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Learning More about Elder Abuse

What is elder abuse?

Elder abuse (also called “elder mistreatment,” “senior abuse,” “abuse in later life,” “abuse of older adults,” “abuse of older women,” and “abuse of older men”) is “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.”

Types

There are several types of abuse of older people that are generally recognized as being elder abuse, including:

  • Physical: e.g. hitting, punching, slapping, burning, pushing, kicking, restraining, false imprisonment / confinement, or giving excessive or improper medication as well as withholding treatment and medication.
  • Psychological/Emotional: e.g. humiliating a person. A common theme is a perpetrator who identifies something that matters to an older person and then uses it to coerce an older person into a particular action. It may take verbal forms such as yelling, name-calling, ridiculing, constantly criticizing, accusations, blaming, or non verbal forms such as ignoring, silence, shunning or withdrawing affection.
  • Elder financial abuse: also known as financial exploitation, involving misappropriation of financial resources by family members, caregivers, or strangers, or the use of financial means to control the person or facilitate other types of abuse.
  • Sexual: e.g. forcing a person to take part in any sexual activity without his or her consent, including forcing them to participate in conversations of a sexual nature against their will; may also include situations where person is no longer able to give consent (dementia)
  • Neglect: e.g. depriving a person of proper medical treatment, food, heat, clothing or comfort or essential medication and depriving a person of needed services to force certain kinds of actions, financial and otherwise. Neglect can include leaving an at-risk (i.e. fall risk) elder person unattended. The deprivation may be intentional (active neglect) or happen out of lack of knowledge or resources (passive neglect).

In addition, some U.S. state laws also recognize the following as elder abuse:

  • Abandonment: deserting a dependent person with the intent to abandon them or leave them unattended at a place for such a time period as may be likely to endanger their health or welfare. Elder abuse includes deserting an elderly, dependent person with the intent to abandon them or leave them unattended at a place for such a time period as may be likely to endanger their health or welfare.
  • Rights abuse: denying the civil and constitutional rights of a person who is old, but not declared by court to be mentally incapacitated. This is an aspect of elder abuse that is increasingly being recognized and adopted by nations
  • Self-neglect: any persons neglecting themselves by not caring about their own health, well-being or safety. Self-neglect (harm by self) is treated as conceptually different than abuse (harm by others). Elder self-neglect can lead to illness, injury, or even death. Common needs that older adults may deny themselves, or ignore are the following: Sustenance (food or water); cleanliness (bathing and personal hygiene); adequate clothing for climate protection; proper shelter; adequate safety; clean and healthy surroundings; medical attention for serious illness; essential medications. Self-neglect is often created by an individual’s declining mental awareness or capability. Some older adults may choose to deny themselves some health or safety benefits, which may not be self-neglect. This may simply be their personal choice. Caregivers and other responsible individuals must honor these choices if the older adult is sound of mind. In other instances, the older adult may lack the needed resources, as a result of poverty, or other social condition. This is also not considered “self neglect”.
  • Institutional abuse refers to physical or psychological harms, as well as rights violations in settings where care and assistance is provided to dependant older adults or others.

Warning signs

The key to prevention and intervention of elder abuse is the ability to recognize the warning signs of its occurrence. Signs of elder abuse differ depending on the type of abuse the victim is suffering. Each type of abuse has distinct signs associated with it.

  • Physical abuse can be detected by visible signs on the body, including bruises, scars, sprains, or broken bones. More subtle indications of physical abuse include signs of restraint, such as rope marks on the wrist, or broken eyeglasses.
  • Emotional abuse often accompanies the other types of abuse and can usually be detected by changes in the personality or behavior. The elder may also exhibit behavior mimicking dementia, such as rocking or mumbling.
  • Financial exploitation is a more subtle form of abuse, in comparison to other types, and may be more challenging to notice. Signs of financial exploitation include significant withdrawals from accounts, belongings or money missing from the home, unpaid bills, and unnecessary goods or services.
  • Sexual abuse, like physical abuse, can be detected by visible signs on the body, especially around the breasts or genital area. Other signs include inexplicable infections, bleeding, and torn underclothing.
  • Neglect is a type of abuse in that it can be inflicted either by the caregiver or oneself. Signs of neglect include malnutrition and dehydration, poor hygiene, noncompliance to a prescription medication, and unsafe living conditions.

In addition to observing signs in the elderly individual, abuse can also be detected by monitoring changes in the caregiver’s behavior. For example, the caregiver may not allow them to speak to or receive visitors, exhibit indifference or a lack of affection towards the elder, or refer to the elder as “a burden.” Caregivers who have a history of substance abuse or mental illness are more likely to commit elder abuse than other individuals.

Abuse can sometimes be subtle, and therefore difficult to detect. Regardless, awareness organizations and research advise to take any suspicion seriously and to address concerns adequately and immediately.

Common abusers

An abuser can be a spouse, partner, relative, a friend or neighbor, a volunteer worker, a paid worker, practitioner, solicitor, or any other individual with the intent to deprive a vulnerable person of their resources. Relatives include adult children and their spouses or partners, their offspring and other extended family members. Children and living relatives who have a history of substance abuse or have had other life troubles are of particular concern. For example, HFE abusive individuals are more likely to be a relative, chronically unemployed, and dependent on the elderly person.

Health consequences of elder abuse

The health consequences of elder abuse are serious. Elder abuse can destroy an elderly person’s quality of life in the forms of:

  • Declining functional abilities
  • Increased dependency
  • Increased sense of helplessness
  • Increased stress
  • Worsening psychological decline
  • Premature mortality and morbidity
  • Depression and dementia
  • Malnutrition
  • Bed sores
  • Death

The risk of death for elder abuse victims are three times higher than for non-victims.