Elder Abuse and Safeguarding

🧓 Elder abuse is any act of commission or omission that harms an older adult’s health, dignity, or welfare. It may be physical, psychological, sexual, financial, or neglect in nature. 📊 Around 1 in 10 adults over 60 experience abuse — but cases are widely underreported due to fear, dependence, stigma, or shame. ⚠️ For clinicians, vigilance and sensitive enquiry are essential.

🔎 Types of Elder Abuse

• 👊 Physical Abuse: Hitting, pushing, restraining, inappropriate use of medication.
• 🗣️ Psychological Abuse: Threats, humiliation, intimidation, isolation, verbal assaults.
• 🚫 Neglect: Failure to provide food, medication, hygiene, or healthcare.
• 🚶 Abandonment: Leaving a dependent adult without arranging care.
• ❌ Sexual Abuse: Non-consensual acts, coercion, exploitation.
• 💷 Financial Abuse: Theft, scams, coercion over wills, unauthorised banking.

⚠️ Risk Factors

• 🧠 Cognitive impairment or dementia.
• 🛏️ Dependence for ADLs (feeding, dressing, toileting, medications).
• 🌐 Social isolation, frailty, poor support networks.
• ♀️ Gender: women disproportionately affected.
• 🍷 Carer stress, burnout, or substance misuse in relatives.

🧾 Signs of Elder Abuse

• 🤕 Unexplained injuries, recurrent falls, repeated A&E attendances.
• ⚖️ Weight loss, dehydration, poor hygiene, pressure sores.
• 😟 Fearful, withdrawn, or submissive behaviour.
• 💳 Sudden financial changes: missing money, unpaid bills, unusual legal activity.
• 🏚️ Unsafe living conditions (hoarding, no heating, hazards).
• 🙊 Carer dominating or blocking communication.

🛠️ Management and Safeguarding

• 🚨 Ensure Immediate Safety: Remove from danger, provide urgent medical care.
• 📝 Document Thoroughly: Record verbatim statements, note injuries on body maps/photos (per policy).
• 📢 Report Concerns:
  • Follow local safeguarding procedures.
  • Escalate to Adult Safeguarding Team or Social Services.
  • Police if crime suspected (e.g., assault, theft).
• 🤝 Multi-Agency Approach: GPs, nurses, social workers, safeguarding leads working together.
• 🧭 Support Services: Age UK, Citizens Advice, advocacy, counselling.
• 🎓 Training: Healthcare staff must complete safeguarding training (Levels 1–3).

🏥 Safeguarding in the NHS

The NHS has a statutory duty to safeguard adults at risk, guided by the Care Act 2014 and Mental Capacity Act 2005.

• 📜 Policy Compliance: Staff must follow local trust safeguarding protocols.
• 🔐 Confidentiality vs Safety: Sharing information is lawful if it protects a vulnerable adult.
• 👥 Interagency Working: Collaboration with local authorities, CQC, and police is crucial.
• 🩺 Duty of Candour & GMC Guidance: Doctors must act in best interests and escalate concerns promptly.

📚 Conclusion

👀 Elder abuse is often hidden but has profound health consequences. NHS professionals are at the frontline of recognition and intervention. By maintaining a high index of suspicion, acting swiftly, and working within safeguarding frameworks, clinicians can protect vulnerable older adults and uphold their dignity and safety.

🔗 References

• NICE Guidance: Safeguarding Adults
• Care Act 2014
• GMC: Raising Safeguarding Concerns

🧾 Clinical Case Examples – Elder Abuse

Case 1 – Physical Abuse 💥 An 82-year-old woman with mild dementia presents with multiple bruises of different ages on her arms and back. She is withdrawn and avoids eye contact. Her son reports she is “clumsy and keeps falling.” 👉 Concern: Physical abuse. 👉 Action: Gentle, open questioning in private. Document carefully. Safeguarding referral to social services, assess capacity, ensure safety.

Case 2 – Financial Exploitation 💷 A 79-year-old man with Parkinson’s disease is brought in by a neighbour. He reports that his grandson has been taking his bank card and withdrawing money without permission. His bills remain unpaid, and his heating has been cut off. 👉 Concern: Financial abuse. 👉 Action: Explore capacity to manage finances. Involve safeguarding team, social services, and potentially police. Consider referral to Age UK or Citizens Advice for support.

Case 3 – Neglect 🛏️ A 90-year-old woman is admitted from a care home with dehydration, a urine infection, and multiple pressure sores. She appears malnourished and is wearing soiled clothing. 👉 Concern: Neglect (possibly institutional). 👉 Action: Document findings, raise safeguarding alert, involve safeguarding lead, CQC notification for care home, multidisciplinary management (nursing, dietician, physio).

Case 4 – Psychological/Emotional Abuse 😔 An 85-year-old man with hearing loss attends clinic with his daughter. Each time he tries to answer questions, she interrupts and belittles him (“He’s useless, don’t listen to him”). He appears anxious and reluctant to speak. 👉 Concern: Emotional/psychological abuse. 👉 Action: Seek opportunity to speak with him alone. Assess capacity and mood. Document interactions. Refer to safeguarding team.

Case 5 – Sexual Abuse 🚨 A 76-year-old woman with advanced dementia is found by carers to have unexplained genital bruising. She becomes distressed when a particular staff member enters the room. 👉 Concern: Sexual abuse. 👉 Action: Urgent safeguarding alert, forensic medical examination if appropriate, immediate steps to protect patient, notify police, involve safeguarding adults board.