Senior Health

Older Adults & Mental Health Part 5: Elder Abuse & Neglect

As a result of biological, psycho-social, and environmental factors, older adults are vulnerable to abuse, exploitation, neglect and a myriad of other safety risks. For example, functional limitation, sensory impairment, memory loss, and social isolation place older adults at increased risk for self-neglect and abuse by others. Many of the elder abuse stories reported in the media are shocking, unconscionable, and may seem unbelievable.

Comprehensive statistics that provide solid data about elder abuse and other maltreatment issues do not exist due to inconsistent reporting and a lack of consistent and clear understanding about what constitutes elder abuse. As a result, the prevalence or incidence is at best a guess. Evidence indicates that definitions of elder abuse vary from state to state so that the problem remains mostly hidden and many thousands have been harmed.¹

Definition and Prevalence

Elder abuse - any form of mistreatment that results in harm or loss to an older person. It is generally divided into the following categories:

Physical, Sexual, Domestic Violence, Psychological, Financial
Neglect is "failure of a caregiver to fulfill his or her caregiving responsibilities."
Self-Neglect is "failure to provide for one's own essential needs."²

Estimates of Prevalence in the U.S.³

"...between 1 to 2 million Americans age 65 and older have been injured, exploited or otherwise mistreated."
One in 14 incidents in domestic settings (excluding self-neglect) are believed to be brought to the attention of authorities.
In overall reporting of financial exploitation, one in 25 cases suggests that there may be five million financial abuse cases.
For every case reported to authorities, an estimated five cases of elder abuse go unreported.

Signs and Symptoms May Include:

Physical/Domestic - Unexplained bruises, cuts, burns, broken bones, marks on the skin
Sexual - Submissive, withdrawal, passive, avoid eye contact, jumpy, twitchy when touched
Psychological - Depression, passive, fear, guilt, denial of problems, won't speak openly
Financial/material - Unpaid bills, sudden change in finances, transfers of money, missing property, checks
Neglect/Abandonment/Self-Neglect - poor hygiene, poor living conditions, unusual weight loss, bedsores, malnourishment, dehydration, lack of basic medical care.⁴

Our Professional Responsibility and Mandated Reporting

In most states health and human service workers, first responders and long-term care workers are required to report suspected abuse. For more information about mandated reporting visit http://elder-law.lawyers.com/Elder-Abuse.html, a service of Lexis-Nexis. Regardless of legal responsibility, as health professionals we have an ethical responsibility and are often in a unique position to identify potential abuse and help older adults get the help they need and deserve. To identify who handles the Adult Protective Services function in your state and county, visit the NCEA Help Hotline or call 800-677-1116. Both the National Center on Elder Abuse (NCEA) and the Elder Care Locator are services of the AOA.

Enhancing awareness of the problem, challenges, legal/ethical responsibilities, and providing resources for assistance is a key toward prevention and protection. Safety must be a priority in addressing this serious challenge to the well-being of the elderly and other vulnerable populations.

Elder Abuse Screening Tools for Professionals

BOMBA - Elder Abuse Diagnostic Tool⁵
Elder Abuse and Mistreatment Assessment Tool: Best Practices in Nursing Care to Older Adults Try This Series #15⁶

Evelyn's Pick: Recommended Resource

Agency for Health Care Research and Quality - Elder Abuse Prevention and Treatment Guidelines: http://www.guideline.gov/summary/summary.aspx?doc_id=6829&nbr=004196&string=elder+AND+abuse

References

National Center on Elder Abuse (NCEA) -www.ncea.aoa.gov/ncearoot/Main_Site/pdf/publication/FinalStatistics050331.pdf
National Committee for the Prevention of Elder Abuse - www.preventelderabuse.org/elderabuse/elderabuse.html
NCEA.
Administration on Aging - www.aoa.gov/

Bomba Elder Abuse Assessment Tool - www.yourlongtermcare.com/elder-abuse-prevention
Hartford Foundation Institute for Geriatric Nursing - www.hartfordign.org/resources/education/tryThis.html

GERO GEMS is a monthly publication of the Center for Aging with Dignity. Compiled by Evelyn Fitzwater, this publication is designed to raise awareness of aging and related issues impacting health care professionals and our society as a whole.

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Last Reviewed: May 20, 2008

Evelyn L. Fitzwater, DSN, RN
Associate Professor Emerita
Associate Director, Center for Aging with Dignity
College of Nursing
University of Cincinnati