The first problem is how to recognize violence. One tool that can help identify violence is a questionnaire:

Does your partner/child/caregiver ever:

• belittle you or put you down?
• blame you for the abuse or arguments?
• deny that abuse is happening, or play it down?
• isolate you from your family and friends?
• prevent you from going outside (to the doctor, for a walk, to church)?
• make unreasonable demands for your attention?
• accuse you of treason, conspiracy, or plotting?
• tell you what to wear, who to see, where to go, and what to think?
• control your money, or refuse to give you enough to buy food or other essential items?

The answers help reveal the scale of violence. What is most important is that the conversation with a senior should take place without any family members present. The senior must not be afraid of the reaction of the person they are dependent on.

The person offering help should remember that victims of abusive relationships may experience some of the following emotions and behaviors:

• Agitation, anxiety, and chronic apprehension
• A constant state of alertness that makes it difficult to relax or sleep
• A sense of hopelessness, helplessness, or despair, believing they will never escape their abuser’s control
• Fear that they cannot protect themselves or their children, which leads them to reject help from relatives, friends, or professionals
• Feeling paralyzed by fear, unable to make decisions or protect themselves
• A belief that they deserve the abuse
• A belief that they are responsible for the abuse
• Flashbacks, intrusive thoughts and memories of the violence, and nightmares about the violence
• Emotional reactions to reminders of domestic violence

Observation of a potential victim of domestic violence is very important. Victims may also present physical symptoms not directly caused by physical abuse but by the constant stress and tension of living in an abusive relationship. These symptoms include:

• Headaches
• Asthma
• Gastrointestinal issues
• Chronic pain
• Disturbed or restless sleep, or inability to sleep
• Genital soreness
• Pelvic pain
• Back pain

When making a diagnosis, various elements should be taken into account, including information from the doctor.

The causes of violence are complex and depend on many factors – related to the senior, the caregiver, and the family. The most common risk factors associated with older people include:

• Poor communication between the senior and family members
• A history of family violence (role reversal)
• Physical or financial dependence on a family member
• Poor health condition of the senior (e.g., memory problems, urinary incontinence, etc.)
• Living in a small house or flat with other family members
• A tendency to self-blame (“I was a bad father/mother”)
• Low self-esteem (“I’m nobody, I haven’t achieved anything in my life”)

Sometimes the cause of violence lies in the family’s situation. The most typical circumstances include:

• No one in the family has experience in caring for elderly or sick people
• The caregiver is also responsible for others (children, grandparents, sick relatives)
• The caregiver was a victim of violence in childhood
• The caregiver is in poor condition (ill, with health problems, etc.)
• The caregiver struggles with work, marital issues, or high stress
• Lack of support from the local community
• Lack of knowledge about available support institutions
• Small, overcrowded housing conditions
• Families with legal issues (ex-prisoners, perpetrators of violence, etc.)