This Is Elder Abuse: Types, Warning Signs, and How to Report It

What Is Elder Abuse? How Prevalent Is It?

Currently, there isn't one universally accepted definition of elder abuse. Legal definitions vary from state to state, and different researchers, government agencies, and non-profit organizations often have their own sets of criteria for defining elderly abuse. However, many basic definitions are similar to this one:

• Elder abuse is any action or inaction that harms, endangers, or causes distress to a person over the age of 60 or 65 and is done intentionally by someone who is known to the victim and in a position of trust.

Crimes like burglary, street robbery, and assault by strangers are generally not considered elder abuse. But physical assault by a family member, neighbor, or caregiver definitely is considered elder abuse if it happens to a senior. Neglect is also frequently considered a form of elder abuse, as is sexual assault, psychological mistreatment, and financial exploitation when there is an expectation of trust between the victim and perpetrator.

How many seniors experience elder abuse? Nobody really knows. Estimates vary substantially since certain actions may be considered elder abuse according to some definitions but not according to others. Plus, the defined age for elder abuse victims varies: Some agencies and researchers say that anyone 55 or older can experience elder abuse, whereas others peg the age at 60, 65, or 70 and older. In addition, it's believed that for every case of elder abuse that gets reported, several more are never brought to light.

Even so, an article in The Lancet Global Health estimates that about 1 in every 10 older Americans experience elder abuse. Worldwide, the rate is estimated to be about 1 in every 6 older people. Among seniors who are ill or disabled, the rate is even higher. For example, the National Center on Elder Abuse (NCEA) says that depending on the particular study, between 27.5 percent and 55 percent of seniors who have dementia are estimated to suffer from elder neglect or abuse.

The consequences of elder abuse can be costly and far-reaching. In America alone, elder abuse causes so many injuries that it may be directly responsible for more than $5 billion in medical costs each year.

How Many Types of Elder Abuse Are There?

Elder abuse can take several different forms. And some seniors experience multiple kinds of abuse at the same time. Here are 7 types of elder abuse that are among the most commonly reported:

1. Financial exploitation: Also known as financial abuse, this type of mistreatment can involve scams, fraud, coercion, theft, or improper use of a senior's money, property, or other valuable resources. It affects about 1 in 18 cognitively healthy, non-institutionalized seniors every year. However, the prevalence rate among all seniors may be much higher than that. Essentially, financial exploitation of an elderly person is any intentional act in which a perpetrator improperly reaps financial benefits at the expense of a victim's livelihood or well-being. Perpetrators often get their victims to trust them by using deception or providing offers of help that are based on false pretenses. They also may use scare tactics or make wildly overstated claims in order to get seniors to give them money or hand over control of their assets. Many scams involve telemarketing, but most financial abuse is carried out by people that seniors already know and trust, such as family members and service professionals.
2. Neglect: This type of abuse happens when a vulnerable senior is deprived of essential necessities like food, water, medical treatment, proper clothing, or a safe, clean, and comfortable living environment. Neglect in the elderly is often intentional, perpetrated as a way to exert power, push a senior toward an earlier death, or coerce a senior into signing away his or her financial assets. But neglect can also happen unintentionally as a result of caregiving failures caused by factors like improper training, a lack of resources, or mental or physical problems that impact a caregiver's ability to do his or her job.
3. Emotional abuse: Also known as psychological abuse, this kind of mistreatment harms a senior's mental health. Perpetrators may ridicule, humiliate, blame, yell at, or threaten their victims. Or they may employ more passive-aggressive tactics like shunning their victims, holding back affection, or remaining silent and disinterested in the face of pleas for help or attempts at reconciliation. Emotional abuse is sometimes used as a way to bully and pressure a senior into doing something that is against his or her wishes or best interests.
4. Physical abuse: Willful infliction of bodily pain or injury can happen to almost any senior, especially a vulnerable elder. Physical abuse can take many forms: Pushing, slapping, punching, choking, kicking, pulling hair, and burning are just a few examples. It can also take the form of a perpetrator inappropriately restraining or imprisoning a victim. And some perpetrators of physical abuse give their victims incorrect or improper doses of medications, which can lead to harmful (and sometimes fatal) side effects.
5. Sexual abuse: Some seniors are raped, molested, or forced to participate in activities of a sexual nature without their consent. Even a conversation about sex can be considered abusive if a senior is uncomfortable or unwilling to engage in the discussion and can't get out of the situation. Sexual abuse also happens to seniors who aren't capable of giving consent, such as those who have dementia or other conditions that make them mentally or physically incapacitated.
6. Abandonment: Many people consider abandonment to be a form of neglect. Indeed, it could probably be classified as extreme elderly neglect. It goes beyond family estrangement. Perpetrators will intentionally desert vulnerable seniors who depend on their care, leaving them with little or no assistance—often for long stretches of time. Abandonment can greatly erode a senior's health and well-being; it can even lead to premature death. Some perpetrators have taken their victims to entirely different states and abandoned them in completely unfamiliar places where they have no support.
7. Rights abuse: Some seniors are denied their basic legal rights. For example, in an institution like a nursing home, abuse of this nature can involve ignoring a vulnerable senior's requests for information or blocking his or her attempts at making official complaints. It can also involve denying proper health care, social activities, privacy, or access to one's money or possessions.

