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What is Elder Abuse?
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Your elderly neighbor

There's an elderly neighbor you've chatted with at civic meetings and block parties for years.  When you see her coming to get her mail as you walk up the street, you slow down and greet her at the mailbox.  She says hello but seems wary, as if she doesn't quite recognize you.  You ask her about a nasty bruise on her forearm.  Oh, just an accident, she explains; the car door closed on it.  She says goodbye quickly and returns to the house.  Something isn't quite right about her.  You think about the bruise, her skittish behavior.  Well, she's getting pretty old, you think; maybe her mind is getting fuzzy.  But there's something else - something isn't right.

As elders become more physically frail, they're less able to stand up to bullying and or fight back if attacked.  They may not see or hear as well or think as clearly as they used to, leaving openings for unscrupulous people to take advantage of them.  Mental or physical ailments may make them more trying companions for the people who live with them.

Tens of thousands of seniors across the United States are being abused: harmed in some substantial way often people who are directly responsible for their care.

More than half a million reports of abuse against elderly Americans reach authorities every year, and millions more cases go unreported.

Where does elder abuse take place?

Elder abuse tends to take place where the senior lives: most often in the home where abusers are apt to be adult children; other family members such as grandchildren; or spouses/partners of elders.  Institutional settings especially long-term care facilities can also be sources of elder abuse.

The different types of elder abuse

Abuse of elders takes many different forms, some involving intimidation or threats against the elderly, some involving neglect, and others involving financial chicanery.  The most common are defined below.

Physical abuse

Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injury, or impairment.  Such abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement.

Emotional abuse

In emotional or psychological senior abuse, people speak to or treat elderly persons in ways that cause emotional pain or distress.

Verbal forms of emotional elder abuse include:
  • Intimidation through yelling or threats
  • Humiliation and ridicule
  • Habitual blaming or scapegoating
Nonverbal psychological elder abuse can take the form of
  • Ignoring the elderly person
  • Isolating an elder from friends or activities
  • Terrorizing or menacing the elderly person

Sexual abuse

Sexual elder abuse is contact with an elderly person without the elder's consent.  Such contact can involve physical sex acts, but activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse.

Neglect or abandonment by caregivers

Elder neglect, failure to fulfill a caretaking obligation, constitutes more than half of all reported cases of elder abuse.  It can be active (intentional) or passive (unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does).

Financial exploitation

This involves unauthorized use of an elderly person's funds or property, either by a caregiver or an outside scam artist.

An unscrupulous caregiver might:
  • Misuse an elder's personal checks, credit cards, or accounts
  • Steal cash, income checks, or household goods
  • Forge the elder's signature
  • Engage in identity theft
Typical rackets that target elders include
  • Announcements of a "prize" that the elderly person has won but must pay money to claim
  • Phony charities
  • Investment fraud

Healthcare fraud and abuse

Carried out by unethical doctors, nurses, hospital personnel, and other professional care providers, examples of healthcare fraud and abuse regarding elders include
  • Not providing healthcare, but charging for it
  • Overcharging or double-billing for medical care or services
  • Getting kickbacks for referrals to other providers or for prescribing certain drugs
  • Overmedicating or under-medicating
  • Recommending fraudulent remedies for illnesses or other medical conditions
  • Medicaid fraud

Signs and symptoms of elder abuse

At first, you might not recognize or take seriously signs of elder abuse.  They may appear to be symptoms of dementia or signs of the elderly person's frailty - or caregivers may explain them to you that way.  In fact, many of the signs and symptoms of elder abuse do overlap with symptoms of mental deterioration, but that doesn't mean you should dismiss them on the caregiver's say-so.

