The word mistreatment can be defined in many different ways, all of which have prompted considerable debate and questions. That being said, even though no consensus has been reached, there is one definition that has garnered general support internationally. It was adopted by WHO in 2002 through the Toronto Declaration at an international meeting of researchers, older adult associations, practitioners and public policy planners [9]. The Québec government drew inspiration from this definition in its first and second action plans on elder mistreatment (AP-1 and 2). The definition it proposed in AP-2 is as follows:

Mistreatment is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older adult, whether the person deliberately wants to cause harm or not [8].

According to this definition, it is not the intentional or unintentional nature of the violence (single or repeated act) or neglect (lack of appropriate action) that matters, but rather the results of such violence or neglect, the presence of a relationship of trust and the severity of the consequences, whether the latter are apparent or not. It should be noted that this definition excludes all forms of physical, moral, or material abuse by strangers. It should also be pointed out that it has drawn numerous criticisms, particularly with regard to the problems involved in rendering it operational in research [10,11].

In Québec, this definition has laid the groundwork for the development of a common language. Given that in the past many stakeholders did not have the same perception of the different forms and types of mistreatment or did not refer to common elements in describing them, steps were taken in 2015 to clarify these concepts [12]. This led to the recognition of two forms of mistreatment (violence and neglect) and seven types of mistreatment (Table 1), all of which are included in AP-2.

Table 1 - Types of mistreatment 

Types of mistreatment


Examples in the form of violence

Examples in the form of neglect

Psychological mistreatment

Gestures, words or attitudes that negatively affect a person’s psychological well-being or integrity.

Emotional blackmail, manipulation, humiliation, insults, infantilization, belittlement, verbal and non-verbal threats, disempowerment, excessive monitoring of activities, etc.

Rejection, ignoring, indifference, social isolation, etc.

Physical mistreatment

Inappropriate gestures or actions, or lack of appropriate action, that negatively affect a person’s physical well-being or integrity.

Shoving, bullying, hitting, burning, force-feeding, improper administration of medications, inappropriate use of restraints (physical or pharmacological), etc.


Failure to provide a reasonable level of comfort and safety, failure to provide assistance with eating, dressing, hygiene, or taking medication when a person is in a situation of dependency, etc.

Sexual mistreatment

Non-consensual gestures, actions, words or attitudes with a sexual connotation that negatively affect a person’s sexual well-being, integrity, or gender identity.

Suggestive comments or attitudes, jokes or insults with a sexual connotation, promiscuity, exhibitionist behaviours, sexual assault (unwanted touching, non-consensual sex), etc.

Failure to provide privacy, failure to respect or denial of a person’s sexuality, sexual orientation, or gender identity, etc.

Material or financial mistreatment

Fraudulent, illegal, unauthorized or dishonest acquisition or use of a person’s property or legal documents, lack of information or misinformation regarding financial or legal matters.

Pressure to change a will, banking transactions without a person’s consent (use of a debit card, online banking, etc.), misappropriation of money or assets, excessive price charged for services provided, identity theft, etc.

Failure to manage a person’s assets in his or her best interest or to provide necessities as required, failure to assess a person’s cognitive abilities, understanding, and financial literacy, etc.

Organizational mistreatment

Any prejudicial situation created or tolerated by organizational procedure in private, public or community organizations providing all types of care and services that compromises a person’s ability to exercise his or her rights and freedoms.

Organizational conditions or practices that do not respect a person’s choices or rights (e.g. services provided in a hasty or offhand manner), etc.

Services ill-adapted to a person’s needs, lack of instructions or poor understanding of instructions by staff, limited organizational capacity, complex administrative procedures, inadequate training of staff, unmotivated staff, etc.


Discrimination based on age, through hostile or negative attitudes, harmful actions, or social exclusion.

Imposition of restrictions or social standards based on age, limited access to certain resources, prejudice, infantilization, scorn, etc.

Indifference to ageist practices or comments, etc.

Violation of rights

Any infringement of individual and social rights and freedoms.

Forced medical treatment, denial of the right to: choose, vote, enjoy one’s privacy, take risks, receive phone calls or visitors, practice one’s religion, express one’s sexual orientation, etc.

Lack of information or misinformation regarding a person’s rights, failure to assist the person in exercising his or her rights, failure to recognize the person’s abilities, etc.

Source : Guide de référence pour contrer la maltraitance envers les personnes aînées, 2nd edition [13].