Consequences

The definition of mistreatment proposed by WHO clearly states that this phenomenon causes harm and distress to older adults [8]. Like any other type of victimization, mistreatment can affect a senior’s family and friends, neighbours, and living environment (e.g. residential facility), etc. [8]. Since older adult mistreatment is a social problem, it also has general long-term effects on society. However, these effects are poorly understood and not well documented [59]. To date, it is the consequences of elder mistreatment that have been documented most extensively.

Consequences of mistreatment for older adults

Mistreatment has short- and long-term impacts on the overall well-being of older adults [39,43]. In addition to causing premature relocation to residential facilities [59–61], mistreatment has a significant effect on the morbidity [60,62] and mortality of seniors [59,62–66]. Although some consequences, such as physical (Friedman, Avila, Tanouye and Joseph, 2011, cited by Roberto [39]) and material or financial ones [12,67], tend to be more visible, others, such as those that are psychological or social in nature [13,59,63], can be fairly subtle. Table 5 gives a few examples13.

Table 5 - Examples of consequences of mistreatment

Types of consequences

Examples

Physical

 
  • Temporary or permanent physical ailments [13,39,59,68];
  • Decline in health [13,60,62,69];
  • Functional decline [69,70;
  • Increased morbidity [60,62];
  • Mortality [16,59,62,64–66].

Psychological
  • Anxiety [13,43,59,68–71];
  • Depression [13,59,68,70,71];
  • Low self-esteem [13,43,68];
  • Sadness, low morale, unhappiness, dissatisfaction [13,43,68];
  • Suicidal ideation [13,72–74];
  • Growing sense of insecurity [13,73,75];
  • Shame [13];
  • Guilt [13];
  • Mistrust [13].

Material or financial

 
  • Loss of financial resources [13,67,76,77];
  • Loss of material possessions [13,77];
  • Being deprived of basic necessities [13,67,77];
  • Debts [13];
  • Insolvency [13];
  • Bankruptcy [13].

Social
  • Loneliness [13,43,68,69];
  • Loss of contact with family and friends [13];
  • Conflicts [77];
  • Growing dependency [13].

Source : Based on a table concerning the consequences of mistreatment of older adults by type of mistreatment in the Guide de référence pour contrer la maltraitance envers les personnes aînées, 2nd edition.[13].

It should be noted that one type of mistreatment can have several different types of consequences. For example, the main consequences of material or financial mistreatment are usually financial in nature, but they can also be psychological, physical, or social [67].

Several of the signs of each of the seven types of mistreatment (psychological, physical, sexual, material or financial, organizational, violation of rights, ageism) [12] are also potential consequences that may be observed among mistreated older adults (Table 6).

Table 6 - Signs of mistreatment for each of the seven types of mistreatment

Types of mistreatment

Signs

Psychological mistreatment

Signs

Fear, anxiety, depression, withdrawal, reluctance to speak openly, mistrust, fearful interaction with one or more people, suicidal ideation, rapid decline of cognitive abilities, suicide, etc.

Caution

Psychological mistreatment is undoubtedly the most common and least visible type of mistreatment:

  • It often accompanies other types of mistreatment;
  • Its consequences can be just as detrimental as those of other types of mistreatment. 

Physical mistreatment

Signs

Bruises, injuries, weight loss, deteriorating health, poor hygiene, undue delay in changing incontinence briefs, skin conditions, unsanitary living environment, atrophy, use of restraints, premature or suspicious death, etc.

Caution

Some signs of physical mistreatment may be mistaken for symptoms associated with certain health conditions. It is therefore preferable to request a medical and/or psychosocial assessment.

Sexual mistreatment

Signs

Infections, genital wounds, anxiety when being examined or receiving care, mistrust, withdrawal, depression, sexual disinhibition, sudden use of highly sexualized language, denial of older adults’ sexuality, etc.

Caution

Sexual assault is above all an act of domination. Cognitive impairment may lead to disinhibition, which can result in inappropriate sexual behaviour. Not recognizing or mocking the sexuality of older adults or preventing them from expressing their sexuality is a form of mistreatment, and it also makes it more difficult to identify and report sexual mistreatment. It is also important to keep an eye out for pathological sexual attraction toward older adults (gerontophilia).

Material or financial mistreatment

Signs

Unusual banking transactions, disappearance of valuable items, lack of money for regular expenses, limited access to information regarding the management of a person’s assets, etc.

Caution

Older adults who are in a relationship of dependency (e.g. physical, emotional, social or business-related) are at a greater risk of material or financial mistreatment. In addition to the financial and material implications, this type of mistreatment can affect older adults’ physical or psychological health by limiting their ability to fulfill their responsibilities or meet their own needs. 

Organizational mistreatment

Signs

Treating a person like a number, inflexible care or service schedules, undue delays in service delivery, deterioration of the person’s state of health (wounds, depression, anxiety), complaints, etc.

Caution

It is important to be aware of organizational shortcomings that can violate a person’s right to receive care and services, or that can lead to conditions that negatively affect the work of staff in charge of providing care or services.

Ageism

Signs

Failure to recognize a person’s rights, skills or knowledge, using condescending language, etc.

Caution 

We are all influenced, to varying degrees, by negative stereotypes and language about older adults. These misguided assumptions lead us to misinterpret various situations that can ultimately lead to mistreatment. 

Violation of rights

Signs

Preventing an older adult from participating in choices and decisions that affect his or her life, failing to respect the decisions that he or she makes, allowing family members to answer on behalf of the older adult, restricting visits or access to information, isolation, complaints, etc.

Caution

Violation of rights occurs in all types of mistreatment. Everyone is entitled to fully retain their rights, regardless of their age. Only a judge can declare a person incompetent and appoint a legal representative. Persons declared incapacitated retain their rights, within the limits of their capabilities. 

Source : Terminologie sur la maltraitance envers les personnes aînées [12].

The signs mentioned above are not always clear indications of mistreatment. Therefore, service providers must do a meticulous assessment of situations of suspected mistreatment [78]. The comments in the “Caution” sections of Table 6 identify avenues that are worth exploring, in addition to providing information that might be useful for assessment purposes. Service providers should also be aware that certain consequences, such as isolation, can constitute risk factors.

The consequences of mistreatment are numerous and vary from one person to the next. Table 6 shows that different types of mistreatment are sometimes associated with the same signs or consequences, such as depressive symptoms. While this may depend on individual experience, it can also be explained by the fact that a person may be a victim of more than one type of mistreatment at a time.

  1. Augmented version of a table in the second edition of the document Guide de référence pour contrer la maltraitance envers les personnes aînées [13].