Abuse and neglect of older adults is a health and social problem with profound consequences that affects people from all walks of life. To prevent and address it, committed effort on multiple levels is required. Several definitions for abuse and neglect of older adults have been developed over time.
Overarching definitions of abuse and neglect
“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, 2002, p.126).
“Mistreatment of older adults refers to actions and/or behaviours, or lack of actions and/or behaviours that cause harm or risk of harm within a trusting relationship. Mistreatment includes abuse and neglect of older adults” (NICE, 2012, p.99).
Note: some people may experience several types of abuse and neglect simultaneously or at different points in their lives.
Types of abuse and neglect discussed in the literature
Physical abuse
“Actions or behaviours that result in bodily injury, pain, impairment or psychological distress” (NICE, 2012, p.99).
“Physical abuse may include one or more of the following, but is not limited to:
- pushing, shoving;
- hitting, slapping, poking;
- pulling hair, biting, pinching;
- spitting at someone; and
- confining or restraining a person inappropriately” (ESDC, 2011).
Emotional/psychological abuse
“Severe or persistent verbal or non-verbal behaviour that results in emotional or psychological harm” (NICE, 2012, p.99).
Psychological, emotional and verbal abuse is also defined as “any action, verbal or non-verbal, that lessens a person’s
- sense of identity, dignity and self-worth” (ESDC, 2011).
- “Psychological, emotional and verbal abuse may include one or more of the following:
- words or actions that belittle an older adult, are hurtful, make the person feel unworthy;
- not considering an older adult’s wishes;
- not respecting an older adult’s belongings or pets;
- inappropriate control of activities for example, denying access to grandchildren or friends;
- threatening an older adult with for example putting them in a “home”;
- treating an older adult like a child;
- removal of decision-making power while the older adult is still competent;
- withholding affection;
- verbal aggression, humiliation, isolation, intimidation; and
- name-calling” (ESDC, 2011).
Financial/material abuse
“An action or lack of action with respect to material possessions, funds, assets, property, or legal documents, that is unauthorized, or coerced, or a misuse of legal authority” (NICE, 2012, p.99).
“Any improper conduct, done with or without the informed consent of the older adult, which results in a monetary or personal gain for the abuser and/or a monetary or personal loss for the older adult. The misuse of another individual’s funds or property through fraud, trickery or force is financial abuse” (ESDC, 2011).
Sexual abuse
“Direct or indirect involvement in sexual activity without consent” (NICE, 2012, p.99).
Sexual abuse “includes coercing an older person through force, trickery, threats or other means into unwanted sexual activity. Sexual abuse also encompasses sexual contact with older adults who are unable to grant consent. This includes inappropriate sexual contact between service providers and their older adult clients” (ESDC, 2011).
Neglect
“Repeated deprivation of assistance needed by the older person for activities of daily living” (NICE, 2012, p.99).
Neglect is also defined as the “intentional or unintentional failure to provide for the needs of the older adult” (ESDC, 2011). Neglect can be divided into two categories: 1) Active neglect is “the deliberate or intentional withholding of care or the basic necessities of life”; and 2) Passive neglect is “the failure to provide proper care due to lack of knowledge, information, experience or ability” (ESDC, 2011).
Systemic abuse
Systemic abuse has multiple meanings. These may include
- rules in a facility or at the government level that inadvertently cause harms;
- repeated patterns of substandard care;
- situations where employees are unaware that their behavior is wrong and therefore there is no corrective action;
- failure of administration to effectively address incidents of abusive conduct; or
- system wide problems, such as inadequate resources or an institutional culture where staff fear consequences for reporting abuse (Spencer et al., 2008).
Note, the Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches guideline includes definitions of other types of abuse.