What is elder abuse?
Elder abuse is any knowing, intended, or careless act that causes harm or serious risk of harm to an older person—physically, mentally, emotionally, or financially. The term is quite broad and encompasses many different types of mistreatment:
Physical abuse: Use of force to threaten or physically injure a vulnerable elder.
Emotional abuse: Verbal attacks, threats, rejection, isolation, or belittling acts that cause or could cause mental anguish, pain, or distress to an elder.
Sexual abuse: Sexual contact that is forced, tricked, threatened, or otherwise coerced upon another person, including anyone who is unable to grant consent.
Exploitation: Theft, fraud, misuse or neglect of authority, and use of ʺundue influenceʺ as a lever to gain control over an older person’s money or property.
Neglect: A caregiver’s failure or refusal to provide for a vulnerable elder’s safety, physical, or emotional needs.
Abandonment: Desertion of a frail or vulnerable elder by anyone with a duty of care.
Self‐neglect: An inability to understand the consequences of one’s own actions or inaction, which leads to, or may lead to, harm or endangerment.
How can I tell if someone is being abusive?
Unfortunately, abusers are not always easy to spot. Adding to the problem, victims may not be physically or mentally able to report their abuse, or they may be isolated and too afraid or ashamed to tell someone. While there is no typical profile of an abuser, the following are some behavioral signs that may indicate problems:
- Abusing alcohol or other drugs
- Controlling elder’s actions: whom they see and talk to, where they go
- Isolating elder from family and friends, which can increase dependence on abuser
- Emotional/ financial dependency on elder, inability to be self‐sufficient
- Threatening to leave or send elder to a nursing home
- Appearing to be indifferent to elder, seeming apathetic or hostile
- Minimizing an elder’s injuries, blaming victim or others for the abuse, neglect, or exploitation
- Threatening to harm an elder’s pet
- Calling elder names
- Previous criminal history
- Mental illness
What are the warning signs of elder abuse?
- Elder abuse can take many forms. Here are some signs that there may be a problem:
- Slap marks, most pressure marks, and certain types of burns or blisters (e.g., cigarette burns) most likely should cause suspicion whatever the explanation. Explanations that don’t seem to fit with the pattern of physical injury are also suspect.
- Withdrawal from normal activities, unexplained change in alertness, or other unusual behavior may signal emotional abuse or neglect.
- Bruises around the breasts or genital area and unexplained sexually transmitted diseases can occur from sexual abuse.
- Sudden change in finances and accounts, altered wills and trusts, unusual bank withdrawals, checks written as ʺloansʺ or ʺgifts,ʺ and loss of property may suggest elder exploitation.
- Untreated bedsores, need for medical or dental care, unclean clothing, poor hygiene, overgrown hair and nails, and unusual weight loss are signs of possible neglect.
If you have concerns about someone, trust your instincts. Don’t be afraid to ask questions. Keep in mind that victims of elder abuse may be experiencing other problems and more than one type of abuse. Who are the abusers? Hard as it is to believe, the great majority of abusers are family members, most often an adult child or spouse. Abuse can also occur at a long term care facility, such as a nursing home or assisted living residence. Employees and temporary staff who have direct contact with residents are the most frequent perpetrators. Other offenders may include other family and old friends, newly developed “friends” who intentionally prey on older adults, and service providers in positions of trust. There is no ʺone profileʺ of a perpetrator, the person who commits the abuse. However, they often share some of the following characteristics:
- Alcohol or drug dependence
- History of domestic violence or abuse
- Mental illness, dependency, family dysfunction
- Economic pressures, personal stress
- Longstanding personality traits (bad temper, hypercritical, tendency to blame others for problems)
In long term care settings, some other potential risk factors are:
- Negligent hiring practices (hiring violent criminals, thieves, and drug users to work as aides, maintenance workers, etc.; failing to do required background checks)
- Too few staff, high turnover, and inadequate training
- Reliance on staff who lack compassion or empathy for older people and those with disabilities
Is everyone at risk?
Elder abuse can happen to anyone. As with other types of interpersonal violence, elder victims are never responsible for their abuse, perpetrators are responsible. Some families and individuals, however, may be more at risk than others. Factors that may increase an elder’s vulnerability include:
- Social isolation/loneliness (lack of social support networks).
- Mental impairment (may increase dependence on abuser).
- Personal problems of abuser (emotionally or financially dependent on the victim; history of mental illness; hostility; alcohol or drug abuse).
What is elder self-neglect?
Self-neglect in later life refers to the inability or failure of an older adult to adequately care for his or her own needs, behavior which puts him or her at risk of serious harm or abuse by others. A significant proportion of adult protective services cases investigated by authorities involve self‐neglect—in some states more than half. Signs of self‐neglect can include:
- Lacking food or basic utilities
- Refusing medications
- Hoarding animals and/or trash
- Unsafe living conditions, vermin‐infested living quarters
- Poor grooming and appearance (soiled or ragged clothing, dirty nails and skin)
- Inability to manage finances (frequently borrowing money, giving away money and property, not paying bills)
- Isolation, lack of social support
- Disorientation, incoherence
- Alcohol or drug dependence
Are there laws against elder abuse?
