by Laura Herman | Safer Senior Care
Elder abuse is a serious problem that is surprisingly common in the United States that affects the lives of millions of elderly individuals.
According to the CDC, from 2002 to 2016:
- Over 643,000 elders were treated for assault in emergency rooms
- Over 19,000 seniors died as a result of abuse
- 1 in 10 people over 60 living at home were victims of some type of elder abuse
- Elder abuse is presumed to be significantly under-reported.
Elder abuse can result in physical injuries and medical emergencies, but it often does not. However, it can leave a lasting emotional scar even when there are no obvious physical signs.
It is important to be alert and know what to look for to protect all seniors from abuse, neglect and mistreatment in its various forms.
What is Elder Abuse and Why Does it Happen?
Elder abuse is defined as non-accidental action, or failure to take necessary action, that results in real or potential harm to an elder. An elder is considered any person over 60 years old.
There are seven distinct types of elder abuse, which include physical, emotional and sexual abuse, financial exploitation, and neglect.
Elder abuse is often committed by someone that an elder knows and trusts. It can happen when well meaning people are overworked and overwhelmed. It can also occur when a predatory person takes advantage of an elder’s vulnerability.
Factors that Put a Senior at Higher Risk for Elder Abuse
There are certain factors that increase an elder’s risk of becoming a victim of abuse. These don’t always lead to abuse, but they do tend to make it more likely.
Poor Health of the Elder
- Poor physical health
- Poor memory or dementia
- Poor mental health or diagnosis of mental illness
- Tendencies toward challenging behavior (such as resistance to assistance, aggression or mood swings)
Preparedness, State, and Wellbeing of the Caregiver
- Poor training or understanding of the elder’s conditions, needs or how to perform necessary care
- Poor health of the caregiver
- Hesitance to accept help
- Poor coping skills
- Alcohol or drug misuse
- Poor self-care habits
- Difficulty sleeping
Relationship Challenges
- Family history of abuse
- Past or current volatile emotions, behavior or relationships
Living Arrangements
- Elder is living with an unprepared caregiver
- Isolated living situation
- Poor social support
- Few assistive services (such as home care, hospice, counseling, or therapy)
Financial Challenges
- Elder or caregiver are financially dependent on the other
- Limited funds
Risks Unique to Institutions
- Poor staff training
- Chronic staffing problems or overworked staff
- Staff burnout
- Stressful working conditions
- Low standards of care
- Poor administrative oversight
- Physical environment is unclean, unkempt, uncomfortable or in disrepair
The Seven Types of Elder Abuse
There are seven different forms of elder abuse.
1. Elder Physical Abuse
Physical abuse occurs when a person purposely uses physical force that may cause pain, injury or impairment to an elder. Among other things, physical abuse can include hitting, pinching or pushing a senior.
Physical abuse can also include confining or restraining the elder, such as locking them in a room or tying them to a chair to prevent a fall. Even if these are done “for their own good” or safety, under most circumstances these actions violate their rights and are considered abuse.
Physical abuse can result in bruises, cuts, sprains, fractures or other physical injuries. It can also terrify and emotionally traumatize the senior.
2. Elder Sexual Abuse
Sexual abuse includes non-consensual sexual contact with an elder. It can also include forcing an elder to undress or watch sexually explicit images or activity.
There are a wide array of activities that are considered sexual abuse:
- A paid caregiver raping or molesting an elder
- A spouse forcing unwanted intercourse or sexual contact
- A person with dementia inappropriately touching an elder who does not want it or who cannot legally consent to it.
- Forcing an elderly to watch pornography or view graphic images
It is sometimes unclear exactly when someone with dementia, or other health condition affecting mental capacity, is able to consent to sexual activity. Laws vary in different locations. In some cases, mental health experts must determine whether an individual has the capacity to consent.
3. Elder Emotional Abuse
Emotional abuse, sometimes also referred to as psychological abuse, includes emotionally distressing activity such as yelling, threatening, intimidating, ignoring or using hurtful words.
