Determining Elder Abuse Risk
- Mary is a 70-year-old widow who lives at home. She has recently begun to rely on her 36-year-old nephew, who has recently moved into her house, for help in driving her and helping her do some activities of daily living (ADL), but she is still very active maintaining and monitoring her own finances.
- Peter is an 80-year-old widower who developed dementia about five years ago. He lives in an assisted living facility that provides help with both physical and dementia care.
- Sally is 65 and Hank is 67. They have been married for 40 years. Both recently retired to Florida after a lifetime spent in the Midwest. They are healthy and have no other family or close friends in the state.
Which of these older people is most likely to experience elder abuse?
But Mary may be at risk as well. The nephew’s recent move to Florida implies they may not have a close relationship. Attenuated relationships can be a risk factor for elder abuse where the perpetrator is a family member. So is dependence upon the elder—such as being reliant on them for a roof over one’s head. In addition, senior citizens who handle their finances on their own could also be vulnerable to one of the categories of elder abuse, financial abuse. Senior citizens affected by financial elder abuse lose on average lose about $42,000 annually. But if the abuser is a family member, the figure rises to over $50,000.
Sally and Hank may also be victims of elder abuse. Why? Because lack of social support and social isolation can also be risk factors for elder abuse. If they are not strongly connected in the state, they could be vulnerable. But what about the fact that they are married and healthy? Neither preclude elder abuse. In fact, the most common form of elder abuse is psychological abuse, which is responsible for nearly 12 percent of all cases, according to the World Health Organization. Psychological abuse can consist of belittling comments and insults. Sally could abuse Hank; Hank could abuse Sally; both could abuse each other.
The crucial point of these descriptions is that all of these people have the potential to become victims of elder abuse. About 10 percent of all Americans past the age of 60 have experienced elder abuse, according to the National Council on Aging. It’s also extremely underreported, at just 1 out of every 14 cases. The net result is that not enough people know its signs or its prevalence.
Risk Factors for Elder Abuse
Determining which people are vulnerable is also very complicated. If social isolation is a risk factor, does that mean that seniors should always live with other people? No, because people who live alone have some of the lowest risks of sexual abuse. Are people who are healthy and enjoy strong social networks safe? Not completely, because they may require care from people who themselves are at risk of being perpetrators. People who abuse alcohol or who weren’t well trained for caregiving, for instance, may be more likely to abuse an elder.
The bottom line: elder abuse is a complex, multifaceted social ill. It exists in every setting, including private homes and nursing homes. It exists across all socioeconomic groups. While not having much money can expose people to elder abuse, so can having significant assets.
While more women seem to be abused than men, some researchers believe that may be because women’s longer life expectancy means they are more prevalent in groups of older people.
The following are additional risk factors for elder abuse:
- Living with others
- Social isolation or loneliness
- Chronic illness or disability
- Depression or other mental health conditions
- Recent losses of friends or loved ones
- Poor or distant relationships with family members
- Lack of cultural or community support
- Substance abuse
- Challenges to caregivers (such as incontinence)
- Poor or limited financial literacy
- Poor or limited technological literacy
- Making financial deposits predictably
- Having a low income
- Having valuable assets
In addition, older people may be at more risk of abuse if their caregivers (whether family members or not) have the following characteristics, according to the U.S. Centers for Disease Control and Prevention (CDC):
- Diagnosed mental illness
- Alcohol abuse
- High hostility levels
- Poor or inadequate preparation or training for caregiving responsibilities
- Young age
- Inadequate coping skills
- History of abuse as a child
- High financial and emotional dependence upon the elder
- Past disruptive behavior
- Lack of social support
- Lack of formal support (e.g., institutional or educational support)
Elder abuse is also more likely in communities where formal services, such as the ability to take a break by having another provider take over caregiving, are limited or unavailable.
Cultures that have a high tolerance for aggression, or promote negative beliefs about aging and older people, may be more prone to elder abuse as well.
Institutions, where healthcare personnel, guardians, and other providers are given greater freedom in routine care and decision making (rather than family members), may lead to situations in which abuse is more likely or less likely to be seen.
Institutions may also develop characteristics that make residents more vulnerable to abuse. These include negative perceptions of residents or negative attitudes towards them, chronic staffing problems, burnout on the part of staff, stressful conditions, and poor or inadequate administrative oversight.
What can you do if you are concerned about being abused or about a loved one’s being abused? It’s important to know the types of elder abuse and their signs. It’s also important to know how to report it.
Elder Abuse: A Definition
The U.S. Centers for Disease Control and Prevention (CDC) defines elder abuse as an “intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult.”
As people age, they become more dependent upon other people’s care. This could be medical care, nursing home care, psychological care, or help with ADLs, such as shopping and cleaning. If they don’t receive this care, they could be placed in harm’s way. They could become ill, develop more severe symptoms of an existing illness, or be injured by attempting to do things they can no longer safely do, such as climb ladders or carry heavy packages.
Sadly, this increased dependence sometimes results in situations in which senior citizens are abused. There are several different types of elder abuse.
