Elder Abuse and Neglect

• Evidence that personal care is lacking or neglected
• Signs of malnourishment (e.g. sunken eyes, loss of weight)
• Chronic health problems both physical and/or psychiatric
• Dehydration (extreme thirst)
• Pressure sores (bed sores)

• Overt signs of physical trauma (e.g. scratches, bruises, cuts, burns, punctures, choke marks)
• Signs of restraint trauma (e.g. rope burns, gag marks, welts)
• Injury – particularly if repeated (e.g. sprains, fractures, detached retina, dislocation, paralysis)
• Additional physical indicators – hypothermia, abnormal chemistry values, pain upon being touched
• Repeated “unexplained” injuries
• Inconsistent explanations of the injuries
• A physical examination reveals that the older person has injuries which the caregiver has failed to disclose
• A history of doctor or emergency room “shopping”
• Repeated time lags between the time of any “injury or fall” and medical treatment

• Unusual banking activity (e.g. large withdrawals during a brief period of time, switching of accounts from one bank to another, ATM activity by a homebound elder)
• Bank statements (credit card statements, etc.) no longer come to the older adult
• Documents are being drawn up for the elder to sign but the elder can not explain or understand the purpose of the papers
• The elders living situation is not commensurate with the size of the elder’s estate (e.g. lack of new clothing or amenities, unpaid bills)
• The caregiver only expresses concern regarding the financial status of the older person and does not ask questions or express concern regarding the physical and/or mental health status of the elder
• Personal belongings such as jewelry, art, furs are missing
• Signatures on checks and other documents do not match the signature of the older person
• Recent acquaintances, housekeepers, “care” providers, etc. declare undying affection for the older person and isolate the elder from long-term friends or family
• Recent acquaintances, housekeeper, caregiver, etc. make promises of lifelong care in exchange for deeding all property and/or assigning all assets over to the acquaintance, caregiver, etc.

• • Psychological Signs:

• • Behavioral Signs:

• Trauma to the genital area (e.g. bruises)
• Venereal disease
• Infections/unusual discharge or smell
• Indicators common to psychological abuse may be concomitant with sexual abuse

• • Caregiver withholds or reads the elder’s mail.
  • Caregiver intentionally obstructs the older person’s religious observances (e.g. dietary restrictions, holiday participation, visits by. minister/priest/rabbi etc.)
  • Caregiver has removed all doors from the older adult’s rooms.
  • As violation of basic rights is often concomitant with psychological abuse the indicators of basic rights violations are similar indicators as those for

psychological abuse.

• Elder is not given the opportunity to speak without the caregiver being present.
• Caregiver exhibits high levels of indifference or anger towards the older adult.
• Overmedication or oversedation.

• Name of elder.
• Address (include room number if in a long-term care facility).
• Age (if known).
• Phone number (if known).
• Specifics of what is happening now – Why did you decide to call today?

Illness, Malnutrition, & Overmedication: Many illnesses (e.g. low grade infections, endocrine imbalance) may result in dementia-like symptoms. If left untreated, these symptoms may interfere with the older adult’s ability to care for themselves. For a variety of reasons, an older adult may be malnourished (poor nutrition, physiological changes).

One of the symptoms of malnutrition, particularly in older adults, is dementia-like symptoms. In addition, overmedication (a common problem in old age due to overprescription of medications and/or age-related changes in the older person’s physiology) may also result in dementia-like symptoms and associated self-neglect. Again, diagnosis and appropriate medical treatment is imperative.

Depression: Depression can be an issue for older adults much as it can be for individuals of any age. While there is a broad range of symptomatology for depression (too extensive for discussion here), two symptoms are particularly relevant: difficulty maintaining self-care and dementia-like symptoms. Contrary to common myth, depression is highly treatable in old age. Rapid intervention and treatment is particularly essential as there is a high risk of suicide for older white males in the United States; it is estimated that the rate of suicide for older white males may by as much as 12 times higher than for any other demographic/age group.

