Introduction

Elder abuse first appeared on the national scene in the late 1970s but was of course present long before then. It has since become a recognized crime and a pressing social concern. There are various definitions of elder abuse. For the purpose of this review, elder abuse is abuse committed against a person in the advanced years of their life and can include physical, emotional or sexual abuse, financial abuse, medical deprivation or over-medication, neglect, or the basic violation of human rights. This abuse can be in the form of family violence, institutional violence, or violence by a stranger.

Prevalence of Elder Abuse

In 2009, statistics Canada reported that 13% of the population was over the age of 65. In this year there were 7,900 reported incidences of elder abuse, a number that had increased by 14% since 2004. Statistics Canada reports that, of the incidences reported to police, approximately ⅓ were committed by family members of the elderly person (most commonly a grown child or spouse), ⅓ were committed by friends or acquaintances, and ⅓ were committed by a stranger.

Profile of the Victim

A victim of elder abuse is typically dependent on the abuser and may have mental or physical disabilities. Due to reduced mental capacity and failing health, a caregiver may find that they need to devote more time to an aging elderly person. Elderly people who are abused are often isolated more from friends, neighbours, and family than those who are not abused. It is unclear whether this isolation is the product of the abuse, or if it is a necessary condition that provokes the abuse. In addition, it is difficult to know who is being abused since the elderly are rarely able to report their abuse to the police. They may still care for the abuser or feel ashamed that they were unable to stop the abuse on their own. It is imperative that the elderly recognize that they are not responsible for the crime committed against them.

Some general signs of abuse may include:

  • Bruises and cuts
  • Bed sores
  • Heightened levels of upset or agitation
  • Unexplained feelings of hopelessness, guilt, or inadequacy
  • Unusual withdrawal from family and friends
  • Discomfort or anxiety in the presence of particular people
  • Reluctance to speak about the situation.

Many of the signs and symptoms of elder abuse do overlap with symptoms of mental deterioration, such as dementia, but this does not mean that they should be dismissed as such. They should also not just be dismissed if the elderly person denies that there is anything wrong.

Profile of the Offender – What To Look For

The abuser is often a middle-aged adult who can be a child, spouse, relative, friend, professional caregiver or a stranger. Behavioural factors such as mental illness, developmental delay, dementia, and drug/alcohol dependency are a major determinant of who abuses the elderly. Caregivers who are experiencing these problems will have greater difficulty in caring for an elderly person. An abusive caregiver may also feel resentment towards the elderly person or overwhelmed by their role as caregiver. External stressors such as problems with their own health, unemployment, or financial and marital problems increase the likelihood of abuse. It is important to recognize that not all of these factors need be present for abuse to occur. Sometimes only one factor may be present, or it could be a combination of factors. The abusive caregiver often depends on the elderly person for money, accommodation and/or emotional support. Caregivers often abuse the elderly because they feel inadequate; if they are able to humiliate and abuse another person, it makes them feel powerful.

Forms of Abuse Committed Against the Elderly

Physical Abuse – This refers to any act of violence or rough treatment, whether or not actual physical injury results. Violent acts such as kicking, slapping, or pushing the elderly person are forms of physical abuse. It also includes sexual assault, deliberate exposure to severe weather, or confining the elderly person to a specific area by locking them in their room or using restraints.

Some of the signs of physical abuse that everyone should be aware of include:

  • Unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on both sides of the body
  • Broken bones, sprains, or dislocations
  • Broken eyeglasses or frames
  • Signs of being restrained, such as rope marks on wrists
  • Caregiver’s refusal to allow you to see the elder alone

The sexual assault of elders includes physical sex acts but can also include activities like showing the elderly person pornographic material, forcing them to watch sexual activity, or forcing them to undress. Some of the signs of sexual abuse can include:

  • Bruises around breasts or genitals
  • Unexplained venereal disease or genital infections
  • Unexplained vaginal or anal bleeding
  • Torn, stained, or bloody underclothing

Psychological Abuse – Psychological abuse includes humiliation, isolation, intimidation, threats, and inappropriate control of activities. It is also considered a form of psychological abuse to remove the decision making power from an elderly person who is still competent to make his/her own decisions. Signs of psychological abuse can include:

  • Depression, fear, anxiety, passivity, sadness
  • Social withdrawal
  • Avoiding eye contact when previously willing to meet eyes
  • Changes in appetite
  • Difficulty sleeping or excessively sleeping
  • Not being allowed to visit or talk to the older person; they may be isolated from the community, social services, and even from other family members by the abuser.

