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Elder Abuse

Topic Overview

Elder abuse refers to any of several forms of maltreatment of an older person by a caregiver, family member, spouse, or friend.

Categories of elder abuse

The 1987 Amendment to the Older Americans Act identified three separate categories of elder abuse:

  • Domestic elder abuse usually takes place in the older adult's home or in the home of the caregiver. The abuser is often a relative, close friend, or paid companion.
  • Institutional abuse refers to abuse that takes place in a residential home (such as a nursing home), foster home, or assisted-living facility. The abuser has a financial or contractual obligation to care for the older adult.
  • Self-neglect is behavior of an older adult that threatens his or her own health or safety. Self-neglect is present when an older adult refuses or fails to provide himself or herself with adequate food, water, clothing, shelter, personal hygiene, medicine, and safety precautions.

Acts of elder abuse

Elder abuse can include:

  • Acts of violence, such as hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, choking, or burning. The inappropriate use of medicines or physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse.
  • Forced sexual contact or sexual contact with any person incapable of giving consent. It includes unwanted touching and all types of sexual assault or battery, such as rape, sodomy, forced nudity, and sexually explicit photography.
  • Emotional or psychological abuse, such as name-calling, insults, threats, intimidation, humiliation, and harassment. Treating an older person like a baby, giving an older person the "silent treatment," and isolating him or her from family, friends, or regular activities are examples of emotional or psychological abuse.
  • Neglect, such as failing to provide an older person with food, clothing, personal shelter, or other essentials, such as medical care or medicines. Neglect can also include failing to pay nursing home or assisted-living facility costs for an older person if you have a legal responsibility to do so.
  • Abandonment or desertion of an older person by a person who has the physical or legal responsibility for providing care.
  • Illegal or improper use of an older person's funds, property, or assets. This includes forging an older person's signature, stealing money or possessions, or tricking an older person into signing documents that transfer funds, property, or assets.

Risk factors for elder abuse

Abuse of elders is a complex problem with many contributing factors. Risk factors include:

  • Domestic violence carried over into the elder years. A substantial number of elder abuse cases are abuse by a spouse.
  • Personal problems of caregivers. People who abuse older adults (particularly their adult children) are often dependent on the older person for financial help and other support. This is often due to personal problems such as mental illness or other dysfunctional personality traits. The risk of elder abuse seems highest when these adult children live with the older person.
  • Social isolation. Caregivers and family members who live with an older person have the opportunity to abuse and often attempt to isolate the older person from others to prevent the abuse from being discovered.

Signs of elder abuse

Signs and symptoms of elder abuse vary widely depending on the type of abuse.

  • Signs that an older person is the victim of acts of violence may include:
    • Bruises, black eyes, welts, lacerations, rope marks, cuts, punctures, or untreated injuries in various stages of healing.
    • Broken bones, including the skull.
    • Sprains, dislocations, or internal injuries.
    • Broken eyeglasses or dentures.
    • Signs of being restrained.
    • Laboratory reports of overdose or underuse of medicines.
    • Reports from the older adult of being physically mistreated.
    • An older person's sudden change in behavior.
    • A caregiver's refusal to allow visitors to see an older person alone.
  • Symptoms of possible sexual abuse include bruises around the breasts or genital area, unexplained venereal disease or genital infections, unexplained vaginal or anal bleeding, underclothing that is torn or stained, and reports from the older person of being sexually assaulted.
  • Emotional or psychological abuse is possible if the older person appears emotionally upset or agitated; acts withdrawn or is noncommunicative, nonresponsive, or paranoid; exhibits unusual behavior including sucking, biting, and rocking; or if he or she reports being verbally or emotionally mistreated.
  • Signs of neglect may include dehydration, malnutrition, untreated health problems, pressure ulcers, poor personal hygiene, hazardous or unsanitary living conditions, and reports from the older person of being mistreated.
  • Abandonment includes the desertion of an older person at a hospital, nursing facility, shopping center, or other public location.
  • Signs of financial exploitation include sudden changes in a bank account or banking practice, such as unexplained withdrawals of large amounts of money; additional names on an older person's bank card; abrupt changes in a will or other financial document; disappearance of funds or valuable possessions; unpaid bills or substandard care despite the availability of funds; evidence of the older person's signature being forged; the sudden appearance of previously uninvolved relatives; payment for unnecessary services; and reports from the older person of financial exploitation.

Help for elder abuse

If you are worried that someone you know might be a victim of elder abuse, talk to your doctor about what to look for, what the risks are, and what help is available.

To report elder abuse or to get help, call Adult Protection Services (APS) in your state.

  • You can find the telephone number for the APS office by calling directory assistance and requesting the number for the Department of Social Services or Aging Services.
  • If you cannot find the correct telephone number, call Eldercare Locator toll-free at 1-800-677-1116 for assistance in locating resources. Eldercare is sponsored by the U.S. Administration on Aging.

Credits

By Healthwise Staff
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
H. Michael O'Connor, MD - Emergency Medicine
Last Revised September 5, 2013

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