Elder Abuse
In modern U.S. society, elders are most often defined as people age 60 or older. While some elders live independently, many receive care. Elder abuse can be committed by people who are responsible for caring for an elder, or who are people that the elder trusts. Elder abuse can include abuse, neglect, and abandonment. It can take many forms, including physical, sexual, emotional, or financial abuse.
According to Rosay and Mulford (Prevalence estimates and correlates of elder abuse in the United States: The National Intimate Partner and Sexual Violence Survey (2017) , Journal of Elder Abuse and Neglect), in the general US population, elder abuse is experienced by an estimated one in every ten people age 60 and older who lives at home. For every case of elder abuse that is identified or reported, approximately 23 cases remain hidden.
There are varying definitions of elder abuse:
The Centers of Disease Control and Prevention (CDC) defines elder abuse as an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult (age 60 or over).
According to the National Center on Elder Abuse, elder abuse refers to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to an elder adult. The specificity of laws varies from state to state, but broadly defined, abuse may be: physical abuse, emotional abuse, sexual abuse, exploitation, neglect, abandonment.
The National Research Council report uses the term "elder mistreatment": intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended) to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the elder, or (b) failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm. The report explains that the term "mistreatment" is meant to exclude cases of self-neglect, as well as cases of victimization by strangers.
Physical Abuse
The intentional use of physical force that results in acute or chronic illness, bodily injury, physical pain, functional impairment, distress, or death. Physical abuse may include, but is not limited to, violent acts such as striking (with or without an object or weapon), hitting, beating, scratching, biting, choking, suffocation, pushing, shoving, shaking, slapping, kicking, stomping, pinching, and burning.
Sexual Abuse or Abusive Sexual Contact
forced or unwanted sexual interaction (touching and non-touching acts) of any kind with an older adult. This may include but is not limited to forced or unwanted completed or attempted contact between the penis and the vulva or the penis and the anus involving penetration, however slight. It might also include forced or unwanted contact between the mouth and the penis, vulva, or anus; forced or unwanted penetration of the anal or genital opening of another person by a hand, finger, or other object; forced or unwanted intentional touching, either directly or through the clothing, of the genitalia, anus, groin, breast, inner thigh, or buttocks. These acts also qualify as sexual abuse if they are committed against an incapacitated person who is not competent to give informed approval.
Emotional or Psychological Abuse
verbal or nonverbal behavior that results in the infliction of anguish, mental pain, fear, or distress. Tactics that may exemplify emotional or psychological abuse of an older adult include behaviors intended to humiliate (e.g., name-calling or insults), threaten (e.g., expressing an intent to send to nursing home), isolate (e.g., seclusion from family or friends), or control (e.g., prohibiting or limiting access to transportation, phone, money or other resources).
Neglect
failure by a caregiver or other responsible person to protect an elder from harm, or the failure to meet needs for essential medical care, basic activities of daily living, or shelter, which results in a serious risk of compromised health and safety. Examples include not providing adequate nutrition, hydration, hygiene, clothing, shelter, or access to necessary health care; or failure to prevent exposure to unsafe activities and environments.
Financial Abuse or Exploitation
the illegal, unauthorized, or improper use of an older individual’s resources by a caregiver or other person in a trusting relationship, for the benefit of someone other than the older individual. This includes, but is not limited to, depriving an older person of rightful access to, information about, or use of, personal benefits, resources, belongings, or assets. Examples include forgery, misuse or theft of money or possessions; use of coercion or deception to surrender finances or property; or improper use of guardianship or power of attorney.
Risk Factors are a combination of individual, relational, community, and societal factors that contribute to the risk of becoming a perpetrator of elder abuse. They are contributing factors and may or may not be direct causes. Understanding these factors can help identify various opportunities for prevention.
Protective factors reduce risk for perpetrating abuse and neglect. Protective factors have not been studied as extensively or rigorously as risk factors. However, identifying and understanding protective factors are equally as important as researching risk factors.
Risk Factors for Perpetration
Individual Level
- Current diagnosis of mental illness
- Current abuse of alcohol
- High levels of hostility
- Poor or inadequate preparation or training for care giving responsibilities
- Assumption of caregiving responsibilities at an early age
- Inadequate coping skills
- Exposure to abuse as a child
Relationship Level
- High financial and emotional dependence upon a vulnerable elder
- Past experience of disruptive behavior
- Lack of social support
- Lack of formal support
Community Level
Formal services, such as temporary help for those providing care to elders, are limited, inaccessible, or unavailable
Societal Level
A culture where:
- there is high tolerance and acceptance of aggressive behavior
- health care personnel, guardians, and other agents are given greater freedom in routine care provision and decision making
- family members are expected to care for elders without seeking outside help
- people are encouraged to endure suffering or remain silent about pain
- there are negative beliefs about aging and elders
Protective Factors against Abuse
Relationship Level
- Having numerous, strong relationships with people of varying social status Community Level
- Coordination of resources and services among community agencies and organizations serving the elderly population and their caregivers.
