9/11-15/08                               

Every year, tens of thousands of elderly Americans are abused in their own homes, in relatives’ homes, and even in  facilities responsible for their care. You may suspect that an elderly person you know is being harmed physically or emotionally by a neglectful or overwhelmed caregiver or being preyed upon financially. By learning the signs and symptoms of elder abuse and how to act on behalf of an elderly person who is being abused, you’ll not only be helping someone else but strengthening your own defenses against elder abuse in the future.

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 undermedicating
• 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

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.

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.

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.

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 longterm care facilities. In addition, information and referral are also available from the national Eldercare Locator: 1-800-677-1116

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 helplines 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.

Finally, if you aren’t in a position to help an elder personally, you can volunteer or donate money to the cause of educating people about elder abuse, and you can lobby to strengthen state laws and policing so that elder abuse can be investigated and prosecuted more readily. The life you save down the line may be your own.

References and resources about elder abuse

General Information on Elder Abuse

Preventing & Reporting Elder Abuse – 39-page PDF booklet covering many aspects of elder abuse. (California Department of Justice)

Elder Abuse and Neglect: In Search of Solutions – Covers the facts about elder abuse, as well as signs of abuse and steps to take if abuse occurs.  (American Psychological Association)

What is Elder Abuse? – Site provides definitions of different types of elder abuse, along with signs and risk factors. (National Committee for the Prevention of Elder Abuse)

Elder abuse: Signs to look for, action to take – Overview of elder abuse: types, signs, and interventions. (Mayo Clinic)

Nursing Home Abuse

www.ltcombudsman.org   An Ombudsman is an advocate for residents of nursing homes, board and care homes, and assisted living. Ombudsmen provide information about how to find a facility and what to do to get quality care. They are trained to resolve problems. If you want, the ombudsman can assist you with complaints. However, unless you give the ombudsman permission to share your concerns, these matters are kept confidential.

Under the federal Older Americans Act, every state is required to have an Ombudsman Program that addresses complaints and advocates for improvements in the long term care system. To find the ombudsman nearest you, contact your State Ombudsman office.

Nursing Home Abuse News – Provides information about elder abuse in nursing homes and steps you can take to protect a loved one from neglect or abuse. (Nursing Home Abuse News)

  Resources used in researching this article 

Distinguishing Between Abuse, Neglect, And Self-Neglect – Defines the different categories of elder mistreatment and resulting psychological symptoms. (University of Missouri at Kansas City)

Ellen Jaffe-Gill, M.A., Tina de Benedictis, Ph.D., and Jeanne Segal, Ph.D., contributed to this article. Last modified on: 2/13/08.