Elder abuse is a serious issue that involves the abuse or neglect of people age 60 and older. The signs of abuse are often not recognized, leading to gross under-reporting of the problem. In fact, the limited research available suggests that only one in 14 cases of abuse are actually reported to the authorities. Sometimes the abuse is a continuation of existing dysfunctional family dynamics. More often, however, the abuse is a result of changes brought about by the stress of illness, dependency and need for increased care.
Adult children and spouses are the most frequent abusers of the elderly, followed by other family members. The National Center on Elder Abuse defines the following seven different types of elder abuse:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Financial exploitation
Physical abuse involves the use of physical force that may result in bodily injury, physical pain, or impairment. Persons who have been physically abused may have bruises, welts, lacerations, rope marks, black eyes, wounds, cuts, or untreated injuries in different stages of healing. Dislocations, sprains, internal injuries, broken eyeglasses or frames, and medication overdosing or under-dosing can also be the result of physical abuse. The elder being physically abused is often withdrawn, anxious, depressed, and fearful around a family member or caregiver. A red flag that physical abuse may be occurring is a caregiver’s refusal to let the patient have visitors without the caregiver being present.
Sexual abuse includes non-consensual sexual contact of any kind with another person. Bruising around the breasts or genital area, sexually transmitted diseases, vaginal or anal bleeding, and torn or bloody undergarments are signs of sexual abuse.
Emotional or psychological abuse involves infliction of anguish, pain, or distress through verbal or non-verbal acts. Emotionally abused persons may appear agitated, upset, withdrawn, non-communicative, or unresponsive. Emotional abuse often accompanies other types of abuse. In the elderly, unusual behavior often attributed to dementia, such as sucking, biting, or rocking behavior, can also be signs of emotional or psychological abuse.
Financial exploitation is a common form of abuse that occurs in the elderly and involves illegal or improper use of an elder’s funds, property, or assets. Financial abuse can include cashing an elder’s checks without permission; forging an elderly person’s signature; stealing money or possessions; coercing or deceiving the elder into signing a contract or will; or improperly using a power of attorney, guardianship, or conservatorship. Other indications of financial abuse include the disappearance of financial papers, checkbooks, and legal documents; a sudden change in banking habits or a change in banking locations; the withdrawal of large sums of money by a person who accompanies the elder; additional names added to an elder’s bank signature card; unauthorized use of an ATM or credit card; the unexplained transfer of assets to a family member or person outside the family; or the unexplained disappearance of funds or possessions.
Additionally, substandard care, even though financial resources are available, can be an indication of financial abuse. Exploitation may also occur in the form of fraud schemes by strangers.
Neglect is the most common type of elder abuse. Neglect may be intentional, such as withholding nourishment, or it may be unintentional, resulting from ignorance or from a genuine inability to provide care. Neglect can also take the form of failure to fulfill an obligation, such as failing to pay for necessary home care services or the failure of a caregiver to provide necessary care. Persons who have been neglected may appear dehydrated and malnourished, have untreated bedsores, lice, a flea infestation, a urine or fecal smell, be inadequately clothed, or live in hazardous, unsafe, or unsanitary conditions.
Abandonment is an extreme form of neglect that involves desertion of a person by an individual who has physical custody or by a person who has assumed responsibility for providing care to the individual. An example would be a caregiver who leaves a dependent elderly person alone for several days while traveling.
Self-neglect abuse primarily occurs in the elderly and includes behaviors or absence of behaviors that threaten a person’s health or safety. This definition does not apply to a mentally competent person who makes the voluntary decision to engage in behavior that threatens his or her safety and who understands the consequences of that decision. Self-neglect can include behaviors such as:
- Failure to take essential medications or refusal to seek medical treatment for serious illness
- Leaving a burning stove unattended
- Poor hygiene
- Not wearing suitable clothing for the weather
- Poor living conditions or the inability to attend to housekeeping
Self-neglect accounts for the majority of elder abuse cases reported to adult protective services. Oftentimes, the problem is paired with declining health, isolation, Alzheimer’s disease or dementia, or drug and alcohol dependence. In some of these cases, self-neglecters will be connected to support systems within the community that can assist the person to continue living independently. Conditions like depression and malnutrition may be successfully treated through medical interventions. If the problems are severe enough, a guardian may be appointed or alternate living conditions arranged.
A combination of individual, relationship, community, and societal factors contribute to the risk of becoming a victim or perpetrator of elder abuse. In many situations, the same risk factors may be shared by both the perpetrator and the victim.
In the elderly population, studies suggest that those at risk are most likely to be female, widowed, frail, cognitively impaired, and chronically ill. Social isolation and mental impairment, such as dementia or Alzheimer’s disease, are two factors that may make an older person more vulnerable to abuse. A history of domestic violence may also make a senior more susceptible to abuse. Particularly in the case of adult children, abusers often are dependent on their victims for financial assistance, housing, and other forms of support. Frequently, these individuals 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 is particularly high when these adult children live with the elder.
Home care clinicians, such as the professional Sun City home health care staff at Nightingale Homecare, are in an ideal position to detect situations for potential abuse and to connect the patient and caregiver with community resources that may prevent escalation of the problem. Stressed caregivers can be put in contact with social organizations and support groups and connected with referrals for adult day care, delivered meals, and respite care. Providing resources for caregiving assistance can be a lifesaver. Clinicians should also teach family caregivers to recognize situations that cause increased stress, as well as appropriate ways to handle difficult patient behaviors like violence, combativeness, and verbal abuse. Identifying actions that can deflate stressful situations is critical to preventing abuse.
Home health providers are mandated to report suspected abuse. Mandated reporters are required by law to report allegations of abuse to law enforcement and regulatory agencies. In most states, Adult Protective Services are the public agencies responsible for investigating reports of elder abuse and for providing victims and families with treatment and protective services. In most situations, the suspicion of abuse is grounds for reporting. Proof is generally not necessary, and the reporter has the option to remain anonymous. Even if a situation has already been investigated, circumstances that seem to be getting worse should continue to be reported and documented by the clinician. If the patient is in immediate danger or a life-threatening situation, it’s important to call 911 or the local emergency authorities.
A trusted home care team, like Nightingale Homecare, is instrumental in reducing the chance for elder abuse and neglect. Contact our Sun City home health care experts to learn how we can help a senior you love stay safe, healthy, and well, in the comfort of home.