- Higher levels of community cohesion and a strong sense of community or community identity
- Higher levels of community functionality and greater collective efficacy
Protective factors within institutional settings can include the following:
- Effective monitoring systems
- Solid institutional policies and procedures regarding patient care
- Regular training on elder abuse and neglect for employees
- Education and clear guidance on durable power of attorney and how it is to be used
- Regular visits by family members, volunteers, and social workers
According to the American Society on Aging, professionals often initially miss many signs and symptoms of abuse as they overlap with symptoms associated with deteriorating mental health. Prompt intervention can reduce the impact of abuse on an elderly person’s psychological and physical well-being.
While behavioral signs are often the first indicators of abuse, abused elders may exhibit a combination of physical and behavioral changes. Behavioral symptoms of elder abuse may mimic symptoms of mental deterioration and can appear to be symptoms of dementia, frailty or other mental health problems. As victims vary in their response, professionals need to be sensitive to the presence of certain physical and behavioral indicators. Since there is no universal response to being a victim of abuse or neglect, knowing about the person’s normal behavior is helpful in recognizing the behavioral signs of abuse, neglect or exploitation.
Behavioral Signs
- Depression
- Isolating or withdrawing from others
- Suffering from anxiety, anger, agitation or fear
- Being ambivalent, resigned or unresponsive
- Making up implausible stories about how an injury occurred
- Hesitant to talk freely
- Disoriented or confused
Physical signs
- Welts, wounds, and injuries (e.g., bruises, cuts, scratches, dental problems, head injuries, pressure sores)
- Broken bones (especially spiral fractures), sprains, dislocations
- Persistent physical pain and soreness
- Nutrition and hydration issues
- Increased susceptibility to new illnesses (including sexually transmitted diseases)
- Exacerbation of preexisting health conditions
- Medication errors including overdose or failure to take medication
- Broken eyeglasses, frames
- Frequent emergency room visits
- Caregiver refusal to allow elder to be seen alone
Sexual Symptoms
- Bruises around breasts, thighs, or genitals
- Unexplained sexually transmitted infection
- Unexplained vaginal or anal bleeding
Neglect (from caregiver and self-neglect)
- Unusual weight loss, malnutrition, dehydration
- Unusual weight loss, malnutrition, dehydration
- Untreated physical problems, such as bed sores
- Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
- Poor hygiene
- Unsuitable clothing or covering for the weather
- Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards)
Emotional Signs
- Withdrawn and fails to participate in usual activities
- Caregiver isolates the elderly person and will not let them be alone with other family members
- The caregiver can be verbally aggressive or demeaning to the elderly person
- The caregiver may be controlling
Reporting
Know the state laws and tribal codes in your area for mandated reporting of elder abuse.
If the danger is immediate and life-threatening, call 911
If you suspect that an elder is being abused, and the danger is not imminent there are additional options:
- Contact the local adult protective services or local law enforcement
- Call Eldercare Locator at 1-800-677-1116, Monday through Friday, 9 a.m. to 8 p.m (ET). Specially trained operators will refer you to a local agency, resources or other assistance.
- Search the Elder Care Locator
- Search by location to find where to report elder abuse
Helplines, Hotlines, and Referral Sources
- National Center on Elder Abuse maps direct links to State information
Resources
Elder Abuse Surveillance: Uniform definitions and recommended core data elements [PDF - 4 MB]
The National Indigenous Elder Justice Initiative (NIEJI) is funded by the Administration for Community Living(ACL) to provide research, education, and training for the identification and prevention of elder abuse in Indigenous communities. NEIJI serves American Indian, Alaska Native, and Native Hawaiian elders in an effort to improve their quality of life, and the site provides links to Tribal Codes for Elder Abuse, State/Tribal Hotlines, and innovation participation.
National Center on Elder Abuse (NCEA) serves as a national resource center dedicated to the prevention of elder mistreatment. Established by the U.S. Administration on Aging (AoA) in 1988 as a national elder abuse resource center. NCEA disseminates elder abuse information to professionals and the public, and provides technical assistance and training to states and to community-based organizations.
Administration on Aging - site from the Administration of Community Living, U.S. Department of Health and Human Services
