Elder Abuse and Neglect – Guidelines to help spot the warning signs and stop the abuse.

What is elder abuse and neglect?

Elder abuse includes physical, emotional, or sexual harm inflicted upon an older adult, financial exploitation, or neglect of their welfare by people directly responsible for their care. In the U.S. alone, more than half a million reports of elder abuse reach authorities every year, and millions more cases go unreported.

As older adults become more physically frail, they’re less able to take care of themselves, stand up to bullying, or fight back if attacked. Mental or physical ailments can make them more trying companions for those who live with them. And 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.

Elder abuse tends to occur where the senior lives: their abusers are often adult children, other family members such as grandchildren, or a spouse or partner. Elder abuse can also occur in institutional settings, especially long-term care facilities.

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. Everyone deserves to live in safety, with dignity and respect. These guidelines can help you recognize the warning signs of elder abuse, understand the risk factors, and learn how to prevent and report the problem.

A Portrait of Elder Abuse

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 and her skittish behavior. Well, you think she’s getting pretty old; maybe her mind is getting fuzzy. But there’s something else—something isn’t right.

Types of elder abuse

Physical elder abuse

The 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.

Emotional elder abuse

The treatment of an older adult in ways that cause emotional or psychological pain or distress, including:

• Intimidation through yelling or threats.
• Humiliation and ridicule.
• Habitual blaming or scapegoating.
• Ignoring the elderly person.
• Isolating an elder from friends or activities.
• Terrorizing or menacing the elderly person.

Sexual elder abuse

Contact with an elderly person without their 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.

Financial exploitation

The unauthorized use of an elderly person’s funds or property 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 scams that target elders include:

• Announcement 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. This can 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.
• Over-medicating or under-medicating.
• Recommending fraudulent remedies for illnesses or other medical conditions.
• Medicaid fraud.

Elder neglect

Failure to fulfill a caretaking obligation. This 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 they do.

Elder self-neglect

One of the most common forms of elder abuse encountered by geriatric care managers is self-neglect. Physical or mental impairment or diminished capacity can mean that an older adult can no longer perform essential self-care. They may lack basic personal hygiene, appear dehydrated, malnourished, or underweight, live in increasingly unsanitary or dirty conditions, and cannot pay bills or properly manage their medications.

Warning signs of elder abuse

Signs of elder abuse can be difficult to recognize or mistaken for symptoms of dementia or 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 overlap with symptoms of mental deterioration, but that doesn’t mean you should dismiss them on the caregiver’s say-so. Frequent arguments or tension between the caregiver and the elderly person or changes in the personality or behavior in the elder can be broad signals of elder abuse. If you suspect abuse but aren’t sure, you can look for clusters of the following warning signs.

Physical abuse warning signs

• Unexplained signs of injury, such as bruises, welts, or scars, especially if they appear symmetrically on two sides of the body.
• Broken bones, sprains, or dislocations.
• A report of drug overdose or an 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.

Emotional abuse warning signs

• Threatening, belittling, or controlling caregiver behavior.
• Behavior from the elder that mimics dementia, such as rocking, sucking, or mumbling to themselves.

Sexual abuse warning signs

• Bruises around breasts or genitals.
• Unexplained vaginal or anal bleeding.
• Torn, stained, or bloody underclothing.

Elder neglect or self-neglect warning signs

• 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.

Financial exploitation warning signs

• 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.
• The senior couldn’t have undertaken financial activity, such as an ATM withdrawal when the account holder is bedridden.
• Unnecessary services, goods, or subscriptions.

Healthcare fraud or abuse warning signs

• Duplicate billings for the same medical service or device.
• Evidence of overmedication or under-medication.
• 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.

Preventing Elder Abuse and Neglect

If you’re a caregiver to an elderly person and feel you are in danger of hurting or neglecting them, help and support are available. Perhaps you’re having trouble controlling your anger and find yourself screaming louder and louder or lashing out at the person in your care. Do you simply feel emotionally disconnected or overwhelmed by the daily needs of the elderly person in your care?

