How to Identify Elder Abuse and How to Report It
Last Updated: December 17, 2019
When older people lose the ability to care for themselves, there is often a network of people collaborating to provide the level of attention and care they need. For people who live in their own homes, this could include family members, nurses or professional at-home caregivers. Others who reside in nursing homes could rely on nurses in the residence, doctors or employees. With so many people involved, it is important to know the early signs of elder abuse.
Unfortunately, caregivers and medical professionals who work with elderly patients may miss the signs of elder abuse due to a lack of proper training. Often, the person who is being abused may not report it. Therefore, noticing signs of abuse early on is critical to stopping it.
According to the National Center on Elder Abuse, the elderly person may be reluctant to report the abuse because of fear of retaliation, lack of cognitive or physical ability to report, or because he or she doesn’t want to get the abuser in trouble. This is often the case if the person is a family member.
The most difficult thing to accept when it comes to the abuse of older adults is how common it is.1 The World Health Organization estimates that two of every three staff members at long-term care facilities and nursing homes report committing acts of abuse in the summer of 2017 to the summer of 2018. This contributes to the one in six older adults over the age of 59 that suffer from some form of abuse every year while living in community settings.
What Is Elder Abuse?
Elder abuse is any form of mistreatment that results in harm or loss to an older person, according to the National Committee for the Prevention of Elder Abuse (NCPEA). The abuse could take the form of domestic violence, financial abuse, neglect, physical harm, psychological abuse or sexual abuse.
As a medical professional or a professional caregiver, you have a moral responsibility to keep the older adult in your care safe. In some instances, you may also have a legal responsibility to do so. You should be aware of what could be considered abuse, what signs to look for, and how to report abuse if you suspect it.
What Constitutes Elder Abuse?
Abusers rarely own up to their actions unless presented with solid evidence. Even when shown proof, many people refuse to admit that their actions constituted elder abuse. Some may even insist that they were just following orders, or most surprisingly, that they were acting in the best interest of the older adults.
Because each type of abuse is so different, the indicators associated with them often vary:
- Financial exploitation, like all other forms of abuse, could have long-lasting effects on a person. Signs of financial abuse could include missing checks, failing to make payments on time, if at all, missing credit or debit cards, missing property, insufficient funds in banking accounts or failing to pay for medical treatment as needed. The perpetrators often are family members, according to the NCPEA.
- Neglect can be committed by all types of caregivers, and the abuse can range from failing to wash clothing to failing to provide necessary medical care. Signs of neglect could include dirty or unsanitary living conditions, poorly managed medications, bedsores, dehydration, malnutrition and other unexplained or untreated medical conditions. Neglect often leads to self-neglect, which, according to the National Adult Protective Services Association, could lead to serious health and safety concerns.
- Physical abuse generally results in some type of bodily injury or impairment. It could range from cuts and scratches to brain injuries or broken bones. If there is a history of repeated injuries, this also could be a sign. No matter the severity of the unexplained injuries, they should be taken seriously. These physical marks also could be indications of sexual abuse and domestic violence.
- Psychological abuse or emotional abuse may be a little more difficult to detect. It could, however, have just as significant of an impact on a person. This abuse could cause the elderly patient to be afraid of a caregiver or person, to become disconnected from family and friends or to act out differently. If the person suffers from a mental illness, his or her actions could be more severe.
Who Is Responsible for Reporting Elder Abuse?
Federal and state laws have been enacted in recent decades to help protect older people. The Elder Justice Act of 2009 is widely regarded as the most comprehensive bill ever passed to combat elder abuse, exploitation, and neglect. Because of laws like this, elder abuse and mistreatment have been taken more seriously and so has the act of reporting it.
In states with mandated reporting requirements, nurses are included among those professionals required by law to report any suspected instances of sexual abuse, financial exploitation or general neglect that they encounter on the job. According to research, nurses and other mandated reporters can be held liable by both the civil and criminal legal systems if they know of possible elder abuse and intentionally fail to report it.
Generally, any person who is in some way responsible for the care of an older adult should make a report if he or she has reason to believe that the elderly person has been abused or is subject to abuse. These could include professional at-home caregivers, caregivers hired through family members or other medical professionals who interact with the elderly person regularly.
How To Report Elder Abuse
According to the NCEA, an overwhelming number of cases of abuse, exploitation, and neglect go undetected and untreated each year. Despite the accessibility of Adult Protective Services in all 50 states, as well as mandatory reporting laws for elder abuse in most states, elder abuse is still severely under reported. Caregivers and professionals, however, should know they have a plethora of ways to safely and efficiently report elder abuse.
