Elder Abuse - What is it and how to deal with it
What is Elder Abuse? What are the signs of elder abuse and how can deal with it?
Elder abuse: the very phrase seems reprehensible to most of us, but according to the American Psychological Association (APA) approximately 4 million elderly Americans are victims of some form of abuse each year (1).
Although we read headlines such as the 2015 conviction of a caregiver in San Diego who was convicted of not only financially robbing her patient but also murdering him (2), we assume this could never happen to those we love. However, even though cases such as this one are extreme, the APA report also gave the staggering figure that for every one instance of abuse reported, there are likely 23 other unreported cases.
Elder abuse is not always physical: it also includes psychological abuse, as well as other forms. Another heartbreaking fact that the APA points out is that most abuse does not occur in an institution such as a nursing home, although those abuses do occur; the majority of abuse occurs in the homes where the elderly persons are staying: either their own home or with relatives. Because of this, it is vital that caretakers understand types of abuse, signs to look for, and ways to avoid abuse to protect the wellbeing of their loved ones.
Types of Abuse
The U.S. Justice Department breaks elder abuse down into four main types: neglect and abandonment, sexual abuse, physical abuse, and psychological abuse (3). Others add financial abuse to the list. Each of these types of abuse has devastating consequences. In fact, in an ongoing study sponsored by Weill Medical College of Cornell University, at least one-third of elderly victims of abuse suffer from “clinically significant depressive symptoms” (4). The study indicates that depression increases the mortality rate and decreases drive to take self-protective steps. Besides depression, other consequences of elder abuse are like those of any other abuse victim, and include self-blame, self-harm, self-deprecation, and hopelessness. In a body already fraught with the signs of aging, these consequences of abuse can be devastating.
- Neglect and Abandonment – this is the easiest form of abuse to occur, usually unintentionally. Abuse by neglect is simply failing to provide for all the needs the senior person has. Most often this occurs out of ignorance: the caregiver simply does not realize the degree of care needed. This can occur whether the caregiver is paid help or a family member. Neglect of this kind is usually easily remedied with education and information related to the patient’s specific conditions, or a conversation with the patient about his or her needs. However, neglect becomes serious when it is intentional, such as when a caregiver willfully chooses to withhold food or water, decides not to turn a bed-ridden patient, or fails to quickly change soiled underclothes, for example. Abandonment involves leaving an elderly person alone without making provision for his care. This can occur when a paid caregiver leaves a home before the appointed time while staying on the clock for payment.
- Physical Abuse – may begin subtly, out of frustration with an elderly person, but can quickly escalate. Physical abuse may include rough handling (such as pushing, yanking, pulling), slapping, and hitting. Some caregivers may simply lack compassion and do not care about their patients, so they become impatient when they cause “more trouble” than they feel that they should. Sometimes otherwise loving caregivers are “driven” to physical abuse because the caregiver himself is overworked, hopeless, feeling alone, etc. Unnecessary confinement or restraint also falls into this category of abuse.
- Psychological – easily the second most common form of elder abuse, this broad category can take many forms including:
- Verbally humiliating and/or ridiculing
- Isolating elderly from family, friends, and others
- Blaming the elder for tying down the caretaker, etc.
This form of abuse may be the most difficult to recognize, whether by the instigator of the abuse (because it has become second nature), or by others, because many who are psychologically abusive may appear like a completely different person when others are around.
- Sexual Abuse – the National Council on Aging defines sexual abuse as any type of sexual activity that takes place with an elderly person who “is unable to understand, unwilling to consent, threatened, or physically forced” (5). Unfortunately, a quick look through the news reveals that such abuse does occur at the hands of caregivers, nursing aides, guardians, and even family members, such as grandsons with their grandmother.
- Financial Abuse – in the world of senior care, there are those who enter it with less than noble intentions: seeking seniors of means from whom they can leech money or property. Usually, when there are instances of financial abuse, one or more of the other forms of abuse will also be involved, because the elderly person is being used as a means to an end, and not being cared for out of compassion. A caregiver may gain the trust of their patient, convince them to sign a power of attorney so that they can “relieve the burden of financial matters,” and then begin to use that new authority to write checks, sign over deeds, etc. Even without a power of attorney, there is usually enough access to personal information for identity theft, forgery of signatures, or misrepresentation of expenses to be reimbursed.
Of course, there are other forms of abuse, including telemarketing scams, medical malpractice, etc., but these are five of the most common abuses found in elder care. Unfortunately, no one is immune from either being the victim of the abuse or the perpetrator. Even family members with no initial evil motives can, in the heat of a moment, find themselves doing the unthinkable and abusing a loved one. Because of this, it is important to recognize the signs of abuse.
