Elder Abuse and Neglect
Warning Signs, Risk Factors, Prevention, and Reporting AbuseIn This Article Many elderly adults are abused in their own homes, in relatives’ homes, and even in facilities responsible for their care. If you suspect that an elderly person is at risk from a neglectful or overwhelmed caregiver, or being preyed upon financially, it’s important to speak up. Learn about the warning signs of elder abuse, what the risk factors are, and how you can prevent and report the problem.
What is elder abuse?
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.
Many seniors around the world are being abused: harmed in some substantial way often by people who are directly responsible for their care.
In the U.S. alone, 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 often adult children, other family members such as grandchildren, or spouses/partners of elders. Elder abuse can also occur in institutional settings, especially long-term care facilities.
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 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.
In emotional or psychological 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 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 intentional or unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does.
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
If you suspect elderly abuse, but aren't sure, look for clusters of the following physical and behavioral signs.
- 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
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
- 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 unbathed
- 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
- 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 undermedication
- 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 who 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.
Preventing elder abuse and neglect
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 possible.
Protecting 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.
- 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 an 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 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.
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. Or call one of the helplines listed in Resources & References below.
If you see an older adult being abused or neglected, don’t hesitate to report the situation. Don’t assume that someone else will take care of it or that the person being abused is capable of getting help if he or she really needs it.
Many seniors don't report the abuse they face even if they’re able. Some 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.
How do I report elder abuse?
For a list of helplines to call in your country, see the Resources & References section below. In the U.S., for example, the first agency to respond to a report of elderly abuse is usually Adult Protective Services (APS). Its role is to investigate abuse cases, intervene, and offer services and advice, although the power and scope of APS varies from state to state. Wherever you’re reporting elder abuse, though, there are some important things to remember to ensure that you’re able to communicate effectively in different situations:
Tip 1: Try to be specific as you can in your description
You don’t need “hard evidence” to report abuse. In many situations, abuse can be subtle or happen gradually. However, the more specific details you can provide, the clearer the picture of abuse can become. For example, if you’re worried that your neighbor is not taking care of himself, instead of reporting, “My neighbor is having a hard time taking care of himself”, try “I’ve noticed that my neighbor wears the same outfit over and over again and it is looking very dirty. When I come to the door, I smell urine and even feces. The house also smells like there is trash accumulating inside.”
Tip 2: Understand the elder does have the right to refuse services
As painful as it may be, unless the older adult no longer has the mental capacity to make their own decisions, he or she does have the right to refuse help. A senior may refuse to admit they’re being abused because they’re afraid the caregiver will retaliate, or because they’re worried about who will take care of them if their abusive caregiver is removed. Sadly, an elder adult may view having an abusive caretaker as better than having no caretaker and being forced to move out of their own home. In these situations, if it is safe for you to do so, continue to stay in contact and encourage the elder to consider alternatives to home care. For example:
- Taking tours of assisted living or other facilities, without any immediate pressure to move, may help dispel myths or eradicate the older person’s fears about moving
- Offering services on a trial basis can help the elder see the positive changes they can have, and make them more open to change. For example, if self-neglect is an issue, encourage them to try housekeeping help for a month, or a meal delivery service for a few weeks.
- Keeping the older adult and caregiver connected to support services can help reduce feelings of isolation and depression, two major risk factors for elder abuse. Also, the more support there is for the elder and the caregiver, the more eyes there will be to watch for any warning signs of abuse.
- If a family caregiver is suspected of abuse, other family members may have the best chance of convincing the older adult to consider alternative care.
Tip 3: Keep your eyes and ears open
If you see future incidences of abuse, continue to call and report them. Each elder abuse report is a snapshot of what is going on. The more information that you can provide, the better the chance the elder has to get the level of care he or she needs. Older adults can be increasingly isolated from society and, with no school or work to attend, it can be easy for abuse cases to go unnoticed for long periods.
Sadly, two of the most common sources of elder abuse are abuse by a primary caregiver—often an adult child—and self-neglect. Here are some tips for handling these situations.
