Elder Abuse...



Elder abuse is a growing problem. While we don't know all of the details about why abuse occurs or how to stop its spread, we do know that help is available for victims. Concerned people, like you, can spot the warning signs of a possible problem, and make a call for help if an elder is in need of assistance.


1.     What is elder abuse?

Elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult. The specificity of laws varies from state to state, but broadly defined, abuse may be:

o    Physical Abuse - Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving them of a basic need.

o    Emotional Abuse - Inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts.

o    Sexual Abuse - Non-consensual sexual contact of any kind.

o    Exploitation - Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.

o    Neglect - Refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder.

o    Abandonment - The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.

Elder abuse can affect people of all ethnic backgrounds and social status and can affect both men and women.


2.     What are the warning signs of elder abuse?

While one sign does not necessarily indicate abuse, some tell-tale signs that there could be a problem are:

o    Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.

o    Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.

o    Bruises around the breasts or genital area can occur from sexual abuse.

o    Sudden changes in financial situations may be the result of exploitation.

o    Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.

o    Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.

o    Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs.

Most important is to be alert. The suffering is often in silence. If you notice changes in personality or behavior, you should start to question what is going on.


3.     What is self-neglect and what are the signs?

Tragically, sometimes elders neglect their own care, which can lead to illness or injury. Self-neglect can include behaviors such as:

o    Hoarding

o    Failure to take essential medications or refusal to seek medical treatment for serious illness

o    Leaving a burning stove unattended

o    Poor hygiene

o    Not wearing suitable clothing for the weather

o    Confusion

o    Inability to attend to housekeeping

o    Dehydration

Self-neglect accounts for the majority of cases reported to adult protective services. Oftentimes, the problem is paired with declining health, isolation, Alzheimer's disease or dementia, or drug and alcohol dependency.

In some of these cases, elders will be connected to supports in the community that can allow them to continue living on their own. Some conditions like depression and malnutrition may be successfully treated through medical intervention. If the problems are severe enough, a guardian may be appointed.



4.     What makes an older adult vulnerable to abuse?

Social isolation and mental impairment (such as dementia or Alzheimer's disease) are two factors that may make an older person more vulnerable to abuse. But, in some situations, studies show that living with someone else (a caregiver or a friend) may increase the chances for abuse to occur. A history of domestic violence may also make a senior more susceptible to abuse.


5.     Who are the abusers of older people?

Abusers of older adults are both women and men. Family members are more often the abusers than any other group. For several years, data showed that adult children were the most common abusers of family members; recent information indicates spouses are the most common perpetrators when state data concerning elders and vulnerable adults is combined.

The bottom line is that elder abuse is a family issue. As far as the types of abuse are concerned, neglect is the most common type of abuse identified. Review our Fact Sheet for more information about who abuses.



6.     Are there criminal penalties for the abusers?

Although there are variations across the country, in most states there are several laws that address criminal penalties for various types of elder abuse. Laws vary state to state. Some states have increased penalties for those who victimize older adults. Increasingly, across the country, law enforcement officers and prosecutors are trained on elder abuse and ways to use criminal and civil laws to bring abusers to justice.


7.     How many people are suffering from elder abuse?

It is difficult to say how many older Americans are abused, neglected, or exploited, in large part because surveillance is limited and the problem remains greatly hidden. Findings from the often cited National Elder Abuse Incidence Study suggest that more than 500,000 Americans aged 60 and over were victims of domestic abuse in 1996.

This study also found that only 16 percent of the abusive situations are referred for help - 84 percent remain hidden. While a couple of studies estimate that between 3 percent and 5 percent of the elderly population have been abused, the Senate Special Committee on Aging estimates that there may be as many as 5 million victims every year.

One consistent finding, over a ten-year study period, is that reports have increased each year. Click on NCEA Fact Sheets and the 2003 National Academy of Sciences' Study Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America for more information.



8.     Who do I call if I suspect elder abuse?

Each one of us has a responsibility to keep vulnerable elders safe from harm. The laws in most states require helping professions in the front lines -- such as doctors and home health providers -- to report suspected abuse or neglect. These professionals are called mandated reporters. Under the laws of eight states, "any person" is required to report a suspicion of mistreatment.

Call the police or 9-1-1 immediately if someone you know is in immediate, life-threatening danger.

If the danger is not immediate, but you suspect that abuse has occurred or is occurring, please tell someone. Relay your concerns to the local adult protective services, long-term care ombudsman, or police.

If you have been the victim of abuse, exploitation, or neglect, you are not alone. Many people care and can help. Please tell your doctor, a friend, or a family member you trust, or call the Eldercare Locator help line immediately.

You can reach the Eldercare Locator by telephone at 1-800-677-1116. Specially trained operators will refer you to a local agency that can help. The Eldercare Locator is open Monday through Friday, 9 a.m. to 8 p.m. Eastern Time.



9.     What should I expect if I call someone for help?

When making the call, be ready to give the elder's name, address, contact information, and details about why you are concerned.

You may be asked a series of questions to gain more insight into the nature of the situation.

o    Are there any known medical problems (including confusion or memory loss)?

o    What kinds of family or social supports are there?

o    Have you seen or heard incidents of yelling, hitting, or other abusive behavior?

You will be asked for your name, address, telephone number, etc., but most states will take the report even if you do not identify yourself.


