Abuse of Elders- What is Elder Abuse?

Who is being abused?

Studies show certain risk factors for elder abuse. Most often, victims are people who:

• Identify as female (over 60% of victims)
• Are cognitively impaired
• Have no close relatives
• Have disabilities
• Are lonely or socially isolated
• Are physically weak or frail
• Are houseless
• Are living in poverty

Studies on the impact of race show mixed results, and it appears socio-economic status is a more significant determinant of elder abuse. Cultures that tend to live in multi-generational households might protect elders from abuse by professional caregivers while concealing abuse by family members. LGBTQ elders are often at particularly high risk of being mistreated and may face homophobic or transphobic treatment as well. In one study of gay, lesbian, and bisexual elders, 65% of respondents reported experiencing victimization due to their sexual orientation.

Some of these risk factors tend to overlap. For example, an elder with no close relatives looking out for them may also be socially isolated.

How common is elder abuse in the United States?

About 1 in 10 adults in the U.S. have experienced elder abuse, but unfortunately, many people mistakenly think elder abuse is a rare or non-existent problem. Only about 1 in 24 cases of abuse are reported to the authorities. Many elders are too isolated to be able to report these crimes. Some may be embarrassed to admit that the abuse happened or may wish to protect the person responsible. 

While studies vary, the general consensus indicates that psychological or emotional abuse is more common than other types of abuse, with one study showing that 11.6% of elder abuse was psychological, and another 4.6% was emotional. In other words, the most common form of elder abuse takes the form of threats, intimidation, guilt-tripping, gaslighting, and other forms of psychological or emotional victimization. In many cases, the perpetrator has real or perceived power over the vulnerable adult. Relationships can become imbalanced, such as spousal relationships where one spouse is healthier than the other. 

However, another study showed that financial abuse was more common, with 61.8% of callers to a National Center on Elder Abuse (NCEA) resource line claiming financial abuse by family members. Financial abuse sometimes happens when a family member gets control over the elder’s accounts due to power of attorney or otherwise. They then pocket the money or spend it on other family members, leaving the elder in poverty.

As many elders live in nursing communities, most abuse happens there. Abuse in nursing homes is less well studied, but one national survey showed that 3% of nursing home staff witnessed at least one incident of physical abuse. In the same study, 10% were willing to admit to committing an act of physical abuse, and 40% admitted to psychological abuse in nursing homes. Nursing home residents who receive fewer visits from family and loved ones are particularly vulnerable to being abused in nursing homes.

Who are the perpetrators of elder abuse?

Caregivers can become abusive if they burn out and become resentful of their relative or if they start fighting over money. The more dependent the older adult is on the caregiver, the higher the risk of abuse.

Most perpetrators tend to be male, reflecting broader patterns of domestic violence. In terms of the relationship to the victim, the most common perpetrator is either an adult child or the victim’s spouse, but other family members may be involved. Elder abuse in these instances takes place mostly at home.

One study showed that of 46.8% of calls to a hotline, the caller identified the abuser as a family member. A primary cause, again, is caregiver burnout, and financial circumstances also contribute.

In some cases, elder abuse may be part of an ongoing pattern of domestic violence. One study found that over 25% of perpetrators had a prior charge for domestic violence, and 20% had a record of crimes relating to drugs or alcohol. Half of the perpetrators were actively using drugs or alcohol. The risk factors, therefore, are not dissimilar from other forms of domestic violence and abuse.

Types of Elder Abuse

Elder abuse can come in multiple forms with different prevalences.

