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Mistreatment of older adults

Elder mistreatment helpline

1-888-489-2287
aideabusaines.ca This hyperlink will open in a new window.

Recognizing elder mistreatment

Elder abuse is a single or repeated attitude, word or act, or lack of appropriate action, occurring within a relationship with a person, community or institution where there is an expectation of trust, which, whether deliberately or not, causes harm or distress to an older adult.

The different situations of abuse experienced by an older adult may be associated with one or more of the following seven types:

Psychological mistreatment

Psychological or emotional abuse refers to attitudes, words, acts or lack of appropriate action undermining a person’s psychological well-being or integrity, such as:

  • Emotional blackmail
  • Manipulation
  • Humiliation
  • Insults
  • Infantilization
  • Verbal and non-verbal threats
  • Disempowerment
  • Excessive monitoring of activaties
  • Comments that are demeaning, xenophobic, sexist, homophobic, biphobic, transphobic, etc.
  • Rejection
  • Indifference
  • Lack of regard
  • Insensitivity

Psychological abuse is the most common and least visible form of elder abuse.

  • It often goes hand in hand with other types of abuse.
  • Its effects may be as detrimental as those caused by the other types of abuse.

Physical mistreatment

Physical abuse refers to attitudes, words, acts or inaction that undermine a person’s physical well-being or integrity, such as:

  • Shoving
  • Brutalizing
  • Hitting
  • Burning
  • Force feeding
  • Inappropriate administration  of medication
  • Inappropriate use of restraints (physical or chemical)
  • Failure to provide a reasonable level of comfort, security or accommodation
  • Failure to provide assistance with feeding, dressing, hygiene or medication to a dependent person in one’s care

Certain signs of physical abuse can be mistaken for symptoms caused by some health conditions. It is therefore preferable to ask for a physical or psychological assessment.

Sexual mistreatment

Sexual abuse refers to non-consensual attitudes, words, acts or a lack of appropriate action with a sexual connotation that undermine a person’s sexual well-being or integrity, such as:

  • Suggestive attitudes or remarks
  • Sexual jokes
  • Inappropriate promiscuity
  • Exhibitionism
  • Sexual assault (unwanted touching, sexual coercion)
  • Failure to provide privacy
  • Treating an older adult as an asexual being or preventing them from expressing their sexuality

A sexual assault is above all an act of domination. Cognitive impairments can lead to disinhibition resulting in inappropriate sexual behaviour. Failing to acknowledge or mocking an older adult’s sexuality or preventing them from expressing their sexuality is abuse, which may go undetected and unreported. A pathological sexual attraction to older adults (gerontophilia) must also be detected.

Material or financial mistreatment

Material or financial abuse refers to the fraudulent, illegal, unauthorized or dishonest appropriation or use of an older adult’s property or legal documents, along with the lack of information or misinformation about financial or legal matters, such as:

  • Exerting pressure to change their will
  • Unauthorized bank transactions (use of their bank card, online transactions)
  • Misappropriation of funds or property
  • Overcharging for services
  • Contract or insurance transactions achieved through deception or coercion
  • Identity theft
  • Signing a lease under pressure
  • Failure to manage the person’s assets in their best interests or refusing or neglecting to provide the necessary goodsFailure to manage the person’s assets in their best interests or refusing or neglecting to provide the necessary goods
  • Failure to assess the person’s cognitive abilities, understanding or financial literacy

Older adults who are dependent on others, whether physically, emotionally, socially or financially, are more vulnerable to this type of abuse. Beyond the financial or material aspect, this type of abuse can affect the older adult’s physical or psychological health by interfering with their ability to fulfill their responsibilities or to meet their needs.

Institutional mistreatment

Institutional mistreatment refers to any harmful situation that is created or tolerated by the practices or procedures of an institution (private, public or community) responsible for providing any type of care or services to older adults, such as:

  • Institutional conditions or practices that exclude older adults from making decisions that concern them, that do not respect their choices or that unjustifiably limit their access to assistance programs, etc.
  • Providing care or services that do not meet the person’s needs
  • Lack of instructions or staff’s poor understanding of instructions
  • Complex administrative proceduress
  • Poorly trained staff
  • Unmotivated staff

Institutional mistreatment is not limited to the health and social services system. We must be alert to any type of institutional shortcoming that can interfere with the individual and collective rights of older adults at any time. These shortcomings can also hinder the work of the staff tasked with providing care or services to older adults.

