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Recognizing the Signs of Elder Abuse and Neglect

Dr. Stephanie Kim is a geriatrician at Mount Sinai Hospital.

As the Canadian population ages, the rate of abuse toward older adults is rising with it. Current estimates suggest that between 4–10 per cent of older Canadians will experience one or more forms of abuse at some point during their later years.

With many older adults suffering in silence, and others not knowing where to turn for help, Sinai Health System Geriatrician Dr. Stephanie Kim warns that unless elder abuse is more comprehensively recognized and addressed, there is potential for it to continue to increase.

Part of the problem, says Dr. Kim, is that acting on suspected abuse is not as “black and white” as it may seem. “Decision-making in the context of elder abuse isn’t as clear cut as child abuse because older adults may have the mental capacity to make decisions for themselves – even if these decisions aren’t ones that we agree with, and continue to put them at risk.”

In recognition of the recent UN-designated Elder Abuse Awareness Day, Dr. Kim spoke with Circle of Care employees about types of elder abuse and how to navigate the grey area between privacy and advocacy when working with clients in the community.

Financial Abuse: More than 60 per cent of elder abuse involves theft or misuse of money or property. It can also include withholding funds or fraud. Warning signs, says Dr. Kim, might include sudden changes in banking practices; large, unexplained withdrawals; unauthorized withdrawal of funds using ATM card; abrupt changes in legal will or financial documents; standard of living not in line with the senior’s income; or refusal to consider moving to long-term care.

Physical Abuse: This might seem simpler to spot since physical abuse can result in tell-tale signs such as bruises or burns. However, older adults are also at high risk of falls resulting in bruises; and slower reaction times can lead to accidental burns. “Clinicians need to have a healthy index of suspicion when caring for patients who are at risk of experiencing abuse. A good indication that warrants further investigation are explanations regarding the mechanism of injuries that don’t line up with the actual injuries themselves,” explains Dr. Kim.

Emotional Abuse: Typically inflicted in private, psychological or emotional abuse can diminish the identity and dignity of the abused person. Common forms of emotional abuse include name-calling, yelling, ignoring, threatening or insulting. In some cases, threats of institutionalization, isolation from social activities, or withholding access to loved ones, such as grandchildren, may occur.

Neglect: Neglect does not typically present with a single symptom, but usually constellation of symptoms of varying severity including dehydration, poor nutrition, poor personal hygiene, inadequate clothing, unsanitary or unsafe living conditions, or bed sores. “When it comes to neglect, oftentimes we’re playing detective to put the pieces together,” says Dr. Kim. “Little clues can add up to a bigger pattern of abuse.”

Sexual Abuse: Although not typically asked about with the geriatric population, it’s important for health-care professionals to screen older adults for signs of sexual abuse, including new sexually transmitted infections (STIs), as well as and bruising and lesions in the chest and pelvic areas.

Systemic Abuse: Also referred to as “ageism,” systemic abuse involves the tendency for our society to infantilize older adults, and minimize their opinions and concerns. This can have major implications in a health-care setting, where oftentimes family members speak on behalf of their loved ones. “It’s important for clinicians to give their patients a proper role in discussions. Even from how we place them in the room – are they in the corner, or are they sitting alongside their loved one – and for us to not assume that family members know everything about their loved one,” says Dr. Kim.

Education and Resources

Raising awareness among older adults and caregivers is key to ending patterns of abuse. “Not all abusers are even aware that they are even engaging in abuse,” says Dr. Kim. Many caregivers feeling overwhelmed by their responsibilities, might act out of frustration or exhaustion. For others, cultural background might influence their actions.

If you suspect an older adult is being abused, start by talking to the person, in private, and ask whether he/she feels safe at home and is being well cared for. In the case of someone with a cognitive impairment, do not discount their claims – they may still be fully capable of recognizing abuse. If the situation is an emergency and you feel the person is at immediate risk, call 911. Learn more and access a wide range of resources and community services.

Circle of Care’s Elder Abuse Program provides counselling, help in developing a plan to keep safe, and information and referral to legal, financial, housing and community resources.