Signs of possible abuse in adults
Abuse can often show as physical effects and symptoms. These are likely to be accompanied by emotional signs and changes in behaviour, but this is not always the case. Any behaviour changes could indicate that the person is a victim of some form of abuse, but remember that they are only an indicator and will need to be linked to other factors to arrive at a complete picture.
Physical abuse includes:
- hitting
- slapping
- pushing
- pinching
- force feeding
- kicking
- burning
- Scalding
- misuse of medication or restraint
- catheterisation for the convenience of staff
- inappropriate sanctions
- a carer causing illness or injury to someone in order to gain attention for themselves (this might be associated with a condition called fabricated and induced illness, or FILL)
- refusing access to toilet facilities.
- leaving people in wet or soiled clothing or bedding.
Potential indicators of physical abuse include the following. Any of these factors are not evidence of abuse - they are a warning indicator only.
- multiple bruising or finger marks (especially in well-protected areas such as eye sockets, inner arms or thights).
- fractures - especially twisting fractures - and dislocations - especially when accompanied with bruising or finger marks.
- scratches or cuts.
- pressure ulcers and sores or rashes from wet bedding/clothing.
- black eyes or bruised ears.
- welt marks - especially on the back or buttocks.
- scalds or cigarette burns.
- a history of unexplained minor falls or injuries or a history of accidental overdoses/poisoning.
- explanations not consistent with the injuries.
- clinical interventions without any clear benefit to the person.
- deterioration of health without obvious cause.
- loss of weight.
- inappropriate, inadequate or soiled clothing.
- withdrawal or mood changes.
- carer’s resistance to allowing people to visit.
- reluctance by the vulnerable adult to be alone wit the alleged abuser.
Risk factors
Some of the factors that are known to contribute to the risk of harm and abuse of adults by family and friend carers are:
- poor communication between supported person and carer - this could be because of a medical condition or a social/relationship issue.
- challenging behaviour by the supported person.
- carer being young or immature.
- carer feeling unable to carry on.
- strong feeling of frustration on the part of the carer.
- carer and supported person having a history of a troubled relationship.
- carer having alcohol or drug dependency.
- carer believing that the cared-for person is being deliberately difficult or ungrateful.
- caring role not having been taken on willingly.
- carer having had to make major lifestyle changes.
- carer having more than one caring responsibility - for example young children and an older relative.
- supported person being violent towards the carer.
- carer having disturbed sleep.
- carer and supported person being socially isolated.
- financial or housing pressures.
- delays or insufficient resources to provide adequate support.
- isolated older people without family support or contact - particularly in relation to financial abuse.
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