Everyone should have the right to live with dignity and be free from physical and psychological harm. Elder abuse has profound negative impact on the elderly persons, their family members, the abusers as well as the society as a whole. As such, prevention of elder abuse is an important issue that deserves our attention.

Definition and Types of Elder Abuse

According to the revised Procedural Guidelines for Handling Elder Abuse Cases (Revised 2021) by the Social Welfare Department, elder abuse is defined as follows:

Generally speaking, elder abuse refers to the commission or omission of any act that endangers the welfare or safety of an elderly person. Usually the elderly person being abused and abuser are known to each other, or abusers are responsible for the care of the elderly being abused.

An elder abuse act may occur once or repeatedly, or within a short period or for a long duration. The abusive act itself may constitute elder abuse, regardless of whether the elderly persons consider themselves being abused. Act that may cause harm to the elderly persons, though not being committed intentionally, may also constitute elder abuse.

There are six types of elder abuse:

Type	Nature	Examples of signs / symptoms / behaviours of elder abuse *
1. Physical abuse	It is physical injury or suffering inflicted on an elderly person non accidentally or due to the absence of any preventive measures.	There are injuries on various body parts of an elderly person, which do not appear to be caused by accident: obvious wounds / bruises at multiple parts of the body sprains, dislocations of joints and fractures burns/ scalds bruises reflecting the shape of finger, palm and cane lacerations internal injuries An elderly person being abused may exhibit unusual behaviour, such as having uncommon wounds but being unwilling to receive medical examination and treatment, making contradictory statements, frequent wandering around until late at night, in low mood, becoming depressed, becoming passive or being absent from activities in which he / she used to participate without cause.
2. Psychological abuse	It is the pattern of behaviour and / or attitudes towards an elderly person that endangers or impairs the elderly person's psychological health, such as acts of insult, scolding, isolation, causing fear to the elderly person for a long duration, intrusion into the elderly person's privacy and unnecessary restriction of the elderly person's freedom of access and movement.	Examples include: An elderly person being subject to constant cynical remarks, scolding, neglect, intimidation, nit-picking or loathing. An elderly person being subject to frequent isolation and not allowed to contact his / her family members, grandchildren and friends. An elderly person being forced to leave home or stay only in his / her room during daytime and forbidden to use the facilities and common area of the house. Psychological abuse often co-exists with other types of abuse, and may also worsen gradually and turn into physical abuse. The following signs are shown with regard to an elderly person's emotional state and behaviour : extremely passive often showing extreme apprehension being afraid of the carer avoiding contacts with others depression tendency emotionally disturbed attempting suicide hysteria
3. Financial abuse	It is any act which involves depriving an elderly person of his / her wealth, or not acting in an elderly person's interests, such as taking away an elderly person's possessions, money or transferring his / her assets without consent.	An elderly person opens a joint account with another person who later withdraws money from it unilaterally. An elderly person suddenly transfers his / her properties to another person, or purchases a property jointly with another person who later sells it unilaterally. An elderly person suddenly loses possessions or assets belonging to him / her. An elderly person has inadequate resources to cover daily basic necessities and daily living expenses even though he / she should be financially sufficient. An elderly person suddenly makes a will to leave all or most of his / her possessions to a non-related person. An appointee or agent entrusted to receive or keep in custody of the Comprehensive Social Security Assistance payments on behalf of an elderly person uses the money without the elderly person's consent. An abuser obtains an elderly person's money by forging his / her signature, using the elderly person's seal without authority or tricking the elderly person into signing a blank withdrawal slip or cheque. An abuser decoys or forces an elderly person to hand over his / her money or property by deceiving, injuring and threatening the elderly person.
4. Neglect	It is severe or persistent lack of attention to an elderly person's basic needs (e.g. adequate food, clothing, shelter, medical treatment, nursing care, etc.) that endangers or impairs the elderly person's health and safety. Neglect also includes the failure of provision of medicine and aids according to medical advice, which causes physical harm to the elderly person. If a formal carer (e.g. Residential Care Home for the Elderly, Integrated Home Care Services Team, Hospital, etc.) fails to perform its caring responsibility and causes harm to an elderly person, the case may also be considered as neglect.	Elders may have the following conditions: serious loss of / extremely low weight, dehydration or malnutrition chronic bed sores lacking medication / medical care needed having dirty appearance frequently wandering around frequently or for prolonged period without being accompanied
5. Abandonment	It is the act of abandoning an elderly person without justifiable reasons committed by a carer or guardian, which endangers or impairs the elderly person physically or psychologically.	Elders may have the following conditions: wandering alone on streets, in parks or malls, etc. for a long period of time having dirty appearance for a long period of time no one paying visits or making arrangement for the elderly person's discharge after the elderly person's admission to hospital. For instance, the carers intentionally take the elderly persons with dementia to an unfamiliar place, making the elderly persons unable to return home by themselves. Or upon the elderly persons' admission to hospitals, family members refuse to provide or give wrong correspondence addresses / phone numbers, resist / avoid contact repeatedly, which makes it impossible for the hospitals to contact the carers or guardians to discuss the medical and welfare issues of the elderly persons.
6. Sexual abuse	It is the act of sexual assault on an elderly person such as exposure of sexual organ to an elderly person, indecent assault and rape, etc.	Physical indicators bruises on chest / genitalia unexplainable sexual diseases unexplainable urethritis unexplainable bleeding in external genitalia, vaginal or anal area, etc. Behavioural indicators being extremely frightened when seeing the suspected abuser excessive masturbation drastic change in sexual attitude / sexual behaviour Environmental indicators torn, stained or bloodied underclothing

