Neglect is one of the most insidious forms of abuse of older people. It’s unobtrusive, it happens privately, and it’s the form of abuse least talked about. But neglect is real, and a concerning issue. Neglect significantly affects the health, dignity and independence of older Australians who experience it, and it can cause serious harm if it’s not stopped.
Many older people may find it difficult to recognise what’s happening as abuse, or they may have limited opportunity to complain. That’s why it’s important that family members, friends or support professionals watch out for signs of neglect and step in to stop it.
What is neglect of older people?
Neglecting someone means failing to meet their basic needs, such as food, shelter, clothing, warmth or essential medical care. It often happens in relationships where there is an expectation of trust, such as between an older person and their partner, adult child or paid carer. It can occur in any setting: within families, at home and in aged care environments.
Like other forms of elder abuse, neglect is a complex issue. Neglect often starts out as a minor incident and gradually grows, which can make it hard for the older person to recognise what’s happening as ‘neglect’. Relationship dynamics, fear, ageism, isolation, carer burnout and cultural factors can all complicate identifying and stopping neglect.
Examples of neglect
Neglect can be many things – for example:
not providing the older person with enough food, water, shelter or heating; withholding physical assistance, such as dentures, walking frames or help to get out of bed or cut up food (physical neglect)
not providing or facilitating necessary medical care, such as access to doctor’s appointments, wound care or pain management, or prescription refills and doses (medical neglect)
not assisting with bathing, dressing or toileting (personal care neglect)
leaving the older person alone for long periods of time, denying them access to company and social participation (emotional neglect)
Neglect at home: George’s story
George, 82, had been able to live by himself in the family home for some years. When George’s chronic arthritis worsened and his mobility grew more limited, his son, Petro, moved back home on the understanding he would take care of his father.
Recently, Petro’s behaviour has become unstable, and he has stopped providing the care George needs. He prevents George’s friends, family and service providers visiting or calling and reacts aggressively if they try.
George is unable to leave the house or shower without assistance. Petro is not only neglecting his father but also stopping others from meeting his needs.
The effects of neglect
If an older person experiences neglect, they may lose their fitness, health and quality of life. Existing medical conditions may get worse, and new ones may develop. The person’s risk of hospitalisation increases.
Often, the older person’s emotional and psychological wellbeing is significantly affected. Feelings of fear, anger, shame, despair or loneliness are common outcomes, along with depression, poor mental health and chronic stress.
And the harm can continue to make itself felt even after the abuse stops.
How neglect happens
Neglect can be intentional (active neglect), but it can also happen unintentionally (passive neglect).
Active neglect often occurs alongside other forms of elder abuse, such as financial or psychological abuse. It may be a form of control or ‘punishment’, or the carer may be indifferent to the older person’s needs and just not bother to look after them.
Passive neglect often occurs when a carer is struggling to cope or lacks the knowledge or resources to provide adequate care all the time. They might be feeling overwhelmed by the responsibilities of caring for someone else on top of their own commitments, or the tasks to be done may be beyond their capabilities.
In a professional setting, carers might struggle to provide appropriate care if their training has not adequately covered the particular needs of older people or their workloads are not well managed.
When older Australians are neglected, partners and adult children are most commonly to blame.
Neglect in professional settings
Generally, paid carers do a great job to the best of their ability. However, inadequate care that amounts to neglect has been reported in professional settings. The cases have mentioned things like:
wounds not being adequately treated or dressings changed
meals being left out of reach of someone who has limited sight or mobility
insulin not being administered to a diabetic resident on time
residents not being showered or toileted.
Why neglect stays hidden
Neglect must be discovered before it can be stopped. It might seem obvious that the older person would speak up and complain, but this doesn’t always happen.
If the person causing harm is a partner or adult child, the older person may not complain because of family dynamics, trust, embarrassment, shame or cultural factors.
They may feel guilty that their care needs are overwhelming for their family member or friend.
They may fear consequences of speaking up, such as losing contact with other family members or being ‘put into a home’.
They may simply feel unable to speak up. Abuse often robs people of any sense of power and control over their lives, resulting in feelings of helplessness.
If the older person is isolated, they have less opportunity to talk to someone about the neglect.
Other people stepping in could end the neglect. But they don’t always notice or respond to neglect, for many reasons.
Unless the neglect becomes publicly visible, they may simply not have an opportunity to notice it. The people causing the harm may cover up the tell-tale signs when others are around, so everything looks fine.
They may not know what neglect is, what the signs mean, or what to do about it.
Many people lead busy lives now and often don’t engage frequently or regularly with older neighbours or family members.
People are hesitant to ‘interfere’ or may worry about damaging relationships.
Language barriers and cultural beliefs about family roles and ageing can affect their perception of what’s happening.
Signs of neglect (see below) can sometimes be subtle and easily attributed to ageing or illness.
Ageist stereotyping can dismiss an older person’s complaints of neglect as imagination or ‘just getting old’.
Common signs of neglect
Whether you’re a family member, friend, community connection or professional service carer, you may be an older person’s lifeline if they are being neglected.
Be aware of the older people in your life or community, and watch out for signs of possible neglect, such as:
noticeable weight loss, persistent hunger
poor personal hygiene, dirty clothes, body odour, unusually untidy appearance, poor dental hygiene
inappropriate dress – underdressed in winter, overdressed in summer
dirty, untidy or poorly maintained home environment
medical conditions worsening or not being treated
long periods of time spent alone
new or increased levels of anxiety and depression, withdrawal or other unexplained changes in mood or behaviour
missed appointments or activities, especially if the person relies on someone else to take them
repeated excuses for their absence or lack of contact, either from the older person or their carer.
How to respond to possible neglect
First, talk to the older person, if you can. Gently ask how they are and whether they need any help. This is easier if you already have some kind of relationship with them, so it may take more than one attempt.
Make notes about what you observe and what the older person tells you. Include dates, as it can be hard to remember timeframes later.
Share your concerns and observations with a trustworthy family member, friend or professional. Ask whether they’ve noticed anything, too.
Call the national elder abuse helpline, 1800 ELDERHelp (1800 353 374), for confidential advice, information and referrals. When you call, you’ll be redirected to your state or territory support service.
Speak to management if your concern is about professional care. Be prepared to lodge a formal complaint, if necessary.
Find out more
‘Neglect’ – Compass webpage
‘The five types of elder abuse’ – Compass webinar
‘Reportable incidents: neglect’ – Compass resource for residential aged care service providers
Australian Institute of Family Studies (AIFS) (2022). Elder abuse in Australia: neglect. (Findings from the National Elder Abuse Prevalence Study). Melbourne: Australian Institute of Family Studies
AIFS (2021). National Elder Abuse Prevalence Study. Melbourne: Australian Institute of Family Studies
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