- Neglect occurs when family members or care-
givers fail to provide for the elder’s daily needs
such as meals, appropriate clothing, assistance
with bathing and toileting, administration of
medications, and receiving medical care. - Physical abuse occurs when the elder receives
injuries or is in physical peril as a result of the
actions of family members or caregivers. Exam-
ples of physical abuse include hitting, pushing,
exposure to water that is too hot or too cold,
physical restraints, and overmedication or
undermedication. - Sexual abuse occurs when there is inappropri-
ate physical contact of a sexual nature between
a family member or caregiver and the elder.
Examples of elder sexual abuse include inde-
cent exposure, touching of the genitals or forc-
ing the elder to touch the caregiver’s genitals,
rape, and sodomy. - Emotional and psychologic abuse occurs when
family members or caregivers intimidate,
threaten, belittle, or ignore the elder. Stealing
from the elder, mismanaging finances, and tak-
ing over control of possessions such as a home
or car are also forms of emotional and psycho-
logic abuse.
Often the elder experiences more than one
type of abuse; emotional and psychologic abuse
are almost always present with any other type of
abuse. Elder abuse may also result from the failure
of family members or caregivers to take actions to
prevent harm or injury. Though the dynamic of
elder abuse is complex, it is nearly always inten-
tional.
Signs of Elder Abuse
Indications of elder abuse may be obvious or dis-
creet and may be physical or manifest as emo-
tional or psychologic symptoms. Signs of elder
abuse may be difficult to distinguish from the
symptoms and consequences of health conditions
such as STROKEor ALZHEIMER’S DISEASE. Signs that
may suggest elder abuse include
- unexplained bruises (especially on the wrists,
lower arms, and lower legs), BURNS, scalds, frac-
tures, or other physical injuries- progressive weight loss
- sunken eyes and dry, loose SKIN
- DECUBITUS ULCER(bed sore)
- health conditions that do not respond as
expected with the medications prescribed - vaginal or anal discharge or bleeding
- SYMPTOMS OF SEXUALLY TRANSMITTED DISEASES
(STDS)- evasiveness or reluctance to participate in social
activities - fearfulness or suspicion
- evasiveness or reluctance to participate in social
Some conditions of old age, such as Alzheimer’s
disease, ORGANIC BRAIN SYNDROME, and stroke, may
result in aggressive, combative, or otherwise chal-
lenging behavior in the older person. Such a cir-
cumstance complicates the picture by making it
difficult to determine who is the abused and who
is the abuser. Patterns of abuse present earlier in
life, such as DOMESTIC VIOLENCEbetween spouses or
CHILD ABUSEthe elder inflicted on a now-adult
child, often continue or may reverse when the
person becomes older and unable to live inde-
pendently. The once-abused child may turn
against the now-dependent parent, for example.It is crucial that anyone who suspects
elder abuse report it to health-care or
law enforcement authorities for investi-
gation. Many communities have anony-
mous telephone hotlines for reporting
suspicions of elder abuse.Detection and Intervention
Elder abuse is difficult to detect because it is possi-
ble for the elder to remain relatively secluded
without raising much suspicion. Older people may
be reluctant to report abuse for fear of retribution
from the abusive family member or caregiver.
Elderly people commonly fear any change that
might require a move to a residential care center.
As well, many older people have well-established
beliefs that what happens in the family stays in
the family; there would be irrecoverable loss of
pride in revealing abuse at the hands of family
members. There are relatively few mechanisms in
American culture to safeguard the health andelder abuse 245