Focus on elder abuse



Indicators of elder abuse

Elder abuse usually happens without anyone knowing. How doe you knowif an elderly person is being abused? Focus on Elder Abuse lists some of the signs to look out for:

Possible indicators of physical abuse

  • cuts, lacerations, puncture wounds
  • bruises, welts, discolouration
  • any injury incompatible with history
  • any injury which has not been properly cared for (injuries are sometimes hidden on areas of the body normally covered by clothing
  • poor skin condition or poor skin hygiene
  • absence of hair and or hemorrhaging below scalp
  • dehydration and or malnourished without illness-related cause
  • loss of weight
  • burns: may be caused by cigarettes, caustics, acids, friction from ropes or chains, or contact with other objects
  • soiled clothing or bed

Possible indicators of psychological / emotional abuse

  • helplessness
  • fear
  • hesitation to talk openly
  • implausible stories
  • depression
  • confusion or disorientation
  • denial
  • anger
  • agitation

Indicators of possible financial abuse

  • unusual or inappropriate activity in bank accounts
  • signatures of cheques, etc., that do not resemble the older person's signature, or signed when older person cannot write
  • power of attorney given, or recent changes or creation of will, when the person is incapable of making such decisions
  • unusual concern by caregiver that an excessive amount of money is being expended on the care of the older person
  • numerous unpaid bills, overdue rent, when someone is supposed to be paying the bills for a dependent elder
  • placement in nursing home or residential care facility which is not commensurate with alleged size of estate
  • lack of amenities such as TV, personal grooming items, appropriate clothing, that the estate can well afford
  • missing personal belongings such as art, silverware, or jewellery
  • deliberate isolation, by a housekeeper, of an older adult from friends and family, resulting in the caregiver alone having total control

Elders may be financially exploited if they are:

  • accompanied by a stranger who encourages them to withdraw a large amount of cash
  • accompanied by a family member or other person who seems to coerce them into making transactions
  • not allowed to speak for themselves or make decisions
  • with an acquaintance who appears too interested in their financial status
  • nervous or afraid of the person accompanying them
  • giving implausible explanations about what they are doing with their money
  • concerned or confused about 'missing funds' in their accounts
  • unable to remember financial transactions or signing paperwork
  • fearful that they will be evicted or institutionalised if money is not given to a caregiver
  • neglected or receiving insufficient care for their needs or financial status
  • isolated from other family members or supports by a family member of acquaintance

Symptoms of financial exploitation - suspicious banking activity

  • unusual volume of banking activity
    • frequent account changes from one branch/bank to another
    • change in pattern of withdrawals (e.g. several in one day) or unusually large amounts
    • large withdrawals or transfers from recently opened joint accounts
  • banking activity inconsistent with customer's usual habits
    • large withdrawal from previously inactive account or savings account
    • frequent withdrawals made through ATMs, especially if elder is physically frail and had not used ATM previously
    • regular rent or utility payments by cheque cease abruptly
    • stable, single beneficiary trusts are revoked
    • distribution provisions are altered to require payments to third parties
  • suspicious signatures on cheques or other documents, like credit card applications
    • elder's signature appears forged
    • cheques /withdrawal slips made out in one handwriting, elder's signature appears correct
  • sudden increases in incurred debt when elder appears unaware of transactions
    • bank loans obtained
    • large credit card or reserve credit debts
    • second mortgages obtained
  • a fiduciary or other begins handling the elder's affairs, withdrawing funds with no apparent benefit to the elder
  • bank statements and cancelled cheques are no longer sent to the elder's home
  • implausible reasons for banking activity are given either by the elder or the person accompanying him/her

Source: Commonwealth of Massachusetts (1996). The Massachusetts Bank Reporting Project. Employee training Manual.