Elder abuse in the home
- Try to have different family members or neutral parties involved in the older adult’s care to provide checks and balances, including reviewing finances. The greater the cognitive or physical impairment of the elder, the more people need to be involved in their care. While there is no excuse for abuse, caregiving can be extremely taxing, both mentally and physically. If a caregiver is unable to get any respite, has disrupted sleep, or is experiencing his or her own health problems, there is a greater risk for elder abuse.
- Feelings of shame can often keep elder abuse hidden. You may not want to believe a family member could be capable of abusing a loved one, or you may even think that the older adult would be angry at you for speaking up. But remember, everyone deserves to live with dignity and respect. The earlier you intervene in a situation of elder abuse, the better the outcome will be for everyone involved.
Look for common risk factors for elder abuse in the home
- Substance abuse can impede a caregiver’s ability to provide adequate care. It also increases the risk of financial abuse as the caregiver struggles to finance a substance abuse habit.
- A history of domestic violence or other violence can often be a marker for elder abuse later in life.
You may notice that an older family member, friend, or neighbor living alone is no longer taking care of themselves. They may appear increasingly disheveled, lack basic personal hygiene, or their home may be growing dirtier and dirtier. In many cases of self-neglect, the older person will refuse to get assistance. However, there are still things that you can do to help.
- Remember, any older adult deserves dignity and respect. He or she may be in denial, feel ashamed about needing help, or worried about having to leave home. Don’t stop checking in with the older adult, even if you are brushed off. Enlist others to express their feelings of concern to the elder. Sometimes a peer or a neutral party, such as a geriatric care manager, may have a better chance of getting through.
- Make sure the older adult is connected with medical services. Self-neglect can be a sign of depression, grief, dementia, or other medical causes. If you know the person’s doctor, you can share your concerns. While the doctor may not be able to discuss the case with you if you do not have the older adult’s permission, you can write a letter or call to make sure that your concerns are heard.
- It can be a real challenge to respect an older adult’s right to autonomy while at the same time making sure they are properly cared for. If you are concerned that a person’s ability to take care of themselves safely is compromised, you can look into legal guardianship or legal conservatorship. If there is not an appropriate family member available, a guardian can be appointed by the court.
More help for elder abuse and neglect
- Caregiver Stress and Burnout: Tips for Recharging and Finding Balance
- Respite Care: Finding and Choosing Respite Services
- Anger Management: Tips and Techniques for Getting Anger Under Control
Resources and references
General information on elder abuse
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)
Frequently Asked Questions – Answers to 16 key questions about elder abuse. (National Center on Elder Abuse, U.S Department of Health and Human Services)
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)
Self-neglect – Provides information on self-neglect including how to advocate for the older adult and the limitations of Adult Protective Services. (Aging and Disability Services Administration)
Nursing home abuse
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)
Preventing elder abuse
Preventing Elder Abuse by Family Caregivers – PDF article describing why it’s hard to be a caregiver, the potential for abuse, and where to find help. (National Center on Elder Abuse)
Preventing & Reporting Elder Abuse – 39-page PDF booklet covering many aspects of elder abuse. (California Department of Justice)
Reporting and stopping elder abuse
State Directory of Helplines, Hotlines, and Elder Abuse Prevention Resources - (National Center on Elder Abuse)
Elder abuse helplines and hotlines:
- US: 1-800-677-1116 (Eldercare Locator).
- UK: 0808 808 8141 or Ireland: 1800 940 010 (Action on Elder Abuse).
- Australia: 1300 651 192 (Elder Abuse Prevention Unit).
- South Africa: 080 111 2131 (Age In Action).
- Canada: visit Alberta Elder Abuse for links to local resources.
Reporting elder abuse in the U.S.
What services are available to stop abuse? – Provides resources in the community for stopping abuse, including counseling, legal services, and case management. (National Committee for the Prevention of Elder Abuse)
National Academy of Elder Law Attorneys – Public section of site that defines elder law, issues to consider, questions to ask when finding an attorney, and how to find an elder law attorney. (NAELA)