There is no clear reason for abuse. Its causes are both complex and concealed. However, experience suggests certain factors are related to abuse, and that the existence of more than one of these factors places a person at high risk of abuse. Key risk factors for abuse include: carer stress, dependency, family conflict, isolation, psychological problems and addictive behaviours.
Caring for a person who is frail or who has special needs is stressful. In many cases, other contributory factors are also present and this additional stress on the carer appears to be the factor that triggers the abuse. The following factors may contribute to an abusive relationship:
- Financial difficulties
- Lack of respite care
- Inadequate support to give high quality care
- Heavy physical or emotional costs of being a carer
- Lack of recognition for the role of carers takes a heavy toll on the health and well-being of the carer
- Personal stress, the carer may be looking after two generations, his or her own children and a dependent parent. This "sandwich" effect can create extreme stress.
- Unfamiliarity with the caring role and its responsibilities.
Clients are at risk of abuse from people with whom they live and share a relationship of dependency. This dependency may be due to physical impairments such as physical frailty, disability, or cognitive impairments such as dementia. These impairments may hinder the person leaving the abusive situation or reporting the situation. Some perpetrators of abuse, who are dependent on the person they care for, may feel trapped or powerless and perpetrate abuse because of frustration or fear. Whilst clients who are abused are often dependent on others for all or part of their day-to-day care, the perpetrator of the abuse may also be dependent on the person in order to meet their own physical, psychological, social, emotional or financial needs.
Abuse can be a continuation of domestic violence or family violence that re-emerges as abuse in the caring situation. Similarly, a child who was previously abused may now be a primary carer and repeat the cycle of abuse to a dependent parent or child.
In some families violence is considered the normal reaction to stress, and it may continue from generation to generation. People are also at risk when two or more generations live together and intergenerational conflict exists. In cross-cultural situations where two or more generations hold different cultural values or roles, tension and conflict can place dependent people at risk of abuse.
The client or carer may be isolated and lack social contacts or support. The following factors increase the risk of abuse:
- Misappropriation of property, money or valuables - a loss of money ranging from removal of cash from a wallet, to the cashing of cheques for large amounts of money, loss of jewellery, silverware, paintings or furniture
- Forced changes to a Will or other legal document - the making of a new Will in favour of a new friend or another family member. Power of Attorney may be obtained improperly from a person without decision-making capacity.
- Denial of the right to access personal funds - A family member may take control of a person's finances or banking, while the older person is still capable of maintaining their affairs.
- Forging of signatures - on bank accounts or legal documents.
- Misusing Enduring Power of Attorney
- Going grocery shopping and not returning the change
- Physical isolation
- Social isolation
- Emotional isolation
- The absence of adequate support or relief for the carer
In many cases of physical and psychological abuse, the mental health of the perpetrator is implicated as the major contributory factor. Abuse may occur when either party has:
- A period of mental illness
- A history of mental problems
- Difficulty in controlling anger and/or frustration
- Low self esteem or feelings of low self worth
An older person may also be considered to be at risk when they suffer from cognitive decline, for example, an older person experiencing a dementia.
Where the carer or family member has a dependency on drugs, both prescription and illicit, alcohol or a gambling problem, an older person can be considered to be at risk of abuse.