Categories of Abuse and Neglect

Abuse describes a violation of a person's rights or dignity by another individual or organisation. In adults, abuse may be perpetrated by family, carers, providers, or strangers. In optical settings, professionals most often encounter patterns rather than single dramatic events; careful history, observation, and documentation reveal risks that accumulate over time.^[1][4]

How categories present in optical practice

• Physical abuse: unexplained facial bruising, orbital trauma mismatched to mechanism, frequent "falls," delay in seeking care; consider domestic violence if patterns recur.^[5][6]
• Emotional/psychological abuse: intimidation, humiliation, threats; the adult appears anxious, hypervigilant, or seeks permission before speaking; a companion answers for them.^[1][7]
• Financial abuse: pressure to buy expensive appliances not clinically indicated; a companion controls payment, card, or PIN; unexplained cancellations after cost discussion.^[1][7]
• Sexual abuse: distress during proximity, disclosures of genital injury, controlling relationships; share concerns promptly where risk is suspected.^[1]
• Neglect/acts of omission: missed glaucoma drop use, uncollected spectacles, untreated infections; care providers fail to support appointments or aftercare.^[1][7]
• Organisational abuse: poor care culture in a setting-routine loss of appliances, missed escorts to clinics, consent processes bypassed; raise with commissioners and SABs.^[1][7]
• Domestic abuse/coercive control: isolation, surveillance, removal of aids, restriction of money/transport; escalation is often needed even if the adult declines support today.^[1][2]

Patterns, differentials, and recording

Optical teams should distinguish clinical differentials (e.g., anticoagulation causing bruising) from safeguarding signals while holding both in mind.^[6]

Patterns are key.

Repeated appliance loss, inconsistent accounts, or new dependency on a controlling companion are typical patterns to watch for.^[7][4]

Recording verbatim statements, noting who was present, and capturing chronology gives partners a clear basis for action. Where risk is credible, seek the adult's consent to share; if refusal leaves them at risk of serious harm and capacity is present, consider lawful bases and share the minimum necessary information, documenting the rationale and balancing exercise.^[2][3][1]

References (numbered in text) Why we include references

1. Care and support statutory guidance (Chapter 14: Safeguarding) — Department of Health and Social Care / GOV.UK Find (opens in a new tab)
2. Information sharing: Advice for practitioners providing safeguarding services — Department for Education Find (opens in a new tab)
3. A 10 step guide to sharing information to safeguard children — Information Commissioner's Office Find (opens in a new tab)
4. Safeguarding children and adults at risk — College of Optometrists Find (opens in a new tab)
5. Ocular Injuries and Intimate Partner Violence: A Review of the Literature — Grace Baldwin; John B Miller. Clin Ophthalmol. 2025. Find (opens in a new tab)
6. Bruising as a marker of physical elder abuse — Aileen Wiglesworth et al. Journal of the American Geriatrics Society, 2009. Find (opens in a new tab)
7. Safeguarding adults in care homes (NICE guideline NG189) — National Institute for Health and Care Excellence Find (opens in a new tab)