ATrain Education

 

Continuing Education for Health Professionals

TX: Geriatric Care

Module 4

Elder Abuse

 

Elder abuse—in all of its forms—is an outrage against humanity.

Kathy Greenlee
Fighting Elder Abuse, 2014

 

Each year hundreds of thousands of older people are abused, neglected, and exploited. Many victims are people who are frail and vulnerable and cannot help themselves. They often depend on others to meet their most basic needs. Abusers of older adults are both women and men and may be family members, friends, or “trusted others” (AOA, 2016b).

Elder abuse is known to be widespread throughout the United States and the world but because it is largely hidden it is under-reported. Although estimates vary widely, experts believe that nearly 85% of elder abuse cases go unreported and 40% of all elder abuse involves some form of financial exploitation by caretakers, guardians/conservators, or attorneys (Abramson, 2003).

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 to continue, do not think someone would want to help, and often reject help when it is offered.

Many older adults are ashamed to report abuse or are afraid a report will get back to the caregiver and the abuse will get worse. If you think someone is being abused—physically, emotionally, or financially—talk to the person alone and offer to get help from adult protective services.

In general, elder abuse is a term referring 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. Legislatures in all fifty states have passed some form of elder abuse prevention laws. Laws and definitions of terms vary considerably from one state to another, but broadly defined, abuse may be:

  • Physical abuse—inflicting physical pain or injury such as 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 older adult
  • Exploitation—the illegal taking, misuse, or concealment of funds, property, or assets of an older adult for someone else’s benefit
  • Emotional abuse—inflicting mental pain, anguish, or distress through verbal or nonverbal acts (humiliating, intimidating, or threatening)
  • Abandonment—desertion of a vulnerable older adult by anyone who has assumed responsibility for care or custody of that person
  • Self-neglect—the failure of a person to perform essential self-care tasks when such failure threatens the older adult’s own health or safety (AOA, 2016b)

Warning Signs of Abuse

While one sign does not necessarily indicate abuse, tell-tale signs of physical, emotional, financial, verbal, or sexual abuse, neglect, or mistreatment include:

  • Bruises, pressure marks, broken bones, abrasions, and burns
  • Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression
  • Bruises around the breasts or genital area
  • Sudden changes in a person’s financial situation
  • Bedsores, unattended medical needs, poor hygiene, and unusual weight loss
  • Behavior such as belittling, threats and other uses of power and control by spouses
  • Strained or tense relationships, frequent arguments between the caregiver and elder (AOA, 2016b)

Texas Adult Protective Services offers some additional perspective on signs of abuse or neglect of the elderly or people with disabilities:

  • Abuse may cause various injuries such as scratches, cuts, bruises, burns, broken bones, or bedsores. It can also result in confinement, rape or sexual misconduct, and verbal or psychological abuse.
  • Neglect may cause starvation, dehydration, over- or under-medication, unsanitary living conditions, lack of personal hygiene. Neglected adults may also not have heat, running water, electricity, medical care.
  • Exploitation may result in loss of property, money, or income. Exploitation means misusing the resources of an elderly or disabled person for personal or monetary benefit. This includes taking Social Security or SSI (Supplemental Security Income) checks, misusing a joint checking account, or taking property and other resources.
  • Sometimes adults who are 65 years old or older or those who have disabilities may become isolated or ill and not have someone who is willing and able to help meet their basic needs (TX DFPS, n.d.a).

Reporting Elder Abuse in Texas

The Texas Department of Family and Protective Services maintains a central place for reporting:

  • child abuse and neglect
  • abuse, neglect, self-neglect, and exploitation of the elderly or adults with disabilities living at home
  • abuse of children in child-care facilities or treatment centers
  • abuse of adults and children who live in state facilities or are being helped by programs for people with mental illness or intellectual disabilities

Who Must Report

Texas law says anyone who thinks a child, or person 65 years or older, or an adult with disabilities is being abused, neglected, or exploited must report it to the Department of Family and Protective Services (DFPS).

A person who reports abuse in good faith is immune from civil or criminal liability. The Department keeps the name of the person making the report confidential. Anyone who does not report suspected abuse can be held liable for a misdemeanor or felony.

How to Report

By phone: 1-800-252-5400

Online: Texas Abuse Hotline https://www.txabusehotline.org/

Relay Service: 7-1-1 or 800-735-2989 (tell the agent to call the abuse hotline)

Emergency: 911 or local law enforcement

Statewide Intake (SWI) operates the Texas Abuse Hotline. It takes reports and any that meet the legal definition of abuse, neglect or exploitation are prioritized and assigned to the appropriate program for investigation. The program operates around-the-clock every day of the year (DFPS, 2015).

Adult Protective Services

Adult Protective Services is the program charged with:

  • investigating reports of abuse, neglect, and exploitation of adults who are elderly or have disabilities
  • conducting in-home investigations and providing or arranging for services
  • investigating allegations at facilities
  • educating the public about the prevention of elder abuse (DFPS, n.d.a)

In 2015 APS received 110,277 reports of alleged abuse/neglect in home, and 12,952 reports for facilities. This was up from 103,019 and 12,314 respectively for 2014, and up dramatically from 2013 when the figures were 87,257 and 11,663 respectively (DFPS, 2013–2015).

While reports of alleged abuse are made by many different people and entities, overall, medical personnel are consistently the largest source of reports of abuse/neglect at 18-19%. In elder and disabled adult abuse the percentage in 2015 was 21.8%, with relatives, community agencies, and victims accounting for another 41.9% of reports.

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