Risk factors for abuse in the victim include dependency, lack of close family ties, a culture of family violence, lack of financial resources, lack of community support and factors such as low pay and poor working conditions in institutions. The perpetrator often has a psychological disturbance and may be subject to external stresses such as employment loss, divorce, or illness. Elder abuse does not usually resolve spontaneously. Abusive events tend to be repetitive, and abuse tends to continue unless a major change occurs in the milieu. In many cases victims or families have refused help.
Victims are particularly afraid of reprisals, loss of autonomy or relocation.
Maneuver Detection of elder abuse is notoriously difficult, often complicated by denial by the individual and caretaker. The victim is often reluctant to admit to abuse, for fear of abandonment, reprisal, institutionalization, or to avoid embarrassment or shame. While physical findings are rarely specific, unusual trauma, signs of hair pulling, human bites or unusual behaviour between client and caregiver may raise the suspicion of abuse. Effectiveness of Intervention Decisions about how and when to intervene in cases of elder abuse and neglect are among the most difficult for service providers. The causes for abuse are complex, little is really known about the causes and risk factors in the individual case.