Knowledge about elder abuse and neglect is not as widespread as the people’s knowledge and concern about child abuse and domestic violence. The elderly population has for many years been neglected by society. Because of the absence of knowledge on elderly abuse and neglect, medical practitioners, policymakers, and trainers do not have the data to guide them in handling this alarming situation.

Medical professionals and caregivers who work with elderly patients may miss the signs of elder abuse because of the lack of proper training. In most cases, the person being abused does not report it. The best way to stop elderly abuse and neglect is to notice the sings so that they can be stopped.
Most elderly persons are reluctant to report abuse because of fear of reprisals, the lack of cognitive or physical ability to report, or because they do not want the abuser to be in trouble as most often, the person perpetrating the abuse is a family member.

The worst problem with elderly abuse is how common it is. The World Health Organization estimated in 2917 to 2018 that two out three staff members of nursing homes and long-term care facilities commit acts of abuse or neglect. It means that one in six older adults 59 years and over are suffering from some form of abuse and neglect while living in community settings. The problem, however, is not limited in the community setting. Even the elderly who live with family members are not spared from this kind of treatment. Family members who are tired and burdened by taking care of an elderly member resort to neglectful, if not abusive, behavior.

What is elder abuse and neglect?

There is no specific definition of what elder abuse really is as the definitions continue to evolve. The World Health Organization defines elder abuse as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.” According to the National Committee for the Prevention of Elder Abuse, elder abuse is any form of mistreatment resulting in harm or loss to an older person.

Elder abuse includes physical, sexual, emotional harm inflicted upon an older adult, their financial exploitation or neglect of their welfare by people are directly responsible for their care.

As older adults become more physically frail, they become less able to take care of themselves and their needs, stand up to bullying, or fight back if attacked. Physical or mental ailments may make them more difficult companions for people who are living with them. These elderly people may not see or hear like what they used to be, providing an opening for unscrupulous people who will take advantage of them.

Elder abuse is rampant where senior lives. Their abusers are often their adult children, other family members including grandchildren, or partner or spouse. Elder abuse is also common in institutional settings, such as long-term care facilities.

Who is at risk for elder abuse?

Even with inadequate statistics on elder abuse, social isolation and the lack of social support have emerged as significant risk factors in elder abuse. Elderly people become isolated from society the moment they lose family members and friends, as well as their physical and mental capacity. When this happens, it becomes a huge burden on the other relatives who may be the only ones available to provide care. Traditionally, children share responsibility for the care of aging parents. But with the migration today of many young families, many elderly are left alone to fend for themselves even with inadequate funds to pay for outside care and with very limited options for care at home.

Abusive caregivers come from different walks of life. They could come from the group of cruel and uncaring to the overwhelmed and well-intentioned. Many factors come into play why caregivers become abusive to their clients. The abuse could stem from a slew of reasons, ranging from mental health, bad financial situation, lack of rest from constant responsibility and work demands, dysfunctional family dynamics, and lack of certainty as to what the family of the elderly client wants. Which older people are most likely to experience elder abuse? Some elderly adults belong to specific groups that are more likely to become a victim of elder abuse than others:

Socially isolated adults – People who are isolated from family members and friends are more likely to experience abuse. The instances of abuse are more likely to go unnoticed or undetected for a long time.
People with poor family relationships – There are instances when family members become the primary caregiver for someone they had a difficult relationship with. The strained relationship may escalate into emotional or physical abuse to which the victim cannot do anything because there is nobody else he can turn to.
Widowed women – Widowed women are facing the greatest likelihood to be exploited financially and have their property taken from them. Men are the most common perpetrators of financial exploitation of widowed women.
Single adults – When an elderly person has no spouse or partner, the risk of financial abuse significantly climbs. While the most common victims are single adult women, single men have the same kind of risk.
Adults younger than 70 – Elderly adults in their 50s and 60s tend to report emotional abuse and financial exploitation more often than older individuals.
Lower-income adults – The elderly adults who are poor or from lower-income family backgrounds significantly increase their risk of being abused. The low economic resources become a stress factor in the relationship between the caregiver and the client.
Black Americans – Black Americans experience a higher risk of financial exploitation than other elderly adults.

