this is an act / omission done directly or indirectly to violate the right of older adult. this may be negligence, financial, material, sexual exploitation, that impact negatively on their physical, social and mental health

1. MANAGEMENT OF OLDER
ADULT ABUSE
REGISTRAR, MENTAL HEALTH DEPARTMENT OAUTHC

2. DEFINITION ; Older adult abuse.
• Abuse of older people as a single or repeated act or lack of
appropriate action occurring within any relationship in which there is
expectation of trust that causes harm or distress to an older person.
• WHO.

3. TYPES OF OLDER ADULT ABUSE
• Abuse can be physical, sexual, financial, psychological, social
and/or neglect.
The vast majority supported the need for a broader understanding of
abuse and for the definition to include:
 imbalance of power and control
 the gendered nature of abuse of older people
 abuse of an older person’s rights
 abuse of an older person’s pets and
 abuse can also involve a negligent act or a failure to act, as in cases
of neglect.

4. ‘Mistreatment’ is a term sometimes used instead
of abuse
 It can involve an act of commission (abuse) or omission (neglect)
which can be
 intentional, wilful, deliberate or malicious, or
 unintentional, benign, passive or reckless.

5. DESCRIPTION OF SPECIFIC ABUSE
 Physical abuse can include being pushed, hit, sexually assaulted,
burned or physically restrained
 Psychological abuse can include humiliation, insults, threats or being
treated like a child.

6. Neglect
 passive neglect: being left alone, isolated, or forgotten
 active neglect: withholding of items that are necessary for daily
living, such as food and medicine, or placing an older adult in
isolated or sub-standard care.

7.  Medical abuse can include the inappropriate use of restraints or the
withholding or careless administration of drugs, failure to treat an
illness, etc
 Social and environmental abuse can include a failure to provide
necessary human services and involuntary social isolation

8. Financial abuse
making improper use of an older adult’s property or money without
his or her knowledge or permission and can include
 forgery
 stealing
 forced changes to a will
 involuntary transfer of money or property to another person
 withholding funds from the older person and the
 failure to repay loans.

9.  Can also include the misappropriation of enduring powers when a
trusted person (usually a family member) is legally appointed with
enduring powers to manage the financial affairs of the older person.
 With the ageing population and the increasing complexity associated
with financial management, this type of abuse is likely to increase.

11. SUMMARY OF RISK FACTORS FOR OLDER ADULTS
ABUSE
OLDER ADULT’S FACTORS
• Dementia
• Physical disability e.g blindness,
defness.
• Alcohol & substance abuse
• Medications that interfere with
judgement.
• Shared living apartment..
CAREGIVER’S FACTORS
• Unemployment
• Substance use
• Dependent on the victim for
housing, and finance.
• Mental illness
• Feel overwhelmed by burden of
care especially in carers of older
adult with neurocognitive
disorder.

13. PREVALENCE OF OLDER ADULT ABUSE
• Domestic settings :
• 4 - 6%
• Commonest form - Financial & material exploitation
Physical abuse by spouses
• Gender distribution : male : ratio - 1 : 1
• This is not representative, because of under reporting of cases.
• Institutional settings :
• In a USA survey of nursing homes; 36% staff witnessed at least 1
abuse while 10% staff admitted to having committed at least 1 act of
physical abuse on their client.

14. Prevalence of types of abuse

15. Financial abuse of older people by relatives
• Research indicates that the people most likely to commit financial
abuse are the older person’s relatives, in particular their adult son or
daughter
• In nigeria..

16. Gender and abuse
 The 2001 SA Aged Rights Advocacy Service study found financial
abuse in one third of 100 cases over a period of 2 years - the
majority of victims were women aged over 75 years (James &
Graycar, 2000; Cripps, 2001).
 Other studies have found that abuse of older people within the
family is still largely the abuse of older women by older and younger
men
 Older women are particularly at risk of financial abuse, physical
abuse, and sexual abuse
(e.g. see Penhale 1999; Boldy et al. 2002; Faye & Selleck 2003;
Nerenberg 2008).

17.  Abuse of older adults is highly likely to be ‘spouse abuse grown old’
or continuing domestic violence
(see Nerenberg 2008; Leisey, Kupstas & Cooper, 2009; Brandl, 2000).

18. Older women’s experiences may be different to
those of older men
 Tend to live longer
 More likely to be financially abused after their partner dies
(Brozowski & Hall 2004)
 More likely to be abused by a broader range of family members
than men (Livermore, Bunt & Biscan 2001).
 Less likely to have access to superannuation and, therefore, more
likely to rely on the Aged Pension

19.  poor native language skills
 social isolation
 dependency on family members
 cross-cultural factors which result in differing expectations of care
and support
 fear of being shamed by and excluded from their communities

20. • Injuries such as bruises, cuts, or broken bones
• Malnourishment or weight loss
• Poor hygiene
• Symptoms of anxiety, depression, or confusion
• Unexplained transactions or loss of money
• Withdrawal from family members or friends
• E.t.c

21. • Increase sense of helplessness & insecurity
• Psychiatric disorder & worsening of outcome
• Malnutrition
• Increase morbidity and mortality...

22.  diminished cognitive capacity
 poor or restricted mobility
 lack of awareness of what constitutes abuse by victims or other
involved agencies.
 lack of knowledge of their rights or resources
 social isolation or fear of alienation

23.  need to preserve a family relationship
 dependency on others in the family
 stigma and shame associated with abuse
 literacy and language barriers
 religious, generational and cultural barriers
 fear of reprisal from the perpetrator
 perceived or actual lack of options or access to services.

24. MANAGEMENT OF OLDER ADULT ABUSE
• Multidisciplinary and multi-agencies
• Bio - psycho - social model
• Detailed history
• Physical examination
• Mental state examination -
features of neglect
thought disorders esp delusions
perceptual disturbance
cognitive functioning
To differentiate between ...

27. MANAGEMENT OF OLDER ADULT ABUSE
• PREVENTION OF OLDER ADULT ABUSE;
• primary secondary and tertiary prevention
• THE STEPPED CARE MODEL (protection of older adult from abuse)
Screening prospective carer/guardians
Educating the prospective carers
Monitoring of their activities (court or other agencies)
Enforcement- carer alleged to abuse client is removed from
his/her duty, pay fine or face jailtime.

28. • PRIMARY PREVENTION :
• Creating awareness about older adult abuse
United nations decade of healthy aging : 2021 - 2030
WHO in 2016 - June 15 as the world elder abuse awareness day.
• Community participation
• Legistlation to protect older adult from abuse..
Nigeria : National senior citizens centre act 2017
by the ministry of humanitarian affairs, distaster
management and social development.

29. • Adequate social services for the older adults
Housing
regular payment of pensions for those entitled
financial services
• Regular screening for any physical or mental illness that could
increase the risk of abuse..

30. SECONDARY PREVENTION
• Removal of victims from the environment
• Train and retrain carers and guardians
• Adequate treatment of sustained injuries
• Application of the stepped care model.

31. TERTIARY PREVENTION
• Rehabilitations of both the victims and perpetrators