In general, elder abuse refers to “any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.” Although all fifty states have passed some form of elder abuse prevention laws, these laws and definitions of terms can vary considerably. Broadly defined, abuse may be:
- Physical abuse—inflicting physical pain or injury on a senior, eg, slapping, bruising, or restraining by physical or chemical means.
- Sexual abuse—non-consensual sexual contact of any kind.
- Neglect—the failure by those responsible to provide food, shelter, healthcare, or protection for a vulnerable elder.
- Exploitation—the illegal taking, misuse, or concealment of funds, property, or assets of a senior for someone else’s benefit.
- Emotional abuse—inflicting mental pain, anguish, or distress on an elder through verbal or nonverbal acts, eg, humiliating, intimidating, or threatening.
- Abandonment—desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.
- Self-neglect—characterized as the failure of a person to perform essential, self-care tasks and that such failure threatens his/her own health or safety. (ACL, 2019a)
In 2009 a National Institute of Justice (NIJ) study of 5,777 adults over 60 years of age found that 11% reported some form of mistreatment other than financial exploitation in the previous year. Among them, the reporting of the mistreatment to authorities ranged from a low of 8% for emotional abuse to 16% for sexual abuse and 31% for physical abuse. Thus 69% of the adults over 60 who are experiencing physical abuse are not reporting that abuse (Acierno et al., 2009). The problem of under-reporting remains a critical concern.
The same NIJ study found that previous-year financial exploitation by a family member had affected 5.2% of respondents and lifetime incidents of financial exploitation by a stranger had affected 6.2% (Acierno et al., 2009). Financial exploitation can directly affect quality of care, depriving victims of the financial means to access medical treatment or obtain medications, sometimes with dire consequences.
Financial exploitation is a fast-growing form of abuse of seniors and, like other forms of abuse, is seriously under-reported. In recent research, 1 in 20 elders reported recent incidents of perceived financial mistreatment, and 90% of abusers are family members or trusted others, such as caretakers, neighbors, friends, and professionals (attorneys, doctors and nurses, pastors, bank employees) (NAPSA, 2019; Acierno et al., 2009).
Many factors—race, gender, age, income and employment, physical and mental health, prior traumatic events, social support—can play a role in the likelihood of becoming a victim. These factors operate differently for the various types of mistreatment; some are indicative of potential for all types of abuse while others are significant only for certain forms of abuse. For example, those reporting very low social support face a three-fold greater risk of emotional mistreatment, while those needing assistance with daily life activities face double the risk. In fact, low social support affects the potential for all types of mistreatment, which may provide clues to important potential avenues of prevention (Acierno et al., 2009).
The NIJ study found that those in the 60 to 70 age group—the “younger old”—have an increased risk of physical, emotional, and stranger-perpetrated financial mistreatment, while age was not related to increased or decreased risk of sexual abuse, financial mistreatment by family members, or neglect. Variation in these findings among studies may be related to whether the experience of institutionalized people is considered.
The NIJ study also found that gender (being female) only increased the risk for sexual abuse, while belonging to a non-white racial group was associated with increased risk of physical mistreatment, financial mistreatment, and potential neglect. It is important to note that the role of risk factors can be affected by many things, and combinations of factors increase that complexity.
In the landmark National Elder Abuse Incidence Study, done in 1998, it was found that nearly half of the perpetrators of elder abuse were adult children of the victims. Spouses accounted for 20% of the perpetrators, while other relatives, grandchildren, and siblings were also noted as perpetrators (NCEA, 1998).
The 2009 NIJ study breaks down similar findings with more detail. It found that in emotional, physical, sexual, and neglect incidents the majority were perpetrated by a family member. Partners or spouses accounted for 57% of physical mistreatment, 40% of sexual mistreatment, 28% of neglect, and 25% of emotional mistreatment. Children, grandchildren, and other relatives also play a significant role in these events (Acierno et al., 2009).
While the NCEA study in 1998 showed that more than half (53%) of abusers were male, 75% were white, and nearly 40% were middle-aged, the NIJ study helps demonstrate that many factors may play a role in who becomes a perpetrator. The better these factors are understood, the better intervention strategies may be developed. For example, “relative to the general population, it appears that perpetrators of emotional, physical, and sexual mistreatment had high unemployment, increased substance abuse, and increased likelihood of mental health problems. Particularly striking was the older adult report that perpetrators of mistreatment were socially isolated. . . . [This] may present targets for intervention. Reducing substance abuse and increasing social connections in isolated family members of older adults may have the secondary benefit of reducing elder mistreatment” (Acierno, et al., 2009; NCEA, 1998).
Why Victims of Abuse Do Not Report
There are many reasons why victims do not report the abuse, including lack of confidence, a history of abuse, fear of retaliation by the abuser, cultural beliefs, embarrassment, and shame. For example, people who have never been self-confident are not likely to ask for help when they become dependent. Those who have been abused or neglected their entire lives expect maltreatment will continue, would never think someone would want to help, and often reject help when it is offered.
Abused adults may have sought help from law enforcement or other agencies in the past, only to experience worse abuse, neglect, or exploitation when representatives of those agencies were not present.
Some cultures believe that whatever happens within a family is no one else’s business. The abused adult may be ashamed or embarrassed to be neglected, abused, or financially exploited by a trusted family member. The victim may promise to keep the abuse secret so the abuser will not further abuse them or other loved ones, including pets. Abusers may threaten to withhold care or food or other necessities, or to send the victim to a nursing home if they tell anyone about the abuse.
