Elder Abuse & NeglectElder Abuse & Neglect

“ “ It Happens At Home”It Happens At Home”

WHAT IS ELDER ABUSE?WHAT IS ELDER ABUSE?

Elder abuse is the mistreatment or Elder abuse is the mistreatment or neglect of an elderly person, usually by neglect of an elderly person, usually by a relative or other caregiver. At a relative or other caregiver. At greatest risk are the frail and/or greatest risk are the frail and/or isolated.isolated.

Elder abuse may include physical Elder abuse may include physical violence, threats of assault, verbal violence, threats of assault, verbal abuse, financial exploitation, physical abuse, financial exploitation, physical or emotional neglect, or sexual abuse.or emotional neglect, or sexual abuse.

Domestic violence among our older Domestic violence among our older population is a realitypopulation is a reality

as the population continues to age, the problem as the population continues to age, the problem not likely to just disappear.not likely to just disappear.

1990 - 4% of the population was 65 or older1990 - 4% of the population was 65 or older

2020 - 22% of the population will be 65 or older2020 - 22% of the population will be 65 or older

As baby boomers age, the need for services for As baby boomers age, the need for services for abused individuals is likely to increase.abused individuals is likely to increase.

Many people believe that elder abuse Many people believe that elder abuse happens in ( to quote elders) “happens in ( to quote elders) “one of one of those places” those places” meaning of course, nursing meaning of course, nursing homes or skilled nursing facilities. While homes or skilled nursing facilities. While some abuse does exist in these facilities, some abuse does exist in these facilities, the majority of elder abuse, neglect and the majority of elder abuse, neglect and exploitation, occurs in the home.exploitation, occurs in the home.

Elder abuse is often compared to child abuse Elder abuse is often compared to child abuse rather than spousal abuse. rather than spousal abuse.

Certain symptoms can appear, such as changes Certain symptoms can appear, such as changes in depth perception, confusion over when an in depth perception, confusion over when an event occurred, loss of control over bodily event occurred, loss of control over bodily functions, and hearing loss. functions, and hearing loss.

These can result in behaviors that some will These can result in behaviors that some will want to identify as “”childlike.” Along with this want to identify as “”childlike.” Along with this attitude can come the imposition of the same attitude can come the imposition of the same kind of control used on children, kind of control used on children, including including physical discipline.physical discipline.

Many older women do not identify themselves as Many older women do not identify themselves as abused. Some may see their relationship as abused. Some may see their relationship as normal.normal.

Many older women believe that battered women Many older women believe that battered women are exclusively young with children. are exclusively young with children.

Many older women were raised in a time when Many older women were raised in a time when they were expected to stay at home and care for they were expected to stay at home and care for their children. Divorce was not considered their children. Divorce was not considered socially acceptable.socially acceptable.

Older women who have internalized rigid gender Older women who have internalized rigid gender roles may be less willing to talk about their roles may be less willing to talk about their abuse or to seek help from community services. abuse or to seek help from community services. She doesn’t want to “air dirty laundry.”She doesn’t want to “air dirty laundry.”

Adult children are often not supportive of change Adult children are often not supportive of change in their parents’ relationship. If the abuse has in their parents’ relationship. If the abuse has been hidden from the children for years, they been hidden from the children for years, they may often refuse to believe it when they are told.may often refuse to believe it when they are told.

In some cases the children have seen the In some cases the children have seen the mother suffering the abuse, have become mother suffering the abuse, have become accustomed to it, and resent the sudden accustomed to it, and resent the sudden rebellion.rebellion.

Who are the Abusers?Who are the Abusers?

In 35% of the elder abuse cases in 30 In 35% of the elder abuse cases in 30 states surveyed, the abuse was states surveyed, the abuse was perpetrated by the victim’s adult children. perpetrated by the victim’s adult children.

The National Aging Resource Center on The National Aging Resource Center on Elder Abuse estimates the incidence of Elder Abuse estimates the incidence of abuse in domestic settings (not abuse in domestic settings (not institutions) at approximately 2.5 million institutions) at approximately 2.5 million cases per year. cases per year.

PrevalencePrevalence

According to the best available estimates, According to the best available estimates, between 1 and 2 million Americans age 65 between 1 and 2 million Americans age 65 or older have been injured, exploited or or older have been injured, exploited or otherwise mistreated by someone on otherwise mistreated by someone on whom they depended for care or whom they depended for care or protection.protection.Estimates of the frequency of elder abuse Estimates of the frequency of elder abuse range from 2% to 10% based on the range from 2% to 10% based on the survey methods and case definitions.survey methods and case definitions.

Data on elder abuse in domestic settings Data on elder abuse in domestic settings suggest that 1 in 14 incidents, excluding suggest that 1 in 14 incidents, excluding incidents of self neglect come to the incidents of self neglect come to the attention of authorities.attention of authorities.