Recognizing that you have a problem is the biggest step to getting help and preventing abuse.

Prevention tips if you’re a caregiver

As a caregiver, the following steps can help you prevent elder abuse or neglect:

• Take immediate steps to relieve stress and burnout.Stress is a major contributor to elder abuse and neglect. You can help reduce stress levels by regularly practicing stress-relieving techniques such as yoga, meditation, or deep breathing exercises.

• Request helpfrom friends, relatives, or local respite care agencies, or find an adult daycare program. Every caregiver needs to take regular breaks from the stress of caring for an elder and attend to their needs, if only for a couple of hours.

• Take care of yourself.If you do not rest enough, you are much more likely to succumb to anger. Eat a healthy diet, exercise regularly, and take care of your medical needs.

• Seek help for depression.Family caregivers are especially at risk for depression, but you can do plenty of things to boost your mood and outlook and overcome the problem.

• Find a support group for caregivers of the elderly.Sharing your concerns and experiences with others facing the same challenges can help relieve the isolation you may feel as a caregiver. It can also be a great place to gain valuable tips and insight into caring for an elder.

• Get help for any substance abuse issues.It’s never easy, but you can take plenty of actions to address drug or alcohol abuse.
• Get professional help.If you can’t seem to stop yourself, no matter how hard you try, it’s time to get help by talking to a therapist.

Prevention tips if you’re a friend or neighbor

If you’re a concerned friend, neighbor, or family member, the following can help to prevent abuse of an elderly person:

• Call and visit as often as possible, helping the elder see you as a trusted confidante.
• Offer to stay with the elder so the caregiver can have a break—on a regular basis, if possible.
• Monitor the elder’s medications to ensure the amounts being taken correspond with the prescription dates.
• Watch for financial abuse by asking the elder if you can check their bank accounts and credit card statements for unauthorized transactions.
• Identify the warning signs of abuse or neglect and report it without delay.

How to protect yourself from abuse as an elder

• 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 a care facility, speak up. Tell someone you trust or call an elder abuse helpline.

Reporting elder abuse

Tell at least one person if you are an elder being abused, neglected, or exploited. Tell your doctor, a friend, or a family member you trust. Or call one of the state helplines listed below.

If you witness an older adult being abused or neglected, don’t hesitate to report the situation. And if you see future incidences of abuse, continue to call and report them. Each elder abuse report is a snapshot of what is taking place. The more information you can provide, the better the chance the elder has of getting the quality of care they need. Older adults can become increasingly isolated from society, and with no work to attend to, it can be easy for abuse cases to go unnoticed for long periods.

Many seniors don’t report the abuse they face even if they can. Some fear retaliation from the abuser, while others view having an abusive caretaker as better than having no caretaker and being forced to move out of their home. When the caregivers are their children, they may feel ashamed that their children are inflicting harm or blame themselves: “If I’d been a better parent when they were younger, this wouldn’t be happening.” Or they may not want the children they love to get into trouble with the law. In any situation of elder abuse, 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.

Reporting abuse by a caregiver

In the case of an elder experiencing abuse by a primary caregiver, such as an adult child:

Do not confront the abuser yourself. This may put the older person in more danger unless you have the elder’s permission and are able to immediately move them to alternative, safe care.

Find strength in numbers. 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.

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 the earlier you intervene in a situation of elder abuse, the better the outcome will be for everyone involved.

In Arizona, Report Elder Abuse to: 

Arizona Adult Protective Services – (877) 767-2385

https://des.az.gov/services/basic-needs/adult-protective-services

Bibliography

Robinson, Lawrence. “Elder Abuse and Neglect – HelpGuide.Org.” HelpGuide.Org, 2 Nov. 2018, https://www.helpguide.org/articles/abuse/elder-abuse-and-neglect.htm.