Results from the National Elder Abuse Incidence Study, funded in part by the Administration on Aging, suggest that over 500,000 people 60 years of age and older are abused or neglected each year in the United States. It was also found that four times as many incidents of abuse, neglect, or self-neglect are never reported, causing researchers to estimate that as many as 2 million elderly persons in the United States are abused each year. In 90% of the cases, the abusers were found to be family members and most often were the adult children or spouses of those abused. In addition, equal numbers of men and women have been identified as the abusers. However, women, especially those over 80 years of age, tend to be victimized more than men.

Elder abuse can take place anywhere, but the two main settings addressed by law are domestic settings, such as the elder’s home or the caregiver’s home, and institutional settings, such as a nursing home or group home. In general, there are five basic types of elderly abuse: physical, sexual, emotional or psychological, financial, and neglect. Data from National Center on Elder Abuse indicates that more than half of the cases reported involve some kind of neglect, whereas 1 in 7 cases involve physical abuse. It is considered neglect when a caretaker deprives an elderly person of the necessary care needed in order to avoid physical or mental harm. Sometimes the behavior of an elderly person threatens his or her own health; in those cases, the abuse is called self-neglect. Physical abuse refers to physical force that causes bodily harm to an elderly person, such as slapping, pushing, kicking, pinching, or burning.

About 1 in 8 cases of elderly abuse involve some form of financial exploitation, which is defined as the use of an elderly person’s resources without his or her consent. The National Center on Elder Abuse defines emotional and psychological abuse of a senior as causing anguish, pain, or distress through verbal or nonverbal acts, such as verbal assaults, insults, intimidation, and humiliation, for example. Isolating elderly persons from their friends and family as well as giving them the silent treatment are two other forms of emotional and psychological abuse. Any kind of non-consensual sexual contact with an elderly person that takes place without his or her consent is considered sexual abuse.

Elder abuse is admittedly a complex problem that can be caused by many factors. According to the National Center on Elder Abuse, “social isolation and mental impairment, such as Alzheimer’s disease) are two factors that may make an older person more vulnerable to abuse.” Studies show that people advanced in years, such as in their eighties, with a high level of frailty and dependency are more likely to be victims of elder abuse than people who are younger and better equipped to stand up for themselves. Because spouses make up a large percentage of elder abusers, at least 40% statistically, some research has been done in the area, which shows that a pattern of domestic violence is associated with many of the cases. The risk of elder abuse appears to be especially high when adult children live with their elderly parents for financial reasons or because they have personal problems, such as drug dependence or mental illness. Some experts have speculated that elderly people living in rural areas with their caretakers may have a higher risk of being abused than city dwellers. The idea behind this theory is that the opportunity exists for the abuse to occur, but there is less likelihood that the abuser will be caught. However, there may be a flaw in that logic, because anyone who has ever lived in a rural town knows that people tend to know one another and eventually someone is bound to notice and report consistent wrongdoing. More research in this very important area is needed in order to illuminate the relationship between these factors.

The National Center on Elder Abuse identifies the following as signs of elder abuse:

• Bruises, pressure marks, broken bones, abrasions, and burns may indicate physical abuse or neglect.
• Unexplained withdrawal from normal activities and unusual depression may be indicators of emotional abuse.
• Bruises around the breasts or genital area, as well as unexplained bleeding around the genital area, may be signs of sexual abuse.
• Large withdrawals of money from an elder’s bank account, sudden changes in a will, and the sudden disappearance of valuable items may be indications of financial exploitation.
• Bedsores, poor hygiene, unsanitary living conditions, and unattended medical needs may be signs of neglect.
• Failure to take necessary medicines, leaving a burning stove unattended, poor hygiene, confusion, unexplained weight loss, and dehydration may all be signs of self-neglect.

The National Committee for the Prevention of Elder Abuse notes that Adult Protective Services (APS) caseworkers are often on the front lines when it comes to elderly abuse. People being abused or those who believe abuse is taking place can turn to their local APS office for help. The APS routinely screens calls, keeps all information confidential, and, if necessary, sends a caseworker out to conduct an investigation. In the event that a crisis intervention is needed, the APS caseworker can arrange for any necessary emergency treatment. If it is unclear whether elder abuse has taken place, the APS caseworker can serve as a liaison between the elderly person and other community agencies.

According to the National Committee for the Prevention of Elder Abuse, “professionals in the field of aging are often the first to discover signs of elder abuse.” Providing encouragement and advice, they play a critical role in educating others with regard to the needs of the elderly. They not only provide valuable support to the victims of abuse, but they also monitor high-risk situations and gather important information that can help validate that abuse has taken place.

But what happens when a person is mentally impaired and there are no physical signs of abuse? Some people might think that a person who has cognitive impairment might be unable to describe mistreatment; however, that is not the case. In fact, guidelines set by the American Medical Association call for &ldquo:routine questions about abuse and neglect even among patients with cognitive impairment in order to improve the identification of cases and implement appropriate treatment and referral.” Rather than an inability to describe mistreatment, what might stop an elderly person from reporting abuse is a sense of embarrassment or fear of retaliation. To complicate matters, as Clarke and Pierson point out in their 1999 article published in Emergency Medical Clinics of North America, differences exist among cultural groups regarding what defines abuse.

Therefore, most states have established laws that define elder abuse and require health care providers to report any cases they encounter with penalties attached for failing to do so. Indeed, statistics show that health care providers, for example, report almost 25% of the known cases of elder abuse. Therefore, physicians play a very important role in identifying and treating elders who have been abused. And yet, in an article published by the Journal of the American Geriatrics Society, Dr. Conlin pointed out that only 1 of every 13 cases of elder abuse are reported by physicians. There may be several reasons for this. In some cases, the problem may simply go unnoticed, especially if the physician has no obvious reason to suspect any wrongdoing. In other cases, the patient may hide or deny the problem.

In recent years, much media attention has been focused on elderly abuse that takes place in institutional settings. Anyone who believes that a loved one is being abused while in a nursing home or other institutional setting should contact the authorities for assistance immediately.

According to a leading 1998 study conducted by Lachs and colleagues, the mortality rate of an elderly person who has been mistreated is higher than the mortality rate of an elderly person who has not experienced abuse. Nonetheless, numerous success stories exist regarding successful interventions. Social workers and health care professionals, as well as concerned citizens from a variety of backgrounds, have played a key role in identifying and obtaining treatment for abused elders.

Planning for the future is one of the best ways to avoid elder abuse. Consider a variety of retirement options, ones that will encourage safety as well as independence. It is important to stay active in the community. Avoiding isolation minimizes the likelihood that abuse will occur. Seek professional counsel when necessary; it is important for everyone to know their rights and to be advocates on their own behalf.