Recognizing Elder Abuse
Talking about Elder Abuse can make us uncomfortable, squeamish, or downright angry. I’ve seen all of these responses and more. While elder abuse still lives mainly in the shadows, approximately 1 in 10 Americans over 65 have experienced some form of abuse. 14.9 percent of the population of the U.S.A. is over 65.
We define elder abuse as “An intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult.” The primary recognized forms of abuse are:
Caregiver neglect
Physical abuse
Financial fraud and exploitation
Psychological abuse
Sexual abuse
Caregiver neglect is one of the more prevalent forms of abuse. It accounts for 58.5% of abuse. Evidence of abuse includes a refusal or failure to fulfill the obligations or duties to an older adult, including deprivation of water, food, shelter, and hygiene. Warning signs include dehydration, malnutrition, unacceptable living conditions, and untreated health issues.
Dependent adults are vulnerable and often resist attempts to talk about their circumstances. They are “dependent” on others and can lack the agency to ask for help. Doing so can further compromise their health and well-being.
Physical abuse represents 15.7% of elder abuse. It is defined as the intentional use of physical force which results in illness, physical pain, functional impairment, or bodily injury. Examples include hitting, pushing, kicking, slapping, etc. Warning signs are burns, pressure marks, and bruises.
Emotional and psychological abuse accounts for 7.5% of elder abuse. Like any emotional or psychological abuse, the signs are sometimes harder to see. For example, they can exhibit unusual depression, a sudden change in alertness, and disappearing from contact with family and friends. In addition, emotional and psychological abuse can come from name-calling, insults, or threatening isolation. Finally, creating mental fear, pain, and anguish are ways abuse occurs. Here is an illustration:
In teaching a Powerful Tools for Caregivers class, I was astounded by the courage of one participant to share how she had been on the verge of being emotionally abusive to her spouse. In the first session, she talked about her frustration with his Parkinson’s Disease debilitation. She had spent years as a special education teacher, but dealing with her husband’s progressive illness was depleting. She told the group that their neurologist took her aside at a visit and said he noticed her manner and behavior. He cautioned her that she was becoming abusive, and he would have to report it if things didn’t change.
Her sharing such a vulnerable story in the first meeting with others floored me. I was also thrilled because I always talk about the potential for abuse as a side effect of caregiving. She laid it out clearly and told the group she had changed her behaviors, and by coming to the class, she was also seeking support. At this point, her spouse was in assisted living, and she was in an apartment nearby. She could visit him knowing he was cared for, and she was rested and caring for herself. Crisis averted in this case.
Sexual abuse accounts for 0.04% of reported cases. It is any kind of forced or unwanted interaction with an older adult. The interaction can include sexual contact directly or above clothing, penetration, sexual harassment, and coerced nudity. Warning signs include bruising around breasts or the genital area, stained or bloody under clothing, and unexplained vaginal bleeding. A key element is the ability to give consent to any sexual interaction.
The ability to give consent is watched more frequently, given the rise in diagnoses of Alzheimer’s disease and other memory disorders. As a result, questions arise about the ability of married couples or other partners to consent to sexual activities that previously were a part of the relationship. For example, in Iowa, a state legislator found himself engaged in a court trial initiated by his wife’s daughters because they were concerned about their mother’s ability to consent to an ongoing sexual relationship with her spouse.
Financial abuse occurs with 12.3% of abuse. Financial abuse is considered illegally or improperly using an adult’s money, benefits, belongings, property, or assets for the benefit of someone other than the older adult. Examples include unauthorized withdrawals of money from an account, changing a will without permission, and the disappearance of valuable possessions.
Be aware of a sudden change in a financial situation, large withdrawal, and a sudden change in a financial institution.
In my years of experience as a therapist, I initiated only one case with Adult Protective Services. The issue was the financial abuse of an older adult with significant emotional problems. She talked about her sons asking her for money and worrying they would cut off the relationship if she refused them. The marriage to their father had been abusive, and she was vulnerable. She also had limited finances, and the requests increased her risks.
I worked with her for several sessions to try to erect boundaries with her sons. However, she was fragile and unable to set limits. She continued to complain about the problem, and with the knowledge of the office psychiatrist, I had to make the referral. I knew it was likely to end our professional relationship. It did. She did continue to see the psychiatrist but refused therapy.
The case was a risk, but it was also a professional responsibility, and I hoped that the investigation would at least let people know she was being watched.
Where does it occur?
Elder abuse doesn’t occur in only densely populated urban environments. It is reported less in rural communities, but this can be related to the concern of it becoming known in a small populace. In addition, there is an increase in Baby Boomers migrating to rural areas, which can increase the frequency of abuse, especially with more significant health concerns and fewer caregiver resources.
Dementia is one diagnosis where we see increases in elder abuse. Caregivers become exhausted and frustrated with the routines of daily care that require increased demands with the knowledge that the situation will not improve. Consent for sexual activity between partners is also a topic of concern because one partner may not be able to agree to prior relationship parameters.
So what can we do?
We can begin by listening to an older adult. Asking questions that aren’t threatening or demeaning is essential. We can also feel shame about someone taking power away from us. Asking what they would like for support is a place to begin. The request might be for something to be done or a personal need. Approaching the caregiver about the conversation can also give clues about what might occur. For example, you might be denied visits or access to the individual if abuse happens.
If you suspect abuse, you can report it to local agencies.
Many people are in the role of mandatory reporters. They include but are not limited to physicians, nurses, other health care professionals, teachers, therapists, and law enforcement. In addition, updated training and certification for license renewal are required.
Reporting abuse can occur anonymously. Adult Protective Services are generally associated with a local or State Department of Human Services. They are required to investigate within a specific period and can also give you a follow-up on whether the case is founded or not. They do not have to share information beyond that with you and can also keep your identity confidential.
Isn’t it risky to report abuse?
Yes, and it’s a risk not to report. Older adults who experience abuse are also 300% higher risk of death than those who have not been abused. In reporting the financial abuse case, I knew I would likely also lose a client and the ability to monitor her emotional, mental, and physical safety. She was committed to her medication regimen with the psychiatrist, which kept her within the practice and could observe. But, more often than not, when people report abuse, they also disappear off the radar.
The ideal scenario is to gain trust and seek to enter a family or care system. There is no time to waste when the abuse is apparent. But, if you’re unsure, keep gathering information and seek help communicating with all parties involved.
Families might have concerns about their loved ones if the vulnerable person is in the care of one person. As mentioned above, changes in weight, appropriate clothing, food, and a clean living situation are red flags. Missing medical appointments, medications, and refusing help are other signs.
Abuse and neglect are more common than acknowledged. Knowing what to look for is one aspect of addressing the problem. Taking action is another aspect.
If you feel unsure of a situation you’re observing or are concerned about your ability to care for someone because of frustration and other challenges; please contact me for help. I am happy to help you assess and make an action plan.
Please email me or book a call at any link on this site for help.