Elder Abuse

Elder Abuse is defined as an intentional or knowing act, or failure to act by a caregiver or another person that causes harm or serious risk to a vulnerable elder adult.  For the purpose of this article an elder adult is defined as someone age 60 or older.   Elder adults who have been abused are at a much greater risk of death then those who have not been a victim of abuse.  The abused and the abuser or perpetrator are of various ethnic backgrounds, gender, and socioeconomic status.  The abuser or perpetrator is typically known to the victim such as a relative, caregiver, or “trusted other.”

Types of Elder Abuse:

According to National Center for Injury Prevention and Control and the Center for Disease Control and Prevention, elder abuse can be categorized into five categories.  These include sexual abuse, physical abuse, emotional abuse, financial exploitation, and neglect.

Sexual Abuse is defined as nonconsensual touching, fondling, intercourse, or any other sexual activity with an elder person.  Under sexual abuse, the person is unable to understand, unwilling to consent, threatened, coerced or physically forced into or witnessing of such behaviors.

Physical Abuse is defined as inflicting or threatening to inflict physical pain or injury to an elder person.  Physical abuse can include acts such as, hitting, biting, beating, choking, suffocating, pushing, shoving, shaking, slapping, kicking, pinching, and burning.

Emotional Abuse is defined as inflicting mental pain, verbal assaults, threats, harassment, humiliation or intimidation.  Emotional abuse can be both verbal and non-verbal acts.  Emotional abuse includes, calling names, insults, isolation and seclusion, prohibiting access to various resources and threatening.  Threats can come in various forms such as telling the elder person that they will never be able to go home (from the nursing home) or that they cannot see friends or family if they do not do things or act in a certain way.

Financial Exploitation is defined as illegally without consent taking, misusing, and cancelling funds, property or assets to benefit someone other than the elder person.  Financial abuse includes forging of checks, use of their credit/ATM cards, coercing to surrender finances, use of their state funded resources, or improper use of guardianship or power of attorney.

Neglect is defined as a caregiver’s failure to provide a person with basic needs such as food, clothing, shelter, medical care, and protection.  Neglect includes but is not limited to not providing proper nutrition, hygiene, environment appropriate clothing, and failing to provide a safe environment.  Neglect can pose a serious risk of compromising health and safety to an elder person.

Warning Signs of Abuse

Many times there are signs of elder abuse that go unnoticed.  Having signs of abuse does not necessarily confirm abuse, but could be an indicator of a possible problem that requires a heightened awareness.

Sexual abuse warning signs could be sudden and unexplained sexually transmitted diseases, bruising, cuts and sores in or around the breasts, genitalia, inner thighs, and buttocks.

Physical abuse warning signs can include unexplained injuries such as bruises, fractures, cuts, sores, burns, and pressure marks.

Emotional abuse may present as unexplained or uncharacteristic changes in mood and behavior, self-isolation, and withdrawal from previously engaged activities.

Financial abuse warning signs include a sudden or slow onset of an inability to afford amenities.  The person may be excessively gifting money to an organization, a friend, a family member, or companion.  A caregiver, family member or Power of Attorney may have control of the person’s finances, and still the needs of the elder person are not being met.  Financial abuse also occurs when the person has signed away property, money, or assets but is unable to comprehend what the transaction means.

Neglect warning signs include lack of basic hygiene, appropriate clothing, food, and medical care.  The elder person may be unkempt, have an odor, bedsores, sudden unexplained weight loss, or dehydration.  The person may also be left unattended or in bed without proper care.  Their home or environment may be dirty, cluttered, in disrepair, lack heating, water, electricity, and appropriate appliances.

With any type of abuse there are also some warming signs not directly related to the person.  These may include actions of the caregiver such as isolating the person, being verbally or physically aggressive, or frequenting financial institutions.

Reporting of Abuse

Anyone suspecting an elder person is being abused should report their suspicion. When reporting abuse, the person making the report does not need to prove or have proof that abuse has actually taken place.  If the person is in immediate danger, 911 should be contacted.  When the situation is not life-threatening, the local Adult Protective Service agencies should be notified.  The person making the report cannot be identified to the abuser or the alleged victim.  There are specific guidelines and regulations for the reporting of suspected abuse within facility settings.  Persons such as physicians, caregivers, persons responsible for the care or custody of the elder, licensed staff, clergy, and ombudsman are required to report any suspicions of elder abuse.

Abuse Prevention

The best way to decrease the elder abuse by caregivers is to focus on preventing the abuse before it occurs.  In order to do this, the facility should focus on the screening of staff and volunteers, training and stress reduction.  These trainings may include definitions and understanding of the types of abuse (including examples), recognition and awareness of signs of possible abuse, requirements for reporting abuse, intervention methods related to dealing with aggressive and/or inappropriate behaviors of residents, and stress reduction.   Through proper and effective development of screening processes and training, facilities can help to decrease the prevalence of elder abuse.