Physical abuse is any action that causes injury or pain (or inactions that cause injury or pain or fail to alleviate pain). Older people can be struck by their caregivers or family members, for example, or kicked.
Older people in institutions such as nursing homes may suffer abuse that includes restraints, forcing them to eat, not providing medications, inappropriate administration of medications and more.
If an older person is in a nursing home or assisted living facility, physical abuse can include withholding medications, inappropriate administration or use of medications, physical punishment, forcing them to eat, or using physical restraints.
Physical abuse can manifest both in physical signs and psychological signs. Symptoms include, but are not limited to:
- Injuries that can’t be explained
- Broken bones
- Open or unhealed wounds
- Contusions (bruises)
- Cuts or scars
- Signs that required medication has not been taken or offered
- Signs that medication has not been administered properly
- Fear on the part of your loved one, either general or of a specific person
- Lack of hygiene, such as lack of bathing
- Sudden changes in your personality or behavior
- Refusal to have visitors
Sexual behavior or actions with an older person constitute abuse if the behavior is unwanted and not consensual. Elder sexual abuse can include rape, unwanted and inappropriate touching, exposure of private parts, and any other event. Sexual abuse can include sexual behavior or contact with a person who is incapable of consent because of mentally incapacitation, such as dementia. Sexual abuse can also include forcing older people to watch sexual behavior or sexual contact.
Symptoms of sexual abuse may include:
- Contracting sexually transmitted diseases (STDs) or genital infections
- Genital bruises or bleeding
- Stained or torn clothing, including underwear
- Sudden personality or behavior changes
- Refusal to have visitors
Elder emotional abuse is using actions or words to cause psychological pain or distress. Insults, threats, yelling, belittling, humiliation, intimidation, and isolation are all forms of emotional abuse. Caregivers who treat older people like children or as if their behavior or presence is annoying can be emotional abuse.
Withholding needed non-medical care, such as meals or sleep, can also constitute emotional abuse. So can refusing to let them see family or friends, or engage in other social activities.
Elder emotional abuse can manifest physically or psychologically, with signs including:
- Agitated or upset behavior
- Lack of communicativeness or unresponsiveness
- Unusual behavior or statements
- Sudden personality or behavioral changes
- Fear of caregiver
- Weight loss
- Refusal to have visitors
Neglectful Elder Abuse
Neglect is a form of abuse. It consists of either denying care, including care that older people may need to live comfortably, such as cleaning their apartment or feeding them regularly, or not providing care. Neglect can be deliberate or stem from inadequate training or chaotic conditions in an institution.
Neglect can result in illnesses or conditions that can cause illness, such as dehydration and poor nutrition. It may result in lack of ADLs such as walking or other exercise. It may result in uncomfortable or unlivable conditions.
Neglect can deprive older people of adequate water, food, shelter, breaks (if they are traveling), hygiene, cleanliness, comfort, safety, medical care, medicine, and adequate clothing for the circumstances, including changes of seasons.
Symptoms of neglect can include:
- Unsanitary conditions
- Lack of personal cleanliness (if the person has help bathing and washing)
- Weight loss or feeling hungry
- Poor nutrition
- Soiled or unwashed clothing
- Inappropriate temperature (too cold or too hot)
- Lack of necessity items
- Signs of a fall (due to lack of walking devices or cluttered or unsafe environments, or both)
- Unsafe living environment (dark, unheated, pests, etc.)
- Untreated or unattended health issues
- Untreated illness
- Failure to take medication
Elder financial abuse has a specific definition: “the illegal, unauthorized, or improper use of an older individual’s resources by a caregiver or other person in a trusting relationship, for the benefit of someone other than the older individual.” Financial elder abuse can encompass stealing money from a wallet or purse, forging a signature, asking for cash (above and beyond agreed-upon payments for services), embezzlement, fraud, using debit and credit cards or checks, and more.
It can also encompass developing fraud or deceptive tactics to gain access and authority over a senior citizen’s financial accounts or assets, their real estate, their will, their powers of attorney, their financial documents, and more.
Signs of financial abuse include but are not limited to:
- Missing cash
- Missing items and property
- Missing credit, debit, or ATM cards
- Bank accounts with funds missing
- Denial of access to accounts
- Caregiver’s name on elder’s bank and credit card
- Seemingly forged signatures on documents
- Undiscussed changes to a will
- Financial documents with caregiver’s name on it
- Misleading fees or services for caregivers or other services
- Persuading an older person to make decisions about their finances or property via coercion or deception.
How Do You Report Elder Abuse?
If you see any of these signs concerning a loved one, what should you do?
First, if the situation seems imminently harmful or even life-threatening, remove the older person from their surroundings immediately. Ensure their safety and health first. Second, if a crime has been committed, call law enforcement. A physical attack, for example, can be assault or stalking, and the person can be arrested and charged. A financial crime such as theft or embezzlement also subjects the perpetrator(s) to arrest. Third, it’s prudent to make an appointment with an experienced elder abuse lawyer to discuss the situation, especially if the abuse took place in a nursing home or other institution or was perpetrated by a paid caregiver. Fourth, be sure to keep notes of the signs of the abuse, including what, where, and when you saw them.
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