How to Identify Types of Elder Abuse and Neglect

Elder abuse is any action or inaction that causes, or has the potential to cause, harm to an older adult. According to the Centers for Disease Control and Prevention, an older adult is defined as anyone over the age of 60.

Some elder abuse (also sometimes referred to as exploitation) involves a deliberate act- for example, developing a scheme to take money from a vulnerable neighbor. Other abuse can take the form of inaction, such as purposely withholding food or medical treatment.

Unfortunately, elder abuse can also be a spontaneous reaction. For example, factors like caregiver burnout can trigger abuse when a caregiver loses her patience and strikes out at her mother. (This is one of many reasons that it's important to be vigilant for the signs of caregiver burnout.)    

Although talking about elder abuse can be uncomfortable, it's very important since it can have a significant impact on the safety and quality of life for older adults. Learning more about elder abuse can increase your awareness of the different types, help you be able to spot its signs, and understand the steps you can take to reduce the risk. 

Types

There are several different types of abuse that may affect older adults. Elder abuse includes the following:

• Physical: Physical abuse includes hitting, kicking, pushing, slapping, biting and other physical violence. Domestic violence is a kind of physical abuse where there is a pattern of violence by a spouse or domestic partner used to control a person.
• Verbal, emotional or psychological: Verbal, emotional or psychological abuse includes using intimidation, humiliation or threats to control another person, as well as yelling, name-calling and verbal insults.
• Sexual: Sexual abuse consists of a wide spectrum of behaviors including sexually inappropriate comments and non-consensual sexual contact of any kind. With people who have dementia, this type of abuse can turn into a dilemma due to the difficulty of determining if a person who is confused may still be classified as a consenting adult.
  Financial or property: This type of abuse is also sometimes referred to as "misappropriation of property" and involves taking or misusing someone’s money or his belongings without the individual’s permission. It can also include coercion of the person so that he agrees to give someone money but only because he is placed under pressure to do so by someone.
  Financial challenges also can arise when a parent frequently gives money away to people who are dishonest, such as through a phone scam.
• Involuntary seclusion: This kind of abuse involves restricting the individual’s freedom to interact with others for extended periods of time against her will.
  Occasionally, this can be used therapeutically, and then it is not considered abuse. For example, if an individual is extremely combative (i.e., hitting or kicking at you) while you’re trying to provide care to her, she may benefit from a few minutes alone in her room to calm down, as well as prevent others from being hurt.
• Neglect: Neglecting someone also can constitute abuse. Neglect can be intentional or unintentional. If someone requires care for a medical condition and her caregiver is not addressing that need, neglect could be present. For example, in a nursing home, if a nurse forgets to give the resident her medications and there's some type of harm that results, that nurse could be reported for neglect even though she had no intention of hurting the resident. Neglect can also be intentional, such as deliberately withholding food or necessary treatment.
  Self-Neglect: Self-neglect is when an individual does not adequately care for themselves. They may be lacking adequate food or water, medications, hygiene or a safe place to live. If someone can no longer bathe herself, doesn’t eat enough food because she regularly forgets that it’s time for a meal, and is unable to take her medications, her case could be reported to the Protective Services department in your area for investigation of neglect because she may not be competent to make appropriate decisions.
  It's important to recognize that self-neglect is not present when a person who is able to think clearly makes a decision that you don't agree with, such as opting to live in his own home even though he struggles with walking and caring for himself independently. If the person can identify and understand the risks and benefits of their choices, they likely still have the right to make a decision that you might feel is unwise and that places them at some risk.
• Abandonment: Some organizations add the additional category of abandonment. Abandonment is a type of neglect where a caregiver deserts (abandons) an older adult for whom they are the caregiver. Sadly, they may leave the elder at a store or a facility, similar to cases when babies have been abandoned.

Facts and Statistics

• The most recent data suggests that approximately 10 percent of adults over the age of 60 have experienced some type of elder abuse, resulting in an estimated 5 million cases of abuse each year.
• According to the National Committee for the Prevention of Elder Abuse, 84 percent of abuse is not reported to the authorities.
• Abuse costs tens of billions of dollars each year due to lost wages, health care, social services, and legal costs.
• The National Center on Elder Abuse reports that approximately 86 percent of abuse perpetrators are related to the victim, and most often are a spouse or adult child.
• While abuse can be perpetrated by nursing home and assisted living staff members, researchers have found that the majority of elder abuse is carried out by individuals (often family members) who are known and trusted by the older adult, such as spouses and adult children. Abuse perpetrators include both men and women.​
• Alzheimer’s disease and other types of dementia place someone at a higher risk of abuse due to memory impairment, poor judgment, an inability to be independent and fear of repercussion. Persons with dementia can be in a vulnerable position of needing help and may easily trust someone they shouldn’t. Their social interaction is often limited, which increases the opportunity for abuse to occur. They also may be targeted because the perpetrator may feel they won't remember the abuse, be able to express it clearly to someone else or be believed if they do tell someone because of their confusion.

Risk Factors

• Social isolation
• Impaired physical health and functioning
• Being female
• Lower income
• No spouse
• African American race

Signs and Symptoms

• Frequent bruising: Matching bruises on arms may indicate rough grabbing of the person, for example. Be aware that an older person’s skin is often very fragile and bruise easily, so a bruise doesn’t always mean abuse is present. Certain medications like blood thinners or steroids can also cause a person to bruise easily.
• Unexplained injuries: The individual can’t or won’t explain what happened, or family members have different explanations that don’t seem to fit with the scenario.
• Pain or bleeding: If there is no explanation for vaginal or anal pain or bleeding, it should be investigated.
• Pain when sitting down: The individual shows unusual or new pain when sitting down.
• Frequent caregiver expressions of anger: If the caregiver often expresses her anger with the older adult, this is a concern since her frustration may be directed toward the person she’s caring for.
• Unpaid bills: The person begins to receive notices of overdue bills or checks are returned because there are insufficient funds.
• A new close friend: Someone may move in with the older adult and begin to ask for gifts or offer to help with his or her banking.
• Inappropriate questions from a caregiver: If for example, the in-home aide begins to ask more questions about someone’s finances, this can indicate a red flag.
• Absence of food or medication: The person is lacking adequate nutrition and is not taking his medications regularly.
• Lack of appropriate treatment: If the older adult has decubitus ulcers (bedsores) that are not being treated, this can be a sign of neglect.
• New power of attorney document: The person has suddenly changed their financial power of attorney and you question her ability to understand the document.
• Isolation: The caregiver may isolate the older adult in order to hide signs of abuse or to control him.
• Withdrawal: The older person may withdraw emotionally and appear depressed, or withdraw physically in response to touch or proximity of another person.
• Emotional distress: The person may begin to frequently cry or appears anxious or worried.
• Verbalization: The older victim may choose to confide in you about her experience of abuse. Take it seriously and report it to your local adult protective services department. You can find this contact information by looking up your local government agencies and searching for adult protective services.

Prevention

• Ask questions
• Be aware
• Ensure financial checks and balances
• Check references of in-home helpers
• Consider monitoring the checkbook
• Be involved in your loved one’s life
• Understand that family, unfortunately, can be the abuser
• Prevent caregiver overload and burnout
• Know how to cope with challenging behaviors in Alzheimer’s and other dementias

What to Do If You Suspect Abuse

If the older person lives in his own home, you should contact your local adult protective services department. You can also consult with social workers, medical personnel or the local police department.

If the older person lives in a facility such as a nursing home or assisted living, you should report your concerns to the administrator of that facility. You can also report suspected abuse to your state agency that oversees nursing homes.