Bones heal. Scratches heal. Bruises disappear.
Therefore it's the psychological abuse against our elderly that can have the longest-lasting effect, and it's the most common form elder abuse takes in Whanganui, Age Concern social worker Sue Evans says.
"Psychological abuse is the most damaging type, and a person may be a vulnerable adult, unable to move away from the address or make arrangements to live somewhere else."
In the Whanganui region, for the six months following July 2015, 48.5 per cent - 16 cases - of settled elder abuse cases were psychological. Neglect made up 9.1 per cent, or three cases.
Ms Evans said examples she knew of included family members caring for the elderly person and calling them a "silly old cow" or making comments such as "look how I've given up my whole life for you," or "can't you even make a cup of tea yourself?"
"And if that's your world, it's very difficult," Ms Evans said. "How do you reach out? How do you do something about that situation?"
She is shining the light on all forms of elder abuse for World Elder Abuse Awareness Day, on Wednesday. It is also Elder Abuse Awareness Week from June 15-22.
Abuse from family members often happened when the older person required care at home.
"Unfortunately, somebody decides that they could provide 24/7 care for the elderly person so they're able to obtain the carer's benefit, and they care for that elderly person at home."
It was easy for things to "deteriorate" and stress to build in that situation, causing the carer to become abusive in some way, Ms Evans said.
"24/7 is 24/7."
There needed to be more education for people considering caring for their family member, she said.
"We want that carer's benefit to sort of have a qualification on it. "Have education around what it means to care for someone at home. We all think 'oh, we've cared for our children'. You're caring for an adult."
One occasion Ms Evans visited a client with dementia who had been left alone by their carer. The carer was about two hours away at the time.
Sometimes the carer might not realise they were abusing or neglecting their family member, it "might be as simple as not giving mum or dad blood pressure pills at the same time each day".
"To me, elder abuse is insidious, as is child abuse. We've really got to work with families."
f a son or daughter was caring for their parent, abuse could often include not allowing other siblings to visit, or not letting the older person make decisions for themselves.
"Just imagine if you're 80 and you're being cared for at home by your abusive son or daughter, and you're frail, you're lacking mobility. How are you going to reach out and find somewhere to live?"
Age Concern supported people's right to remain at home instead of going into residential care, but Ms Evans said people had been made more vulnerable on occasion by staying at home.
"People, to me, seem safer in residential care, but I support the right of people to live at home."
Then there's the financial side of elder abuse. In the six months from last July, there were eight settled cases of material or financial abuse, which is 24.2 per cent.
"When people get financially abused, how the heck are they going to make up that kind of money? They can't exactly go to Pak'n Save and start packing on the night shift, can they?
"You hope you've brought your children up well and then you find one of them has been busy filching your money. How hard is that to bring up? They feel like they're going to be judged on their parenting."
It was often a family member or person in a position of trust who committed the financial abuse.
Two years ago, the Chronicle revealed a case of abuse against 65-year-old paraplegic Chris, whose caregiver stole nearly $7000 from his bank account, leaving him $4200 in debt for his rest home accommodation.
The offender, Klazina Ann Hedges, was sentenced to four months of home detention last year.
In November last year another caregiver, Sarah Hill, was sentenced to seven months of home detention for stealing at least $14,000 worth of cash and jewellery from clients.
Judge David Cameron said at the time the offending happened in a "position of complete trust".
"With that came a responsibility for her to act professionally and with integrity. Instead she acted disgracefully."
One of Hill's victims, Glendys Bird, told the Chronicle Hill's actions were "elder abuse of the very worst kind.
"When something like this happens it's pretty bad that you have to go hiding things in your home just in case someone decides they've got more right to it than you do", she said.
Another case revealed in October last year ended with Nikayla Helen Hawea being sentenced to community work for setting up automatic payments to herself out of the bank account of a 69-year-old friend with dementia.
Ms Evans said elderly people could feel "shame" when they were financially abused.
"'Oh, I was foolish because I trusted the guy who came to paint my house. He needed some financial assistance and I gave him $3000'."
It could include people befriending older people in the community and ripping them off, she said.
While psychological and financial abuse is the most common type in Whanganui, there are a number of other types too.
Physical abuse sits at 3 per cent, institutional abuse also at 3 per cent, and self neglect at 12.1 per cent.
Ms Evans said Age Concern was not funded to deal with elderly people neglecting themselves, but would still turn out anyway.
"Just recently a woman came in here who delivers for one of those prepared meals options. She said 'Look, I've got a bit of a problem'.
It turns out it was an elderly client who was lying on the floor.
The person had gone to deliver the meal . . . peeked in the windows and saw that. [The elderly person] said 'No, no, go away.' . . . She had apparently been lying there for two days but she didn't want to be helped."
Self neglect was "a huge problem".
"We get hoarding, we get people with 23 cats. We get people that can hardly move in their house."
About eight years ago, when Ms Evans started at Age Concern Wanganui, they received about eight references a month for elderly people who could be being abused.
Now Ms Evans could get 22 references in a month, something she partly puts down to awareness.
"Elder abuse is gaining recognition in Whanganui.
"People are really understanding that it occurs. It's taken a lot of hard work by Age Concern Wanganui to bring this to the fore.
"The manager and I have actually got out there and made people more aware of elder abuse and what it is."
Manager Tracy Lynn said Ms Evans was "very passionate" in her role, which made people feel "comfortable" referring to her.
"She's very good at her job."
They wanted to encourage people to come into the Age Concern office on Guyton Street or call on 06 345 1799 if they were feeling abused or if they were concerned about someone being abused or if they were struggling to care for an older person themselves.
"Walk in, there's no judgement. You're getting stressed, just ring or just walk in the door," Ms Evans said.
And above all, they asked that people "say something".
"They don't have to come in here and write a story. "All they have to do is bullet point it. Don't sit there and do nothing.
"How are we going to make changes if it's all kept secret?"
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Of 1103 referrals Age Concern received nationally, Age Concern Elder Abuse and Neglect Prevention Services intervened in 899 cases of elder abuse. Of those cases:
-76 per cent was psychological
-53 per cent was financial
-20 per cent was neglect
-19 per cent was self neglect
-19 per cent was physical
-5 per cent was institutional
-0.8 per cent was sexual