General signs of abuse

The following are warning signs of some kind of elder abuse:
  • Frequent arguments or tension between the caregiver and the elderly person
  • Changes in personality or behavior in the elder

If you suspect elderly abuse, but aren't sure, look for clusters of the following physical and behavioral signs. Signs and symptoms of specific types of abuse

Physical abuse
  • Unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two side of the body
  • Broken bones, sprains, or dislocations
  • Report of drug overdose or apparent failure to take medication regularly (a prescription has more remaining than it should)
  • Broken eyeglasses or frames
  • Signs of being restrained, such as rope marks on wrists
  • Caregiver's refusal to allow you to see the elder alone

Emotional abuse

In addition to the general signs above, indications of emotional elder abuse include
  • Threatening, belittling, or controlling caregiver behavior that you witness
  • Behavior from the elder that mimics dementia, such as rocking, sucking, or mumbling to oneself
Sexual abuse
  • Bruises around breasts or genitals
  • Unexplained venereal disease or genital infections
  • Unexplained vaginal or anal bleeding
  • Torn, stained, or bloody underclothing
Neglect by caregivers or self-neglect
  • Unusual weight loss, malnutrition, dehydration
  • Untreated physical problems, such as bed sores
  • Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
  • Being left dirty or un-bathed
  • Unsuitable clothing or covering for the weather
  • Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards)
  • Desertion of the elder at a public place
Financial exploitation
  • Significant withdrawals from the elder's accounts
  • Sudden changes in the elder's financial condition
  • Items or cash missing from the senior's household
  • Suspicious changes in wills, power of attorney, titles, and policies
  • Addition of names to the senior's signature card
  • Unpaid bills or lack of medical care, although the elder has enough money to pay for them
  • Financial activity the senior couldn't have done, such as an ATM withdrawal when the account holder is bedridden
  • Unnecessary services, goods, or subscriptions
Healthcare fraud and abuse
  • Duplicate billings for the same medical service or device
  • Evidence of overmedication or under-medication
  • Evidence of inadequate care when bills are paid in full
  • Problems with the care facility:
    - Poorly trained, poorly paid, or insufficient staff
    - Crowding
    - Inadequate responses to questions about care

Risk factors for elder abuse

It's difficult to take care of a senior when he or she has many different needs, and it's difficult to be elderly when age brings with it infirmities and dependence.  Both the demands of caregiving and the needs of the elder can create situations in which abuse is more likely to occur.

Risk factors among caregivers

Many nonprofessional caregivers - spouses, adult children, other relatives and friends - find taking care of an elder to be satisfying and enriching.  But the responsibilities and demands of elder caregiving, which escalate as the elder's condition deteriorates, can also be extremely stressful.  The stress of elder care can lead to mental and physical health problems that make caregivers burned out, impatient, and unable to keep from lashing out against elders in their care.

Among caregivers, significant risk factors for elder abuse are:
  • Inability to cope with stress (lack of resilience)
  • Depression, which is common among caregivers
  • Lack of support from other potential caregivers
  • The caregiver's perception that taking care of the elder is burdensome and without psychological reward
  • Substance abuse

Even caregivers in institutional settings can experience stress at levels that lead to elder abuse.  Nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities, are unsuited to caregiving, or work under poor conditions.

The elder's condition and history

Several factors concerning elders themselves, while they don't excuse abuse, influence whether they are at greater risk for abuse:
  • The intensity of an elderly person's illness or dementia
  • Social isolation; i.e., the elder and caregiver are alone together almost all the time
  • The elder's role, at an earlier time, as an abusive parent or spouse
  • A history of domestic violence in the home
  • The elder's own tendency toward verbal or physical aggression

In many cases, elder abuse, though real, is unintentional.  Caregivers pushed beyond their capabilities or psychological resources may not mean to yell at, strike, or ignore the needs of the elders in their care.

Reporting elder abuse

If you are an elder who is being abused, neglected, or exploited, tell at least one person.  Tell your doctor, a friend, or a family member whom you trust.  Other people care and can help you.  Or call the Abuse Hotline at 1800-962-2873.  In other parts of the country, you can also call Eldercare Locator at 1-800-677-1116.

The person who answers the phone will refer you to a local agency that can help.  The Eldercare Locator answers the phone Monday through Friday, 9 am to 8 pm, Eastern Time.

