Elder Abuse - Assessment and Intervention Reference Guide

Seniors deserve to live with dignity and respect

Abuse and neglect of an older person is any action or  inaction by any person that causes harm to an older person.

What To Do

Acknowledge - Suspicion of abuse may develop over time.  Accumulate and document evidence.

Barriers - Fear of retaliation, withdrawal of caregiver  support and breach of confidentiality creates barriers  to seeking help.

Urgency - Assess immediate needs and potential risk of physical harm.

Screen - Assess person’s physical, emotional and mental  capacity to help themselves.

Empower - Educate the person about their rights and available resources. Assist with establishing a safety plan

Refer - Seek support from, or consult with other  professionals.

Check For abuse…  

Physical Abuse

Any act of violence causing injury or physical discomfort,  including sexual assault (e.g., slapping, pinching,  punching or other rough handling; forcible restraint or  intentional over/under medication).

Indicators – unexplained injuries in areas normally  covered (e.g., bruises in various stages of healing,  burns or bites), untreated medical problems, history of  “accidents,” signs of over/ under medication, wasting,  dehydration.

Psychological Abuse 

Any action or comment causing emotional anguish, fear or  diminished self-esteem or dignity (e.g., threats to do harm,  unwanted institutionalization, harassment, abandonment,  imposed isolation, stopping a mentally capable senior  from making his or her own decisions or choices). Indicators – fear, anxiety, depression, withdrawal,  cowering, reluctance to talk openly, fearful interaction with  caregiver, caregiver speaking on behalf of person and not  allowing privacy. 

Financial Abuse 

Theft or exploitation of a person’s money, property or  assets (e.g., fraud, forgery, misuse of Power of Attorney). Indicators – standard of living not in keeping with  income or assets, theft of property noted, unusual or  inappropriate activity in bank accounts, forged signatures  on cheques, forcing a person to sign over property or  execute a Will, overcharging for services or products,  overdue bills, mail going missing. 

Neglect

Failure to provide basic or personal care needs (e.g.,  food, water, required medications, shelter, hygiene,  clothing, exercise, social interaction, physical aids  such as eyeglasses, hearing aids, dentures), lack of  attention, abandonment, undue confinement, inadequate  supervision or safety precautions, withholding medical  services/treatment

• Active Neglect – Intentional failure of a caregiver to fulfill their  caregiving responsibilities.
• Passive Neglect – Unintentional failure of a caregiver to fulfill  their caregiving responsibilities because of lack of knowledge,  skill, illness, infirmity or lack of awareness of community  supports and resources.
• Self Neglect – Although not a form of elder abuse, it is the  person’s inability to provide for their own essential needs  because of physical infirmity or inability to make sound  choices due to addiction, mental illness and/or cognitive  impairment.

Indicators – Unkempt appearance, inappropriate or  dirty clothing, signs of infrequent bathing, unhealthy  living conditions, home environment dangerous and/or  in disrepair, hoarding, lack of social contact, no regular  medical appointments

Institutional Abuse

Any physical, sexual, psychological or financial abuse or  neglect occurring within a facility (e.g., active victimization,  withholding or denying individual care needs, failure to  respect an individual’s rights, overmedication, misuse of  chemical or physical restraints and/or failure to carry out  reasonable requests).

Domestic Abuse

Actual or threatened physical, sexual, financial or  psychological abuse of a person by someone with whom  they have an intimate or familial relationship (e.g., aims to  instill fear and/or to coercively control the individual).

Interview Strategy

1. Develop trust and be sensitive to the person’s culture,  religion, comfort level and timing in obtaining disclosure.  Interview alone and listen, be patient, non-threatening  and non-judgmental. Validate feelings and offer  emotional support; avoid premature assumptions and  suggestions. Some cultures may require a family member  to be present during the interview or it may be necessary  to negotiate in order to interview someone alone.
2. Note suspicious histories: explanations vague, bizarre  or incongruent with the type or degree of injury; denial  of obvious injury; long delay between injury and  treatment history of “doctor shopping.”
3. Be alert to the person’s wishes. Assess whether the  person has the ability to “understand” and “appreciate”  what is happening (whether they are mentally competent)  and try to determine what their needs are.
4. Identify what information is missing (e.g., frequency  and duration of abusive incidents, urgency, need for  physical examination).
5. Be aware of interdependent relationships and power  differentials. Be cautious of the involvement of a third  party who may be the abuser; note conflicting histories. Where appropriate, interview family members, but  remember that it’s key to TALK TO THE SENIOR even if  family are available.