Current estimates put the overall reporting Current estimates put the overall reporting of financial exploitation at only 1 in 12 of financial exploitation at only 1 in 12 cases suggesting that there maybe at cases suggesting that there maybe at least 5 million financial abuse victims each least 5 million financial abuse victims each year.year.

Facts and FiguresFacts and Figures The U.S. has 44 million persons age 60 or older, and 36 million The U.S. has 44 million persons age 60 or older, and 36 million people with disabilities.people with disabilities.

In the most recent year studied, Adult Protective Services In the most recent year studied, Adult Protective Services completed 364,512 investigations of abuse, neglect, or exploitation completed 364,512 investigations of abuse, neglect, or exploitation involving older persons living at home (in private, non-institutional involving older persons living at home (in private, non-institutional settings).settings).

Of these, an estimated 43% were confirmed.Of these, an estimated 43% were confirmed.

In the last decade, the number of domestic elder abuse reports In the last decade, the number of domestic elder abuse reports investigated by Adult Protective Services across the nation has investigated by Adult Protective Services across the nation has increased by more than 150 percent.increased by more than 150 percent.

Almost 62% percent of all cases of abuse, neglect, or exploitation of Almost 62% percent of all cases of abuse, neglect, or exploitation of adults living at home involve mistreatment by other people and 38% adults living at home involve mistreatment by other people and 38% involve self-neglect.involve self-neglect.

Domestic elder abuse is a family problem – almost 90% of abusers Domestic elder abuse is a family problem – almost 90% of abusers were family members.were family members.

Men were the abusers in over half of elder abuse cases.Men were the abusers in over half of elder abuse cases.

Risk Factors For AbuseRisk Factors For Abuse

Physical or cognitive impairment of the victimPhysical or cognitive impairment of the victimThe most likely victims are 75 and olderThe most likely victims are 75 and olderDependent on others for care and protectionDependent on others for care and protection

Isolation of the victimIsolation of the victim• Gradually preventing access to the telephoneGradually preventing access to the telephone

Barring visitors or service providersBarring visitors or service providersElder lives aloneElder lives aloneNo family or friendsNo family or friendsNot known to any community agencyNot known to any community agency

Caregiver stressCaregiver stress

Lack of skill in handling a frail personLack of skill in handling a frail person

Unaware of community resources and Unaware of community resources and respite programsrespite programs

Work outside the homeWork outside the home

Caring for childrenCaring for children

Fulfilling household dutiesFulfilling household duties

Caregivers own frailtyCaregivers own frailty

Dependence of the abuser on the victimDependence of the abuser on the victim

Financial dependence forcing families to Financial dependence forcing families to live togetherlive together

Psychopathology or mental incapacity of the Psychopathology or mental incapacity of the abuserabuser

Unresolved issues from childhoodUnresolved issues from childhood

that affects personality and behaviorthat affects personality and behavior

Mental illness or mental retardationMental illness or mental retardation

Alcohol or drug abuseAlcohol or drug abuse

Types of Elder AbuseTypes of Elder Abuse1. Financial or Material Exploitation: the illegal or improper 1. Financial or Material Exploitation: the illegal or improper

use of an elderly person’s funds, property or assets.use of an elderly person’s funds, property or assets.Unusual or inappropriate activity in bank accounts.Unusual or inappropriate activity in bank accounts.

Signatures on checks, etc. that do not resemble the Signatures on checks, etc. that do not resemble the older person’s signature or signed when the older person older person’s signature or signed when the older person cannot write.cannot write.Power of attorney given, or recent changes or creation of Power of attorney given, or recent changes or creation of a will, when the person is incapable of making such a will, when the person is incapable of making such decisions.decisions.Unusual concern by caregiver that an excessive amount Unusual concern by caregiver that an excessive amount of money is being expended on the care of the older of money is being expended on the care of the older person.person.Numerous unpaid bills, overdue rent, when someone is Numerous unpaid bills, overdue rent, when someone is supposed to be paying the bills for a dependent elder.supposed to be paying the bills for a dependent elder.

Lack of amenities, such as TV, personal Lack of amenities, such as TV, personal grooming items, appropriate clothing, that grooming items, appropriate clothing, that the estate can well afford.the estate can well afford.

Missing personal belongings such as art, Missing personal belongings such as art, silverware, or jewelry.silverware, or jewelry.

Deliberate isolation, by a housekeeper of Deliberate isolation, by a housekeeper of an older adult from friends and family, an older adult from friends and family, resulting in the caregiver having total resulting in the caregiver having total control.control.