Why Mandatory Reporters Do Not Want to Report
Those who are required by law to report suspected abuse of elders share some of the same fears as the abused individuals: that reporting will hurt the relationship with the victim or the abuser or will cause retaliation by the perpetrator. Other stated reasons for reluctance to report include:
- Damage relationship with victim and/or suspected abuser
- Fear of losing a job
- Court time—with loss of work time
- Nothing will change, and everyone involved will get upset
- Cannot get DHS or DIA to accept a report
- Do not want to get involved (“none of my business”)
Reporting Suspected Abuse
Any person who believes that an elder has suffered abuse may make a report of the suspected abuse to DHS or the designated entity in their state. For example, an employee of a financial institution may report suspected financial exploitation of elder. Greater public awareness of the prevalence of abuse of elders and people with disabilities would bring this crime out of the shadows. People who report suspected abuse even though they are not legally required to are called permissive reporters.
Those who are required by law to report elder abuse are known as mandatory reporters. In most states, most healthcare professionals are mandatory reporters. Check with your state or your licensing board to find out when, where, and how you make a report in your state.
Communication with Victims and Families
Effective communication is based first of all on the principle of respect. Both the sender and the receiver of the message have unique physical, emotional, mental, social, and spiritual characteristics. Effective communication shows acceptance of a person’s individual worth and involves good listening skills.
Overcoming Communication Barriers
When talking with a dependent adult, the following principles will facilitate communication:
- Use clear, simple language.
- Ask open-ended, one-part questions.
- Be an attentive listener and allow for periods of silence.
- Allow sufficient time so there is no pressure to hurry.
- Use explanations that progress from simple to complex.
- Allow eye contact, but do not force it.
- Allow plenty of space to move; medications may cause restlessness.
- Keep background noise to a minimum.
- Sit facing the person to help them identify visual cues.
Ways to Ask About Abuse
First, be direct. Ask non-threatening questions and respond empathetically. Second, universalize the question rather than personalizing it. For example, “Many people are hurt physically or in other ways by someone they know. Is this happening to you?”
Make your questions gradual and exploratory, such as:
- How are things going for you?
- What kinds of stresses do you have in your everyday life?
- Is there anyone in your life who is pretty strict, or hard to please?
- Do you get blamed a lot?
- Can you disagree? What happens when you don’t agree?
- Have there been situations in which you felt afraid?
- How often are you called names? How often are your feelings hurt?
- Are you ever threatened with forced sex, been pushed or shoved, had your hair pulled or been slapped?
- Have you had things thrown at you?
- Have any of your precious possessions been deliberately broken?
- Have your pets, children, grandchildren, or other people close to you been intentionally hurt?
- Are you ever prevented from leave the house, or from seeing friends or family?
- Do you feel safe in your home?
- Should I be concerned for your safety?
Supportive Ways to Respond
When talking with victims of abuse:
- Allow time for the person to speak.
- Believe what the person says.
- Empathize: validate the person’s feelings.
- Make it clear that the abuse was wrong and it was not the victim’s fault.
- Speak directly about the violence.
- Ask in what ways you can be helpful.
- Respect the person’s right to self-determination.
- Assure the person there are resources to help and that he or she is not alone.
- Discuss a safety plan and offer follow-up contacts.
When talking with victims of abuse:
- DON’T talk to the victim while others are present. Confidentiality and privacy are essential and the presence of others may interfere with information the victim wants to provide, particularly if the perpetrator is present.
- DON’T blame the victim. Societal attitudes often blame the victim for the abusive situation. This is extremely harmful to the victim and may result in an inability to trust.
- DON’T tell the victim it is not that bad or minimize the pain. The shame and fear he or she feels is natural.
- DON’T check out the story with the abuser. Talking with abusers may tip them off to a possible evaluation. This not only hinders the evaluation but may also endanger the victim.
- DON’T demand that the victim take a certain course of action. You may offer suggestions, but it is necessary for him or her to be comfortable with the plan of recourse.
- DON’T think you have failed if you did not fix the situation. Many abusive situations indicate long-entrenched patterns of behavior. To assume that you can always alleviate the situation by reporting the abuse or other action is unrealistic.
Try to establish whether the victim is competent and does or does not want help, or whether he or she is incompetent to make decisions. If the individual is not competent, someone else is needed to make decisions for that person. In some cases, the victim is competent to make decisions but there are barriers to that person’s being able to ask for or accept help.
Ten Tips for Preventing Abuse
The following list suggests actions that are designed to prevent abuse and to help the family and caretaker develop effective coping mechanisms and support systems:
- Assess the person for signs of abuse/neglect. Early identification is essential to break a pattern of abuse or neglect.
- Assess the family at risk for abuse or neglect, and intervene as necessary before abuse occurs. Identifying high-risk families can stop abuse before it starts.
- Develop a trusting relationship with the dependent adult and their relatives. This promotes open discussion of difficulties.
- Offer guidance in caregiving. The caretaker may lack information on how to properly care for the person.
- Provide information about community resources and alternative living arrangements before an older person moves in with an adult child. Knowledge of options and services can help avoid situations that may lead to abuse.
- Encourage the caretaker to join a self-help group and/or to use respite services. Discussion groups provide education and support. They also help relieve frustration.
- Emphasize the importance of social involvement. Using multiple support sources lessens the caretaker’s responsibilities and increases the older adult’s sense of independence.
- Report suspected abuse accurately. Use direct quotes and give specific descriptions of physical findings. Sketches and photographs of injuries may be extremely helpful. Accurate and comprehensive documentation is essential for diagnosis and intervention by legal or social services.
- Consult a social worker about referring the person to community agencies or providing alternative living arrangements. This encourages her/him to choose formal support services that maximize independence and enhance well-being.
- Discuss the possibility of alternative living arrangements to prevent abuse or neglect. If appropriate, the dependent adult may need to relocate to live with relatives, friends, or in a boarding home, retirement community, or healthcare facility.