Safety Plan

The plan may include a change to an element of their  environment or their relationship which could result in the  elimination of the role of the abuser or context of the abuse. Consider:

• Home visits and telephone contact by service providers,  contact with other family and friends, regular appointments.
• Securing assets (e.g., hiding emergency money, such as coins  for a pay phone, somewhere outside home).
• Giving copies of important documents and keys to trusted  friends or family members.
• Planning escape by packing a bag of extra clothing, medicine  and personal aids (e.g., glasses, hearing aids, etc.).
• Keeping phone numbers of friends, relatives, shelters or other  trusted individuals handy.

Possible Interventions

• Consider the impact on the person, their wishes, their  willingness to make changes and their ability to recognize  that they may be a victim of abuse. Note their mental  capacity for decision-making and understanding of the  consequences of their decisions. Understand that often  before a person will seek or agree to accept help, they  need to be able to trust you and know that you will follow  through with the help you offer to give. Your role could be  singular or part of a team of service providers that could  support the person to be healthy and safe. Be aware  of appropriate resources or know how to link with the  broader community.

PRIVACY LEGISLATION

Police services need to understand relevant provincial,  territorial and federal privacy legislation in order to be able  to access records and information relevant to investigations  of allegations of abuse. Privacy legislation creates the rules  about the collection, use and disclosure of information  about individuals and when this collection, use and  disclosure can be done with and without consent of the  individual.

Privacy law is complex. It is recommended that you seek  legal advice from your own agency/authority (legal counsel,  internal directives, etc) to determine what legislation  applies in your jurisdiction, to your particular investigation  and how that legislation and the associated case law is  interpreted in practice.  

The federal government, and the provinces and territories,  have passed legislation governing the collection, use  and disclosure of personal information in a manner that  recognizes the right of privacy of individuals with respect to  their personal information and the need of organizations to  collect, use or disclose personal information for purposes  that a reasonable person would consider appropriate in  the circumstances. There also may be provisions in other  statutes (other than the specific privacy legislation) that  may be relevant to the collection, use and disclosure of  personal information in reference to your investigation.  In most provinces and territories, you need to consider both  the federal and provincial/territorial legislation unless the  federal legislation does not apply to your province.

For example, the federal Personal Information Protection  and Electronic Documents Act (PIPEDA) is applicable in  all provinces and territories unless the province/territory  has passed provincial/territorial legislation that has been  determined to be substantially similar to PIPEDA. This is  the case in Quebec, Alberta and BC.

Ontario has passed privacy legislation with respect to  health information that is substantially similar to PIPEDA,  but PIPEDA would still apply to non-health information in  that province.

Issues addressed in privacy legislation include:

• when and how information may be collected, used and  disclosed to whom the legislation applies  
• an individual’s right of access to their personal information - requirements for an individual’s consent to disclosure - who may consent if the individual is not mentally capable - exceptions to the requirements for consent or access

Education

Provide information and support according to the interests  expressed by the person. Be aware of services outside the  health care system that are specific to the needs of any  older adult or specific to the needs of older people who  are being victimized or are at risk. These include social  services, legal services, financial assistance, housing  options and faith communities.

Possible Interview Questions

In considering using these questions, follow your professional  standards in investigative interviewing and in obtaining client consent.

• Is there something that you would like to share with me? » Has there been a recent incident causing you concern? » Are you afraid of anyone at home?
• Has anyone ever forced you to do things you didn’t want to do?
• Has anyone ever tried to take advantage of you?
• Has anyone ever failed to help you take care of yourself when you needed help?
• Have you ever signed any documents that you didn’t understand  or didn’t want to sign?
• Do you make decisions for yourself or does someone else make  them for you?
• Would you like some help with ............................?

This tool is considered to be a promising approach  based on front-line practice experience. It is an  adaptation of the original that was developed in  collaboration with the Hamilton Police Service,  Hamilton Council Against Abuse of Older Persons,  McMaster Centre for Gerontological Studies and  Hamilton area hospitals.