Patient Barriers to Disclosure

There are a wide variety of reasons why an elder or dependent adult patient may not tell you about abuse or neglect:

• not cognitively aware
• denial
• afraid that by telling, the abuse will escalate (this may happen with destruction of personal property, injury to pets, or increased physical harm, even death)
• they don't think people will believe them
• pride - they want to maintain autonomy and not admit vulnerability
• fear of dependency and poor care
• shame, embarrassment - especially if sexual abuse is involved, or they have been a victim of a monetary scam
• wanting to protect relatives, usually abusive children, from possible prosecution or public censure
• cultural boundaries prohibit talking about this situation outside of the family
• feeling disgraced that children/relatives would treat them this way
• not wanting to initiate legal action
• belief they are being "paid back" for their earlier behavior in life
• may believe institutionalization is the only other option, and want to avoid (solution to the problem worse than the problem)
• cycle of isolation and intimidation -> learned helplessness, resignation, hopelessness
• depression, psychological decline
• grief over loss of physical function and loss of role in family
• sense of worthlessness that they are a burden to others and can't expect any better