Abuse of the elderly can be physical, financial, emotional or neglect. This article will teach you how to recognize elder abuse and how we as a society can help prevent it.
Public education and awareness programs have changed social attitudes about domestic violence and sexual abuse. The identification and reporting of abuse, intervention, support groups, treatment and other programs that help victims of abuse have risen dramatically over the last twenty years. Unfortunately, the abuse suffered by the elderly can not claim the same progress.
It is estimated that between one and two million Americans over the age of sixty-five are subjected to physical, emotional, financial or sexual abuse each year. Accurate statistics are not readily available because there is no uniform reporting system; therefore, there are no official national statistics. Researchers estimate only one in fourteen abuse cases are reported.
Signs of Elder Abuse
Signs of elder abuse can be difficult to detect due to medication, or diseases and illness the elderly person may have. Certain signs and symptoms can appear to be part of a disease process or a side effect of medication when in fact, it may be elder abuse. Knowing the signs of elder abuse will increase awareness and intervention of abuse to our elderly.
Physical Abuse
Willfully inflicting pain or injury to an elderly person is considered physical abuse. This includes slapping, kicking, restraining against one’s will, inappropriate use of drugs/medication, force feeding or the use of force.
Case #1
Marie is a 76 year old who presented to the Emergency Department with a broken arm. Her daughter accompanied her. They both state that Marie fell, landing on her arm. Marie continually looks at her daughter as she’s telling the story. Marie’s daughter does not leave Marie’s bedside the entire six hours she is in the ER. The nurse notices multiple bruises in various stages of healing on Marie’s wrists and upper arms. When asked if she falls a lot, Marie’s daughter answers “No”. In response to questioning about how she got all the bruises, Marie starts to cry.
Awareness of physical abuse is key to identifying and intervening on behalf of any elderly patient. Naturally Marie loves her daughter and doesn’t want her to get into trouble. Maybe her silence is because she fears for her safety. Or maybe she does have frequent falls and her daughter isn’t aware of it. It is common to see bruising on elderly people. Having a keen awareness of the situation the person is in can help clarify what’s going on in their environment. If your instinct tells you something is wrong follow it.
Signs of physical abuse can be blatant or very subtle. No one sign can be evidence of elder abuse. Because bruising and other injuries are common in the elderly, it is prudent and justifiable to question the person about how their injuries occurred. Inconsistent stories or explanations should alert you that the possibility of abuse exists.
Other signs of elderly abuse include:
Bruises, black eyes, lacerations, punctures, rope marks
Bone fractures, skull fractures
Open wounds, cuts
Untreated injuries in various stages of healing
Sprains, dislocations, internal injuries
Broken glasses
Signs of being restrained
Medicine overdose or underutilization
Sudden change in behavior
Caregiver refuses to allow visitors to see elderly person alone
Repeated unexplained injuries
Dismissive attitude of caregiver
Financial Abuse
Financial abuse is the improper act of using the resources of an older person for someone else’s benefit without their consent. It is estimated that there are possibly five million victims of financial abuse per year.
Case #2
Charlie is an 88 year old gentleman who recently lost his wife. He lives in a large house he and his wife bought fifty years ago. He is lonely and has been in ill health for a few months. Charlie has a good pension and has a comfortable savings account. Charlie’s niece, Olivia, insisted on moving in to help Charlie. Olivia wants Charlie to sign papers giving her Power of Attorney so she can take the burden of paying bills and household maintenance off of Charlie.
It is possible that Olivia is sincere in her attempts to help Charlie. Families all over the country help their aging relatives without taking advantage of them. Did Olivia take an active role in helping Charlie and his wife before she died or has she suddenly appeared after being uninvolved?
Seniors are more at risk for financial abuse than any other age group. The elderly (over age 50) control over 70% of the nation’s wealth.
Many elderly people do not realize the value of their assets. Isolation and loneliness provide an open avenue for anyone having interest in an elderly person’s financial resources. Those with mental or physical disabilities are usually dependant on caregivers who may have access to their assets.
Elderly people are less likely to take action when they have suffered financial loss or theft. The reason for this is not clear, however it is suggested that physical disability, illness and embarrassment about the situation are the predominant contributing factors.
There are signs of financial abuse family members, caregivers, social workers and other interested parties should be aware of:
Sudden change in the elderly person’s bank account
Withdrawal of large sums of money
Abrupt change in the will or financial documents
Signature on checks and documents that does not look like the elderly person’s
Sudden appearance of uninvolved relative claiming right to elders affairs/possessions
New “best friends”
Bills not paid when funds are available
Inclusion of additional names on a signature card
Excessive interest on how much money is spent on the elderly person
Items of value are missing
Recent acquaintances, housekeepers, "care" providers, etc. declare undying affection for the older person and isolate the elder from long-term friends or family
Sexual Abuse
Sexual abuse is the least recognized offense and most underreported abuse against our elderly population. Sexual abuse is defined as the coercing of an older person through force, trickery, threats or other means into unwanted sexual activity. Simply put, it is the infliction of any non-consensual sexual act of any kind.
Case #3
An 82 year old Alzheimer’s patient is brought to the clinic by her daughter. She has had a small amount of vaginal bleeding. Tests confirm that the patient has a venereal disease.