If you suspect abuse, you should be sure to document the signs. This could include the following:
- Taking note of his or her changes in behavior
- Taking photographs of injuries
- Writing descriptions of the victim’s injuries
- Written statements from the victim
- Written statements from any witnesses
All of these things could help to confirm or disprove your suspicions. If the evidence you collect leads you to believe abuse may have taken place, then it may get the case handled quickly by Adult Protective Services.
If you are reporting abuse or neglect of an elderly person in a nursing home or other long-term care facility, contact your long-term care ombudsman. Each state has an ombudsman program, which resolves complaints and advocates on behalf of residents’ rights and quality of care in LTC facilities. These professionals can investigate the claim and make the appropriate changes.
If the abuse is severe or you suspect the person is susceptible to more harm, you should call 911. There should be no shame or fear in making the call. If the person is in need, police officers will investigate and make the appropriate call on how to get the person the help needed. It is better to report any possible signs early rather than wait until something tragic happens.
Depending on the severity of the abuse, how the abuse is reported and to whom, the name of the person making the report could remain confidential. This could help make it easier for professionals to report signs of elder abuse, especially if they suspect it has been committed by a colleague. They should not fear retaliation, such as demotions, job loss or any verbal harassment.
If you suspect someone has been abused, whether by a loved one or someone within your care facility, you should be adamant about reporting it.
Which Older People Are Most Likely To Experience Elder Abuse?
Some adults belong to specific demographics that are more prone to becoming a victim of elder abuse than others:
- Socially Isolated Adults: The WHO finds that people who are isolated from family and friends are more likely to experience abuse. These instances of abuse are also more likely to go undetected for a long time.
- People With Poor Family Relationships: In some unfortunate instances, family members become the sole or primary caregiver for someone they had a difficult relationship with. That strained relationship may eventually escalate into physical or emotional abuse.
- Widowed Women: Widowed women face the greatest likelihood of financial exploitation and often have their property seized. According to the American Psychology Association, most victims of elder abuse are women, and most perpetrators are male.2
- Single Adults: Widows aren’t the only victims. When an elderly person has no partner or spouse, the risk of financial abuse climbs. While this is more commonly experienced by women, men are also at risk.
- Black Americans: Americans of African descent also experience a higher risk of financial exploitation, according to the NCEA.3
- People Younger Than 70: The NCEA found that people in their 50s and 60s tended to report financial exploitation and emotional abuse more often than older patients.
- Lower-Income Adults: The NCEA also found that when the elderly were poor or from lower-income backgrounds, the risk of abuse climbed. The organization identified low economic resources as a stress factor in these instances.
What Conditions Increase the Likelihood of Elder Abuse?
Some health conditions increase the risk of the elderly falling prey to abusers in the healthcare system or even at home. Here are some of the most common ones:
- Poor Cognitive Function: The WHO identifies people with mental health problems or mental disorders as experiencing an elevated risk of abuse. More specifically, the NCEA states that 50% of patients with dementia suffer from some form of abuse at the hands of their caretakers.
- Increased Physical Dependency: An older adult may be more or less dependent on his or her caregivers than other seniors. Some elderly people are fully functional but require some level of supervision, while others need assistance with even the most basic tasks. The more dependent the elderly are on their caregivers, the greater the probability that abuse may take place.
- Substance Abuse or Alcoholism: Substance abuse increases the risk of violence against the elderly, whether the person struggling with substance abuse is the victim or the perpetrator.4 While by no means the only substance people may become addicted to, organizations express the need for greater research on the specific links between alcohol consumption and elder abuse.
Knowing how to identify abuse and how to report it can be critical to stopping it and getting that person the care he or she needs. As a care professional, you could have more than a moral obligation to report it. In most states, you have a legal obligation. The resources above can help you report it clearly and to the most appropriate agency.
Are you a health care professional who has witnessed acts of abuse or neglect? What are some additional tips we should include to help people identify and report these cases?
1World Health Organization. (2018). Elder abuse. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/elder-abuse
2American Psychology Association. (n.d.). Elder abuse. Retrieved from: https://www.apa.org/pi/prevent-violence/resources/elder-abuse
3The U.S. National Center on Elder Abuse. (n.d.) Statistics and data. Retrieved from: https://ncea.acl.gov/What-We-Do/Research/Statistics-and-Data.aspx
4Institute of Medicine, et al. (2014). Elder abuse and its prevention: Measuring and conceptualizing elder abuse. Retrieved from: https://www.nap.edu/read/18518/chapter/4
We Can Help! Our local advisors can help your family make a confident decision about senior living.