Elder Abuse: How to Spot It and Prevent It

Health Writer
Medically Reviewed

The victims are often frail, ill, and confused. The perpetrators are the people you’d least expect to harm them—family members, friends, sometimes even professional caregivers. The crime is elder abuse, and it’s a public health problem far more common than most of us realize.

In the February 2017 issue of The Lancet, researchers found that almost 16 percent of older people—or one in six—were victims of abuse. In the United States, one in 10 adults ages 60 and older who live at home suffers elder abuse, says the Centers for Disease Control and Prevention.

Most cases of elder abuse go unreported. Elderly victims often appear in emergency departments after being physically abused or neglected, making ERs a front line in identifying abuse.

Yet, in a 2017 study in the Journal of the American Geriatric Society, researchers reviewed data from almost 30 million emergency room (ER) visits by older adults. Of those, ER doctors identified only 3,846 cases of elder abuse—a fraction of the number of cases known to occur.

“Elder abuse is a pervasive and serious public health problem, but one that we are only beginning to find ways to address,” says Christopher R. Carpenter, M.D., an associate professor of emergency medicine at Washington University in St. Louis and president of the Academy of Geriatric Emergency Medicine.

A crime that takes many forms

Elder abuse is any intentional mistreatment committed by someone who cares for an older person. Nine in 10 abusers are family members, usually spouses or adult children. Abuse can include:

• Physical abuse, which can include inflicting physical pain or injury

• Psychological abuse, or using words or nonverbal means to inflict mental pain, anguish, or distress

• Sexual abuse, or any sexual contact without consent

• Financial abuse, which includes illegally misusing or concealing funds, property, or assets owned by a vulnerable elder

• Neglect, or failing to provide food, shelter, healthcare, or other essential protections and basic needs

• Abandonment, or deserting a vulnerable elder when someone has assumed responsibility for his or her care or custody. Victims of abuse often feel ashamed and don’t speak up. They may fear being removed from their home. Often, abusers blame their victims and threaten them not to reveal what’s happening.

Unfortunately, doctors aren’t always alert to the signs of abuse, compounding the problem. “Screening for elder abuse hasn’t been a high priority,” says Carpenter. “And making a diagnosis of abuse can be difficult. Symptoms of a fall and symptoms of physical abuse may look very similar, for example.”

How to prevent elder abuse

Risk factors that may make older adults particularly vulnerable include dementia, a history of stroke or a hip fracture, age 80 or older, and social isolation.

Of special concern is a caregiver who is financially dependent on the elderly person, has psychological problems, is violent or antisocial, or abuses drugs or alcohol.

Researchers are developing more effective screening tools to help doctors spot elder abuse. In a growing number of medical centers, specialized geriatric emergency medicine nurses are tasked with identifying community resources that patients and families can turn to for help.

If you have an elderly loved one who is dependent on care, check in frequently to see how he or she is doing. Find time to chat when the caregiver isn’t present, and look for signs of abuse or neglect.

If you suspect elder abuse, notify your state’s Adult Protective Services (APS) agency immediately. You can find your state’s APS number through the Eldercare Locator or by calling 800-677-1116.

You don’t need proof of abuse; you can simply report your concerns. APS keeps all information confidential. If you think someone is in immediate danger, call 911.

If you are a victim of abuse, speak with your doctor, a clergy member, a friend, or a family member you can trust or call the Eldercare Locator.

Warning signs of elder abuse

• Bruises, pressure or grip marks, unexplained broken bones, abrasions (often on the back of hands or arms), burns, and similar signs of physical violence

• Injuries or bruises around the breasts or genitals, genital infections, and genital bleeding, which can be signs of sexual abuse

• Bedsores and other indications of patient-care neglect

• Unexplained personality changes, including anxiety, lack of interest in activities, depression, and lethargy, which can be a sign of overmedication with the intent to keep the victim docile

• Dirty clothes, dirty surroundings, lack of dental care, unkempt fingernails or toenails and other signs of poor hygiene

• Unusual and unexplained weight loss, malnutrition, and dehydration

• Unpaid bills and unexplained transfers or withdrawals from accounts

• Abusive language and belittling comments by spouses or other family members directed at a vulnerable elder

• Strained or tense family relationships, including frequent arguments

• A caregiver who refuses to let others into the home or who hovers over an elderly person in their care, not letting him or her speak independently

• The appearance of a new “friend” who accepts generous “gifts” from the elder