The primary types of elder abuse are:

Physical Abuse

Physical abuse is the infliction of intentional pain or injury. The perpetrators are often people who have committed other forms of domestic or non-domestic violence. It includes:

• Hitting or kicking
• Intentionally dropping the person or causing them to fall
• Inappropriate use of restraints, such as strapping the person to a bed
• Choking
• Pinching
• Slapping
• Removing mobility aids in order to confine the person to their room

Sexual Elder Abuse

Sexual abuse of elders is relatively rare but does happen. In a nursing home context, the perpetrator is sometimes another resident. Some elders may not have the cognitive capability to consent to sexual activity, or they may be too weak to fight it off. Sexual abuse includes:

• Rape
• Unwanted touching and fondling
• Coerced nudity
• Sending non-consensual sexually explicit photographs

Neglect and Abandonment

Neglect can be passive or willful, with the latter implying the intent to cause physical or psychological harm. It can take the form of denying or refusing:

• Food
• Shelter
• Water
• Medication
• Necessary physical assistance, such as helping the elder go to the bathroom
• Assistance with hygiene
• To move or turn a bed-bound elder, resulting in bedsores

An exception is if the elder is competent and has expressed a desire not to receive assistance. For example, if caregivers don’t provide cold medicine to somebody who doesn’t want it, or if the person insists on getting to the bathroom on their own, caregivers are not committing elder abuse.

Emotional Abuse

Emotional abuse can be particularly hard to recognize both by the victim and by onlookers. Thus, it is likely that emotional abuse is much more prevalent than is generally realized. The fact that the victim may not think they are being abused makes this kind of behavior particularly challenging to handle. It covers a wide variety of behaviors, including:

• Verbal assaults
• Threats
• Intimidation
• Name-calling
• Violations of privacy: There is a line between monitoring somebody’s whereabouts or digital activity for their safety and abuse.
• Public embarrassment
• Patronizing behavior
• Dismissiveness
• “Jokes” and sarcasm
• Putting down of interests
• Unilateral decision making, treating the elder as if they have no say
• Outbursts
• Treating the elder like a child, including telling them what to wear, eat, and so on
• Gaslighting, which is “editing” the truth, so the person questions their mental state
• Shutting down communication and withholding affection
• Denying social contact with others

These are just some of the many forms emotional abuse can take. While some things may be a normal part of an argument, emotional abuse is a pattern of behavior.

Financial Abuse

Financial abuse or exploitation can be perpetrated by a family member, a caregiver, or even a total stranger. The abuser either controls the elder’s access to their own money and other resources, or takes advantage of them to extract money or resources. Examples of financial abuse include:

• Making the elder ask every time they need money or giving them an “allowance” (unless this is an arrangement they prefer)
• Making them account for all the money they spend
• Tricking or coercing them into giving away money or changing their will
• Not including a competent adult in investment or banking decisions
• Running up debt on their credit card
• Stealing their identity, such as opening accounts in their name
• Not paying bills as requested by the victim
• Forcing them to turn over their Social Security benefits or other payments

Recent Cases of Elder Abuse

The stress of the COVID-19 pandemic has caused an increase in elder abuse. Here are some incidents that have occurred over the last couple of years.

Washington County, VA

A paid personal care services attendant abused the client she was assigned to care for through the Virginia Department of Medical Assistance’s Commonwealth Coordinated Care Plus Waiver Program. By the time authorities removed the victim from her care, profound neglect had left the victim weighing only 65 pounds. The victim had been denied food, medication, help with hygiene and had a “large cancerous mass” on their head.

This case highlights the need for families to keep tabs on their relatives even if they are employing a home care aide. While abuse by personal care assistants and similar is rare, it can certainly happen.

Okaloosa County, FL

In 2018, Ray Anthony Hughes was appointed as a plenary guardian to a totally incapacitated, disabled veteran. He depleted the man’s bank account, transferring more than $74,000 to his personal checking account. Hughes never visited the victim at his care facility and never purchased anything for him. He also deprived the victim of his share of an estate, using the money to buy a pickup truck.

This kind of financial abuse is sadly common. Therefore, guardians appointed to handle incapacitated people’s funds should be very carefully chosen to avoid potential mishandling.

Richmond, VA

A case from 2020 had a Virginia woman sentenced to 14 years in prison for physically assaulting an 87-year-old woman suffering from dementia. Her relationship with the victim is unclear, but she was looking after both this woman and another elderly woman in her home. A nurse who came to the home found the victim with multiple injuries, a black eye, a lump on her head, and an abrasion on her arm.