The elderly are at heightened risk for sexual abuse. Predators are attracted to victims who are vulnerable and easy to manipulate. They seek victims who would be unlikely to report sexual abuse or who would not be deemed credible if they did report it. Elderly people with decreased cognitive or emotional functioning or people who are dependant on the assistance of caregivers can also be at risk for sexual abuse.
Nursing homes are generally thought of when the topic of sexual abuse among our senior citizens is discussed. Not all sexual abuse occurs in nursing homes however. Relatives and caregivers who sexually abuse elderly people are likely to be male and seek victims over the age of seventy who are totally dependant for their care. Sexual abuse in the elderly can be difficult to identify because many victims suffer from confusion or some form of dementia.
Signs of sexual abuse include:
Bruising to the breasts or genital area
Unexplained venereal disease or infection
Vaginal or anal bleeding
Emotional/Psychological Abuse
Causing an elderly person mental or emotional distress by means of humiliation, intimidation or threats is emotional abuse. This includes any form of verbal assault, insult, harassment, isolation, or giving the “silent treatment”.
Case #4
Norma is a 67 year old female who lives by herself. Her daughter comes to check on her three or four times a week. Occasionally, Norma has urinary incontinence. Norma’s daughter is frustrated and irritated about her mother’s inability to hold her urine, and tells her she will have to put diapers on her “like a baby” and will have to put her in a nursing home if she doesn’t stop wetting her pants.
Obviously Norma’s daughter is mentally abusing her mother. Emotional abuse may be hard to detect if it is not directly observed. Many elderly people tolerate emotional abuse because they are afraid of being sent to nursing homes or losing their own homes. Relatives or caregivers who bully or cause the elderly person to feel threatened sometimes do so in a way that the elderly person can not verbalize.
The signs of emotional abuse are:
Emotional upset or agitation
Elderly person becomes extremely withdrawn
Elderly person becomes non-communicative
Obvious behavior changes
Neglect
Neglect is the failure to provide food, water, clothing, shelter, hygiene, medication, safety and comfort by someone who is responsible for the elderly person.
Case #5
Francis has been caring for her confused mother for two years. She works full time and is gone until five o’clock every evening. Her mother is confused and frequently roams the neighborhood. Neighbors have noticed that the elderly woman wears the same clothing every day and smells of urine and feces. She is very thin and is often underdressed for the weather.
Many adult children have good intentions to care for their elderly family members. Ignorance of how to care for them or purposeful neglect can be the cause, but if the needs of the elderly person are not being met, it is still neglect. Many times, other forms of abuse are happening in cases of neglect.
Abandonment is also a type of neglect. Family members have been reported to leave their elderly relatives at hospitals, shelters or other places without returning.
Neglect of the elderly can include any of the following signs:
Dehydration
Malnutrition
Poor hygiene
Untreated health problems
Unsafe living arrangements
Unclean environment or living conditions
Lack of supervision or monitoring
Inappropriate clothing for the weather
Lack of attention to needs, calls for help, etc. of the elderly
Lack of assistance when needed
What to Do if You Suspect Elder Abuse
It is the responsibility of everyone to protect and ensure that our elderly population is being respectfully and properly cared for. Elderly victims of abuse are unlikely to report the abuse for several reasons. If you suspect that someone you know is being physically, financially or emotionally abused, or if they are neglected, it is your responsibility to intervene in a manner that will aid the elderly person in receiving the care, attention and safety they deserve and have a right to.
If an elderly person tells you about abuse that is happening to them do not display alarm. Protect their privacy and assess to see if they are in immediate danger or need medical attention. Do not display disbelief. Report the abuse to the police, a social worker or a hotline.
Where to Report Elder Abuse
National Center on Elder Abuse- 1-202-898-2586
To find the elder abuse hotline in your state call 1-800-677-1116. All calls are confidential.
Prevention
There is no one predominant reason people abuse the elderly. Many times caregivers are under a great deal of stress. Not knowing how to care for an elderly person only adds to the already high levels of stress.
Initiating education programs, intervention programs and support groups in communities and among health care professionals will heighten awareness of abuse of our elderly. Many clinics and emergency departments have prescreening questions for abuse. Further training of law enforcement officials and medical professionals on how to recognize and respond to elder abuse is needed.
Support and assistance for care givers will help relieve the stress that goes with caring for elderly patients. Educating the caregiver about disease processes, stages of disease the elderly person may be at, and how to manage problems would all be beneficial and lend support.
Support groups that allow the caregiver to verbalize problems and difficulties would be of great value to many caregivers. Being able to relate to other caregivers that are having similar problems and feelings takes much of the stress away from perceived difficulties.
An increase in respite centers is needed in all communities. Respite centers allow the caregiver time off. Volunteers or paid caregivers sometimes go to the home of the elderly person to help out for a given period of time. There are respite centers that function much like daycares and the elderly person is brought to the center and cared for part of the day. This allows the caregiver to focus on themselves and take needed breaks in caring for the elderly.
Our elderly population deserves good quality care regardless of who is caring for them. Abuse of the elderly is widespread and should not be tolerated. Awareness of elder abuse is the first step to prevention.