*Remarks: The behaviours or signs listed above may not necessarily be evidence of elder abuse. However, once they appear, we should be alerted and pay more attention to the elderly person. Where necessary, assistance of relevant professionals (e.g. social workers, healthcare personnel and police officers, etc.) should be sought as soon as possible.

Risk Factors for Elder Abuse

1. Factors related to the elderly victims
   1. Poor physical and mental health: Elderly persons who are relying on others' care, e.g. elderly people suffering from dementia, stroke and Parkinson's disease.
   2. Weak social network: Elderly persons who have few relatives and friends as well as limited contact with the outside world can only trust and rely on their carers. As a result, it would be hard for them to seek assistance from outside when relationship with their carers turns sour.
   3. Family problems or changes: Longstanding family problems (e.g. poor living conditions, dissatisfactory family relationship, lack of communication, habitual use of violence in problem solving) or adjustment problems to family changes (e.g. after passing away of spouse or carer, an elderly person has to live with other family members). If both parties fail to adjust to the new living condition, elder abuse may arise as clashes and disputes escalate.
2. Factors related to the abusers
   1. Poor personal well-being: Carers having physical or mental problems, aggressive behaviour tendency, authoritarian character, unhealthy habits such as drug or alcohol abuse.
   2. Financial problem: In case the carers are distressed by unemployment, unstable income or debts, or in case they rely on the elderly persons financially to make ends meet, the chance of elder abuse especially for financial abuse is higher.
   3. Carer stress: For some carers, taking care of frail elderly persons brings them tremendous stress. If they cannot manage well or have inadequate support, they would easily become discontent and the likelihood of elder abuse would increase.