Emotional abuse can also include isolating the elder from their friends or family members.
4. Senior Financial Abuse or Exploitation
Financial abuse includes all kinds of misuse of an elder’s money or property. There is a wide array of activities considered financial abuse, including:
- Theft
- Scams
- Fraud
- Identity theft
- Withdrawing money from a bank account, writing checks or using credit cards without permission or under false pretenses
- Changing names on insurances, wills, financial accounts or property titles
- Charging an elder for products or services (such as high-fee loans, investments or insurance products) that are unaffordable or inappropriate for the elder, especially when the elder doesn’t authorize it, or deceit is used to gain authorization
Healthcare fraud is a specific type of financial abuse that occurs when healthcare providers engage in unscrupulous activity such as billing for services not rendered or prescribing inappropriate treatment for their own financial gain.
5. Elder Neglect
Elder neglect occurs when a caregiver fails to fulfill their obligations to meet an elder’s needs.
Neglect can be either passive – when the caregiver is unaware of needs that they should be aware of – or willful. Willful deprivation occurs when food, assistance, medical care or other necessities are purposely withheld.
Examples of neglect can include failing to provide adequate:
- Food, hydration or nutrition
- Shelter
- Hygiene assistance
- Medication
- Health care when needed
- Activities for social and mental health wellness
6. Elder Abandonment
Abandonment is a severe form of neglect. It occurs when a caregiver has assumed responsibility for care or custody of an elder and then leaves them without arranging appropriate replacement care.
7. Elder Self-Neglect
Elder self-neglect occurs when an elder fails to meet his or her own needs.
Self-neglect may be a result of dementia, depression or other physical or mental health condition that make it hard for them to realize or meet their own needs.
Self-neglect may be a result of dementia, depression or other physical or mental health condition that make it hard for them to realize or meet their own needs.
Signs of Elder Abuse: What to Look Out For
Signs of elder abuse can be difficult to discern at times. While a pattern of obvious bruising or injury might be apparent, other signs can be subtle.
Symptoms of abuse may manifest as vague behavior changes, which might be hard to distinguish from symptoms of dementia or depression. Pay attention to any intuitive feelings that something may be wrong in a senior’s situation.
Some of the more general signs that something is wrong could include:
•Sudden changes in behavior, such as becoming more nervous, jumpy, aggressive or withdrawn
•Losing interest in favorite activities
•Difficulty sleeping
• Unexplained or sudden weight loss
Any of these changes could indicate that an elder is emotionally distraught, which could be a result of physical, emotional or sexual abuse.
It also could mean that some of their needs are being neglected. For example, weight loss could indicate that their nutritional needs are changing and that the change is being overlooked.
Other signs that should raise some red flags to possible abuse could include:
• Increased nervousness around a particular caregiver
• Hostility or frustration in the relationships between an elder and the caregiver
• Threatening, controlling or demeaning behavior from the caregiver towards the elder
• A caregiver who won’t permit the elder to be alone with trusted friends and family members
Signs of Senior Physical Abuse
Aside from the general signs listed above, potential signs of physical abuse could include unexplained bruising or injuries.
