Guide to Recognizing Elder Abuse And Knowing Your Rights

Experts report that knowledge about elder abuse lags as much as two decades behind the fields of child abuse and domestic violence. Limited past research means limited data to guide practitioners, policymakers, and trainers. What we do know now is alarming: elders who experience a form of abuse, even modest abuse, have a reported 300% higher risk of death. Even verbal abuse has been linked to seniors’ physical health issues and well-being.

With resource constraints in a constantly aging population, a once-hidden problem will be impossible to overlook. But as more studies come to light – and as state Adult Protective Services data show an uptick in the reporting of incidents – elder abuse has emerged as an important social public health issue. But whatever the statistics for the U.S. and beyond, researchers do agree that elder abuse is an epidemic.

What is Elder Abuse?

Specific definitions vary on what elder abuse really is, and those definitions continue to evolve. The WHO calls elder abuse “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”. It can be verbal, physical, psychological or emotional, sexual or financial. It can also be neglect–either intentional or unintentional.

Who is at Risk for Elder Abuse?

Even with imperfect statistics on elder abuse, we do know that social isolation and lack of social support is a significant risk factor. Losing friends and family members, as well as their own physical and mental capacity, often isolates elderly people. This can place a burden on the nearby relatives who are available to tend to their care…and who become isolated themselves. Historically, children shared the responsibility for the care of aging parents. Today, migration of young families means that many elderly are left alone with inadequate funds to pay for outside care and limited options for care at home.

Abusive home caregivers, like their victims, come from all walks of life. They range from the cruel and uncaring to the well-intentioned and overwhelmed. Many factors come into play: mental health, finances, lack of respite from constant responsibility, dysfunctional family dynamics, even lack of certainty about what an elderly family member wants.

How Prevalent is Elder Abuse?

One U.S. survey of nursing home staff reported that 36% of respondents witnessed at least one incident of physical abuse of an elderly patient that year. Forty percent stated that they themselves had psychologically abused patients, while 10% admitted to physical abuse. This can mean physical restraint, restricting patients’ choice over daily affairs, depriving them of dignity (e.g., not replacing soiled clothes); intentionally providing substandard care (such as allowing sores to develop); over-or under-medicating patients; as well as emotional neglect and abuse.

Even in community settings, it is impossible to know for sure how many seniors are being victimized. Some professionals miss signs of elder abuse because of lack of awareness or limited training on detecting abuse. The victim may not speak up for fear of retaliation, because they do not want to cause trouble for a relative, or due to a lack of physical and/or cognitive ability to communicate.

This is particularly problematic with dementia patients. Research indicates that this population is at greater risk of elder abuse. Impaired in memory, communication abilities, and judgment, they often cannot or will not report problems. Among studies of cases that are reported, the figures of dementia sufferers who experienced abuse range from 27.5% to 55%. One 2010 study found that 88.5% of participants with dementia experienced psychological abuse, 29.5% were neglected, and 19.7% suffered physical abuse. Several other studies confirm that as dementia progresses, so does the risk of all types of abuse.

Knowledge of verbal abuse in particular is more limited. The first nationally representative study to ask older people about verbal mistreatment was published in 2008. Nine percent of its elderly respondents cited that they had experienced verbal abuse by family members. But knowing how common this verbal abuse is can be challenging without standardized definitions and methodologies.

More recently, a Northeastern University study presented at the Gerontological Society of America showed that 38% of their older subjects at a large New York medical center professed at least one incident of verbal mistreatment from a primary caregiver in the past year.

The seniors who said a caregiver had yelled, sworn or threatened them in the past year had significantly lower social functioning and poorer mental health than the group reporting no verbal mistreatment.

What Can Be Done If Elder Abuse Has Occurred?

Every American state has an Adult Protective Services law with definitions, and may have other relevant civil or criminal laws. Definitions vary by state: some specifically criminalize acts of elder abuse. But in every state, these acts may violate other criminal laws (sexual assault, battery, theft, fraud). Some state laws enhance penalties based on a victim’s age or vulnerability status.

Adult Protective Services itself is provided by state and local governments nationwide. It serves older adults and adults with disabilities who are in need of assistance because of abuse, neglect, or financial exploitation (adult maltreatment). In all states, APS is charged with receiving and responding to reports of adult maltreatment and working closely with clients and a wide variety of allied professionals to maximize clients’ safety and independence.

Administration on Aging (AoA) services to empower older persons to remain independent, healthy, and safe within their homes and communities, for as long as possible. Legal assistance and elder rights programs work in conjunction with other AoA programs and services to maximize the independence, autonomy and well-being of older persons.

Also under the AoA, the National Legal Resource Center and Legal Assistance Developers are programs designed to protect older individuals from direct challenges to independence, choice, and financial security. They help them understand their rights and achieve optimal benefit from the support and opportunities promised by law.

Legal Services for the Elderly (Title III-B) provides legal assistance nationwide on issues such as income security, healthcare, long-term care, nutrition, housing, utilities, protective services, defense of guardianship, abuse, neglect, and age discrimination. This assistance is targeted towards older individuals in social and economic need.

The National Center on Law and Elder Rights serves as a centralized access point for a national legal assistance support system serving professionals and advocates working in legal and aging services networks.

Office of Long-term Care Ombudsman Programs operate in all states, the District of Columbia, Puerto Rico and Guam. Along with every state office headed by a full-time state ombudsman. thousands of local ombudsman staff and volunteers help residents and their families.

Along with building public awareness of elder abuse, the best preventative measure is seeking respite for caregivers. The AARP website offers comprehensive information and advice on For caregiving specific to Alzheimer’s and dementia, the Alzheimer’s Association can direct you to a local chapter for respite resources.

Whether you are caring for an elderly relative–or need to secure safe care for yourself–seek help from caregiver support groups, social workers, and physicians in your community.

Visit the AoA and the NCEA for more information.

Sources:

ncea.acl.gov/whatwedo/research/statistics.html#prevalence
www.who.int/ageing/projects/elder_abuse/en/
https://www.acl.gov/programs/legal-help/national-center-law-and-elder-rights
newoldage.blogs.nytimes.com/2013/12/02/words-that-wound/?_r=0
www.tandfonline.com/doi/abs/10.1080/08946566.2013.801817
www.washingtonpost.com/local/crime/elderly-bethesda-woman-suffered-abuse-under-sons-care-authorities-say/2015/05/06/b85d5e12-f3f4-11e4-84a6-6d7c67c50db0_story.html?tid=a_inl&utm_term=.6c33625d64c4
www.aarp.org/relationships/caregiving-resource-center/info-08-2010/pc-respite-care-a-break-for-the-caregiver.html
www.alz.org/care/alzheimers-dementia-caregiver-respite.asp