Risk factors for abuse can be related to facility employees, residents, to domestic caregivers, to conditions in a facility or home. Listed below are some factors, which increase the risk of abuse. The more of them that are present in a situation, the greater the risk. There are also other forces, which contribute to a problem such as holidays, reactions to family visits, weather and time of day. Being aware of what to watch for and averting a build up of such risk factors can help to prevent abuse.

Caregiver Factors:

• Mental illness
  
• Alcohol/drug abuse
  
• Poorly trained/educated
  
• Insubordinate/power, conflicts/rivalry
  
• Chronic physical illness
  
• Financial problems
  
• Role reversal, i.e., looking to resident to fulfill their own needs
  
• Pattern of excessive absenteeism
  
• Family problems or history of family violence
  
• Tardiness or disappearance from site
  
• Social isolation

Facility Factors:

• Crowding/concentration of vulnerable adults
  
• Inadequate staffing levels
  
• Staff shortages (e.g. least experienced staff required to work holidays when staff is skeletal/residents are agitated)
  
• Inadequate managerial response to abuse
  
• Staff poorly paid, low investment in jobs, resentment when demands made
  
• Poor role definition; obscure organizational chart
  
• Use of facility for detention of anti-social persons
  
• High employee absenteeism
  
• High personnel turnover; frequent "reorganization"
  
• Poor building maintenance (ventilation, noise, lighting)
  
• Inconsistently applied standards
  
• Lack of staff training i.e. staff is not prepared to act wisely or correctly
  
• Unrealistic budget or reimbursement rates

Resident/Individual Risk Factors:

• Non-verbal
  
• Incompetent
  
• Dementia
  
• History of multiple incidents not associated with illness/disease
  
• History of substance abuse
  
• Assaultive- i.e. spitters, hitters
  
• Verbally abusive, racist
  
• Intrusive-resident has figured out what "buttons" to push
  
• Hostile, passive aggressive
  
• Argumentative
  
• Demanding
  
• Passive

Victim Factors

Intermediate Factors:

• 60+ female
  
• Diminishing capacity
  
• Moderate physical disability
  
• Difficulty ambulating, hands-on assistance
  
• Occasionally non-ambulatory
  
• Limited social support/ unpredictable visitation by family/others

High Risk Factors:

• 75+ male or female
  
• Severe and functionally limiting disability
  
• Confined to bed
  
• Completely dependent on others
  
• Chronic disease
  
• Terminal illness
  
• Rapid deterioration of functional abilities
  
• Loyalty to caregiver
  
• Internalized blame
  
• Severe cognitive impairment
  
• Obesity

The contributing factors for adult abuse and neglect are related to the individuals being cared for, the abuser and the environment. This chart summarizes the factors, which contribute to adult abuse.

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