The table below provides a description of the different forms of abuse and neglect that adults at risk may experience and ways in which the maltreatment may manifest itself.
It is important to note that maltreatment may be linked to one specific incident or ongoing and/or repeated abuse and neglect.
The maltreatment may result from one issue such as alcohol or drug misuse or an accumulation of circumstances and stressors, such as domestic violence and abuse, social isolation and deprivation.
Practitioners should be mindful that assessing harm does not mean merely listing the risk factors that are accumulating and assuming the longer the list the more likely the level of harm: just one risk factor may have a significant impact.
Form of maltreatment: Physical abuse
Description:
- assault, hitting, slapping, punching, kicking, hair-pulling, biting, pushing
- rough handling -scalding and burning
- physical punishments
- inappropriate or unlawful use of restraint
- making someone purposefully uncomfortable (e.g. opening a window and removing blankets)
- involuntary isolation or confinement
- misuse of medication (e.g. over-sedation)
- forcible feeding or withholding food
- unauthorized restraint, restricting movement (e.g. tying someone to a chair)
Possible indicators:
- no explanation for injuries or inconsistency with the account of what happened
- injuries are inconsistent with the person’s lifestyle
- bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps
- frequent injuries
- unexplained falls
- subdued or changed behaviour in the presence of a particular person
- signs of malnutrition
- failure to seek medical treatment or frequent changes of GP
Form of maltreatment: Sexual abuse
Description:
- rape, attempted rape or sexual assault
- inappropriate touch anywhere
- non- consensual masturbation of either or both persons
- non- consensual sexual penetration or attempted penetration of the vagina, anus or mouth
- any sexual activity that the person lacks the capacity to consent to
- inappropriate looking, sexual teasing or innuendo or sexual harassment
- sexual photography or forced use of pornography or witnessing of sexual acts
- indecent exposure
Possible indicators:
- bruising, particularly to the thighs, buttocks and upper arms and marks on the neck
- torn, stained or bloody underclothing
- bleeding, pain or itching in the genital area
- unusual difficulty in walking or sitting
- foreign bodies in genital or rectal openings
- infections, unexplained genital discharge, or sexually transmitted diseases
- pregnancy in a woman who is unable to consent to sexual intercourse
- the uncharacteristic use of explicit sexual language or significant changes in sexual behaviour or attitude
- incontinence not related to any medical diagnosis
- self-harming
- poor concentration, withdrawal, sleep disturbance
- excessive fear/apprehension of, or withdrawal from, relationships
- fear of receiving help with personal care
- reluctance to be alone with a particular person
Form of maltreatment: Psychological and emotional abuse
Description:
- enforced social isolation – preventing someone accessing services, educational and social opportunities and seeing friends
- removing mobility or communication aids or intentionally leaving someone unattended when they need assistance
- preventing someone from meeting their religious and cultural needs
- preventing the expression of choice and opinion
- failure to respect privacy
- preventing stimulation, meaningful occupation or activities
- intimidation, coercion, harassment, use of threats, humiliation, bullying, swearing or verbal abuse
- addressing a person in a patronising or infantilising way
- threats of harm or abandonment
- cyber bullying
Possible indicators:
- an air of silence when a particular person is present
- withdrawal or change in the psychological state of the person
- insomnia
- low self-esteem
- uncooperative and aggressive behaviour
- a change of appetite, weight loss/gain
- signs of distress: tearfulness, anger
- apparent false claims, by someone involved with the person, to attract unnecessary treatment
Form of maltreatment: Domestic violence
Description:
- Incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those who are or have been, intimate partners or family members regardless of gender or sexuality
- 'honour’ -based violence, female genital mutilation and forced marriage
- coercive behaviour can include:
- acts of assault, threats, humiliation and intimidation
- harming, punishing, or frightening the person
- isolating the person from sources of support exploitation of resources or money
- preventing the person from escaping abuse
- regulating everyday behaviour
Possible indicators:
- low self-esteem
- feeling that the abuse is their fault when it is not
- physical evidence of violence such as bruising, cuts, broken bones
- verbal abuse and humiliation in front of others
- fear of outside intervention
- damage to home or property
- isolation – not seeing friends and family
- limited access to money
Form of maltreatment: Financial abuse
Description:
- theft of money or possessions
- fraud, scamming
- preventing a person from accessing their own money, benefits or assets
- employees taking a loan from a person using the service
- undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions
- arranging less care than is needed to save money to maximise inheritance
- denying assistance to manage/monitor financial affairs
- denying assistance to access benefits
- misuse of personal allowance in a care home
- misuse of benefits or direct payments in a family home
- someone moving into a person’s home and living rent free without agreement or under duress
- false representation, using another person's bank account, cards or documents
- exploitation of a person’s money or assets, e.g. unauthorised use of a car
- misuse of a power of attorney, deputy, appointeeship or other legal authority
- rogue trading – e.g. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship
Possible indicators:
- missing personal possessions
- unexplained lack of money or inability to maintain lifestyle
- unexplained withdrawal of funds from accounts
- power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity
- failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so
- the person allocated to manage financial affairs is evasive or uncooperative
- the family or others show unusual interest in the assets of the person
- signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA
- recent changes in deeds or title to property
- rent arrears and eviction notices
- a lack of clear financial accounts held by a care home or service
- failure to provide receipts for shopping or other financial transactions carried out on behalf of the person
- disparity between the person’s living conditions and their financial resources, e.g. insufficient food in the house
- unnecessary property repairs
Form of maltreatment: Neglect
Description:
- failure to provide or allow access to food, shelter, clothing, heating, stimulation and activity, personal or medical care
- providing care in a way that the person dislikes
- failure to administer medication as prescribed
- refusal of access to visitors
- not taking account of individuals’ cultural, religious or ethnic needs
- not taking account of educational, social and recreational needs
- ignoring or isolating the person
- preventing the person from making their own decisions
- preventing access to glasses, hearing aids, dentures, etc.
