Elder abuse refers to any actions that cause physical, psychological, financial or sexual harm to an older adult. Neglect includes situations where a person or organization fails to provide services or necessary care to an older adult.
Examples of elder abuse and neglect include:
Sometimes, elder abuse and neglect results in a criminal offence.
Elder abuse and neglect may occur at home, in the community or in institutions (e.g. hospitals, health care facilities and long-term care homes). A person might intentionally or unintentionally harm an older adult in any of these settings.
Ageism can lead to elder abuse. Ageism is an attitude towards older adults based on negative beliefs about aging and assumptions that older adults are weak, frail or incapable. Ageism can result in demeaning, discriminatory or dismissive behaviour.
Indicators of elder abuse will vary, depending on an older adult’s experience. Knowing what is important to the older adult, what support and assistance is available, and what risk factors exist will help identify abusive situations.
Some hospitals and health authorities have developed diagnostic tools to help health care professionals identify elder abuse.
The National Initiative for the Care of the Elderly (NICE) has published user-friendly versions of the following tools:
IOA: Indicators of Abuse
(byMyrnaReisandDaphneNahmiash)
CASE: Caregiver Abuse Screen
(byMyrnaReisandDaphneNahmiash)
EASI: Elder Abuse Suspicion Index
(byMarkJ.Yaffe,MaxineLithwick,ChristinaWolfson)
IN HAND: An Ethical Decision-Making Framework
(byMarieBeaulieu)
Refer to the Charting Sheet: Responding to Elder Abuse and Neglect for a helpful way to document facts, concerns and risks related to elder abuse and neglect.
The appropriate response to elder abuse and neglect is to offer the most effective, but least restrictive and intrusive, support or assistance. Any support must recognize the older adult’s right to privacy and right to make decisions.
Refer to the brochures Confidential Patient and Client Information: Responding to Elder Abuse and Neglect and Mental Capacity and Consent: Responding to Elder Abuse and Neglect for more information.
Nurses need to seek consent from the older adult before initiating a care plan, implementing a plan of support or assistance, or disclosing personal or health care information.
An adult with mental capacity has the right to refuse treatment. Likewise, the mentally capable older adult who has experienced abuse or neglect, or is at risk of abuse or neglect, is entitled to decide what assistance or support is necessary. Refer to the brochure Mental Capacity and Consent: Responding to Elder Abuse and Neglect for more information.
The laws are different in each province and territory. The legal obligation to respond to elder abuse or neglect will depend on:
In some provinces, nurses must notify a delegated person or government authority about incidents of abuse or neglect when an older adult is receiving assistance from a health care facility or living in a long-term care home. In other provinces, the person who operates the care facility is legally obligated to notify the patient’s representative, medical employees, funding program or health authority.
In some provinces and territories, nurses must notify an appointed person or organization when an older adult is being abused or neglected and is in need of assistance or support, or is unable to care for himself or herself.
In some provinces, nurses also have a legal obligation to notify a designated person or government authority when an older adult is at risk of abuse or neglect.
Refer to the comparative table Summary of the Law in Each Province and Territory: Responding to Elder Abuse and Neglect for details about when to notify the appropriate person, organization or government body.
Elder abuse and neglect may occur at home, in the community or in institutions (e.g. hospitals, health care facilities and long-term care homes). Nurses will sometimes need to notify a designated person, organization or government body about incidents that occur at work.
Employers cannot discipline or discharge a nurse for fulfilling a legal requirement to notify a designated person, organization or authority about elder abuse, neglect or risk. Workplace policies should provide clear, practical guidance about when and how to respond to elder abuse and neglect
This project has been supported by the Public Health Agency of Canada through the Federal Elder Abuse Initiative. The views expressed herein do not necessarily reflect the official views of the Public Health Agency of Canada.
You should not rely on information tools for medical, financial or legal advice. It provides general information only. NICE is not responsible for any use of the information other than for general educational/informational purposes and no claim can be made against NICE or any of its personnel for any such use.
