolate them from activities or seeing their friends or families, this is one sign of emotional abuse can be a victim suddenly withdrawing from seeing friends r family without warning. They may also terrorize or menace the elderly person. Although emotional abuse may be difficult to spot there may be some signs pointing towards it.
Especially if a career is seen being verbally abusive towards an elderly person. The victim may also seem frightened of the specific abuser, they may try to over please them in fear of causing them to become angry. “As a result, actions and access are controlled, and the person often seems to have no freedom or capacity to make independent decisions. ” (sharecare. com, 10/03/12) The victim may think before they act as they begin judging everything they do based on the way the abuser is going to react. This may cause depression or sleeping/ eating disorders, which can be another sign to look out for.
Another way elderly people may be abused is sexually. This is sexual contact with an elderly person without their consent, it can also include acts such as making an elderly person watch sex acts or look at pornographic material, also considered as elder sexual abuse is forcing an elderly person to undress. Sexual abuse on an elderly may be planned, for example a abuser may try and get a job in a residential home as they have certain service users. Or it may be in a result of opportunity that the care worker sees.
In some cases sexual abuse may have been carried on from an earlier age into old age. “There are also reported cases of older woman from minority communities being targeted because of their ethnic origins” (minorityrights. org, 10/03/12). Although sexual abuse is a crime it is often denied by the elderly and they often chose to suffer in silence, they begin to feel guilty like it is their fault, when it is not. The trouble with this is not only the fact that the abuser goes on to abuse many other people and potentially ruining lives or causing people distress and depression.
But also the opportunity for prove that it happened may be missed. Sometimes people that have been told by others that they have been sexually abuse may react by offering that they can have a bath and to wash their clothes, although this is meant to be a kind gesture it means that forensic evidence can be lost. So it is important that this doesn’t happen and instead the police are rang straight away as sexual abuse is a crime no matter what age the victim is.
Often an older person will tell what is wrong, even if they are confused. Even with dementia people can often make their feelings known as long as time is taken to listen, observe and take notice” (apa. org 10/03/12) Some signs of sexual abuse can include, genital or breast area having bruises around them, unexplained sexually transmitted infections or venereal disease/ genital infections, bleeding from the vagina or anus that can’t be explained. The victim having a sudden unusual difficulty in walking or standing can be another sign of sexual abuse. Underclothing that is stained, torn or has blood on it can also be a sign of sexual abuse.
Or if an elderly person says they have been abused sexually or raped. In this case the accusation should be taken seriously, even for confused service users and a protocol should be fallowed. Other signs of sexual abuse can include a change in the victim’s behavior; they may feel worthless and embarrassed. They may become angry and hostile and may not want to be left alone with the abuser. The act of sexual abuse may cause them to become fearful, shameful and their self- esteem will be lowered.
They may have extra physical illness or post traumatic stress syndrome, along with many more symptoms such as “insomnia, nightmares, fear of the dark, fear of being alone, and agoraphobia” (familymattersuk. org, 10/03/12). They may start to have eating, drug or alcohol problems and may begin to wear lots of layers of clothes. As sexual abuse is not often reported by elderly people it is important to look out for cues and do the right thing when they do report it. Another type of abuse can be financial abuse, or financial exploitation.
This is using resources of an elder inappropriately without permission for somebody else’s benefit, including for the abusers own benefit. This can also come under emotional abuse. This kind of abuse can range from embezzlement to a misuse of an elderly person’s money and can include; “fraud, taking money under false pretenses, forgery, forced property transfers, purchasing expensive items with the older person’s money without the older person’s knowledge or permission, or denying the older person access to his or her own funds or home” (apa. org, 10/03/12).
Sometimes power of attorney, or the use of legal guardianship is used to financially abuse an elder. As well as relatives, friends and families financially abusing an elder, companies set out to scam older people are also included. Such as mortgage companies, financial managers or sales people. Theft us quite a big problem towards the elderly as people around them enrich their self’s at the elderly person’s dispense by deceiving them “On occasions even banks and solicitors are found to have assisted in the misuse of Enduring Powers of Attorney. (lawsociety. org. uk. 10/03/12) There are many signs of financial abuse and sometimes these are quite clear for example a person may admit they are trying to get a family members money as it will be their inherence anyway, or maybe they may argue with the victim about money and saving some for when they pass away. Other signs can include signatures that look fake which are on financial documents such as cheques; this can especially be a sign if the victim is unable to write. Also changes in the victims will can be a sign of financial abuse.
