Elder Abuse

What is Elder Abuse?

Elder abuse involves any type of mistreatment of an elderly person that results in physical or psychological harm.

Elder abuse is a significant social problem.

Based off of recent estimates, about 4 to 6 percent of seniors experience some form of abuse in their lifetime (1).

According to research by the National Incidence Study on Elder Abuse, about 551,000 elderly people experience abuse in the United States every year.

Elders who suffer from abuse can experience extreme personal losses. These losses include life savings, homes, independence, dignity, security and health.

It has been found that people who suffer from elder abuse do not live as long as people who were not subjected to abuse in their later years. There are several categories of elder abuse that can negatively impact the livelihood of our elders.

Elder Physical Abuse

This form of abuse involves any kind of physical contact with an elderly person that causes pain, bodily injury or physical impairment. Things that fall under the category of physical abuse include inappropriate use of restraint, battery or assault.

The main perpetrators of physical abuse are usually the children, grandchildren and acquaintances of the elder. The abuse is typically committed in order to gain power over the victim.

Elders who are abused are likely to be single, and they usually live with their victim. Caregivers assigned to tend to an elder are also often perpetrators of elder abuse. Some of those who enact physical violence on an elder also have an added problem of alcohol or illicit drug abuse.

There are various signs that indicate physical abuse has occurred. These symptoms of abuse include:

• Broken bones
• Dislocations
• Sprains that cannot be explained
• Cigarette burns
• Burns from hot water or appliances
• Arm, leg or torso abrasions that look like strap or rope lesions
• Internal injuries
• Bruises in various stages of healing that go around the person’s legs, arms or torso from physically restraining the elder or those indicating sexual abuse 
• Loss or pulling out of hair
• Unexplained tooth loss

Behavioral indicators of physical abuse include the following:

• Family members covering up reasons behind different injuries
• Unexplained injuries
• Recent hospitalizations
• Bringing the victim to different emergency rooms so that the pattern of abuse is undetected
• Delays between the time of injury and when they are cared for

Elder Sexual Abuse

Sexual abuse of an elder is any kind of sexual contact with an elder that is not consensual. The perpetrators are usually employees of nursing facilities, family members or healthcare attendants. Sometimes the abuse takes place between two residents of the same facility.

Those with the greatest risk of sexual abuse are women, but this form of abuse can also occur in older men. Those with cognitive disabilities and physical limitations are have a heightened risk of sexual abuse, as well as those who reside in isolated quarters.

The physical and behavioral indicators of sexual abuse include:

• Bruises on the thighs or external genitals
• Bleeding, pain and irritation of the genital or anal area
• Stained, torn or bloody underwear
• Problems sitting or walking
• Unexplained STDs
• Inappropriate relationships between the perpetrator and the victim
• Engaging in unusual, improper or aggressive behavior

Elder Domestic Violence

Domestic abuse of an elder is a pattern of violence in the home that escalates out of control. It is committed by those who want to have power over the victim. Domestic violence can be the continuation of a pattern of abuse over the course of a lifetime, or it can begin in old age.

Domestic violence can be related to a disability, changes in one’s sexuality, retirement or adapted roles of family members. Most perpetrators are male and the intimate partner of the victim. Some abusers may also use illicit drugs or alcohol, which can increase the frequency of these violent episodes.

Those at the greatest risk for domestic abuse are women who have experienced domestic violence in the past with their partner, or one who has just entered a risky relationship.

The main indicators of domestic violence are similar to the signs seen in physical and sexual abuse of an elder. In addition to those listed above, there is usually an increase in the severity and frequency of injuries over time, with the victim becoming very confused or dissociated. The domestic violence tends to arise without warning and come and go over time.

Psychological Abuse

Psychological abuse is the infliction of emotional or mental anguish on an elder by way of threats, nonverbal conduct or humiliation.

The perpetrators may be caregivers, family member or acquaintances, and it usually affects those who are socially isolated.

The physical and behavioral indicators of psychological elder abuse include:

• High blood pressure or other stress-related disorders
• Unexplained weight loss or weight gain
• The elder becomes socially isolated by perpetrator
• Difficulty sleeping in the elder
• Confusion and depression in the elder
• An elder that is emotionally agitated, non-responsive or withdrawn
• An elder expresses fear of the perpetrator
• An elder that shows age-inappropriate behavior, such as biting, rocking or sucking behaviors

Elder Financial Abuse

Financial abuse of an elder is the improper use of the elder’s property, funds or resources. It involves stealing money or property, forging signatures, coercing the elder to sign important documents, con crimes, scams, fraud and telemarketing scams.

The main perpetrators of financial abuse are the children, grandchildren and spouses of the victim. Many perpetrators of elder financial abuse also have problems with gambling, shopping or substance abuse.

The perpetrator may also stand to inherit from the victim. They possess a sense of entitlement and exhibit negative emotions towards other family members who may be interfering with their inheritance. They offer to assist the elder in order to gain access to them by becoming personal care attendants. Perpetrators of elder financial abuse may also exhibit a pattern of latching onto people who have recently lost someone and constantly move around to avoid detection.

The victim at the greatest risk for financial abuse are:

• Lonely
• Isolated
• Diagnosed with one or more disabilities
• Have unemployed family members
• Unfamiliar with financial issues
• Wealthy individuals who have disabilities and depend on others
• Unsure about the actual value of their assets
• Not technologically savvy and depend on others for financial matters

The main indicators of financial abuse include bank withdrawals the elder could not have done, unpaid bills, legal documents they do not understand and bank statements that no longer go to the elder’s address. Also, the perpetrator of this form of abuse is likely to pay an unreasonable amount of attention to the financial matters of the elder. Despite their attentiveness, there continues to be unexpected ATM withdrawals or missing property.

Elder Neglect

Elder neglect is when the caregiver fails to take care of the elder. It is called self-neglect if the elder does not take care of themselves. This neglect can be active, in which the caregiver withholds the elder’s necessities. Neglect can also be passive, in which the caregiver themselves is sick, stressed, disabled, ignorant or lacks the resources to care for the elder. In self-neglect, there is no perpetrator.

Most perpetrators of elder neglect are family members, paid attendants or employees of nursing facilities. Neglecting caregivers may have little time, energy, training and skills to care for the elder. The caregiver may also have substance abuse problems or a mental illness.

Those that carry the highest risk of elder neglect are people with mental or physical disabilities who require the care of others in order to survive. They usually have a large amount of daily needs that can stress out the caregiver. If self-neglect is involved, the individual usually has mental health problems that contribute to their lack of self-care. 

Signs of neglect include lacking water, food, heat or air conditioning. They reside in a poorly managed living environment that does not provide the necessities to care for the elder. There may be infestations of insects, animals or the housing is in disrepair and unsafe to live in. Elder neglect can also be evident in the mismanagement of medications.

Physical and behavioral indicators include:

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Dr. Christine Traxler

Christine Traxler, MD is a retired family practice physician, graduate of the University of Minnesota School of Medicine in 1986, and freelance writer, having worked with patients in rural Minnesota for two decades. She has written several books on medical topics and currently resides in Minneapolis, MN, where she works as a freelance writer on medical topics.

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