Elder Abuse

June 15th was World Elder Abuse Awareness Day. Although, like many awareness days, it should probably be observed EVERY day.

Elder abuse is more common than you might think. Just in the United States, more than half a million reports of elder abuse reach authorities every year, and millions more cases go unreported.

If you suspect that an elderly person is at risk from a neglectful or overwhelmed caregiver, or being preyed upon financially, it’s important to speak up. Everyone deserves to live in safety, with dignity and respect. These guidelines can help you recognize the warning signs of elder abuse, understand what the risk factors are, and report the problem.

Abuse of elders happens in many forms. Some involve intimidation or threats against the elderly, some involve neglect, and others involve financial abuse. Here are the most common forms:

• Physical elder abuse – The non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. Such abuse includes not only physical actions, but the inappropriate use of drugs, restraints, or confinement.
• Emotional elder abuse – The treatment of an older adult in ways that cause emotional or psychological pain or distress, such as: Intimidation through yelling or threats, humiliation and ridicule, habitual blaming or scapegoating, ignoring the elderly person, isolating an elder from friends or activities, terrorizing or menacing the elderly person.
• Sexual elder abuse – Contact with an elderly person without their consent. Such contact can involve physical sex acts, but activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse.
• Elder neglect – Failure to fulfill a caretaking obligation. This constitutes more than half of all reported cases of elder abuse. It can be intentional or unintentional, based upon factors such as ignorance or denial that an elderly charge needs as much care as they do.
• Financial exploitation – The unauthorized use of an elderly person’s funds or property, either by a caregiver or an outside scam artist. An unscrupulous caregiver might misuse an elder’s personal checks, credit cards, or other financial accounts, steal cash, income checks, or household goods, forge the elder’s signature, or engage in identity theft.

There are warning signs of elder abuse, although they can be difficult to recognize or mistaken for symptoms of dementia, or the elderly person’s frailty–or caregivers may explain them to you in that way. In fact, many of the signs and symptoms of elder abuse do overlap with symptoms of mental deterioration, but that doesn’t mean you should dismiss them on the caregiver’s word.

Frequent arguments or tension between the caregiver and the elderly person or changes in the personality or behavior in the elder can be broad signals of elder abuse. If you suspect abuse, but aren’t sure–you can look for clusters of these warning signs.

Physical Abuse Warning Signs

• Unexplained signs of injury, such as bruises, welts, or scars, especially if they appear symmetrically on two sides of the body
• Broken bones, sprains, or dislocations
• A report of drug overdose or an apparent failure to take medication regularly (a prescription has more remaining than it should)
• Broken eyeglasses or frames
• Signs of being restrained, such as rope marks on wrists
• Caregiver’s refusal to allow you to see the elder alone

Emotional Abuse Warning Signs

• Threatening, belittling, or controlling caregiver behavior
• Behavior from the elder that mimics dementia, such as rocking, sucking, or mumbling to themselves

Sexual Abuse Warning Signs

• Bruises around breasts or genitals
• Unexplained vaginal or anal bleeding
• Torn, stained, or bloody underclothing

Elder Neglect or Self-Neglect Warning Signs

• Unusual weight loss, malnutrition, dehydration
• Untreated physical problems, such as bed sores
• Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
• Being left dirty or unbathed
• Unsuitable clothing or covering for weather
• Unsafe living conditions (no heat or running water, faulty electrical wiring, other fire hazards)
• Desertion of the elder at a public place

Financial Exploitation Warning Signs

• Significant withdrawals from the elder’s accounts
• Sudden changes in the elder’s financial condition
• Items or cash missing from the senior’s household
• Suspicious changes in wills, power of attorney, titles, and policies
• Addition of names to the senior’s signature card
• Financial activity the senior couldn’t have undertaken, such as an ATM withdrawal when the account holder is bedridden
• Unnecessary services, goods, or subscriptions

REPORTING ELDER ABUSE

If you are an elder who is being abused, neglected, or exploited, tell at least one person. Tell your doctor, a friend, or a family member whom you trust. Or call one of the helplines listed below. If you see an older adult being abused or neglected, don’t hesitate to report the situation. And if you see future incidences of abuse, continue to call and report them. Each elder abuse report is a snapshot of what is taking place. The more information that you can provide, the better the chance the elder has of getting the quality of care they need. Older adults can become increasingly isolated from society and, with no work to attend, it can be easy for abuse cases to go unnoticed for long periods.

Many seniors don’t report the abuse they face even if they’re able. Some fear retaliation from the abuser, while others view having an abusive caretaker as better than having no caretaker and being forced to move out of their own home. When the caregivers are their children, they may feel ashamed that their children are inflicting harm or blame themselves: “If I’d been a better parent when they were younger, this wouldn’t be happening.” Or they just may not want children they love to get into trouble with the law. In any situation of elder abuse, it can be a real challenge to respect an older adult’s right to autonomy while at the same time making sure they are properly cared for.

In the case of an elder experiencing abuse by a primary caregiver, such as an adult child:

Do not confront the abuser yourself. This may put the older person in more danger unless you have the elder’s permission and are able to immediately move them to alternative, safe care.

Find strength in numbers. If a family caregiver is suspected of abuse, other family members may have the best chance of convincing the older adult to consider alternative care.

Feelings of shame can often keep elder abuse hidden. You may not want to believe a family member could be capable of abusing a loved one, or you may even think that the older adult would be angry at you for speaking up. But the earlier you intervene in a situation of elder abuse, the better the outcome will be for everyone involved.

In the case of self-neglect:

Even if the elder refuses your help, keep checking in with them. Enlist others to express their feelings of concern to them. Sometimes a peer or a neutral party, such as a geriatric care manager, may have a better chance of getting through.

Make sure the older adult is connected with medical services. Since self-neglect can have medical causes, share your concerns with the elder’s doctor if possible.

Offer the elder home services on a trial basis. This can help them see the positive changes they can experience, and open them up to considering alternative care. For example, encourage them to try housekeeping help for a month or a meal delivery service for a few weeks.

Tour assisted living or other senior housing facilities without any immediate pressure to move. This may help dispel any myths or eradicate the older person’s fears about moving.

Consider legal guardianship. If you are concerned that a person’s ability to take care of themselves safely is compromised, you can look into legal guardianship or legal conservatorship. If there is not an appropriate family member available, a guardian can be appointed by the court.