Financial Abuse – This refers to any improper conduct, with or without the informed consent of the older adult, which results in a monetary or personal gain for the abuser and/or monetary or personal loss for the older adult. Financial abuse occurs when a person forces an elderly person to sell property or steals their pension cheques or other possessions through the use of fraud, forgery and extortion, or through the wrongful use of Power of Attorney. Signs of financial abuse include:

  • Significant withdrawals from the elder’s accounts
  • Sudden changes in the elder’s financial condition
  • Items or cash missing from the senior’s household
  • Suspicious changes in wills, power of attorney, titles, and policies
  • Addition of names to the senior’s signature card
  • Unpaid bills or lack of medical care, although the elder has enough money to pay for them
  • Financial activity the senior couldn’t have done themselves, such as an ATM withdrawal when the account holder is bedridden
  • Unnecessary services, goods, or subscriptions

Rights Violations – This occurs when the elderly person’s basic and fundamental rights, as guaranteed under the Canadian Charter of Rights and Freedoms and the United Nations Declaration of the Rights of Older Persons, are violated. Some examples of violations include withholding information, denying privacy, restricting liberty, censuring mail, and not informing the person of her or his rights.

Medical Abuse – This form of abuse usually occurs in an institutional setting. This involves “any medical procedure or treatment that is done without the permission of the older person or his/her legally recognized proxy”. It also refers to actions that are not within accepted medical practice. Examples include medication, prescriptions, or treatments without the person’s consent, withholding medication, over-medicating (use of medical restraints), and forcing treatment. Some specific examples of this type of abuse include:

  • Duplicate billings for the same medical service or device
  • Evidence of over medication or under medication
  • Evidence of inadequate care when bills are paid in full
  • Reports of drug overdose or apparent failure to take medication regularly (a prescription has more remaining than it should)
  • Problems with the care facility:
    • Poorly trained, poorly paid, or insufficient staff
    • Crowding
    • Inadequate responses to questions about care

Neglect – There are three forms of neglect. These include active, passive and self neglect. Active neglect is deliberately withholding basic necessities such as food, shelter, and clothing. Passive neglect is usually the failure to care for the older person which is not deliberate. In institutions this may occur because there are fewer staff members and there is difficulty in helping the elderly quickly and efficiently. Family members may also be abusing the elderly through passive neglect because they do not have adequate training on how to care for an elderly person. Self neglect occurs when the older person fails to care for themselves by not practicing oral hygiene, feeding themselves, or dressing appropriately.

Causes and Contributions to Elder Abuse

Elder abuse can occur in many forms by a variety of different people. Below are a few of the causes or reasons that have been attributed to elder abuse.

  1. Family Pattern of ViolenceA history of family violence may mean that children who were formerly abused may repeat the violence against aging parents. Children who do not know how to deal with the frustration of caring for an aging parent may begin abusing. In fact, resorting to abuse is a common coping method for children who have been abused themselves. They may simply imitate the behaviour of their abusive parents, or resort to abuse out of retaliation. Although caregivers may have been abused by the elderly person in the past, it does not make it right for them to begin abusing the person now.
  2. Negative Attitudes about the ElderlyThese are the mistaken beliefs that the elderly are frail, dependent, forgetful, and at the end of their productive years. This attitude makes it difficult for the elderly person to be seen as a human being with real needs and desires. Many people view the elderly as weak and dependent and show little respect towards them. “Infantilization” is one way in which the elderly are further abused. Infantilization occurs when an elderly person is treated like a child. It can be verbal (such as use of pet names or directing child-like remarks, gestures, and patterns of speaking toward older persons), but it can also be physical (such as encouraging participation in child-like activities and having an age-inappropriate setting, such as a classroom, for the elderly people to interact and participate in activities).
  3. StressThe added pressure of caring for an aging parent may be overwhelming if the care giver is unaware of the support programs available to them to help with this responsibility. Life changes such as marital status and employment or coping with the recent death of a loved one increase the possibility of abuse as well. Abuse is also found in understaffed retirement homes and long term care institutions as employees are overworked and unable to give appropriate attention to the residents and patients there.
  4. Difficult Family RelationshipsElder abuse may in fact be long-term abuse occurring over a number of years. Many times elder abuse is spousal abuse which has simply aged. Other conflicts in the family which have not been resolved can also lead to abuse. For example, sibling rivalry may dominate in a family. This is enhanced when the parent talks positively about their child who isn’t there, while criticizing the one who cares for them. These feelings of hostility can build up and the caregiver may redirect their frustration through violence.