Self-neglect is also a form of elder mistreatment. However, in the case of self-neglect, there is no outside perpetrator; affected seniors cause harm to themselves. They may ignore their own basic needs or even refuse essential care, which can lead to new or worsening illnesses or injuries. In some cases, self-neglect is ultimately fatal. But it isn't always caused by mental or physical decline. Many seniors are poor or socially isolated, don't have the resources to meet all of their basic needs, and don't know where to find help, which means they have to make tough choices. For instance, they may go without heat in order to pay for food and medication. Or they may deny themselves essential medications in order to stay warm.

Some people also categorize healthcare fraud as a type of elder abuse or financial exploitation. Like other types of mistreatment, healthcare fraud can take many forms. For example, dishonest medical professionals may take advantage of elderly patients by providing insufficient care yet billing Medicare or Medicaid as if those patients were given full and proper care. Or unscrupulous pharmacists may under-fill prescriptions while charging full price for them.

What Are the Signs of Elder Abuse or Neglect?

Sometimes it's obvious that elder abuse is taking place. However, in many cases, it isn't so easy to recognize abuse or neglect by others. Signs and symptoms can often mirror or get obscured by existing medical conditions, or they can be hidden by the efforts of devious perpetrators. But it's important to follow your intuition, take clues seriously, and make note of any troubling patterns you observe. Generally speaking, the signs of abuse or neglect in the elderly are associated with particular types of mistreatment. For example, consider the following warning signs.

When it comes to financial exploitation of the elderly, you may observe signs such as:

• Unusual spending habits, especially for unnecessary products or services
• Confusing bank transactions, including unexplainable transfers or withdrawals
• Missing bank statements or other financial documents
• A large amount of unopened mail or sweepstakes offers
• Unpaid bills or warning letters from creditors or utility companies
• A new "friend" who offers to provide low- or no-cost care
• Missing property or personal possessions
• Suspicious legal documents related to asset control or powers of attorney
• Signatures on documents that look like they were forged or made under duress
• Confusion about recent financial arrangements
• A reduced level of care despite the ability to pay for better service

Signs of neglect in adults over the age of 60 can include things like:

• Rapid or unexpected weight loss
• A sudden decrease in appetite
• Dehydration
• Unexpected breathing problems
• Dirty or inappropriate clothing
• Lack of personal hygiene
• Frequent skin rashes
• Untreated injuries or infections
• Bedsores
• Expired prescriptions
• Faster-than-expected health decline
• Lack of assistive devices
• Missing or broken eyeglasses, dentures, or hearing aids
• Filthy or unsafe living conditions
• Pest infestations
• Lack of attention to needed repairs
• Uncharacteristic confusion, despair, social withdrawal, or sleeping problems

Emotional abuse can be one of the most challenging types of mistreatment to detect. However, it often occurs alongside other forms of abuse that are easier to spot. Signs of emotional neglect in adults aged 60 or above may include:

• Heightened fear or agitation when around a particular person
• Greater-than-expected weight gain or loss
• New or worsening depression or social anxiety
• Significant personality changes
• Uncharacteristic disorientation or confusion
• Strange behaviors like rocking back and forth, sucking a thumb, or biting oneself
• Blood pressure that's consistently higher than what would be expected
• New or worsening sleep problems

When it comes to physical abuse, the signs can sometimes be mistaken for the results of accidents or unintentional injuries. That's why it's important to look for patterns, unusual behaviors, or injuries that are unlikely to be the result of accidents. You may see signs like:

• Bruises or abrasions that wrap around the person's wrists, arms, ankles, legs, or torso
• Bruises that are in the same places on both sides of the body
• Bruises that are multicolored
• Cigarette burns
• Other unexplainable burns, bruises, abrasions, or scars
• Frequent sprains or bone fractures
• Unusual bleeding
• Broken dentures or eyeglasses
• Unexpected tooth loss
• Strange hair loss in just one small part of the head
• Frequent hospitalizations for the same types of injury
• Injuries that haven't been treated right away
• Changing stories or excuses that don't make sense
• Suspicious patterns of medical treatment (such as getting treated at a variety of different facilities for no clear or credible reason)

Sexual abuse in adults is a type of mistreatment that can remain hidden for a long time, often because of embarrassment, fear of further humiliation, or memory problems caused by dementia. Plus, the most tell-tale signs are usually out of view unless you're a trusted caregiver, medical professional, or intimate partner. Indications of sexual abuse may include:

• Groin or inner-thigh bruises
• Pain, irritation, or unusual bleeding in the buttocks or genital area
• Bruises or cuts around the breasts
• Unexplained infections such as sexually transmitted diseases (STDs)
• Bloodied, stained, or ripped clothing, especially underwear
• Uncharacteristic behavior of a sexual nature

It's also important to know what to look for in the behavior of potential abusers. People who abuse or neglect seniors may:

• Refuse or try to delay visitations or social activities
• Unfairly criticize or express frequent frustration with family members or care providers
• Resist outside assistance
• Display little or no kindness, compassion, or affection
• Act excessively or inappropriately affectionate
• Show poor caregiving abilities
• Claim that care is adequate when it clearly needs to improve
• Complain of exhaustion
• Get angry easily
• Change the stories they tell about the same incidents
• Make seemingly out-of-context excuses
• Abuse drugs or alcohol

Who Are the Most Common Abusers?

Chances are good that you already know someone who has the motive and opportunity to mistreat or take advantage of a vulnerable senior. Abuse can be inflicted by almost anybody who benefits from having power, authority, or an expectation of trust. For example, potential elder abusers can include:

• Spouses or romantic partners
• Sons or daughters
• Brothers or sisters
• Nieces, nephews, or other blood relatives
• In-law relatives
• Paid or volunteer caregivers
• Friends
• Legal guardians
• Neighbors or other acquaintances
• Financial advisors
• Salespeople
• Healthcare practitioners
• Religious leaders

In most cases of elder abuse, the victims know the perpetrators very well. That's even true when it comes to financial abuse. In fact, according to the NCEA, family members account for close to 60 percent of those who financially exploit seniors. And friends, neighbors, and home care aides collectively account for nearly 32 percent of financial abusers who target the elderly. Financial abusers are often motivated by a sense of entitlement, the opportunity for a sizeable inheritance, a lack of money caused by unemployment, or the need to pay off debts or fuel an addiction to drugs, shopping, or gambling.

Many elderly people experience domestic violence. Couples who retire together often deal with new financial challenges, disabilities, or changes to their roles that strain their relationships. Physical or emotional abuse can become a problem as tensions escalate and frustration sets in. Adult children who live with their elderly parents can also become violent and frustrated when faced with the costs and demands of caregiving, especially if they depend on their parents' financial resources. In some cases, the elder abuse is merely a continuation of past domestic violence.

Some residents of long-term care facilities experience violent assaults or verbal aggression by other residents. Whether or not resident-on-resident violence should be considered elder abuse is still open for debate among many researchers. Such violence is often caused by dementia or other types of mental illness or cognitive decline.