Ageism

Ageism refers to discrimination based on age, through hostile or negative attitudes, harmful actions or social exclusion, such as:

  • Imposing restrictions or social standards based on age
  • Limiting access to certain resources or services
  • Prejudice
  • Infantilization
  • Scorn
  • Indifference to ageist practices or remarks that are witnessed

Violation of rights

Violation of rights refers to the infringement of an older adult’s personal or social rights and freedoms, such as:

  • Imposing medical treatment
  • Denying the right to:
    • Choose
    • Vote
    • Enjoy privacy
    • Be informed
    • Take risks or make decisions
    • Receive telephone calls or visitors
    • Practise their religion or express their spirituality
    • Express their sexual orientation
  • Failing to inform or misinforming them about their human rights
  • Failing to assist the person in exercising their rights
  • Refusing to acknowledge the person’s capacities
  • Refusing to provide care or services

The violation of rights is an issue pertaining to all the types of abuse. Everyone fully retains their rights, regardless of their age. Only a judge can declare a person to be incompetent and appoint a legal representative. Moreover, people deemed incompetent still retain their rights, which they can exercise insofar as they are able.

Risk factors and vulnerability factors

There is no typical profile either for an abused older adult or for an abuser. Anyone can at any point become the victim or perpetrator of abuse. However, certain factors predispose people to experience abuse:

Factors associated with abused older adults

Some conditions, related to the characteristics of older adults or their environments, could predispose them to being the target of abuse. Each older adult therefore has risk factors and vulnerability factors.

Risk factors are related more closely to the person’s environment and to aspects characterizing their relationships with their limited or extended social networks.

The main risk factors are:

  • Social isolation and limited social network
  • Living with one or more relatives
  • Conflicts with family members or friends
  • Lack of access to resources
  • Social isolation and undeveloped social network
  • Financial dependence as it relates to immigration and sponsorship
  • Sharing the same home
  • Tension in the relationship between the older adult and the caregiver

Vulnerability factors concern the older adult’s personal characteristics that may make them more liable to be abused.

The main vulnerability factors are:

  • Social isolation and limited social network
  • Major neurocognitive disorders
  • Low income
  • Mental health problem (especially depression)
  • Physical disabilities
  • History of violence and neglect
  • Alcohol and drug dependence
  • Being a woman
  • Personality traits (hostility, passive or avoidance coping strategy)
  • Ethnic origin
  • Age
  • Civil status
  • Education level
  • Dependence on others
  • High level of stress and poor stress-management skills
  • Attitudes adopted by the abused older adult

When several of these factors are present, the person is even more vulnerable, and therefore at greater risk of abuse. This is often the case for older women, who, in 2021, accounted for around 54% of people aged 65 years and older. Statistics over the past few years also show that older women in Québec:

  • Make up the bulk of victims of abuse
  • Are poorer than men of the same age: in 2020, their earnings equalled about 70% of men’s income.
  • Are more likely to live alone because they have a longer life expectancy than men, but more often live with a disability requiring assistance for daily living activities: 27.7% of women need assistance compared with 13.3% of men.
  • Are less likely than men to receive the help they need, especially if they are single or widowed.

Factors associated with abusers

The abuser may be the person’s son, daughter, spouse, caregiver, friend or neighbour.

Abusers also have specific characteristics that may predispose them to inflict abuse on others.

The main risk factors and vulnerability factors for abusers are:

  • Hostility
  • Alcohol and drug dependence
  • Functional, emotional or financial dependence on the older adult
  • Loss of employment
  • Stress and burden of being a caregiver
  • Cognitive losses and major neurocognitive disorders
  • Mental health problem (especially depression)
  • Poor general health (combination of physical symptoms)
  • Living alone
  • Difficult personal relationship between the victim and the abuser (e.g., history of domestic violence)

The presence of these factors does not systematically lead to abuse situations.

Consequences

The consequences of abuse to an older adult may be felt in the short term, that is, at the time or shortly after the abuse occurs, or over the long term. The older adult’s general well-being can be affected for a long time, even when the abuse has stopped.

Abused older adults can experience effects on various levels:

  • Physically, such as:
    • Temporary or permanent physical effects
    • Deterioration in their health
    • Decline in their functional abilities
    • Greater number of illnesses
    • Mortality
    • Sleep problems
    • Increased alcohol use
    • Exhaustion and lack of energy
  • Psychologically, such as:
    • Anxiety
    • Depression
    • Low self-esteem
    • Sadness, low morale, unhappiness
    • Suicidal thoughts
    • Suicide attempts
    • Growing feeling of insecurity
    • Stress
    • Shame
    • Guilt
    • Deterioration in their healthy lifestyle caused by their poor mental health
    • Feeling of loss of control over their life
  • Socially, such as:
    • Solitude
    • Loss of contact with loved ones
    • Increased distrust or others
    • Conflicts
    • Increased dependence
    • Difficulty performing daily activities
    • Change in living environment leading to distance from the people they care about
  • Materially or financially, such as:
    • Loss of financial resources
    • Loss of property
    • Deprivation of basic necessities
    • Debts
    • Insolvency
    • Bankruptcy
    • Mistrust in others’ managing their affairs
    • Faster likelihood of being declared incompetent to manage their assets

Protective factors

Protective factors are aspects that help reduce the chances that abuse will occur or continue. They are divided into two categories: aspects specific to older adults themselves and those related to their close or extended environment.