2. Emotional /Psychological2. Emotional /Psychological

The infliction of anguish, pain or distress through The infliction of anguish, pain or distress through verbal or non-verbal acts such as: humiliating, verbal or non-verbal acts such as: humiliating, insulting, name calling or threatening, treating insulting, name calling or threatening, treating like a childlike a child

HelplessnessHelplessness Fear FearHesitation to talk openlyHesitation to talk openly AgitationAgitationWithdrawalWithdrawal ConfusionConfusionDepressionDepression DenialDenial Implausible stories Implausible stories AngerAnger

3. Neglect3. Neglect

the refusal or failure to fulfill any part of a person’s the refusal or failure to fulfill any part of a person’s obligations or duties to an elderly person; failure obligations or duties to an elderly person; failure to provide necessary careto provide necessary care

Dirt, fecal/urine smell, or other health and safety Dirt, fecal/urine smell, or other health and safety hazards in elder’s living environment.hazards in elder’s living environment.

Rashes, sores, liceRashes, sores, lice

Elder is inadequately clothedElder is inadequately clothed

Elder is malnourished or dehydratedElder is malnourished or dehydrated

Elder has an untreated medical conditionElder has an untreated medical condition

4. Physical & Sexual4. Physical & Sexual

any physical pain or injury which is willfully inflicted upon an any physical pain or injury which is willfully inflicted upon an elder by a person who has care or custody of, or who elder by a person who has care or custody of, or who stands in a position of trust with that elder. This includes stands in a position of trust with that elder. This includes direct beatings, sexual assault, unreasonable physical direct beatings, sexual assault, unreasonable physical restraint, and prolonged deprivation of food or water.restraint, and prolonged deprivation of food or water.Cuts, lacerations, puncture woundsCuts, lacerations, puncture wounds

Bruises, welts, discolorationBruises, welts, discoloration

Any injury incompatible with historyAny injury incompatible with history

Injuries not properly cared for Injuries not properly cared for

Poor skin condition, poor hygienePoor skin condition, poor hygieneAbsence of hair and/or hemorrhaging Absence of hair and/or hemorrhaging below scalpbelow scalpDehydration and/ or malnourished without Dehydration and/ or malnourished without illness-related causeillness-related causeLoss of weightLoss of weightBurns, which may be caused by Burns, which may be caused by cigarettes, caustics, acids, friction from cigarettes, caustics, acids, friction from ropes or chains ropes or chains Soiled clothing or bedSoiled clothing or bedGenital bruising or irritationGenital bruising or irritation

desertion or willful forsaking of an elder by desertion or willful forsaking of an elder by

any person having the care and custody ofany person having the care and custody of

that elder, under circumstances in which athat elder, under circumstances in which a

reasonable person would continue to reasonable person would continue to

provide care of custody.provide care of custody.

5. Abandonment5. Abandonment

6. Self Neglect6. Self Neglect

behavior of an elderly person that threatens his or behavior of an elderly person that threatens his or her own safety or healthher own safety or healthInability to manage personal finances, e.g. Inability to manage personal finances, e.g. hoarding, squandering, giving money away, hoarding, squandering, giving money away, failure to pay billsfailure to pay billsInability to manage ADLsInability to manage ADLsSuicidal acts, wanderings, refusing medical Suicidal acts, wanderings, refusing medical attention, isolation, substance abuseattention, isolation, substance abuseLack of toilet facilities or animal infested living Lack of toilet facilities or animal infested living quarters quarters

Rashes, sores, fecal/urine smell, Rashes, sores, fecal/urine smell, inadequate clothing, malnourished, inadequate clothing, malnourished, dehydrationdehydration

Changes in intellectual functioning, e.g. Changes in intellectual functioning, e.g. confusion, inappropriate or no response, confusion, inappropriate or no response, disorientation to time and place, memory disorientation to time and place, memory failure, incoherence, etc.failure, incoherence, etc.

Not keeping medical appointmentsNot keeping medical appointments

Refusal of medicationRefusal of medication

Interviewing The VictimInterviewing The Victim

Denial is an important element in elder Denial is an important element in elder abuse both for the victim as well as the abuse both for the victim as well as the offenders.offenders.Many victims blame themselves and Many victims blame themselves and minimize the extent of the abuse. minimize the extent of the abuse. Feelings of victims:Feelings of victims:Shame or embarrassmentShame or embarrassmentFear of retaliationFear of retaliationPowerlessness Powerlessness

Interview all clients in private without the Interview all clients in private without the caregiver’s presence. The client should:caregiver’s presence. The client should:Be treated with respectBe treated with respectBe asked for permission to ask questions, Be asked for permission to ask questions, examine injuriesexamine injuriesBe told that the person’s situation is one Be told that the person’s situation is one that you have seen beforethat you have seen beforeBe told that in many cases injuries are Be told that in many cases injuries are caused by someone in the elder’s familycaused by someone in the elder’s familyBe asked if the injuries were caused by Be asked if the injuries were caused by someone that the victim knowssomeone that the victim knows

