6. Elder Abuse

Elder Abuse Is a Serious Problem

Each year hundreds of thousands of older persons are abused, neglected and exploited by family members and others. Many victims are people who are older, frail, and vulnerable and cannot help themselves and depend on others to meet their most basic needs.

Legislatures in all 50 states have passed some form of elder abuse prevention laws. Laws and definitions of terms vary considerably from one state to another, but all states have set up reporting systems. Generally, adult protective services (APS) agencies receive and investigate reports of suspected elder abuse.

The 1998 National Elder Abuse Incidence Study found the following:

• 551,011 persons, aged 60 and over, experienced abuse, neglect, and/or self-neglect in a one-year period;
• Almost four times as many new incidents of abuse, neglect, and/or self-neglect were not reported as those that were reported to and substantiated by adult protective services agencies;
• Persons, aged 80 years and older, suffered abuse and neglect two to three times their proportion of the older population; and
• Among known perpetrators of abuse and neglect, the perpetrator was a family member in 90 percent of cases. Two-thirds of the perpetrators were adult children or spouses.

Generally Accepted Definitions

Elder abuse is an umbrella term used to describe one or more of the following:

• Physical abuse is the willful infliction of physical pain or injury, e.g., slapping, bruising, sexually molesting, or restraining.
• Sexual abuse is the infliction of non-consensual sexual contact of any kind.
• Emotional or psychological abuse is the infliction of mental or emotional anguish, e.g., humiliating, intimidating, or threatening.
• Financial or material exploitation is the improper act or process of an individual, using the resources of an older person, without his/her consent, for someone else’s benefit.
• Neglect is the failure of a caretaker to provide goods or services necessary to avoid physical harm, mental anguish or mental illness, e.g., abandonment, denial of food or health related services.
• Self-neglect is characterized as the behavior of an elderly person that threatens his/her own health or safety.

Major Types of Elder Abuse

Physical Abuse

Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include but is not limited to such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse.

Signs and symptoms of physical abuse include but are not limited to:

• bruises, black eyes, welts, lacerations, and rope marks;
• bone fractures, broken bones, and skull fractures;
• open wounds, cuts, punctures, untreated injuries in various stages of healing;
• sprains, dislocations, and internal injuries/bleeding;
• broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained;
• laboratory findings of medication overdose or under utilization of prescribed drugs;
• an elder’s report of being hit, slapped, kicked, or mistreated;
• an elder’s sudden change in behavior; and
• the caregiver’s refusal to allow visitors to see an elder alone.

Sexual Abuse

Sexual abuse is defined as non-consensual sexual contact of any kind with an elderly person. Sexual contact with any person incapable of giving consent is also considered sexual abuse. It includes, but is not limited to, unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.

Signs and symptoms of sexual abuse include but are not limited to:

• bruises around the breasts or genital area;
• unexplained venereal disease or genital infections;
• unexplained vaginal or anal bleeding;
• torn, stained, or bloody underclothing; and
• an elder’s report of being sexually assaulted or raped.

Emotional or Psychological Abuse

Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant; isolating an elderly person from his/her family, friends, or regular activities; giving an older person the “silent treatment;” and enforced social isolation are examples of emotional/psychological abuse.

Signs and symptoms of emotional/psychological abuse include but are not limited to:

• being emotionally upset or agitated;
• being extremely withdrawn and non communicative or non responsive;
• unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking); and
• an elder’s report of being verbally or emotionally mistreated.

Neglect

Neglect is defined as the refusal or failure to fulfill any part of a person’s obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care.

Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder.

Signs and symptoms of neglect include but are not limited to:

• dehydration, malnutrition, untreated bed sores, and poor personal hygiene;
• unattended or untreated health problems;
• hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water);
• unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing); and
• an elder’s report of being mistreated.

Abandonment

Abandonment is defined as the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.

Signs and symptoms of abandonment include but are not limited to:

• the desertion of an elder at a hospital, a nursing facility, or other similar institution;
• the desertion of an elder at a shopping center or other public location; and
• an elder’s own report of being abandoned.

Financial or Material Exploitation

Financial or material exploitation is defined as the illegal or improper use of an elder’s funds, property, or assets. Examples include, but are not limited to, cashing an elderly person’s checks without authorization or permission; forging an older person’s signature; misusing or stealing an older person’s money or possessions; coercing or deceiving an older person into signing any document (e.g., contracts or will); and the improper use of conservator ship, guardianship, or power of attorney.

Signs and symptoms of financial or material exploitation include but are not limited to:

• sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder;
• the inclusion of additional names on an elder’s bank signature card;
• unauthorized withdrawal of the elder’s funds using the elder’s ATM card;
• abrupt changes in a will or other financial documents;
• unexplained disappearance of funds or valuable possessions;
• substandard care being provided or bills unpaid despite the availability of adequate financial resources;
• discovery of an elder’s signature being forged for financial transactions or for the titles of his/her possessions;
• sudden appearance of previously uninvolved relatives claiming their rights to an elder’s affairs and possessions;
• unexplained sudden transfer of assets to a family member or someone outside the family;
• the provision of services that are not necessary; and
• an elder’s report of financial exploitation.

Self-neglect

Self-neglect is characterized as the behavior of an elderly person that threatens his/her own health or safety. Self-neglect generally manifests itself in an older person as a refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions.

The definition of self-neglect excludes a situation in which a mentally competent older person, who understands the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her health or safety as a matter of personal choice.