The following characteristics are protective factors for older adults:

  • Having and applying effective stress-management skills
  • Ability to easily express their feelings and emotions
  • Ability to cope with and to make sense of events
  • Self-knowledge allowing them to recognize when to ask for help
  • connaître ses droits civils et humains;Knowledge of their civil and human rights
  • Having a personal safety plan
  • Developing a sense of competence by having the necessary resources to develop their skills
  • Looking forward to the future
  • Having a positive outlook on their sexual orientation or gender identity
  • Feeling connected to their community
  • Being socially engaged through leisure or volunteer activities
  • Being a long-term immigrant
  • Holding permanent immigration status
  • Being eligible for public benefits
  • Having adequate health and medication insurance upon immigration

With respect to protective factors related to the environment, the likelihood that elder abuse occurs or lasts is reduced when the older adult:

  • Has a quality social network including appropriate, available and resourceful people
  • Lives in a healthy and safe physical and psychosocial environment
  • Lives in a place free from ageism and social exclusion
  • Has a good financial situation with secured assets

Help and resources

General notice

For emergencies, call 9-1-1 immediately.
24 hours a day, 365 days a year

  • Elder Mistreatment Helpline This hyperlink will open in a new window.
    The “Elder Mistreatment Helpline”, is a provincial helpline and referral service that specializes in mistreatment. It provides services for the general public and for professionals and educators who work in the field of mistreatment.
    Services are provided in French and English (an interpreting service is available for some languages on request)
    8:00 a.m. to 8:00 p.m., 7 days a week.
  • Info-Social 811
    8-1-1
    The Info-Social 811 service provides advice and answers questions on psychosocial issues. If necessary, Info-Social 811 professionals can also refer the person to an appropriate resource in the health and social services network or to a community resource. Anyone who lives in Québec can call Info-Social 811 for themselves or a family member.
    24 hours a day, 7 days a week.
    Services are provided in French and English.

Resources for caregivers of older adults

  • Info-aidant This hyperlink will open in a new window.
    1-855-852-7784
    Info-aidant is a professional, confidential, free helpline for people who provide care to older adults and their families and friends as well as for health care providers and professionals.
    8:00 a.m. to 8:00 p.m., Monday to Friday.
    Services are provided in French and English.
  • L’Appui pour les proches aidants d’aînés This hyperlink will open in a new window.
    L’Appui pour les proches aidants d’aînés helps improve the quality of life of those providing care to older adults and makes their day-to-day life easier.

Resource in the event of incapacity

  • Curateur public du Québec This hyperlink will open in a new window.
    1 844 LECURATEUR (532-8278)
    The Curateur public ensures the protection of people who have been placed under public tutorship or curatorship. It also provides support to families and loved ones who are representing a person under tutorship or curatorship or who are members of a tutorship council. It ensures that decisions are made are in the interest of the person who is represented and in a manner that respects their rights and maintains their autonomy.

Other resources

  • Local Service Quality and Complaints Commissioner 
    The Commissioner receives and examines complaints regarding care and services received in the health and social services network. Any network user who believes their rights have not been respected or who is not satisfied with the services they received may express their dissatisfaction or file a complaint.
  • Coordonnateurs régionaux spécialisés en matière de lutte contre la maltraitance This hyperlink will open in a new window. (in French only) 
    The aim of the 18 regional coordinators deployed in each of Québec’s regions is to promote and support collaboration between the actors involved in the fight against mistreatment.
  • Commission des droits de la personne et des droits de la jeunesse (CDPDJ) This hyperlink will open in a new window.  
    1-800-361-6477
    The mission is to promote and uphold human rights and freedoms pursuant to the Charter of Human Rights and Freedoms. It also ensures compliance with the Act respecting equal access to employment in public bodies.
    Some information is available in English.
  • Autorité des marchés financiers (AMF) This hyperlink will open in a new window.
    1-877-525-0337
    Financial Markets Authority assists consumers of financial products and protects them, for example, in matters of insurance, investment or financial fraud. It also provides information on the prevention of financial mistreatment of older adults and provides training to its members on the subject.
    Some information is available in English.

Last update: August 23, 2022

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