There may be additional names added to their bank accounts or sudden changes or unexplained withdrawals from the bank account, especially if these are for large sums of money. Another sign of financial abuse can be bills that are going unpaid, such as overdue rent if someone else is meant to be helping with this, or if they lack in things such as clothing, a TV, personal hygiene items and other amenities that they should be able to afford.
Another sign can be “The sudden appearance of previously uninvolved relatives claiming their rights to an older person’s affairs or possessions” (elder-abuse-spotlight. logspot. com, 10/03/12) and/or an unusual concern by abuser that too much money is being spent on the care of an older person. Family members or other people suddenly receiving a transfer of assets can also be a indication of financial abuse, as well as disappearance in possessions or funds. A sign that an older person is being financially abused by a career can be that the elderly person is deliberately isolated from their friends and family so that control can be gained by the career.
Another sign can be the older person saying that they are being abused financially, they may not say it as straightforward as this but for example they may complain of repeated phone calls from people moaning about money. Although victims of elderly abuse are not to blame there are many ways of minimizing abuse but one if the first points is for everyone to work in partnerships with individuals and key people to ensure that elder abuse is made aware of and that everyone involved with the care of an older person is educated about elder abuse and the fact that it is not acceptable.
Giving older people plenty of support from friends and family as well as making family knowledgeable about respite care so they can have a guilt free break. Combating isolation in older people and allowing them to meet plenty of people gives more of a chance that abuse can be recognized, and isolation can actually be an indication of abuse. “Everyone involved in the care and support of older people must be aware of the existence of elder abuse and be able to provide advice on how to deal with the situation” (ageing. xfordjournals. org, 10/02/12) Other professionals such as doctors must also be alert to elder abuse and how to identify it. To minimize the impact on older people all professions should be in strong support of multi-agency working, both management and prevention of elderly abuse. Another way an elderly person can help minimize abuse to their selfs is by refusing anyone to have their bank details, they should also set boundaries and not tolerate any one who over steps these.
They should also speak up if they are unhappy with the way that they are being treated, they should do everything in their power to be treated right and fairly. Developing positive, trusting and sensitive relationships with service users to aid communication can also help minimize elder abuse. This will not only help the service user feel more safe and secure so they can open up and explain any abuse that has happened but it will also help the service user to see the differences between a good care worker that doesn’t abuse them to the person who is the abuser.
This will help the service user see that it is wrong and that it isn’t their fault. To build an effective relationship with an older service user a care worker will need to build on the trust they have with them, this can come in the form of respecting the service user, their home and their belongings. For example when cleaning a room a care worker may ask the service user where they want things to go, and if they need to go in a draw they might ask before hand just in case the service user doesn’t want them to.
This will give the service user dignity as well as privacy. This will help build an effective relationship and build the service user trust. It can also help if a care worker knows their own prejudices and how they can effect the way they behave towards a service user, this means that they need to be non-judgmental and getting to know the service user for who they are “Good quality of care requires competently delivered services that meet the client’s needs” (bacp. co. uk/ethical_framework/good_standard. hp, 10/03/12). If the care worker understands this and knows the limit of their role then it can help minimize abuse as they are less likely to abuse a service user (even by accident) as they understand what they are and are not meant to do. If a care worker applies the care values in what they do then they are more able to meet the service user’s needs, rights and preferences. This will help the service user feel more worthy which in turn builds up their confidence and self esteem.
This can help them feel like they are able to be more independent and they will be more able to say no to abuse and speak up for themselves. This will help minimize abuse as the service user will be more confident and will be less venerable to abusers, it will also help them speak out if they are getting abused as they will have the confidence to do so and realize that it is not their fault and they don’t deserve to be treated in that way.
As one of the seven principles of the care value base is to “Acknowledging people’s personal beliefs and identities” (en. wikipedia. org, 10/03/12) these are included in legal and organizational requirements that need to be met which can also help with minimizing abuse. A care worker has a duty of care which means that they need to work with a person-centered approach where the individual is at the center of their work. Service users should know about their treatment and what it involves so they are able to make informed decisions.
Although a service user doesn’t have a right to demand a certain treatment and may not necessarily be able to have a complete choice they still are “able to make informed choices about the most suitable treatments for themselves” (preventelderabuse. org, 10/03/12). Also providing the service user with privacy and dignity can help minimize abuse as they are able to see the correct way in which they should be treated. There are certain actions to be taken when abuse is recognized or reported and systems and procedures that should be followed in order to safeguard older service users from abuse.
It should be reconised by both service users and care workers that care workers cannot keep a promise that they wont pass on information about abuse. This reason for this is to protect the service user as well as others. However it should be known that this type of information will only be passed on to those who need to know it and it will remain confidential to just these people. Here is a flow chart that shows what usually happens if abuse is suspected in an elderly person.