If the client has the capacity to understand the If the client has the capacity to understand the dangers of the abuse and the consequences of dangers of the abuse and the consequences of remaining in the abusive situation, efforts should remaining in the abusive situation, efforts should be made to educate him or her about:be made to educate him or her about:

The fact that assault is a crimeThe fact that assault is a crime

The likelihood that the abuse will increase in The likelihood that the abuse will increase in frequency and intensityfrequency and intensity

The abuser needs help that the victim cannot The abuser needs help that the victim cannot provideprovide

The need for a safety plan to get away the next The need for a safety plan to get away the next time the situation becomes dangeroustime the situation becomes dangerous

The need for a safety plan to get away the The need for a safety plan to get away the next time the situation becomes next time the situation becomes dangerousdangerous

The fact that the abuser is responsible for The fact that the abuser is responsible for the violence not the victimthe violence not the victim

The need for support from othersThe need for support from others

Indicators of Abuse from the Indicators of Abuse from the CaregiverCaregiver

Elder not given opportunity to speak for Elder not given opportunity to speak for him/herself or see others without the presence him/herself or see others without the presence of the caregiverof the caregiverAttitudes of indifference or anger toward the Attitudes of indifference or anger toward the dependent person, or the obvious absence of dependent person, or the obvious absence of assistanceassistanceFamily member or caregiver Family member or caregiver blamesblames the elder the elder (e.g. accusation that incontinence is a deliberate (e.g. accusation that incontinence is a deliberate act)act)Aggressive behavior by caregiver toward the Aggressive behavior by caregiver toward the elderelder

Previous history of abuse to othersPrevious history of abuse to others

Problems with alcohol or drugsProblems with alcohol or drugsInappropriate displays of affection by Inappropriate displays of affection by caregivercaregiverFlirtations, coyness, etc as possible Flirtations, coyness, etc as possible indications of inappropriate sexual indications of inappropriate sexual relationshiprelationshipSocial isolation of family or isolation or Social isolation of family or isolation or restriction of activity of the older adult restriction of activity of the older adult within the family unit by the caregiverwithin the family unit by the caregiver

Conflicting accounts of incidents by family, Conflicting accounts of incidents by family, supporters or victimsupporters or victim

Unwillingness or reluctance by the Unwillingness or reluctance by the caregiver to comply with service providers caregiver to comply with service providers in planning for care and implementationin planning for care and implementation

Inappropriate or unwarranted Inappropriate or unwarranted defensiveness by caregiverdefensiveness by caregiver

OLDER ABUSE VICTIM PROFILEOLDER ABUSE VICTIM PROFILE

Female Female - Older women are less likely to - Older women are less likely to resist abusive behavior and are more resist abusive behavior and are more vulnerable to sexual molestations.vulnerable to sexual molestations.Advanced AgeAdvanced Age - As people age they lose - As people age they lose the capacity of physical strength to resist the capacity of physical strength to resist or defend themselves.or defend themselves.DependentDependent - Older persons who depend - Older persons who depend on others for their care are more on others for their care are more vulnerable.vulnerable.

Excessive loyaltyExcessive loyalty - If the victim has a - If the victim has a strong sense of loyalty to the care giver, strong sense of loyalty to the care giver, he/she will probably not seek help.he/she will probably not seek help.

StoicismStoicism - Some persons accept their - Some persons accept their troubles without seeking relief based on a troubles without seeking relief based on a philosophy, job, tolerance, resignation, or philosophy, job, tolerance, resignation, or fear.fear.

Substance abusersSubstance abusers - Older substance - Older substance abusers are very susceptible to abusive abusers are very susceptible to abusive behavior and are frequently self-neglectfulbehavior and are frequently self-neglectful

ImpairmentImpairment - the greater the infirmities of - the greater the infirmities of the one needing care, the greater the the one needing care, the greater the demand on the care giver. If the person’s demand on the care giver. If the person’s infirmity includes mental impairment, it infirmity includes mental impairment, it exacerbates the stress for the care giver.exacerbates the stress for the care giver.

Poverty Poverty - Poverty is common among - Poverty is common among elderly which adds stress to the care giver.elderly which adds stress to the care giver.

WHAT CAN YOU DO?WHAT CAN YOU DO?

Elder Abuse is a serious offense. Elder Abuse is a serious offense. Report it to the Abuse Hotline at Report it to the Abuse Hotline at

1-800-96ABUSE1-800-96ABUSE

ACT SERVICESACT SERVICESALL SERVICES ARE FREE TO VICTIMS AND ALL SERVICES ARE FREE TO VICTIMS AND

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