Safeguarding Older Patients: Identifying Abuse, Neglect, and Early Warning Signs

Physical abuse involves the intentional use of force that results in injury, pain, or impairment and it can happen in homes, care facilities, schools, workplaces, or community settings.

• Examples:

  • Hitting, slapping, punching, or kicking
    
    
  • Pushing or shaking
    
    
  • Burning or inappropriate physical punishment
    
    
  • Improper use of restraints
    
    
  • Misuse or overmedication
    
    

  Warning Signs:

  • Unexplained bruises, burns, or fractures
    
    
  • Frequent injuries with inconsistent explanations
    
    
  • Fear of a specific person
    
    
  • Flinching or withdrawal from physical contact
    
    
  Impact:
  Physical abuse can cause long-term health problems, trauma, anxiety, and distrust of caregivers or authority figures.

This form of abuse damages a person’s self-worth, confidence, and emotional well-being and it may not leave visible marks, but the effects can be severe and long-lasting.

Examples:

• Constant criticism or humiliation
  
  
• Threats or intimidation
  
  
• Controlling behaviors
  
  
• Isolation from friends or family
  
  
• Gaslighting or manipulation
  
  

Warning Signs:

• Low self-esteem
  
  
• Sudden withdrawal or depression
  
  
• Fearfulness around certain individuals
  
  
• Changes in behavior or personality
  
  

Impact:
Emotional abuse can lead to anxiety disorders, depression, difficulty forming relationships, and, in severe cases, self-harm.

• Financial abuse involves the illegal or improper use of a person’s money, property, or assets and it is especially common among older adults and individuals with care and support needs.

  Examples:

  • Stealing money or valuables
    
    
  • Forcing someone to sign financial documents
    
    
  • Unauthorized use of bank accounts
    
    
  • Manipulating someone into changing a will
    
    
  • Scams targeting vulnerable individuals
    
    

  Warning Signs:

  • Sudden changes in bank accounts or financial documents
    
    
  • Missing possessions
    
    
  • Unpaid bills despite available funds
    
    
  • Dependence on a controlling person for financial decisions
    
    
  Impact:
  Financial abuse can cause stress, loss of independence, housing insecurity, and reduced access to essential services.

Neglect occurs when a caregiver fails to provide necessary care, whether intentionally or unintentionally and it can affect children, adults with disabilities, and older people.

Examples:

• Failure to provide adequate food or water
  
  
• Not administering prescribed medication
  
  
• Poor hygiene or unsafe living conditions
  
  
• Lack of supervision
  
  
• Ignoring medical needs
  
  

Warning Signs:

• Malnutrition or dehydration
  
  
• Poor personal hygiene
  
  
• Untreated medical conditions
  
  
• Unsafe or unsanitary living environment
  
  

Impact:
Neglect can lead to serious health complications, developmental delays, emotional distress, and in extreme cases, death.

Sexual abuse includes any sexual activity without consent and it can occur in any setting and affects people of all ages and genders.

Examples:

• Non-consensual touching or intercourse
  
  
• Sexual exploitation
  
  
• Exposure to sexual content without consent
  
  
• Coercion or manipulation into sexual acts
  
  

Warning Signs:

• Unexplained injuries in genital areas
  
  
• Sudden changes in behavior
  
  
• Fear of being alone with a particular person
  
  
• Age-inappropriate sexual knowledge (in children)
  
  

Impact:
Sexual abuse can cause severe emotional trauma, PTSD, depression, and long-term physical health issues.

• Financial abuse involves the illegal, improper, or unauthorised use of a person’s money, property, pensions, benefits, or assets. It may be carried out by:

  • Family members
    
  • Informal carers
    
  • Friends
    
  • Professionals
    
  • Scammers (including online fraudsters)
    

  Older adults are particularly vulnerable due to social isolation, cognitive decline, bereavement, or dependence on others for support.

• Financial exploitation can take many forms, including:

  1. Unauthorized Bank Withdrawals

  • Use of ATM cards without consent
    
  • Forged signatures
    
  • Online banking misuse
    

  2. Pressure to Change Wills or Legal Documents

  • Coercion to alter a will
    
  • Manipulation to grant power of attorney
    
  • Forced property transfers
    

  3. Family Member Exploitation

  • “Borrowing” money without repayment
    
  • Taking pensions or benefits
    
  • Controlling access to funds
    

  4. Online Scams Targeting Older Adults

  • Phishing emails
    
  • Romance scams
    
  • Fake investment schemes
    
  • Fraudulent phone calls claiming to be from banks or authorities
    

  Many older adults may feel embarrassed or fearful about reporting scams, which contributes to underreporting.

Recognising early indicators can prevent devastating losses.

Sudden Financial Difficulties

• Unexpected lack of funds
  
• Changes in spending patterns
  

Missing Valuables

• Jewellery or personal items disappearing
  
• Important documents missing

Anxiety or Distress When Discussing Finances

• Fearfulness around a specific individual
  
• Reluctance to speak openly about money
  

Unpaid Bills Despite Available Funds

• Utilities being disconnected
  
• Care home fees unpaid
  
• Rent arrears
  

Sudden Changes in Legal Arrangements

• New individuals added to bank accounts
  
• Unexpected updates to wills or property ownership
  

For PMH professionals, emotional changes such as anxiety, withdrawal, or depression may be early indicators of financial exploitation.

Financial abuse does not only affect bank balances, it deeply impacts mental health.

Older adults who experience exploitation may develop:

• Depression
  
• Anxiety
  
• Loss of trust
  
• Shame and embarrassment
  
• Social withdrawal
  
• Suicidal ideation in severe cases
  

Primary Mental Health services are often the first professionals to notice psychological changes linked to financial stress or coercion.

Preventing financial abuse requires a proactive, multi-agency approach.

1. Establish Trusted Financial Oversight

• Encourage use of reputable legal advisers
  
• Promote appropriate power of attorney arrangements
  
• Involve more than one trusted person where possible
  

2. Educate Patients and Families About Scams

• Provide information on common fraud tactics
  
• Encourage scepticism toward unsolicited calls or emails
  
• Promote safe online banking practices
  

3. Monitor Financial Activity for Irregularities

• Regular review of bank statements
  
• Encourage alerts for unusual transactions
  
• Identify sudden changes in spending patterns
  
  

4. Include Financial Safeguarding in Organisational Policies

Healthcare and PMH organisations should:

• Integrate financial abuse into safeguarding training
  
• Develop clear reporting pathways
  
• Conduct risk assessments
  
• Ensure multidisciplinary collaboration
  

A strong safeguarding framework helps protect both patients and professionals.

Under the Care Act 2014, professionals must act when an adult with care and support needs is at risk of abuse and unable to protect themselves.

Early intervention can:

• Prevent catastrophic financial loss
  
• Reduce psychological harm
  
• Preserve independence
  
• Strengthen protective support networks
  

Safeguarding financial wellbeing is safeguarding overall wellbeing.