Management and Prevention of Elder Abuse

1. Advice for elderly persons
   1. Immediate actions under emergency situation When personal safety is under threat, elderly persons should:
      1. Keep calm and do not provoke the abuser
      2. Dial 999 for immediate help if there is physical injury
      3. Take your Hong Kong Identity Card, wallet/purse, mobile phone and medication with you and leave the scene. Seek help from your neighbours, relatives or friends, and welfare organisations. Please refer to the last section on 'How to seek assistance for elder abuse?'
      4. If the elder abuse happens in institutions, report it to the officer-in-charge or other staff immediately
   2. Self-empowerment methods for prevention: To prevent elder abuse, elderly persons should:
      1. Stay healthy: Practise healthy lifestyle to maintain physical functioning, which can enhance your ability to manage daily matters and cope with sudden life changes independently
      2. Build up good interpersonal relationships: Keep contact with peers and relatives, participate in social activities in the community and expand your social network. As such, you can turn to them for help and support when you feel upset or have difficulties in life
      3. Stay alert to the news: Stay in touch with current affairs and the news. Learn from others’ experience, particularly about their abusive experience, so as to increase personal awareness for prevention of abuse
      4. Manage own finances properly: Learn to manage your own finances properly. Even though you may have assigned someone to handle your financial affairs, you should check them regularly. If someone suggests you to transfer your assets, do not sign on any documents recklessly. Think twice or seek advice from someone you trust
2. Advice for the main family carers
   1. Provide acceptance and support: Pay attention to elderly persons' emotional reactions. Accept their feelings and offer support. Be more empathetic to their health condition. Adjust our expectations of them and offer assistance appropriately.
   2. Provide what the elderly persons need: Other than food and shelters, basic needs of elderly persons also include drugs / medical care, assistive aids (e.g. walking stick, glasses, dentures etc). If the elderly persons are bedridden, you should take steps to prevent bedsores (e.g. changing their posture regularly). If the elderly persons feel unwell, you should take them to see the doctor as soon as possible
   3. Anger management: In case you feel angry when interacting with the elderly persons, firstly find ways to calm yourself down. Wait until both parties' mood is settled down, and then share each other's viewpoints and feelings to improve mutual understanding and seek practical solutions.
   4. Stress management: Take good care of yourself by having sufficient rest, physical and leisure activities, social participation, sharing of feelings with others etc. This could help regulate your mood and relieve your stress.
   5. Seek assistance proactively: The main family carers, particularly for those who are shouldering enormous pressure solely (e.g. the dementia caregivers), should join support groups or relevant talks to learn the caregiving skills and share experience with others. Take initiative to discuss with other family members about how to share the caregiving responsibilities, and use the community resources to ease the caregiving burden. If you experience chronic and excessive stress and find it difficult to cope with, and that your daily functionings are adversely affected, please seek help promptly.
3. Advice for people who know the elderly persons
   1. Stay connected: Keep in touch with the elderly persons by visiting them and phoning them more frequently. Care about their well-being and offer comfort and support as needed.
   2. Be observant: Victims of elder abuse may feel helpless, useless and have self-blame. They may even think that no one could help them. They cannot but bear the suffering continuously. If you observe elderly persons who are exceedingly fearful of their carers, emotionally unstable and behave awkwardly (e.g. the elderly person looks dull and withdrawn, becomes absent from their regular activities, displays incoherent speech when asked), you should look for a place with privacy. Then, enquire the elderly persons what has happened to them and see if they have been abused.
   3. Seek help early: If elder abuse is suspected, accompany the elderly persons to go for help seeking

Note: For Institutional Carers, please refer to another article on 'Prevention of Elder Abuse' at 'Carers' Corner' *.

How to Seek Assistance for Elder Abuse?

Elderly persons being abused should seek help as early as possible. Those who know them should encourage and accompany them to go for help seeking. Professionals (such as social workers, health care professionals and police officers, etc) will respect the views of the elderly persons and provide them with protection and assistance in the most appropriate manner so as to remedy the situation. Bearing in mind that the safety of the elderly persons is the prime concern, professionals will also help abusers solve their personal or family problems and, where possible, will try their best to help the elderly persons improve their relationship with their family members, including the abusers.

Persons in need of assistance may approach:

1. District Elderly Community Centres or Integrated Family Service Centres/ Integrated Services Centres in respective districts. Telephone numbers for enquiries and addresses of these centres are available on the Social Welfare Department website at https://www.swd.gov.hk/en/svcdesk/faqs/serelderly/#q16
2. If the elderly persons being abused are receiving other social services, they may seek assistance from the social workers of the service units concerned, who may arrange referrals where necessary
3. Social Welfare Department Hotline : 2343 2255
4. Crisis Line of Caritas Family Crisis Support Centre (24-hour hotline) : 18288
5. Tung Wah Group of Hospitals CEASE Crisis Centre 24-hour Hotline : 18281