Adults can be abused in many different ways. Some groups, such as the elderly and frail, are at particular risk of abuse and harm. Safeguarding adults is about protecting those at risk of harm (vulnerable adults) from suffering abuse or neglect.
What is adult abuse?
Abuse of adults can happen anywhere. It can happen at home, in a residential or nursing home, in a hospital, at work or in the street. There are different types of abuse, which include:
- Physical - being hurt or harmed either deliberately or through rough, careless or thoughtless behaviour.
- Emotional abuse or bullying - Being humiliated or put down or made to feel anxious or frightened.
- Financial abuse or theft - someone using your money or possessions in a way that you don't want.
- Neglect - not being given the things you need to feel safe and comfortable or not making sure you get the care or treatment you need.
- Sexual abuse - being made to do something that you don't want to do.
- Discrimination - including racist, sexist or abuse about a person’s disability.
- Domestic abuse - examples include psychological, physical, sexual, financial, emotional abuse or ‘honour’-based violence.
- Modern slavery - includes slavery, human trafficking and forced labour.
- Organisational abuse - include neglect and poor care within an institution or specific care setting such as a hospital or care home.
- Self-neglect - includes not caring for personal cleanliness, health or surroundings and includes behaviour such as hoarding.
Who is at risk?
Anyone can be vulnerable to abuse at some time in their life. Those who need safeguarding help are often elderly and frail, living on their own at home, or without much family support in care homes.
Many other groups of people are also at increased risk of suffering harm. Examples include those with physical or learning difficulties, people with mental health needs, young adults and immigrant workers.
The person who is responsible for the abuse is often well known to the person abused. They could be:
- A paid carer or volunteer.
- A health worker, social care or other worker.
- A relative, friend or neighbour.
- An employer.
- Another resident or service user.
- An occasional visitor or someone who is providing a service.
- Someone who deliberately exploits vulnerable people.
How large is the problem?
Abuse of vulnerable adults is common but often not reported. It is not known exactly how common it is.
How can I spot adult abuse?
At first, you might not recognise the signs of abuse. They may appear to be symptoms of dementia or signs of the elderly person's frailty. Examples of adult abuse include:
General signs of abuse
- Frequent arguments between the carer and the elderly person.
- Changes in personality or behaviour in the person being abused.
- Unexplained signs of injury such as bruises, burns or scars, or more serious unexplained injuries such as broken bones.
- Report of a person taking too much of their medicines or not taking their medicines regularly (a prescription has more remaining than it should).
- Broken eye glasses or frames.
- Signs of being restrained, such as bruises on the wrists.
- Staff in a care home refusing to allow you to see the elderly person alone.
- Threatening, belittling, or controlling behaviour by the abuser.
- Behaviour from the abused person that seems like dementia, such as rocking, sucking, or mumbling to themself.
- Bruises around the breasts or genitals.
- Unexplained genital infections.
- Unexplained bleeding from the vagina or from the back passage.
- Torn, stained or bloody underwear.
Neglect by caregivers or self-neglect
- Unusual weight loss because of not eating enough food or drinking enough fluids.
- Untreated physical problems, such as bedsores.
- Dirty living conditions: dirt, bugs, soiled bedding and clothes.
- Being left dirty or unbathed.
- Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards).
This may include:
- Significant withdrawals from the vulnerable person's bank account.
- Items or cash missing.
- Suspicious changes in wills, power of attorney, policies or other documents.
- Suspicious addition of names to the person's signature card.
- Unnecessary services, goods or subscriptions.
What should I do next?
If you are being abused or concerned about someone else being abused, it is very important to talk about your concerns.
If you are worried that there is an immediate danger of harm then you should contact the police. If you think the person is at immediate risk of serious harm from physical violence then you should dial 999/112/911.
It can be difficult for the abused person to talk to someone about what is happening, especially if:
- The person abusing them is otherwise someone they love such as a family member.
- They feel guilty.
- The person abusing them is someone they depend on for care or financial support.
- They feel frightened of what might happen if they tell someone
Who can provide me with support?
You can obtain help just by talking to someone you trust or by talking to:
- A GP or doctor.
- A social worker or care manager.
- Home carers.
- Community or district nurses.
- Daycare workers.
- Hospital staff.
Further reading and references
Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively; NICE Public Health Guidance (February 2014)
Safeguarding Vulnerable Older People (Abuse and Neglect) - Good Practice Guide; British Geriatrics Society (2009)
Adult Safeguarding Network; NHS England
Safeguarding adults; Social Care Institute for Excellence
Boland B, Burnage J, Chowhan H; Safeguarding adults at risk of harm. BMJ. 2013 May 14346:f2716. doi: 10.1136/bmj.f2716.
Cooper C, Selwood A, Livingston G; The prevalence of elder abuse and neglect: a systematic review. Age Ageing. 2008 Mar37(2):151-60. doi: 10.1093/ageing/afm194.
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