Signs of Abuse
Recognizing abuse is a delicate subject. The effects of aging muddle the signs. For example, many elderly people bruise easily, so that someone reaching out and grabbing the arm of an elderly person to catch them for a fall may cause an ugly looking bruise. Was the act of grabbing the arm abuse? Certainly not, but the mark it leaves could definitely make it appear to be so. Further, it is impossible to be vigilant 100% of the time, so was the fall that resulted in a broken hip an accident or the result of abuse? Patterns and consistency are key factors to consider, rather than single, isolated events.
- Neglect – signs of neglect are usually pretty clear: dirty or inappropriate clothing (for the occasion or the weather), lack of basic hygiene, and a consistently uncared for appearance are some of the telltale signs. Neglect can also be detected in the home environment: a cluttered, dirty home, or the lack of functioning utilities or needed home repairs all may indicate the elder person is being neglected.
- Physical Abuse – again, this is a delicate area due to the frailty of the bodies of seniors, but unexplained injuries such as cuts, burns, sores, and bruises (especially on the head or torso) are warning signs. Other signs in this category would include the effects of overmedication, or the lack of needed assistive devices such as hearing aids, glasses, walkers, etc.
- Psychological Abuse – fearfulness or agitation around specific people, cowering, an unwillingness to talk, or a change in personality may be red flag warnings that someone is intimidating, threatening, or shaming an elderly person.
- Sexual Abuse – look for the usual signs of this type of abuse: unexplained vaginal or anal bleeding, bruised genitals or breasts, and bloodied or torn underwear.
- Financial Abuse – if someone is looking, this is often easy to spot. Look for changes in spending patterns or unusual withdrawals from accounts. Other signs may include unpaid bills or utilities being turned off, or unusual “gifts” to previously unknown “friends”.
What to Do
Realizing that elder abuse is both possible and likely is the first step to prevention. Recognizing that 90% of elder abuse and neglect actually occurs at the hands of someone well known to the senior (6) is a huge and frightening fact to handle. However, rather than succumb to fear, there are concrete, practical steps to take that can both protect your loved one from ever being abused in the first place, or ensure that repeated abuse is unlikely to occur.
- Caretaker Support – if the caregiver(s) are family members, ensure that she (or you) gets adequate support. Caretaker burnout is a serious problem and a leading cause of family member instigated abuse.
- Call or Visit Regularly – most seniors who are abused by non-family member caretakers have little contact with family members, especially when family lives far away. Check in frequently with your loved ones.
- Check out Credentials – when having outside care, do careful research. Run background checks, look into the company that hires the individuals, look for training credentials.
- Report Abuse – do not simply accept an apology or a promise that it will never occur again. Reporting the abuse is the best protection for your loved one and the abuser.
Keep in mind that although many signs of abuse, such as depression, confusion, anxiety, bruising, changes in behavior, etc., are frequently symptoms of aging, dementia, and other conditions, this is not a reason to brush aside concern. If you are in doubt, inquire. Set up cameras, drop-in unexpectedly. And, if you find yourself on the edge of being an abuser, get help. Reach out. No one need be alone in this difficult path of elder care.
A comprehensive listing of Eldercare services can be found on the website for the U.S. Administration on Aging. It offers the option of choosing what services you are looking for, then searching the database by location.
- Administration on Aging. (N.D.). Eldercare Locator. Retrieved from: https://eldercare.acl.gov/Public/Index.aspx
The California Department of Justice has put together a guide for preventing elder abuse as well as information on how to report it, if necessary. It can be found online in PDF format.
- California Department of Justice. (2002). A Citizen’s Guide to Preventing & Reporting Elder Abuse. Office of the Attorney General. Retrieved From: http://ag.ca.gov/bmfea/pdfs/citizens_guide.pdf
An easy, at-a-glance guide to identifying and preventing elder abuse is provided by the Health in Aging Foundation. Also found in PDF form, it can be a great first source of education for family members of the elderly.
- Health in Aging Foundation. (2017). Preventing and Addressing Elder Abuse. Retrieved from: http://www.healthinaging.org/files/documents/tipsheets/elder_abuse.pdf
The National Consumer Voice for Quality Long-Term Care offers a state-by-state guide to resources and advocates for elder abuse prevention. Go to the website then click on your state to find resources specific to your area.
- National Consumer Voice for Quality Long-Term Care. (2017). National Long-Term Care Ombudsman Resource. The Consumer Voice. Washington D.C. Retrieved from: http://theconsumervoice.org/get_help
A wonderful education resource for family caregivers is provided by the National Center on Elder Abuse. It can be found in PDF form online.
- Nerenberg, Lisa. (2002). Preventing Elder Abuse by Family Caregivers. National Center on Elder Abuse: Washington, D.C. Retrieved from: https://ncea.acl.gov/resources/docs/archive/Preventing-EA-Family-Caregivers-Tech-2002.pdf
The AARP offers a comprehensive list of questions to ask potential caregivers on their website.
- Schmitt, R. (N.D.). Elder Abuse: When Caregiving Goes Wrong. AARP. Retrieved From: https://www.aarp.org/caregiving/basics/info-2017/elder-abuse-assisted-living.html