Maltreatment: Types, forms and risk factors

Psychological maltreatment refers to attitudes, words, acts, or a lack of appropriate actions that have a negative effect on a person’s psychological well-being or integrity. For example:

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

Physical maltreatment refers to attitudes, words, acts, or a lack of appropriate actions that have a negative effect on a person’s physical well-being or integrity. For example:

• Shoving
• Brutalizing
• Hitting
• Burning
• Force-feeding
• Improper administration of medication
• Inappropriate use of restraints (physical or pharmacological)
• Failure to provide a reasonable level of comfort and safety or housing
• Failure to provide assistance with eating, dressing, hygiene or taking medication in a situation where the person is dependent

Sexual maltreatment refers to non consensual attitudes, words, acts, or a lack of appropriate actions, that carry a sexual connotation and have a negative effect on a person’s sexual well-being and integrity. For example:

• Suggestive attitudes or comments
• Jokes with a sexual connotation
• Inappropriate promiscuity
• Exhibitionist behaviours
• Sexual assault (unwanted touching, non-consensual sex)
• Failure to provide privacy
• Treating older adults as asexual beings or preventing them from expressing their sexuality
  
   
   

Material or financial maltreatment refers to the fraudulent, illegal, unauthorized or dishonest acquisition or use of a person’s property or legal documents, the concealment of information or providing false information regarding financial or legal matters. For example:  

• Pressure to change a will
• Banking transactions without consent (use of a debit card, online banking)
• Misappropriation of money or assets
• Charging an excessive price for services rendered
• Forced or concealed contractual or insurance transaction
• Identity theft
• Signing of a lease under duress
• Failure to manage a person’s assets in their best interest or to provide them with the necessities required
• Failure to assess a person’s cognitive abilities, understanding or financial literacy

Organizational maltreatment refers to any prejudicial situation created or tolerated by the practices or procedures of an organization (private, public or community) that is responsible for providing care and services to older adults. For example:  

• Organizational conditions or practices that exclude older adults from making decisions that concern them, that do not respect their choices or that limit their access to assistance programs, without adequate justification, etc.,
• Providing care or services that are not adapted to the person’s needs
• Lack of instructions or poor understanding of  instructions by staff
• Complex administrative procedures
• Poorly trained staff
• Non-mobilized staff

Ageism refers to discrimination based on age, through hostile or negative attitudes, harmful actions or social exclusion. For example:

• Imposing restrictions or social standards based on age
• Limiting access to certain resources or services
• Prejudice
• Infantilization
• Contempt
• Indifference towards ageist practices or comments when witnessed
  
   
   

The violation of rights refers to any infringement of an individual’s personal or social rights and freedoms. For example:

• Forced medical treatment
• Being denied the right to:
  • choose
  • vote
  • privacy
  • be informed
  • take risks or make decisions
  • receive phone calls or visitors
  • practice one’s religion or express one’s spirituality
  • express one’s sexual orientation
• Failing to inform or misinforming a person about their rights
• Failing to assist a person in exercising their rights
• Failing to recognize a person’s capacities
• Refusing to provide care and services

Risk factors are more closely related to a person’s environment and the relationships they have with those in their immediate or extended circle. Here are the most common ones:

• Social isolation and limited social network
• Living with one or more relatives
• Conflicts with family or friends
• Lack of access to resources, geographic isolation
• Being financially dependent due to immigration or sponsorship status
• Maltreated adult and perpetrator living in the same home
• Tension in the relationship between the maltreated adult and their caregiver

Vulnerability factors refer to characteristics specific to the adult that can make them more likely to experience mistreatment. Here are the most common ones:

• Age
• Being a woman
• Major neurocognitive disorders
• Low income
• Mental health disorders
• Physical disabilities
• History of violence and neglect
• Alcohol or drug abuse
• Unkept appearance (e.g.: body odour, overall appearance, etc.)
• Personality traits (hostility, passive, avoidant)
• Ethnicity
• Marital status
• Level of education
• Illiteracy
• Poor knowledge of English or French
• Being dependent on others
• High level of stress and poor coping skills
• Behaviours exhibited by the mistreated older adult