Signs and symptoms of self-neglect include but are not limited to:

• dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene;
• hazardous or unsafe living conditions/arrangements (e.g., improper wiring, no indoor plumbing, no heat, no running water);
• unsanitary or unclean living quarters (e.g., animal/insect infestation, no functioning toilet, fecal/urine smell);
• inappropriate and/or inadequate clothing, lack of the necessary medical aids (e.g., eyeglasses, hearing aids, dentures); and
• grossly inadequate housing or homelessness.

Source: National Center on Elder Abuse
1201 15th Street, N.W., Suite350
Washington, DC 20005
(202) 898-2586
www.elderabusecenterorg.

Reporting Elder Abuse

To report elder abuse, contact APS through your state’s hotline. The APS agency screens calls for potential seriousness, and it keeps the information it receives confidential. If the agency decides the situation possibly violates state elder abuse laws, it assigns a caseworker to conduct an investigation (in cases of an emergency, usually within 24 hours). If the victim needs crisis intervention, services are available. If elder abuse is not substantiated, most APS agencies will work as necessary with other community agencies to obtain any social and health services that the older person needs.

The older person has the right to refuse services offered by APS. The APS agency provides services only if the senior agrees or has been declared incapacitated by the court and a guardian has been appointed. The APS agency only takes such action as a last resort.

Risk Factors for Elder Abuse

Elder abuse, like other types of domestic violence, is extremely complex. Generally a combination of psychological, social, and economic factors, along with the mental and physical conditions of the victim and the perpetrator, contribute to the occurrence of elder maltreatment.

Although the factors listed below cannot explain all types of elder maltreatment, because it is likely that different types (as well as each single incident) involve different casual factors, they are some of the risk factors researchers say seem to be related to elder abuse.

Domestic Violence Grown Old

It is important to acknowledge that spouses make up a large percentage of elder abusers, and that a substantial proportion of these cases are domestic violence grown old: partnerships in which one member of a couple has traditionally tried to exert power and control over the other through emotional abuse, physical violence and threats, isolation, and other tactics.

Personal Problems of Abusers

Particularly in the case of adult children, abusers often are dependent on their victims for financial assistance, housing, and other forms of support. Oftentimes they need this support because of personal problems, such as mental illness, alcohol or drug abuse, or other dysfunctional personality characteristics. The risk of elder abuse seems to be particularly high when these adult children live with the elder.

Living with Others and Isolation

Both living with someone else and being socially isolated have been associated with higher elder abuse rates. These seemingly contradictory findings may turn out to be related in that abusers who live with the elder have more opportunity to abuse and yet may be isolated from the larger community themselves or may seek to isolate the elders from others so that the abuse is not discovered. Further research needs to be done to explore the relationship between these factors.

Other Theories

Many other theories about elder abuse have been developed. Few, unfortunately, have been tested adequately enough to definitively say whether they raise the risk of elder abuse or not. It is possible each of the following theories will ultimately be shown to account for a small percentage of elder abuse cases.

• Caregiver stress. This commonly-stated theory holds that well-intentioned caregivers are so overwhelmed by the burden of caring for dependent elders that they end up losing it and striking out, neglecting, or otherwise harming the elder. Much of the small amount of research that has been done has shown that few cases fit this model.
• Personal characteristics of the elder. Theories that fall under this umbrella hold that dementia, disruptive behaviors, problematic personality traits, and significant needs for assistance may all raise an elder’s risk of being abused. Research on these possibilities has produced contradictory or unclear conclusions.
• Cycle of violence. Some theorists hold that domestic violence is a learned problem-solving behavior transmitted from one generation to the next. This theory seems well established in cases of domestic violence and child abuse, but no research to date has shown that it is a cause of elder abuse.

Elder Abuse Resources:

• National Center on Elder Abuse (NCEA)

Five partner organizations that make up NCEA:

• National Association of State Units on Aging
• ABA Commission on Law and Aging
• The Clearinghouse on Abuse and Neglect of the Elderly
• The National Committee for the Prevention of Elder Abuse
• National Association of Adult Protective Services Administrators

Other Elder Abuse Resources:

• 1998 National Elder Abuse Incidence Study
• AoA Aging Internet Information Note: Elder Abuse and Neglect

Domestic Violence Resources

• Closing the Gap: Violence
  This HHS newsletter provides links to numerous federal fact sheets containing supportive information, statistics, and initiatives under way to eliminate domestic violence.
• Community Checklist
  Important Steps to End Violence Against Women - This publication provides information for community groups, schools, religious institutions, law enforcement agencies, and others to raise awareness and prevent domestic violence.
• Frequently Asked Questions: Violence Against Women
  This fact sheet provides a definition of domestic violence, intimate partner violence and sexual assault and provides resources for help if you are a victim or know someone who is a victim of domestic violence.
• HHS Fact Sheet: Access to HHS-funded Services for Immigrant Survivors of Domestic Violence
  The welfare reform law passed in 1996 created new requirements affecting access to federally funded programs for immigrants. One vulnerable population specifically addressed in the legislation is battered immigrants and their children. This Fact Sheet provides guidance about eligibility for all the various programs and services funded by Department of Health and Human Services (HHS).
• HHS Fact Sheet: Preventing Violence Against Women
  This publication is about government initiatives to prevent violence against women. Topics discussed include the Violence Against Women Act, The National Domestic Violence Hotline, and other government programs.

Domestic Violence - Federal Offices/Organizations

• Division of Violence Prevention, NCIPC, CDC, OPHS, HHS
• Violence Against Women Office, OJP, DOJ

You will be asked for your name, address, telephone number, etc., but most states will take the report even if you do not identify yourself.