Conditions that increase the likelihood of elder abuse Certain health conditions may increase the risk of the elderly becoming easy prey to abusers at home or in the healthcare system, such as:

Poor cognitive function – People with mental health problems or mental disorders have an elevated risk of abuse, particularly people with dementia who commonly suffer various forms of abuse from their caregivers.
Increased physical dependency – Some older adults may become heavily dependent on their caregivers while others may be fully functional but still require some level of supervision. There are older adults who need assistance even with the most basic tasks. The more dependent an elderly person is on his caregiver, the higher is the probability that abuse may take place.
Substance abuse or alcoholism – The risk of violence against the elderly becomes higher when the person who struggles with substance abuse is the victim or the perpetrator. The same high risk for abuse is present when elderly persons are struggling with alcohol abuse.

Prevalence of elder abuse

Elder abuse may be more common and widespread that what many people recognized, particularly among adults with cognitive impairments such as dementia. In North and South America, the prevalence of elder abuse ranges from 10 percent of lucid older adults to about half of those with dementia. In Europe, the prevalence of elder abuse ranges from 2 percent in Ireland to about 61 percent in Croatia. In Asia, exposure of the elderly population to abuse ranges from 14 percent in India to 36 percent in China. Elder abuse is a common and identifiable condition that is present across socioeconomic, and sociodemographic strata worldwide. It includes physical, psychological, or sexual mistreatment as well as neglect and financial exploitation. Abuse harms a person’s health and has been linked to psychological and physical illnesses. A study has shown an association between elder abuse and premature mortality. Elder abuse is also associated with the increased use of health services, especially visits to the emergency rooms and hospitalizations. The world faces an increasingly aging population so it is also expected that elder abuse will increase.

Types of elder abuse

Elder abuse takes different forms, some involving threats or intimidations against the elderly, some involve neglect, and others involve financial trickery. The most common types of elder abuse are: Physical elder abuse – This involves the non-accidental use of force against an elderly person resulting in physical injury, pain, or impairment. The abuse includes not only physical assault such as shoving or hitting but the inappropriate use of restraints, drugs, or confinement.

Emotional elder abuse – This is a type of treatment of an older adult that may cause emotional or psychological distress or pain, including:

Humiliation and ridicule
Intimidation through threats or yelling
Habitual blaming or scapegoating
Isolating an elder from friends or activities
Ignoring an elderly person
Terrorizing or menacing the elderly person

Sexual elder abuse – It refers to contact with an elderly person without his or her consent. Such contact can involve physical sex acts, activities such as showing an elderly person pornographic materials, forcing the elderly person to watch sex acts, or forcing the elder to undress may also be considered sexual elder abuse. Elder neglect – This is the failure of the caregiver to fulfill caretaking obligations. This act constitutes more than half of the reported cases of elder abuse. The failure can be intentional or unintentional, based on many factors such as denial or ignorance that an elderly person needs as much care as he does. Financial exploitation – This involves the unauthorized access to the funds or property of an elderly person, either by an outside scam artist or a caregiver. An unscrupulous caregiver might do the following:

Misuse the elderly person’s accounts, personal checks, or credit cards
Forge the elder’s signature
Steal cash, household goods, or income checks
Engage in identify theft

Typical scams targeting the elderly include:

An announcement of a prize that the elderly person has won but requires to pay money to claim
Investment fraud
Phony charities

Healthcare fraud and abuse – This scheme is carried out by unethical healthcare personnel and professional caregivers. The scheme may include:

Charging but not providing healthcare
Overcharging or double-billing for medical care or services
Overmedicating or under medicating
Getting kickbacks for referrals to other providers or for prescribing certain drugs Recommending fraudulent remedies for illnesses or other medical conditions
Medicaid fraud

Elder self-neglect

A very common form of elder abuse geriatric care managers and healthcare professionals encounter is self-neglect. Because of physical or mental impairment or diminished capacity, an older adult may no longer be able to perform essential self-care. The elderly adult may lack basic personal hygiene, appear malnourished, dehydrated, or underweight, living in dirty or unsanitary conditions, and be unable to pay bills or properly manage his medication. Self-neglect can be a sign of grief, depression, dementia, or other medical conditions. In many cases, the older person refuses to seek assistance as he may be in denial, worried about losing his independence, or feeling ashamed about needing help.