- failure to ensure privacy and dignity
Possible indicators:
- poor environment – dirty or unhygienic
- poor physical condition and/or personal hygiene
- pressure sores or ulcers
- malnutrition or unexplained weight loss
- untreated injuries and medical problems
- inconsistent or reluctant contact with medical and social care organisations
- accumulation of untaken medication
- uncharacteristic failure to engage in social interaction
- inappropriate or inadequate clothing
Form of maltreatment: Self-neglect
Description:
- lack of self-care to an extent that it threatens personal health and safety
- neglecting to care for one’s personal hygiene, health or surroundings
- inability to avoid self-harm
- failure to seek help or access services to meet health and social care needs
- inability or unwillingness to manage one’s personal affairs
Possible indicators:
- very poor personal hygiene
- unkempt appearance
- lack of essential food, clothing or shelter
- malnutrition and/or dehydration
- living in squalid or unsanitary conditions
- neglecting household maintenance
- hoarding
- collecting a large number of animals in inappropriate conditions
- non-compliance with health or care services
- inability or unwillingness to take medication or treat illness or injury
Form of maltreatment: Modern slavery
Description:
- human trafficking
- forced labour
- domestic servitude
- sexual exploitation, such as escort work, prostitution and pornography
- debt bondage – being forced to work to pay off debts that realistically they never will be able to
Possible indicators:
- signs of physical or emotional abuse
- appearing to be malnourished, unkempt or withdrawn
- isolation from the community, seeming under the control or influence of others
- living in dirty, cramped or overcrowded accommodation and or living and working at the same address
- lack of personal effects or identification documents
- always wearing the same clothes
- avoidance of eye contact, appearing frightened or hesitant to talk to strangers
- fear of law enforcers
Taken from: At a Glance 69 Safeguarding Adults: Types and Indicators of Abuse SCIE
For further information see:
Ashton, K., Bellis, M. A., Davies, A. R., Hardcastle, K., and Hughes, K. (2016a). Adverse Childhood Experiences and their Association with Chronic Disease and Health Service Use in the Welsh Adult Population. Public Health Wales,
Ashton, K., Bellis, M. A., Hardcastle, K., Hughes, K., Malby, S., and Evans, M. (2016b). Adverse Childhood Experiences and their Association with Mental Wellbeing in the Welsh Adult Population. Public Health Wales,
Bellis, M. A., Ashton, K., Hughes, K., Ford, K., Bishop, J., and Paranjothy, S. (2015). Adverse Childhood Experiences and their Impact on Health-harming Behaviours in the Welsh Adult Population., Public Health Wales,
Bennett, D., Flood, S., Howarth, J., Melsome, M., and Northway, R. (2013). Looking into Abuse Research Team, Looking into Abuse: Research by People with Learning Disabilities. University of Glamorgan / Rhondda Cynon Taff People First / New Pathways 2013,
Berry, V., Stanley, N., Radford, L., McCarry, M., and Larkins, C. (2014). Building Effective Responses: An Independent Review of Violence against Women, Domestic Abuse and Sexual Violence Services in Wales. University of Central Lancashire / Welsh Government Social Research.
NHS UK Abuse and neglect of vulnerable adults
SCIE At a Glance 69 Safeguarding Adults: Types and Indicators of Abuse SCIE
Wydall, S., Zerk, R., and Newman, J. (2015). Crimes Against, and Abuse of, Older People in Wales. Access to support and justice: working together. The Older People’s Commissioner for Wales and Aberystwyth University.