Elder abuse refers to harm or the threat of harm to an older person by another person.
Older people can be abused by having harmful things done or said to them or by having necessary things withheld from them. Abuse usually becomes more frequent and severe over time. Abused older people have injuries, poor physical health, psychologic damage, repeated hospitalization, financial loss, and premature death more often then nonabused older people.
Each year in the United States, thousands of older people are abused or neglected. The perpetrator is usually a family member, most often an adult child who is the older person’s caregiver. Sometimes professional caregivers, such as home health care workers or employees of nursing homes and other institutions, abuse older people.
Worldwide, as many as 1 in 6 people who live in the community and who are age 60 and older experience abuse. About 12% of these people experience several different types of abuse.
Reports of elder abuse increased during the COVID‐19 pandemic, possibly due to increased vulnerability of victims and more stress or triggers affecting abusers due to social isolation, financial hardships, and poor mental health. Also, rates of physical and emotional abuse were significantly higher, and victims were more likely to experience several forms of abuse.
Caregivers are often overwhelmed by the demands of care, have inadequate preparation or resources, or do not know what is expected of them. They may also become increasingly socially isolated, sometimes increasing their resentment and making abuse more likely. Many caregivers do not intend to abuse the person, and some may not even know that they are abusing the person.
Common types of elder abuse include physical abuse, sexual abuse, psychologic abuse, neglect, and financial abuse. Many forms of abuse often happen in combination.
Physical abuse is the use of force to harm or to threaten harm. Examples are striking, shoving, shaking, beating, restraining, and force-feeding. Possible indications of physical abuse include unexplained injuries or injuries that are not treated adequately, rope burns and other rope marks, broken eyeglasses, and scratches, cuts, and bruises. A caregiver’s refusal to allow an older person to have time alone with visitors or health care practitioners can raise concerns about physical abuse.
Sexual abuse is sexual contact without consent or by force or threat of force. Examples are intimate touching and rape. Bruises around the breasts and genital area or unexplained bleeding from the vagina or anus may indicate sexual abuse. However, sexual abuse does not always result in physical injuries.
Psychologic abuse is the use of words or actions to cause emotional stress or anguish. It may involve
Issuing threats, insults, and harsh commands
Ignoring the person (for example, by not speaking for a long time or after being spoken to)
Treating the older person like a child (infantilization), sometimes with the goal of encouraging the person to become dependent on the perpetrator
People who are psychologically abused may become passive and withdrawn, anxious, or depressed.
Neglect is the failure to provide food, drugs, personal hygiene, or other necessities. Some older people neglect themselves (called self-neglect). Others are neglected by their caregivers. Necessities may be withheld intentionally or simply be forgotten or overlooked by irresponsible or inattentive caregivers. Signs of neglect include
Weight loss because of undernutrition
Dry skin and mouth because of dehydration
Unpleasant odor from being inadequately cleaned
Pressure sores on the buttocks or heels from being left to sit or lie in one position too long
Missing necessary aids, such as eyeglasses, hearing aids, or dentures
Missing scheduled doctor appointments or not be taken for care when disorders are obviously worsening
Some caregivers are unaware that their treatment of an older person has crossed the line from being less than ideal to being neglect. These caregivers may lack a sense of what constitutes adequate and appropriate care, or they may have very different notions of what conduct is and is not acceptable. Sometimes neglect results from desperate circumstances, such as financial difficulties, despite the caregiver’s best intentions. Sometimes willing caregivers are unable to provide adequate care because of their own physical limitations or mental impairment. For example, caregivers may be unable to bathe the older person or to remember to give the person a drug.
Financial abuse is the exploitation of a person's possessions or funds. It includes
Swindling
Pressuring an older person to distribute assets
Managing an older person's money irresponsibly
Caregivers may spend most of an older person's income on themselves and provide only a minimum amount for the older person.
Restricting an older person’s freedom to make important life decisions, such as whom to socialize with and how to spend money, is sometimes considered another form of abuse.
Risk Factors for Elder Abuse
Any older person, regardless of health, can be abused. However, abuse is more likely when older people
Are physically frail, often because of disabling chronic disorders
Have problems doing daily tasks
Have difficulty communicating
Are socially isolated
Have dementia, confusion, or another form of mental impairment
Abuse is also more likely when the perpetrators
Are financially dependent on or living with the older person
Abuse alcohol or drugs
Have a psychologic disorder, such as schizophrenia
Have been violent before
Have stress, such as financial problems or a family death
Lack skills and resources, making caregiving frustrating
Have a disorder (such as dementia) that makes them agitated or violent (even if they were previously mild-mannered)
When to Suspect Elder Abuse
Doctors, nurses, social workers, friends, and family members often do not recognize the signs of abuse. The signs can be difficult to distinguish from other problems. For example, if an older person has a hip fracture, health care practitioners may be unable to distinguish whether the cause is physical abuse or osteoporosis, falls, or both (which are much more common causes). Also, if older people are confused, they may not have their complaints of abuse taken seriously, so the abuse goes unrecognized.
When older people have certain problems or make certain changes, family members and friends, as well as health care practitioners, should be aware that abuse may be the cause. These problems include the following:
Poor hygiene or an unpleasant odor
Pressure sores
Weight loss and a dry mouth
Missing eyeglasses, hearing aids, or dentures
Many bruises, bruises in places not usually injured by accident (such as the buttocks), or bruises in the shape of objects (such as a utensil, stick or belt)
Rope marks
Broken bones
Scratches and cuts
Anxiety, depression, or withdrawal and passivity
Sudden financial changes (such as changes in a will, loss of money or other assets, or addition of names to an older person’s bank card)
The caregiver’s behavior may also suggest abuse, as in the following:
Not letting the older person speak
Treating the older person like a child
Giving implausible explanations for injuries
If health care practitioners suspect abuse, they interview the older person alone as well as the possible perpetrator. They may interview other people who know the older person, sometimes alone.
Practitioners may use questionnaires designed to identify elder abuse. They may ask general questions about feelings of safety as well as direct questions about possible mistreatment. Practitioners also thoroughly examine the person to check for signs of abuse. Imaging and blood tests may be needed to identify signs and/or complications of abuse and, if signs are present, to document the abuse.
Practitioners also evaluate the older person's circumstances, including the following:
Social and financial resources to determine whether financial abuse is occurring and to help plan management so that the older person is protected (for example, by arranging a different living arrangement or hiring a professional caregiver).
Mood to check for depression, anxiety, anger, and fear
The ability to do daily activities
Any physical limitations that interfere with self-protection
If help with daily activities is needed, practitioners determine whether the current caregiver has sufficient emotional, financial, and intellectual ability for the task. Otherwise, a new caregiver needs to be identified.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
National Institute on Aging: Elder Abuse: Information and links to additional resources for older adults and caregivers regarding signs, prevention, and long-term affects of elder abuse
National Center on Elder Abuse (NCEA): Guidance from the NCEA, a national resource center dedicated to the prevention of elder mistreatment, including advice and resources to professionals, researchers, advocates, and families