The perpetrator was convicted of malicious wounding and elder abuse. While few details are known, physical violence against elders is sadly prevalent.

Las Vegas, NV

Three staff members at a group home for adults with cognitive disabilities were arrested earlier this year on neglect and abuse charges. One of the victims was an elderly woman. The staffers were also charged with conspiracy in what appears to have been a planned system of abuse that was eventually caught on video. 

The ability to photograph and video abuse immediately and discreetly may help ensure that perpetrators are apprehended.

What are the warning signs of elder abuse?

How can you tell if an elderly relative is being abused? Unfortunately, vulnerable adults may not admit to being victims, and unless you do catch the abusers on video, you may have to resort to looking out for symptoms of abuse.

There are various warning signs of abuse, including:

Physical Warning Signs

• Bruises
• Pressure marks
• Broken bones
• Abrasions
• Burns
• Dehydration
• Unusual weight loss
• Missing or broken daily living aids
• Unsanitary living conditions
• Poor hygiene
• Untended medical needs or missing medication
• Bedsores

Emotional and Psychological Warning Signs

• Withdrawal from normal activities
• Sudden changes in alertness
• Depression
• Strained or tense relationships
• Frequent arguments
• Increased fear or anxiety
• Increased isolation from friends or family, refusal of social contact for no good reason
• Changes in sleep

Other Warning Signs

• Signatures on financial documents that look unfamiliar
• Changes in spending patterns
• Unpaid bills
• Unexplained transactions or loss of money

Long-Term Effects of Elder Abuse

Elder abuse can have several long-term effects, some of which can persist after the abuse stops. Long-term effects can include:

• Deterioration in relationships
• Feelings of shame and guilt
• Loss of self-esteem
• Diminished psychological wellness
• Depression
• Post-traumatic stress disorder
• Increased cognitive decline or functional impairment
• Diminished independence (particularly after financial abuse)
• Loneliness
• Sleep disturbances

Who can help prevent elder abuse?

Anyone who is in contact with an elder or observing one can help. Older people can also help protect themselves by, for example, keeping a close eye on their finances and learning how to recognize scams.

Here is just some of what you can do to help reduce bedsores and prevent elder abuse:

• Be alert for the signs listed above that can help you detect possible abuse.
• Learn how to report elder abuse to the proper authorities.
• Check on your older friends and relatives regularly, especially if they live alone or in a nursing home.
• Encourage your older friends and relatives to take care of their health and stay active and connected in the community.
• Educate older friends and relatives about scams, including ensuring that they don’t give personal information over the phone.
• Listen to complaints from seniors concerning possible abuse.

Remember that you are not helpless in these situations. Elder abuse is a criminal offense in most places, and if needed, you can report an incident of elder abuse to the authorities.

How can I report suspected elder abuse or neglect?

You can report suspected elder abuse to the police or local adult protective services. The National Center on Elder Abuse has a listing of state elder abuse hotlines. You can also call the Eldercare Locator at 1-800-677-1116, Monday through Friday, from 9 a.m. to 8 p.m. This resource is a great option for older people who might not have a computer.

If the situation involves an imminent threat, you should call 911 to get immediate help.

Be aware that doctors and home health providers are required to report suspected abuse or neglect. Assuming they are not involved, they may be able to help you report the issue.

What happens when you report elder abuse?

When you report an incident, it goes through these steps or similar:

1. The call is screened to see how serious the situation is. All information is kept confidential.
2. If the call appears to indicate an abusive situation, a caseworker is assigned.
3. The caseworker investigates the situation.
4. If the abuse is not substantiated, the person will be offered other social and health services, which they can refuse.
5. If the abuse is substantiated, crisis services are made available. The police may become involved if the law has been broken.

There is no penalty for reporting suspected abuse that isn’t substantiated, and you may still help the person get the help they need.

Elder abuse is a genuine problem that has become even more common recently. Unfortunately, abuse is sometimes left unanswered, so it’s important for older people, caregivers, and the public to become more aware of the situations that can occur. Know the warning signs of elder abuse and what to do if you suspect it, and you can help keep vulnerable people safe.