Substance Abuse: Substance abuse can also be an issue for older adults. Some older adults suffer from long-term addictions and the concomitant disorders that accompany such additions (e.g. Korsakoff’s Syndrome with accompanying dementia). Thus, not only may the older person self-neglect as a direct result of the addiction but they may also self-neglect as a function of the resultant disorder. In addition, some older adults develop substance abuse problems in old age possibly in response to depression, stress, loss, or anxiety.

They may also develop a substance abuse problem as a result of overprescription of medicines (e.g. Valium, Xanax) by their physician. Therefore, the substance abuse by itself, the underlying cause of the substance abuse, and/or the often accompanying dementia-like symptoms may result in self-neglecting behavior.
Poverty: Many older adults live on the edge financially. Below are the 1990 census data for median incomes per month based on gender and race for individuals 70 or older.

Clearly, many of these individuals are forced to choose between food, housing, and medication. From the outside looking in, it may appear that the individual is choosing to self-neglect (e.g. he/she neglects take their heart medication or are undernourished) when in fact, they simply can not afford to adequately care for themselves. Therefore, intervention must take the form of increased social services/supports (e.g. rental subsidies, food stamps, low cost health care). Note that currently most older adults are not eligible for many of these services/subsidies as their income is above the Federal Poverty Line for individuals 65 and over (in 1990, the poverty line for seniors was 437.91 per month).

Isolation: There is a clear cut correlation between social support and life satisfaction. As life satisfaction decreases, the risk for self-neglect increases. Isolation is a risk factor for all forms of elder abuse. Intervention entails the creation of trust, increased involvement of the older adult in the community, and the creation of social supports. This, of course, may be problematic for those individuals who have had little social support throughout their life-span.

Caregiver stress: Caring for a non-well older adult suffering from a mental or physical impairment is highly stressful. Individuals who do not have the requisite skills, information, resources, etc. and who are otherwise ill-prepared for the caregiving role may experience extreme stress and frustration. This may lead to elder abuse and/or neglect.

Dependency or impairment of the older person: It has been argued that as an older adult1s dependency increases so does the resentment and stress of the caregiver. Studies have found that individuals in poor health are more likely to be abused that individuals who are in relatively good health. In addition, caregivers who are dependent on the elder financially is also more likely to perpetrate abuse. This is hypothesized to counteract the feelings of powerlessness that may be experienced by the caregiver.

External Stress: External stress such as financial problems, job stress, and additional family stressors have been hypothesized to also increase the risk for abuse. This correlation has been clearly demonstrated in studies examining spousal or child abuse.

Social Isolation: Abuse, whether spousal abuse, child abuse, or elder abuse occurs most often in families characterized by social isolation. Of course, this may be both an indicator of potential abuse as well as a potential contributing cause of abuse.

Intergenerational transmission of violence: Individuals who are abused as children are hypothesized to become part of a cycle of violence. Violence is learned as a form of acceptable behavior in childhood as a response to conflict, anger, or tension. Thus, when these feelings arise during caregiving, the caregiver is at risk for becoming a perpetrator of elder abuse or neglect. Some have also hypothesized a “what goes around, comes around” theory of elder abuse. If the older person receiving the care previously abused their child, that child now in the role of caregiver simply is returning the abuse they suffered.

Intra-individual dynamics or personal problems of the abuser: Some caregivers may be at risk for abusing elders as a function of their own difficulties. For example, a caregiver who suffers from such problems as alcoholism, drug addiction, and/or an emotional disorder (e.g. a personality disorder) is more likely to become an abuser than an individual who do not suffer from such problems.

• Maintain social contacts; increase network of friends.
• Keep in touch with old friends and neighbors even if you move.
• Develop a buddy system with a friend outside the home.
• Ask friends to visit you at home.
• Participate in social and community activities.
• Volunteer.
• Get legal advice concerning arrangements you can make not for future disability (e.g. powers-of-attorney).
• Review your will periodically.
• Arrange to have your social security check or pension deposited directly into your bank account.
• Don’t live with someone who has a history of violent behavior or substance abuse.
• Don’t leave your home unattended.
• Don’t sign a document unless someone you trust has reviewed it.