While some elders do tend to bruise easily, be alert for “suspicious” bruising such as:
• Patterns of bruises resembling fingertips
• Symmetrical patterns of bruising on both sides of the body
• Bruises, cuts or abrasions on wrists or ankles
• Unexplained bruising or bleeding from the lips, cheeks, face or head
• Bruising in odd places, such as the abdomen or underarms
Signs of Elder Sexual Abuse
• Bruising around breasts, buttocks or thighs
• Bruising or tearing around genitals
• Unexplained bleeding from anus or vagina
• Ripped or bloody underclothes
• Unexplained venereal disease or infections
• The elder stating or hinting that abuse, including unwanted advances, has occurred
• Odd interactions between the elder and possible abuser (such as the elder appearing tense or uncomfortable with another person’s touch, or another resident in a memory care community seeming somehow too close and intimate)
Signs of Senior Financial Abuse
• Unexpected eviction notices or utility shut off
• Unexpected bills
• Unpaid bills, especially if someone is supposed to be helping manage finances
• Unnecessary services or subscriptions
• Cash or items of value are missing
• Suspicious changes to wills, property titles or other legal documents
• Suspicious bank withdrawals (such as unexplained large sums, or withdrawals from a location that the senior couldn’t have accessed)
• Duplicate billings for medical services, or billings for services not rendered
Signs of Senior Neglect
Red flags that neglect, or self-neglect, may be occuring include:
• Unkempt appearance, such as messy hair and clothing
• Poor body odor
• Home appears unclean or unsafe
• Dressed inappropriately for the weather
• Not using or wearing hearing aids, braces, or other medical devices as they should
• Evidence of medications being taken inappropriately (such as too many pills remaining when it’s time to refill)
• Bedsores or signs of inadequate care (wearing soiled incontinence products, bandages not being changed as required)
Changes in sleeping, eating and behavior can be general signs of abuse, but they can also be signs of other conditions, such as depression. If left untreated, these changes can lead to worsening health, lower quality of life and even an earlier death.
If the caregiver doesn’t notice these changes, it could qualify as neglect, because failure to treat the medical condition results in harm upon the elder.
While the caregiver may not intend to neglect the elder, it is important that they are either able to recognize and meet their needs, or to involve someone else who is. Geriatric care managers, home care agencies or other services can help support the elder and their caregivers, and recognize these changing needs.
Not all of these signs necessarily mean that abuse is taking place. However, they should be taken as red flags and may warrant further investigation, especially if there are multiple signs present. If something just doesn’t seem quite right in the situation, do not ignore it.
What to do When Signs of Elder Abuse are Noticed
Many times, elders won’t be willing or able to discuss abuse, but if they do express feeling concerned or taken advantage of be sure to listen. Speak to them privately, in a safe and comfortable environment.
Even if an elder has dementia, and may not always be accurate in their details, it is important to listen and investigate their concerns.
Depending on the situation, it may be appropriate to first talk directly to the elder or another involved person – such as a family member, paid caregiver or facility administrator – about your observations or concerns.
You can also always report your observations to Adult Protective Services. These professionals are able to take a closer look at the situation and have resources to assist the elder.
How to Report Elder Abuse
If an elder is in life threatening danger, call 911.
Any other suspected mistreatment of an elder should be reported to Adult Protective Services.
Calls can be made anonymously and callers do not need to know with certainty that abuse is occuring. Callers simply report their concern, and a professional will be assigned to investigate the situation.
If the senior’s safety or well-being is at risk, Adult Protective Services will initiate the appropriate interventions.
Elder Abuse Frequently Asked Questions
Who is most likely to abuse the elderly?
Statistically, family members are the most likely to commit abuse, accounting for 60% of cases. Adult children and spouses are by far the most common.
Long term care staff also account for a growing number of cases as more elders reside in care homes such as skilled nursing homes and assisted living communities.
Why does elder abuse go undetected so often?
Because elder abuse is so often committed by people they know and trust, elderly victims of abuse can be hesitant to report them.
They may not want their loved one to get in trouble. They may feel embarrassed or ashamed, or they might excuse the abusive behavior in their own mind.
Since the abuser often is a key caretaker of the elder, they may fear what will happen to them if they do report it. Will the abuse get worse; will they be put in an institution or left all alone?
Many elders are unable to report abuse due to memory or communication impairments, or for other reasons.
Some elders may not even realize what has happened at all, such as in the case of financial exploitation. They may suddenly find themselves without funds, facing unpaid bills or an eviction notice, and not know how to handle the situation.
Elder Abuse: A Hidden Epidemic
Elder abuse has been called a hidden epidemic that impacts the health and wellbeing of six million elders annually in the United States alone.
By being aware of the problem, the potential signs of abuse and the steps to take when these signs are noticed, we can make a big impact on this epidemic as a whole. We can make an even bigger impact on the health and well being of each individual elder for whom we speak up.
