Understanding Elder Abuse

Often, when the word “abuse” is mentioned, we immediately think of children. But the reality is that abuse happens to individuals of all ages, including elder adults. Elder abuse is classified as an intentional action that causes or threatens harm to an elder adult or the failure to protect an older adult from harm. Elder abuse can also include neglect or failing to meet an older adult’s basic needs. Sexual abuse of elders can encompass any sexual activity with a person incapable of giving consent, whether physical contact, verbal harassment, photography, or coerced nudity, and is often accompanied by other forms of abuse or neglect. 

The World Health Organization estimates “[a]round 1 in 6 people 60 years and older experienced some form of abuse in community settings during the past year.” However, similar to child physical and sexual abuse, elder abuse is difficult to measure due to barriers in recognizing and reporting, particularly in institutional settings. Elderly adults may be incapable of verbalizing their experiences or reluctant to report them due to concerns about shame or credibility. Unfortunately, only about half of states maintain a central registry of individuals determined to have engaged in the abuse, neglect, or exploitation of seniors or adults with disabilities. 

Risk Factors  

All elders, particularly those with dementia, are more likely to be abused by someone they know, such as a family member, caregiver, or another facility resident. About 80% of the time, the offender of elder sexual abuse is a caregiver; about 67% of offenders are family members. The abuse often occurs in either the elder’s home or the offender’s home. Other individual risk factors for experiencing elder sexual or physical abuse are:  

• Being female 
• Residing in an institutional care center 
• Isolated socially or geographically from family members 
• Past family conflict 
• Has cognitive or physical disabilities
• Medical conditions that cause difficulties communicating, confusion, or memory loss  
• History of disruptive behavior 

For organizations that serve elder adults, risk factors for experiencing an incident of abuse include maintaining inadequate staff ratios, untrained staff, stressful working conditions, and staff burnout. Whether you are working in an organizational setting or are an in-home professional or relative caregiver, be aware of the following risk factors for caregiver burnout: 

• Current diagnosis of mental or physical health condition  
• Current or past abuse of drugs or alcohol
• Past experience of trauma or abuse 
• Poor or inadequate preparation or training for caregiving responsibilities 
• High stress levels 
• Inadequate coping skills or support system 

Additionally, organizational leadership should be informed on staff risk factors and indicators of abuse: 

• Raising a voice when speaking or not remaining calm in stressful situations 
• Belittling or teasing elder consumers 
• Personalizing consumers’ behaviors 
• Getting into power struggles; breaking policies related to de-escalation 
• Talking to elder consumers about other consumers or staff, their own personal problems, or dating/sexual activities; telling inappropriate jokes 
• Bending the rules or giving gifts only for certain consumers
• Unnecessary one-on-one or private interactions 
• Failure to complete required training or documentation 
• Failure to report incidents or injuries 

Signs of Abuse  

Older adult victims are less likely to have someone believe them and are less likely to aid in the conviction of the offender. Certain populations may be reluctant to seek psychological services following their abuse. Even when medical or psychological treatment is obtained, providers often fail to recognize signs of abuse in elder adults.  

Behavioral symptoms are often the first indicators of sexual or physical abuse. Unfortunately, behavioral and physical changes can be confused with medical conditions and typical challenges commonly associated with aging. Therefore, it is vital that service providers, caregivers, and family members be familiar with and respond to the following warning signs: 

• Stops taking part in activities he or she enjoys; withdraws from friends, family, or neighbors 
• Acts agitated or violent 
• Sudden inability to meet own physical needs (ex: looks disheveled, unwashed hair, torn or dirty clothes)
• Loses weight with no medical explanation; appears hungry, malnourished, disoriented, or confused 
• Has trouble sleeping  
• Problems walking or sitting 
• Appearance of bruises, burns, cuts, sprains, dislocations, fractures, scars, internal injuries, or vomiting; especially if no or insufficient explanation given 
• Displays signs of trauma, like rocking back and forth
• Develops an STI 

Prevention 

Organizations should have written policies outlining appropriate verbal and physical interactions between staff and consumers, including when providing personal care assistance. In addition, organizations should provide adult consumers with written policies that govern how they may interact with each other.   

Staff in hospital, residential, outpatient, and community programs, as well as relatives and caregivers in home environments, can participate in preventing and detecting elder abuse through increased contact and observations. Check in more frequently with older adults who have fewer social and family connections. Provide opportunities for community and recreational engagement. Offer respite and support to in-home caregivers. Other preventative steps include:  

• Watch how staff/caregivers/family members interact with the elder individual 

• Note how the adults in programs or facilities interact with each other 
• Ask: what are the established supervision practices in this program, facility, or home setting? 
• Listen to and advocate for adult consumers’ needs and offer resources 
• Allow staff/caregivers/family members to vent; offer encouragement and empathy 

Take Action 

If you suspect abuse:  

• Call 911, local police;  
• Find your state’s local Adult Protective Services agency; or 
• Contact the National Domestic Violence Hotline at 800-799-7233. 

Protect your elder consumers and your organization: Praesidium can work with your teams to prevent sexual abuse and harassment through education, training, supervision, and feedback.  

Sources 

National Center on Elder Abuse 

National Institute on Aging 

National Adult Protective Services Association 

Centers for Disease Control and Prevention 

World Health Organization. (2022, June 13). Abuse of older people. Retrieved from https://www.who.int/news-room/fact-sheets/detail/abuse-of-older-people

Burgess, A. W. (2006, December). Elderly victims of sexual abuse and their offenders. Boston College Connell School of Nursing. Retrieved from https://www.ojp.gov/pdffiles1/nij/grants/216550.pdf 

National Center on Elder Abuse. (1998, September). The National Elder Abuse Incidence Study. U.S. Department of Health & Human Services. Retrieved from https://acl.gov/sites/default/files/programs/2016-09/ABuseReport_Full.pdf