Elder Abuse in Institutions

Abuse in institutions is also known to occur and can include over or under-medicating the elderly people, inappropriate use of medical or physical restraints, and the theft of the elderly persons’ property. The Canadian Center for the Prevention of Elder Abuse cites the following reasons elder abuse may occur in an institution:

  • Isolation: many of the facilities that elderly people live in are separate from the community and few “outsiders” have contact with the elderly people, except for the family members who may visit.
  • Mismatch of skills: staff may not know how to properly care for elderly people with different medical needs, particularly when the elderly person is cognitively or physically impaired.
  • Ageism and Able-bodied-ism: Society places considerable value on being young and active. When people grow older or develop conditions that impair their abilities, they may become devalued. Their preferences and wishes are given less weight than other, younger, people’s needs or interests. Some consider the institution that the elderly person is living to be the last place they will live before they die and, because they are much closer to the “end of their life”, the elderly person is often devalued.
  • Systemic Problems: problems arise from the facility’s culture (whether or not they recognize the dignity and worthiness of their patients as expressed by upper management); inadequate staffing (insufficient number of people working at the facility or lack of appropriate training); staff minimization and rationalization of abuse; policy deficiencies; financial constraints (contributes to poor quality care); poor enforcement of standards of adequate care; work related stress and professional burnout; powerlessness and vulnerability of residents in general; staff retaliation (particularly in response to aggressive behaviours  in people with dementia).
  • Personality Traits: workers, administration or volunteers may not have the personality that is best suited for helping frail older adults.

Some potential solutions for minimizing stress among staff in institutions include:

  • Emphasizing that health care professionals are not to respond to aggression with aggression.
  • Educating the staff on how to deal with conflict with the patients.
  • Promoting support groups and counselling for staff members.
  • Listening to employees about concerns they have in regard to work overload or other problems that head staff may be unaware of.

Preventing Elder Abuse on the Streets

Seniors can also be easy targets for street violence. There are a number of things seniors can do to reduce the risk of becoming a victim of crime. Some preventive measures include:

  • Walking only in well-lit areas.
  • Do not burden yourself with packages and/or a bulky purse.
  • Never display large sums of money in public.
  • Walk near the curb and away from alleys and doorways.
  • Go shopping in pairs or in a group.
  • Be aware of your surroundings and avoid areas that increase your chances of being assaulted.
  • Report problem areas to the police.
  • If you suspect you are being followed, cross the street, go to the nearest home, service station, or business, and call the police.

Financial Abuse and Fraud

The most common form of abuse committed against the elderly is fraud. Here are some examples of schemes that target the elderly:

Bank Examiner – The victim is contacted by a fake bank examiner who claims that he is trying to catch a dishonest bank employee. The victim is asked to withdraw money so the fake banker can examine the serials. After the victim hands him or her the money, the bank examiner disappears.

Door to Door Sales – Many of these are illegitimate. Provincial laws protect the consumer from quick sales; enquire about them.

Consumer Frauds – This involves contests claiming that the victim could win or will win as long as they buy a product – be wary of them.

Home Improvement Offers – Be careful of home improvement offers made at the mall or on the spot. Occasionally, people posing as home renovators will approach a home and state that they were in the area fixing another house and noticed that the your home needed repairs. They will claim that, since they were in the area anyway, they will give you a discount. In reality, their prices will be much higher than necessary and often the work will not be done.

Utility scam- this fraud occurs when a pair of supposed home inspectors come to an elderly person’s home and say that they need to inspect their gas/water/hydro meter. One of the inspectors accompanies the elderly person to the utility meter while the other asks to use the washroom/telephone or states that he will wait for them. This person then proceeds to search the house for valuables while the elderly person is occupied with the other “inspector.”

Retirement Estates – Retirement estates offered at surprisingly low prices should be avoided. They are probably fraudulent in nature.

Business Opportunities – Schemes which offer the victim the opportunity to work from home or offer a business opportunity requiring the victim to give a substantial amount of money are usually fraudulent.

Preventing Financial Abuse

These are recommendations put forward by the Crime Prevention Council and the Ottawa Police Department. These preventative measures can help an elderly person to avoid financial abuse.

  • Do not rush into something involving your money or property.
  • Be wary of “something-for-nothing” or “get-rich-quick” schemes.
  • Never sign a contract until you and your lawyer, banker, or other expert have thoroughly read it.
  • Never turn over large sums of cash to anyone, especially a stranger, no matter how promising the deal looks.
  • Do not hesitate to check the credentials of a salesman or public official.
  • Report all suspicious offers to the police immediately.
  • Arrange for incoming cheques to be sent directly to the bank.