While there is currently no federal law protecting elders from abuse, all states have adopted laws specifically dealing with elder abuse, neglect, and exploitation. Laws vary from state to state. In some states, laws may protect older and vulnerable adults who are living alone or with family (ʺdomestic abuseʺ). Other state laws also include individuals who live in nursing homes or other long term care facilities (ʺinstitutional abuseʺ). More and more states have begun to spell out clear criminal penalties for elder abuse. Several states have laws ordering victim restitution (a monetary payment by the offender to the victim for the harm done to the victim). State laws covering murder, rape, battery, assault, theft, rape, fraud, and domestic violence may also apply to situations of elder abuse. A number of states take into account the victim’s age when determining a sentence. To learn about your state laws, check with your state office on aging, Attorney Generalʹs office, adult protective services agency, or local agency on aging
What should I do if I suspect elder abuse? You should call police or adult protective services right away if you suspect that an elder is being abused, neglected, or exploited. You do not need to prove abuse in order to make a report. Most states have a toll‐free hotline number that you can call to relay your concerns. To find your stateʹs number, go to the National Center on Elder Abuse Web site at www.elderabusecenter.org and then click ʺWhere to Report Abuse.ʺ If you are concerned about a nursing home or assisted living facility resident, the long term care ombudsman also can serve as a resource. To find your local long term care ombudsmanʹs office, call the U.S. Administration on Agingʹs Eldercare Locator at 1 (800) 677‐1116 or go to www.eldercare.gov. The toll‐free line is open Monday through Friday, 9 a.m. to 8 p.m. Eastern Time.
What should I expect when I call for help? You will be asked to give the person’s name, address, contact information, and details about why you are concerned. You may also be asked for your name and telephone number, or some other way of contacting you in case the investigator has any follow‐up questions. But most states will take an anonymous report if you do not wish to identify yourself. State laws protect the confidentiality of the person making a report.
Who will investigate? Adult protective services (APS) workers usually are the first responders to reports of elder abuse and neglect. In nursing homes and assisted living facilities, state licensing agencies and community long term care ombudsmen may be involved. Depending upon the situation, law enforcement may also be called upon to investigate.
What is Adult Protective Services? APS agencies take reports, investigate allegations, and provide assistance to victims of elder abuse, neglect, abandonment, and exploitation. Most also respond to reports of self‐neglect, but some do not. If abuse is confirmed, APS will work closely with other agencies in the community to ensure the victim’s health and safety. If criminal prosecution needs to be explored, law enforcement will take the lead in collecting evidence necessary for prosecution. In extreme cases, when an older adult is not mentally capable of managing his or her affairs or personal care, a court may appoint a guardian or a conservator to make decisions. APS supports victims’ right make their own choices, and to live in the least restrictive environment. An elder who has been abused has the right to refuse interventions or withdraw consent at any time. Examples of services that APS may offer include (but are not limited to):
- emergency shelter
- emergency in‐home protection
- emergency food,
- emergency medicine and medical care
- assistance with moving, clothing, transportation
- court advocacy
- money management assistance
- trash removal
- home repairs
- emergency protective orders.
Is there anything people can do to reduce the risk of elder abuse? While it is absolutely true victims of abuse are never responsible for the harm done to them, there are a number of simple steps each of us can take to protect ourselves:
- Stay busy and engaged in life
- Try not to become isolated
- Cultivate a strong support network of family and friends
- Take good care of yourself — for life. Older adults in declining health can become more vulnerable to abuse because of the increasing dependence.
- Be aware of the link to addiction problems. People who drink too much or who use other drugs are at high risk of being abusive. Reach out to support
- Refuse to allow anyone, even a close relative, to add his or her name to your bank account without your clear consent
- Never make financial decisions under pressure
- Avoid signing over money or property to anyone without first getting legal advice
- Assert your right to be treated with dignity and respect.
- Be clear about what you will and will not tolerate, and set boundaries. You have the right to make your own decisions.
- Trust your instincts. Listen to the voice inside you when it calls out something is not right. Ask for help if you need it.
What can I do to help? Every older person has the right to be safe. Here are some important ways you can make a difference:
- Know that elder abuse can happen. To anyone.
- Speak up if you have concerns. Trust your instincts!
- Report any suspicions of elder abuse to the nearest authorities
- Become a community “sentinel.” Keep a watchful eye out for family, friends, and neighbors who may be vulnerable. Ask local care providers if they have conducted criminal background checks on all staff and volunteers working for
- Donate your time as a volunteer. People really do make the difference. Find out how you can get involved
- Spread the word. Share what you’ve learned
National Center on Elder Abuse National Association of State Units on Aging 1201 15th Street, NW, Suite 350 Washington, DC 20005