Adult Protective Services (APS)

The first agency to respond to a report of elderly abuse, in most states, is Adult Protective Services (APS).  Its role is to investigate abuse cases, intervene, and offer services and advice.  Again, the power and scope of APS varies from state to state.  However, every state has at least one toll-free elder abuse hotline or helpline for reporting elder abuse in the home, in the community, or in nursing homes and other long term care facilities

How do I report suspected elder abuse?

The 500,000 to 1,000,000 reports of elder abuse recorded by authorities every year (the vast majority of which are proven to be true) are only the tip of the iceberg; according to data from different states, for every case of elder abuse reported, another 12 or 13 are not.  Accordingly there's a great need for people to report suspected abuse.

In every state, physical, sexual, and financial abuses targeting elders that violate laws against assault, rape, theft, and other offenses are punishable as crimes.  With some variation among states, certain types of emotional elder abuse and elder neglect are subject to criminal prosecution, depending on the perpetrators' conduct and intent and the consequences for the victim.

States differ on who is required to report suspected elder abuse (there's no federal standard), though the categories of mandatory reporters are expanding.  Typically, medical personnel, nursing home workers, peace officers, emergency personnel, public officials, social workers, counselors, and clergy are listed as mandatory reporters, and that responsibility is spreading to financial institutions and other entities that work with seniors.

While it's important for elders to seek refuge from abuse, either by calling a local agency or telling a doctor or trusted friend, many seniors don't report the abuse they face even if they're able.  Many fear retaliation from the abuser, while others believe that if they turn in their abusers, no one else will take care of them.  When the caregivers are their children, they may be ashamed that their children are behaving abusively or blame themselves: "If I'd been a better parent when they were younger, this wouldn't be happening." Or they just may not want children they love to get into trouble with the law.

Reporting Elder Abuse : How to Stand Up for an Older Adult in Need
Tips for communicating effectively in different situations.

Preventing elder abuse and neglect

We can help reduce the incidence of elder abuse, but it'll take more effort than we're making now.  Preventing elder abuse means doing three things:
  • Listening to seniors and their caregivers
  • Intervening when you suspect elder abuse
  • Educating others about how to recognize and report elder abuse

What you can do as a caregiver to prevent elder abuse

If you're overwhelmed by the demands of caring for an elder, do the following:
  • Request help, from friends, relatives, or local respite care agencies, so you can take a break, if only for a couple of hours.
  • Find an adult day care program.
  • Stay healthy and get medical care for yourself when necessary.
  • Adopt stress reduction practices.
  • Seek counseling for depression, which can lead to elder abuse.
  • Find a support group for caregivers of the elderly.
  • If you're having problems with drug or alcohol abuse, get help.

And remember, elder abuse help lines offer help for caregivers as well.  Call a helpline if you think there's a possibility you might cross the line into elder abuse.

What you can do as a concerned friend or family member
  • Watch for warning signs that might indicate elder abuse.  If you suspect abuse, report it.
  • Take a look at the elder's medications.  Does the amount in the vial jive with the date of the prescription?
  • Watch for possible financial abuse.  Ask the elder if you may scan bank accounts and credit card statements for unauthorized transactions.
  • Call and visit as often as you can.  Help the elder consider you a trusted confidante.
  • Offer to stay with the elder so the caregiver can have a break - on a regular basis, if you can.
How you can protect yourself, as an elder, against elder abuse
  • Make sure your financial and legal affairs are in order.  If they aren't, enlist professional help to get them in order, with the assistance of a trusted friend or relative if necessary.
  • Keep in touch with family and friends and avoid becoming isolated, which increases your vulnerability to elder abuse.
  • If you are unhappy with the care you're receiving, whether it's in your own home or in a care facility, speak up.  Tell someone you trust and ask that person to report the abuse, neglect, or substandard care to your state's elder abuse helpline or long term care ombudsman, or make the call yourself at 1800-962-2873.

Authors: Laurence Robinson , Tina de Benedictis, Ph.D., and Jeanne Segal, Ph.D.  Last updated June 2011 © 2001-2011.  All rights reserved.  This reprint is for information and support only and NOT a substitute for professional diagnosis and treatment.  Visit WWW.HELPGUIDE.ORG for more information and related articles. Hi-Tech Nursing

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