10. How can elder abuse be prevented?

Educating seniors, professionals, caregivers, and the public on abuse is critical to prevention. On an individual level, some simple but vital steps to reduce the risk:

o    Take care of your health.

o    Seek professional help for drug, alcohol, and depression concerns, and urge family members to get help for these problems.

o    Attend support groups for spouses and learn about domestic violence services.

o    Plan for your own future. With a power of attorney or a living will, health care decisions can be addressed to avoid confusion and family problems, should you become incapacitated. Seek independent advice from someone you trust before signing any documents.

o    Stay active in the community and connected with friends and family. This will decrease social isolation, which has been connected to elder abuse.

o    Know your rights. If you engage the services of a paid or family caregiver, you have the right to voice your preferences and concerns. If you live in a nursing home or board and care home, call your Long Term Care Ombudsman. The Ombudsman is your advocate and has the power to intervene. Please visit our Help for Elders and Families section to learn more.

All states have adult protective and long-term care ombudsman programs, family care supports, and home and community care services that can help older adults with activities of daily living. Call the Eldercare Locator at 800-677-1116 for information and referrals on services in your area.


11. What is being done to stop elder abuse?

At the national level, Elder Justice Act legislation has recently been proposed to provide federal leadership to help reduce elder abuse. The Elder Justice Coalition is working to help pass the Elder Justice Act S. 333.

Community collaborations, meanwhile, are playing an increasingly important role in educating the public and professionals. In recent years, State Attorneys General offices and law enforcement have stepped up efforts to prosecute. On the front lines, "multidisciplinary teams" (social workers, nurses, lawyers, etc.) have begun to be created to better target interventions.

Elder abuse coalitions also are working to make life safer for vulnerable elders and are an important step forward in the fight against elder abuse. Find out how you can be involved.


12. How can I help stop elder abuse?

Knowing the warning signs of abuse is a first step toward protecting elders. Some specific tips: Become a community "sentinel" - Keep a watchful eye out for loved ones, friends, or neighbors who may be vulnerable. Speak up if you have concerns. That means even if you are not sure. You have a right to question. Be involved. Volunteer with older adults in your community. Support initiatives to increase and strengthen adult protective services in your state.



* Information provided by The National Center for Elder Abuse.




Here is a listing of Major Types of Elder Abuse as provided by the National Center for Elder Abuse

Physical Abuse

Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include but is not limited to such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse.

Signs and symptoms of physical abuse include but are not limited to:

       bruises, black eyes, welts, lacerations, and rope marks;

       bone fractures, broken bones, and skull fractures;

       open wounds, cuts, punctures, untreated injuries in various stages of healing;

       sprains, dislocations, and internal injuries/bleeding;

       broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained;

       laboratory findings of medication overdose or under utilization of prescribed drugs;

       an elder's report of being hit, slapped, kicked, or mistreated;

       an elder's sudden change in behavior; and

       the caregiver's refusal to allow visitors to see an elder alone.

Sexual Abuse

Sexual abuse is defined as non-consensual sexual contact of any kind with an elderly person. Sexual contact with any person incapable of giving consent is also considered sexual abuse. It includes, but is not limited to, unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.

Signs and symptoms of sexual abuse include but are not limited to:

       bruises around the breasts or genital area;

       unexplained venereal disease or genital infections;

       unexplained vaginal or anal bleeding;

       torn, stained, or bloody underclothing; and

       an elder's report of being sexually assaulted or raped.

Emotional or Psychological Abuse

Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant; isolating an elderly person from his/her family, friends, or regular activities; giving an older person the "silent treatment;" and enforced social isolation are examples of emotional/psychological abuse.

Signs and symptoms of emotional/psychological abuse include but are not limited to:

       being emotionally upset or agitated;

       being extremely withdrawn and non communicative or non responsive;

       unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking); and

       an elder's report of being verbally or emotionally mistreated.


Neglect is defined as the refusal or failure to fulfill any part of a person's obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care.

Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder.

Signs and symptoms of neglect include but are not limited to:

       dehydration, malnutrition, untreated bed sores, and poor personal hygiene;

       unattended or untreated health problems;

       hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water);

       unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing); and

       an elder's report of being mistreated.


Abandonment is defined as the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.

Signs and symptoms of abandonment include but are not limited to:

       the desertion of an elder at a hospital, a nursing facility, or other similar institution;

       the desertion of an elder at a shopping center or other public location; and

       an elder's own report of being abandoned.

Financial or Material Exploitation

Financial or material exploitation is defined as the illegal or improper use of an elder's funds, property, or assets. Examples include, but are not limited to, cashing an elderly person's checks without authorization or permission; forging an older person's signature; misusing or stealing an older person's money or possessions; coercing or deceiving an older person into signing any document (e.g., contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.

Signs and symptoms of financial or material exploitation include but are not limited to:

       sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder;

       the inclusion of additional names on an elder's bank signature card;

       unauthorized withdrawal of the elder's funds using the elder's ATM card;

       abrupt changes in a will or other financial documents;

       unexplained disappearance of funds or valuable possessions;

       substandard care being provided or bills unpaid despite the availability of adequate financial resources;

       discovery of an elder's signature being forged for financial transactions or for the titles of his/her possessions;

       sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions;

       unexplained sudden transfer of assets to a family member or someone outside the family;

       the provision of services that are not necessary; and

       an elder's report of financial exploitation.


Self-neglect is characterized as the behavior of an elderly person that threatens his/her own health or safety. Self-neglect generally manifests itself in an older person as a refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions.

The definition of self-neglect excludes a situation in which a mentally competent older person, who understands the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her health or safety as a matter of personal choice.

Signs and symptoms of self-neglect include but are not limited to:

       dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene;

       hazardous or unsafe living conditions/arrangements (e.g., improper wiring, no indoor plumbing, no heat, no running water);

       unsanitary or unclean living quarters (e.g., animal/insect infestation, no functioning toilet, fecal/urine smell);

       inappropriate and/or inadequate clothing, lack of the necessary medical aids (e.g., eyeglasses, hearing aids, dentures); and

grossly inadequate housing or homelessness.