Assessing the mental health needs of older people

Types and indicators of abuse

The following is based on a list developed by the Multi-Agency Adult Protection Policy for Kent and Medway.

Hitting, slapping, scratching
Pushing or rough handling
Assault and battery
Restraining without justifiable reason
Misuse of medication
Inappropriate sanctions including deprivation of food, clothing, warmth and health care needs

A history of unexplained falls or minor injuries especially at different stages of healing
Unexplained bruising in well-protected areas of body, e.g. on the inside of thighs or upper arms etc.
Unexplained bruising or injuries of any sort
Burn marks of unusual type, e.g. burns caused by cigarettes and rope burns etc.
A history of frequent changes of general practitioners or reluctance in the family, carer or friend towards a general practitioner consultation
Accumulation of medicine which has been prescribed for a client but not administered
Malnutrition, ulcers, bed sores and being left in wet clothing

Sexual activity which an adult client cannot or has not consented to or has been pressured into
Sexual activity which takes place when the adult client is unaware of the consequences or the risks involved
Rape or attempted rape
Sexual assault and harassment
Non contact abuse e.g. voyeurism, pornography

Unexplained changes in the demeanour and behaviour of the vulnerable adult
Tendency to withdraw and spend time in isolation
Expression of explicit sexual behaviour and/or language by the vulnerable adult which is out of character
Irregular and disturbed sleep pattern
Bruising or bleeding in the rectal or genital areas
Torn or stained underclothing especially with blood or semen
Sexually transmitted disease or pregnancy where the individual cannot give consent to sexual acts

Emotional abuse
Verbal abuse
Humiliation and ridicule
Threats of punishment, abandonment, intimidation or exclusion from services
Isolation or withdrawal from services or supportive networks
Deliberate denial of religious or cultural needs
Failure to provide access to appropriate social skills and educational development training

Inability of the vulnerable person to sleep or tendency to spend long periods in bed
Loss of appetite or overeating at inappropriate times
Anxiety, confusion or general resignation
Tendency towards social withdrawal and isolation
Fearfulness and signs of loss of self-esteem
Uncharacteristic manipulative, uncooperative and aggressive behaviour

Unexplained inability to pay for household shopping or bills etc.
Withdrawal of large sums of money which cannot be explained
Missing personal possessions
Disparity between the person's living conditions and their financial resources
Unusual and extraordinary interest and involvement in the vulnerable adult's assets

Ignoring medical or physical care needs
Failure to give prescribed medication
Failure to provide access to appropriate health, social care or educational services
Neglect of accommodation, heating, lighting etc.
Failure to access care or equipment for functional independence
Failure to give privacy and dignity
Professional neglect

Inadequate heating, lighting, food or fluids
Failure by carer to give prescribed medication or obtain appropriate medical care
Carer's reluctant to accept contact from health or social care professionals
Refusal to arrange access for visitors
Poor physical condition in the vulnerable person e.g. ulcers, bed sores
Apparently unexplained weight loss
Unkempt clothing and appearance
Inappropriate or inadequate clothing, or nightclothes worn during the day
Sensory deprivation - lack of access to glasses, hearing aids etc.
Absence of appropriate privacy and dignity
Absence of method of calling for assistance

Discrimination demonstrated on any grounds including sex, race, colour, language, culture, religion, politics or sexual orientation
Discrimination that is based on a person's disability or age
Harassment and slurs which are degrading
Hate crime