Why Are Some Seniors More Vulnerable to Abuse Than Others?

Most of us like to imagine growing old peacefully, with few worries and lots of freedom to enjoy our most cherished personal interests. But the reality is that, for many of us, our senior years will be different than what we envisioned. We may face new challenges that we didn't expect. And we may increasingly need to rely on the help of other people. As a result, we may become targets for abuse, neglect, or exploitation. Here are some of the risk factors:

• Chronic illness or disability
• Dementia
• Depression or other mental health issues
• Recent losses of friends or loved ones
• Loneliness or social isolation
• Poor relationships with family members
• Lack of cultural or community support
• Substance abuse
• Anything that's extra challenging for caregivers (such as incontinence or sundowners syndrome)
• Poor financial or technological literacy
• Predictable financial deposits
• Low income
• Valuable assets
• Sharing a living space
• Having caregivers who lack the necessary skills, feel tired and overwhelmed, abuse drugs or alcohol, or have financial or mental health problems

Remember: Nobody who is abused or neglected is ever to blame. No matter how vulnerable you may be due to your circumstances, you never deserve to be mistreated. If you're a victim, it's not your fault. There is never a good excuse for anyone to abuse or neglect someone else.

What Should I Do If I See, Suspect, or Experience Elder Mistreatment?

Trust what you're seeing or feeling. Elder abuse can sometimes be subjective, but it's usually better to err on the side of caution. That's even true for potential elderly neglect by family members. Your emotions may be conflicted, but choose to do what's necessary in order to protect yourself or the senior in your life who you suspect is being mistreated. Don't stay silent.

If there is an immediate danger to life, limb, or property, call 911 right away.

Otherwise, call Adult Protective Services (APS) in your state. APS exists to protect vulnerable seniors and investigate reports of alleged abuse or neglect. The APS agency in your region may have its own elder abuse hotline, allowing you to maintain confidentiality while reporting mistreatment. In many states, APS workers will:

• Evaluate the level of danger
• Take steps to ensure the safety of you or the alleged victim
• Help relieve the immediate effects of emotional trauma
• Gather evidence and assess the nature and scope of the alleged abuse
• Determine what social services may be needed
• Make arrangements for any necessary services, whether legal, financial, social, or medical in nature
• Work as advocates to help protect you or the alleged victim from future harm

When it comes to nursing home abuse, reporting can also be done through your state's Long-Term Care Ombudsman Program (LTCOP). Residents of nursing homes, assisted living communities, and other long-term care facilities can contact their region's LTCOP to make complaints and get independent advocates working on their behalf. The LTCOP in your region may even operate a confidential nursing home abuse hotline.

It's also a good idea to know your state's laws as they pertain to elder abuse. Explore the resources in your state so that you can learn your rights and know where to turn for help.

How Can Elder Abuse Be Prevented?

Increased awareness of this problem is essential. So don't be afraid to share what you know. Reach out to other seniors or younger adults. Even many politicians and professionals in the fields of healthcare, criminal justice, and financial services need reminders about the problem of elder abuse and neglect. They also need to be encouraged to report it when they suspect it.

Some of the ways to lower your risk of being abused or neglected as a senior include:

• Taking care of your physical health by going for regular check-ups, exercising, and eating a nutritious diet
• Maintaining close friendships, having fun, and interacting with your community
• Keeping a senior-friendly cell phone to ensure a connection to the outside world if you need to reach out for help or even get perspective on a potentially abusive situation
• Getting legal assistance to create a living will and other documents that clearly outline what should happen to you and your assets if you ever become incapacitated
• Learning your rights
• Seeking counseling or therapy for relationship troubles, substance abuse problems, or mental health issues
• Registering your phone number with the National Do Not Call Registry
• Empower yourself by staying connected and informed on the latest news by joining e-newsletters such as the Elder Justice Coalition

When all is said and done, you may not be able to fully prevent mistreatment. But seniors who stay active and involved in their communities often make poor targets for abusers. Help look after other people so that they'll help look after you.