Elder Abuse

Elder abuse is the abuse of an elderly person, most often by someone known and trusted by the abused. Elder abuse may take many forms and can occur in either a home or institutional environment.

When the apartment door opened, Jada expected to see her grandmother Pearl's familiar, smiling face. Instead, she found Pearl weak, bruised, and disoriented. Reluctant to move Pearl to a nursing home so long as she could perform some degree of care for herself, the family had hired a home healthcare aide to visit daily to help Pearl bathe and ensure she had properly taken her medication. Unbeknownst to the family, the caregiver's help had deteriorated to neglect and even abuse in rough-handling Pearl and making verbal threats.

Jada voiced her concerns to her parents, who terminated service with Pearl's caregiver and called for an investigation. Because Pearl had Jada and other family members advocating for her, the abuse was discovered and ended.

Elder abuse is defined by the National Committee for the Prevention of Elder Abuse as any form of mistreatment that results in harm or loss to an older person. There are several types of elder abuse: physical abuse, psychological or emotional abuse, financial exploitation, sexual abuse, neglect, abandonment, and self-neglect. In many cases an elder may be subjected to multiple types of abuse at the same time.

Physical abuse is inflicting injury or pain on another person, including hitting, slapping, kicking, bruising, biting, and burning; being restrained inappropriately by physical or chemical means; and being threatened or assaulted with a knife, gun, or other object.

Psychological or emotional abuse involves inflicting mental pain, anguish, or distress on an elderly person through verbal or nonverbal acts, including threatening, embarrassing, humiliating, intimidating, and isolating acts. This type of abuse also includes restricting access to means of communication (such as the telephone) and transportation; damaging an elder's property; and disregarding the elder's wishes and needs.

Financial exploitation is the unauthorized or inappropriate use of an elder's resources, including funds, property, or assets, for personal benefit. Exploitation may include theft of money or possessions, forgery to gain access to accounts, coercion of an elder to get funds or property, or the improper use of legal guardianship or power of attorney.

Sexual abuse is nonconsensual sexual contact of any kind or forcing an elder to witness a sexual act.

Neglect is the failure of a caregiver to provide an elder with adequate physical, emotional, or social care, including food, hygiene, shelter, access to health care, and protection from injury or other harm.

Abandonment is the desertion of a vulnerable elder by anyone who has assumed responsibility for care.

Self-neglect is the inability of an elderly person to perform essential self-care tasks. This inability may threaten his or her health or safety.

Elder abuse also occurs in residential care facilities, but it is relatively rare. In such settings, the most common form of abuse is verbal or psychological abuse.

Many signs may indicate elder abuse. One sign alone is not always an indicator of abuse. For example, older people fall and acquire bruises. If they are taking medications that thin their blood, they may bruise easily. So, bruising is not necessarily a sign of elder abuse. However, as many of the signs of elder abuse are also signs of general mental and physical decline, they should not be dismissed merely on the word of the caregiver.

If one suspects an elder is in immediate danger, emergency services should be called at 911.

Approximately 90 percent of those who abuse the elderly are family members, often an adult child, spouse, or grandchild of the abused. In some, but certainly not all cases, the abuse is related to the stress of caring for a physically and/or mentally frail, highly dependent person.

Often the abuser has been a victim of abuse and through that experience has learned to be abusive. He or she sees violence as a way to solve problems. Abusers often feel they are not getting enough recognition for the care they are providing to the elderly person, which causes them to lash out. Societal and community influences can factor in as well. Incidents of elder abuse are more likely to occur in low-income households, in situations where the caregiver is unemployed or retired, and in communities with few options for social support.

Screening questions should be asked in a calm, nonjudgmental fashion of the elderly person to find out if anyone has ever hurt them physically or verbally, made them do anything they did not want to do, or failed to assist them when they needed help. The potential victim's caregiver should also be evaluated. Warnings signs include a change in caregiver, the caregiver having little or no knowledge of the medical needs or issues of the elderly person, or the caregiver not allowing the elderly person to be interviewed alone.

When the healthcare provider suspects elder abuse, it is her or his ethical and professional responsibility to report the person to the local Adult Protective Services, who will make a home visit to assess the caregivers and the environment. If the elder is believed to be in immediate danger, he or she may be admitted to a care facility until a long-term determination can be made. Physical injuries are treated as appropriate. Psychological injuries, sexual abuse, and financial exploitation must be reported to law enforcement personnel for appropriate follow-up.

Information about respite care or adult daycare services can be given to caregivers who are experiencing caregiver fatigue. If the elder has several chronic health problems that make care difficult for an individual family member, a home health aide can be recommended to assist with the elder's care.

If someone suspects a case of elder abuse, it should be reported to the state's Department of Adult Protective Services. A list of resources for each state and territory is maintained by the National Center on Elder Abuse.

The National Center on Elder Abuse lists strategies that can be implemented to prevent elder abuse. They include:

See also Bedsores (Pressure Sores) • Broken Bones (Fractures) • Burns • Selective Mutism • Sexual Abuse

* bedsores are skin sores caused by prolonged pressure on the bony prominences of the hips, sacrum, heels, elbows, and shoulders; typically seen in people who are confined by illness or paralysis to beds or wheelchairs. Also called pressure sores.