Possible indicators of neglect by care giver

  • dirt, faecal/urine smell, or other health and safety hazards in elder's living environment
  • rashes, sores, lice on elder
  • elder is inadequately clothed
  • elder is malnourished or dehydrated
  • elder has an untreated medical condition

Possible indicators of self neglect

  • inability to manage personal finances, e.g. hoarding, squandering, giving money away or failure to pay bills
  • inability to manage activities of daily living, including personal care, shopping, meal preparation, housework etc.
  • suicidal acts, wanderings, refusing medical attention, isolation, substance abuse
  • lack of toilet facilities, utilities or animal infested living quarters (dangerous conditions)
  • rashes, sores, fecal/urine smell, inadequate clothing, malnourished, dehydration etc.
  • changes in intellectual functioning, e.g. confusion, inappropriate or no response, disorientation to time and place, memory failure, incoherence, etc.
  • not keeping medical appointments for serious illness

Possible indicators of abuse from the care giver

  • the elder may not be given the opportunity to speak for him or herself, or see others, without the presence of the caregiver (suspected abuser)
  • attitudes of indifference or anger toward the dependent person, or the obvious absence of assistance
  • family member or caregiver blames the elder (e.g. accusation that incontinence is a deliberate act)
  • aggressive behaviour (threats, insults, harassment) by caregiver toward the elder
  • previous history of abuse of others
  • problems with alcohol or drugs
  • inappropriate display of affection by the caregiver
  • flirtations, coyness, etc. as possible indicators of inappropriate sexual relationship
  • social isolation of family, or isolation or restriction of activity of the older adult within the family unit by the caregiver
  • conflicting accounts of incidents by family, supporters, or victim
  • unwillingness or reluctance by the caregiver to comply with caregiver to comply with service providers in planning for care and implementation
  • inappropriate or unwarranted defensiveness by caregiver

How to spot physical abuse

Physical signs

  • Unexplained bruises or marks
  • Unexplained burns
  • Fractures
  • Lacerations (cuts)
  • Abdominal injuries
  • Bite marks
  • Bruises on the head
  • Unbelievable explanations for injuries

Violation of Human Rights

The withholding of information or domination to make decisions. It is the denial of fundamental rights, for example respect for dignity, personal privacy, freedom of thought, belief, opinion, speech, expression and movement.

Older persons have the right to freedom, security, accurate information and not be subjected to cruel, inhuman or degrading treatment.

Nature of abuse

Profile of the victim

  • Average age is between 70 and 80 years
  • Gender-7 females to 1 male
  • The victim is most probably depressed, confused or demented and/or demanding.
  • The care needs of the older person plays an important role with regard to abuse especially where constant supervision, assistance with daily living requirements and 24 hour care are needed.
  • Social factors contributing towards abuse are limited financial resources, social interaction, living space, care, community resources as well as the past history of violence.
  • The physical state of the older person is also a factor-might be chronically ill, immobile and incontinent.

    It is clear that the potential victim demands a great deal of care and attention and is highly dependent on their caregivers.

Profile of an abuser

  • 85% of abusers are family members or a person known to the victim.
  • Feeling of loss of control, depression, confusion, low self esteem, resentment, helplessness and quilt as well as a lack of acknowledgement and support are all psycho-social factors.
  • Social factors can be described as constant negative and aggressive communication, accompanied by punishment through hurtful criticism or withdrawal, poor inter-personal relationships, isolation, financial stress, inadequate housing, lack of appropriate caring skills, lack of supervision, lack of knowledge of needs and resources and absence of care facilities.

One cannot help but realize that care of frail elderly persons places extreme demands and responsibilities on a caregiver. In an institutional setting, the demand on care staff can also be excessive, especially in the face of inadequate training, supervision and knowledge, care equipment, plus long working hours and staff shortages.

Should you wish to report cases of abuse or would like to obtain more information, contact
Pretoria Care for the Aged
Tel: +27 12 320 3577
Fax: +27 12 320 3577


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Page last revised on:: 2007-11-20 * web site feedback: web team