Signs of elder abuse

The signs of elder abuse are difficult to recognize or might be mistaken for symptoms of dementia or the frailty of the elderly person. It may also the same excuse that caregivers might give to explain the unusual behavior or attitude of the elderly person. What makes recognizing signs of elderly abuse as very difficult is that many of those signs and symptoms overlap with the common symptoms of mental deterioration. But even if the caregiver explains the elderly behavior as symptoms of mental deterioration, the same should not be dismissed outright. The prudent thing to do is to continue the observation until it is fully established that the behavior of the elderly person is really attributed to mental deterioration. Tension and frequent argument between the caregiver and the elderly person or changes in the personality or behavior in the elder person are red flags that something could be wrong. If there is a suspicion of abuse, but are not sure, look for clusters of the following warning signs:

Warning signs of physical abuse:

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

Warning signs of emotional abuse:

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

Warning signs of healthcare fraud:

Evidence of overmedication or under-medication
Duplicate billings for the same medical device or service
Problems with the care facility such as poorly trained, poorly paid, or insufficient staff, overcrowding, inadequate responses to questions about care
Evidence of inadequate care when bills are paid in full

Preventing elder abuse and neglect

If you are a caregiver to an elderly person and you feel that you might hurt or neglect him, intentionally or unintentionally, seek support which currently is abundantly available. If you are that type of caregiver who has a problem controlling your anger, and often finds yourself unnecessarily screaming at people or lashing out at the person in your care, you need help. There could be various reasons for your behavior. You could be emotionally disconnected or simply overwhelmed by the daily needs of the elderly person under your care. The best step to get help is to recognize that you have a problem. As a caregiver, you have to follow these steps to prevent elder abuse or neglect:

Taking immediate steps to relieve stress and avoid burnout – Stress on the part of the caregiver is a major contributor to elder abuse and neglect. Your stress level could be brought down by practicing stress-relieving techniques such as meditation, yoga, or deep breathing exercises.
Seek help from relatives, friends, and local respite care agencies or find an adult daycare program. All caregivers need to take a regular break from the stressful situation of caring for an elder person and make time for themselves to attend to their own needs, even if only for a few hours.
Learn techniques for controlling your anger – There are classes on anger management that you could attend when you are off from your work. Keeping your anger under control will greatly benefit you and the elderly you care caring for.
Seek help for depression – If you recognize that you suffer from depression, seek medical help. Find the things that you can do to boost your mood and outlook, which will help you overcome the problem.
Find a support group – There are support groups for caregivers of the elderly. Sharing with them your experiences and concern can help you relieve your isolation as a caregiver. You can also get important tips from the group on how to better handle the elderly you are caring for.
Get professional help – If you cannot change your behavior or stop your abuse or neglect of the person you are caring for, you should seek help from a therapist. The therapist will attempt to discover the underlying reasons for your problems and help you get over them.

What to do if you suspect elder abuse?

Many cases of elderly abuse, exploitation, and neglect go undetected and unaddressed each year. Despite the laws in most states addressing this problem, elder abuse is still under-reported. Healthcare professionals should know that there are many ways to efficiently and safely report elder abuse. If you suspect elder abuse, document the signs, including:

Take photographs of injuries
Take note of the changes in the elder’s behavior
Write descriptions of the victim’s injuries
Take a written statement from the victim
Take a written statement from any witnesses

The documents can help confirm or disprove any suspicions of elder abuse. If the evidence collected will lead you to the conclusion that abuse may have taken place, let the case handled quickly by your local Adult Protective Services. If you want to report abuse or neglect of an elderly person in a nursing home or other long-term care facility, you should submit your report to the long-term care ombudsman of your state. That position exists in each state, a specific task to handle complaints of elderly abuse. If you observe that the abuse is severe or if you suspect that the elderly person could be susceptible to more harm, immediately call 911. You should not be afraid or ashamed of making such a call as the life of a person could be in danger. The 911 operator will assess your report and will send the appropriate person, such as a police officer, to investigate and decide on how to get the elderly person the help he needs. It is important to report any possible signs early, even if you happen to be wrong than wait until something tragic happens. In many cases, the name of the person reporting the abuse could be kept confidential, except when the abuse is so severe that witnesses will be needed. If you will report a case of elder abuse committed by a colleague in the same facility you work for, you should not fear reprisal or retaliation. You cannot be fired, demoted or given any verbal harassment as they will be against the law.

(copyscape hit: WHO definition of elder abuse)

https://www.aginginplace.org/guide-to-recognizing-elder-abuse/
https://en.wikipedia.org/wiki/Elder_abuse
https://www.aplaceformom.com/blog/for-professionals/2-26-16-identifying-elder-abuse/
https://www.helpguide.org/articles/abuse/elder-abuse-and-neglect.htm
https://www.ncoa.org/public-policy-action/elder-justice/elder-abuse-facts/