Rights of the Elderly

As with any other citizen, the elderly have basic rights guaranteed under the Canadian Charter of Rights and Freedoms which, for example provides for the protection of life, liberty, and security of the person. The United Nations has also adopted legislation regarding the elderly known as the United Nations Principles for Older Persons. These are as follows:

  1. Independence“Older persons should have access to adequate food, water, shelter, clothing and health care through the provision of income, family and community support and self-help.”“Older persons should be able to live in environments that are safe and adaptable to personal preferences and changing capacities.”
  2. Care“Older persons should be able to utilize appropriate levels of institutional care providing protection, rehabilitation and social and mental stimulation in a humane and secure environment.”“Older persons should be able to enjoy human rights and fundamental freedoms when residing in any shelter, care or treatment facility, including full respect for their dignity, beliefs, needs and privacy and for the right to make decisions about their care and the quality of their lives.”
  3. Dignity“Older persons should be able to live in dignity and security and be free of exploitation and physical or mental abuse.”

Criminal Code of Canada

Many forms of elder abuse are prohibited by the Criminal Code. Physical abuse, financial abuse, neglect and mental cruelty are all covered by the Criminal Code. Physical assault is prohibited through areas such as assault, sexual assault, forcible confinement, and murder or manslaughter. Financial abuse and the punishment for this crime are covered in areas such as theft/power of attorney, fraud, robbery, forgery, extortion and stopping mail with intent. Neglect is prohibited by areas such as a breach of a duty to provide necessities and criminal negligence causing bodily harm. Mental cruelty is covered in the Criminal Code in areas such as intimidation and uttering threats.

Services Available To Elderly Victims

There are various services available to the elderly person. These include emergency services, home support services and financial resources. Many elderly victims may be unaware of these services, and may falsely believe that there are no services available to them.

  1. Emergency InterventionIf a person is in immediate danger, the first thing to do is to dial 9-1-1, the police, or ambulance in your community. Once the person is out of the threatening situation, other services may be made available.If the older person needs housing, there are transition houses for women of all ages who are abused. However, if an older person needs emergency housing but also needs help with eating, dressing, or personal hygiene, they may not be able to get adequate help at a transition house. However, some homes for the aged do offer emergency housing arrangements. In Toronto, organizations such as Senior Support Services and Seniors’ Central Housing Registry will help find housing for the elderly. In addition, the Ontario government publishes a “Directory of Accommodation for Seniors in Ontario.” This lists a number of rest homes, retirement homes, homes for the aged, and seniors apartments.
  2. Home Support Services

    An elderly person who is being abused may wish to remain at home as opposed to going to a group home. There are a number of support services that can reduce the stress between the caregiver and the elderly person. These services also give the older person contact with someone other than the caregiver. These workers can also help monitor abuse which occurs in the home. Some examples of these services include:

    • Adult Day Care
    • Caregiver relief and companionship
    • Escort service
    • Friendly visiting
    • Home help
    • Homemaking
    • Home Care

    Unfortunately, not all of these services are available across Canada. However, some should be available in each province.

  3. Financial ResourcesOne of the main reasons that many elderly people do not leave an abusive situation is because they feel that they will be unable to survive without the income from the caregiver. There are a number of financial resources of which the elderly may be unaware and which can help them.Old Age Security Pensions – This is a fixed amount which every person over 65 who has landed immigrant status or who is a Canadian citizen receives. It does not depend on income or the person’s assets.

    Guaranteed Income Supplement (GIS) – Elderly people who only have the old age security pension may also be eligible for this benefit. This amount is dependent on how much the elderly person receives from other sources. Single people receive more from the GIS than married people do. For those elderly who have recently separated from their spouse, they must wait six months before they can apply to Health and Welfare Canada to claim single status on their GIS.

    Ontario Guaranteed Annual Income Supplement (GAINS) – If an elderly person receives both the old age security pension and the GIS, they may also be eligible to receive the GAINS supplement. Those people who receive the other two forms of assistance do not have to apply for this small pension given by the Ontario Ministry of Revenue; Health and Welfare Canada puts forth an application for the senior when they receive GIS.

Conclusion

In recent decades, elder abuse has become a widely recognized crime. The kinds of services available to the elderly vary significantly from province to province, but most police forces across Canada have special divisions dedicated to preventing and investigating elder abuse. As with all types of victimization, those that are committed against elderly people are wide ranging and can be committed by almost anyone, from their own children to complete strangers. Abuse against elderly people does differ in some respects however, as the abuse is often the consequence of the added stress placed on the caretaker of the elderly person. There is no excuse for abusing an elderly person, they have earned our respect and deserve our protection.

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