• Maintain close ties with aging relatives and friends.
• Find sources of help and use them.
• Examine closely your family’s ability to provide long-term, in-home care.
• Explore alternative sources of care.
• Anticipate potential incapacitation and make plans based on discussion of the elder’s wishes.
• Don’t offer personal home care unless you thoroughly understand the demands and can meet the responsibility and costs involved.
• Don’t ignore your limitations and overextend yourself.
• Don’t expect family problems to disappear once the elder moves into the home.
• Don’t hamper the older person’s independence or intrude unnecessarily upon his/her privacy.

• Develop new ways to provide direct assistance to caregiving families.
• Ask other community groups to become more involved in aging service programs.
• Encourage both public and private employers to help caregiving families.
• Publicize available support services and professionals available to caregivers.
• Give public agency employees basic training in responses and case management.
• Provide training for community “gatekeepers” and service providers.
• Recognize that many forms of abuse or mistreatment are crimes.

1. Sufficient income, health care, and social services for all older adults.
2. Public awareness and professional training in relation to elder abuse and other older adult issues.
3. Coalition building.
4. Mental health services and family counseling available to all in need of such services.
5. Alcohol and substance abuse treatment programs available to all in need of such services.
6. Assertiveness training, promotion of elder rights, and self-advocacy training for all older adults.
7. Adequate caregiver training and services.
8. Adequate and available financial management and planning services.
9. Violence reduction, conflict resolution, and mediation programs and services available to all in need of such services/programs.
10. Awareness and facilitation of positive and productive aging.

• Baumhover, Lorin A. and Beall, S. Colleen (eds.). (1996). Abuse, Neglect, and Exploitation of Older Persons: Strategies for Assessment and Intervention. Baltimore, MD: Health Professions Press.
• Bureau of Justice Statistics. (1994). Elderly Crime Victims: National Crime Victimization Survey. Washington, D.C.: U.S. Dept. of Justice, Office of Justice Programs, Bureau of Justice Statistics.
• Byers, Bryan and Hendricks, James E. (1993). Adult Protective Services: Research and Practice. Springfield, Ill.: C.C. Thomas.
• FHP Foundation. (1995). Silent Suffering: Elder Abuse in America: Elder Abuse in Rural and Urban Settings: Report on Focus Group Activities and Recommendations for the 1995 White House Conference on Aging. Long Beach, CA: FHP Foundation.
• Kosberg, Jordan (Ed.) (1983). Abuse and Maltreatment of the Elderly: Causes and Interventions. Boston: John Wright.
• Galbraith, Michael (Ed.) (1986)Elder Abuse: Perspective on an Emerging Crisis. Kansas City, Kansas: Mid-American Congress on Aging.
• National Institute of Justice et al. (1993).Triad: Reducing Crime Against the Elderly: An Implementation Handbook. Washington, D.C.: U.S. Dept. of Justice, National Institute of Justice.
• Nerenberg, Lisa. (1993).Improving the Police Response to Domestic Elder Abuse: Instructor Training Manual and Participant Training Manual. Washington, D.C.: Police Executive Research Forum.
• Quinn, Mary, and Tomita, Susan. (1986). Elder Abuse and Neglect: Causes, Diagnosis, and Intervention Strategies. New York: Springer Publishing.
• Tatara, Toshio. (1995). An Analysis of State Laws Addressing Elder Abuse, Neglect, and Exploitation: A Final Report. Washington, D.C.: National Center on Elder Abuse.
• Tatara, Toshio. (1993).Summaries of the Statistical Data on Elder Abuse in Domestic Settings for FY90 and FY91: A Final Report. Washington, D.C.: National Aging Resource Center on Elder Abuse.
• Victim Services. (1993).Close to Home: Elder Abuse: Intervention Strategies for Clinicians.New York: Victim Services. (Videotape)
• Vinton, Linda. (1993). Abused Elders or Older Battered Women?: Report on the AARP Forum, October 29-30, 1992, Washington, D.C. Washington, D.C.: AARP Women’s Initiative.

• Elder Abuse Prevention – (AoA Fact Sheet)
• The National Elder Abuse Incidence Study; Final Report [PDF Format]
• National Center for Elder Abuse