Elder abuse and neglect is all too common in our society. It is estimated that hundreds of thousands of elders are
abused at home and in institutions each year. Sadly, the number of victims is expected to rise as the population
Our picture of elder abuse is limited, due to the problem’s hidden and complex nature. Often, a shroud of secrecy
surrounds those involved. Many times victims remain unnoticed and untreated, because they are isolated.
Another challenge for healthcare workers is that subtle forms of mistreatment can be hard to spot.
Whether you work in long-term care, acute care, outpatient care or home care, you may have to face the abuse
and neglect of elders. Show you care by committing yourself to safeguarding the elders in your care. When you
learn how to recognize and respond to mistreatment, you prepare yourself to break the cycle of abuse and neglect.
WHAT IS ABUSE AND NEGLECT?
The American Medical Association defines elder abuse and neglect as physical, psychological or financial
mistreatment of an elderly person. It may or may not be intentional and an older adult will often suffer several
forms of abuse and neglect at the same time.
Physical Abuse describes actions that result in mistreatment. It is an act that results in bodily harm, injury,
impairment or disease, it usually takes the form of hitting, slapping, pushing, punching, pinching, burning or striking
with objects. It may also include sexual coercion or assault, incorrect positioning of the elder, forced feeding, and
improper use of physical restraints. Physical abuse is the most obvious form of abuse, because it leaves behind
telltale physical signs. Some forms of physical abuse are hard to spot such as:
- Rushing an elder or pulling him or her too fast when helping them walk.
- Tying a wandering senior to a chair, so she or he won’t get lost while you are busy.
- Roughly assisting a senior to a chair, so you can once again change wet sheets.
- Giving an elder too much or too little medication.
It is never acceptable to use chemical or physical restraint for discipline or convenience.
Psychological Abuse inflicts emotional pain or distress on its victims. It comprises verbal scolding, harassment or
intimidation, threatening punishment or deprivation, treating the victim like a child or infant, or isolating the elder
from family, friends, or activities. It often goes hand-in-hand with physical abuse. When it doesn’t, it’s harder to
spot unless you witness it. Generally, the victim’s demeanor and behavior offer clues. Depression, fear,
hopelessness, withdrawal or isolation can signal psychological abuse.
- You may not recognize some of the more subtle forms of psychological abuse such as: taking something away
from a patient or resident when you are angry, scolding someone in front of others when he has done something
embarrassing like soiled his pants, or isolating someone. These acts create an environment where the person may
feel shame, insecurity or a lack of control and can be psychologically damaging.
Financial Abuse occurs when people take control of the elder’s resources through misrepresentation, coercion or
outright theft for their own gain. Financial abuse may include stealing money or possessions, forcing the elder to
sign contracts or assign durable powers of attorney to someone, or charging the older adult for unnecessary
services or services never rendered. Financial abuse can be difficult to identify, because there are often no
obvious indicators, and the victim may be unaware it’s happening.
Physical Neglect refers to omissions or lack of attention to an elder’s person or environment. It involves failure to
provide goods and services necessary for the health and well-being of the elder. Physical neglect may include
withholding adequate meals or hydration, physical therapy or hygiene, as well as failure to provide physical aids
such as hearing aids, glasses, and false teeth, or safety precautions such as night lights or safety bars.
- You are neglecting elders if you take your time answering a call bell, if you move the button out of reach or if you
unplug it, even if the patient or resident uses the call button inappropriately sometimes. You are also neglecting
someone if you leave that person on the toilet for an extended time, even if you just forgot. If you remove an elder’
s cane or walker from the side of the bed, and it keeps the person from getting around, you are neglecting that
senior. It is also physical neglect if you mark the chart that the elder was repositioned in bed as ordered in the plan
of care, and then fail to do so.
Psychological neglect is failure to provide social stimulation. That may mean leaving the older person alone for
long periods of time, ignoring him or giving him the “the silent treatment,” or failing to provide companionship,
changes in routine, or links to the outside world.
Financial Neglect consists of failure to use available resources to sustain or restore the health and security of the
older adult. Signs may include: a family seeking care that does not meet the senior’s needs even though money is
available to provide the proper level of care, an elder’s confusion about her financial situation or a sudden transfer
Violation of Rights
Elders suffer abuse when their patient or resident rights are violated, in other words, when a caretaker ignores the
older person’s rights and abilities to make decisions. Rights violations may include denying the elder a right to
privacy, not allowing the elder to make decisions about healthcare or personal issues or treating the person
disrespectfully. For example, an elder’s rights are violated if forced to bathe or use the toilet or turn off the
television at your convenience, without being given a choice.
WHICH ELDERS GET ABUSED?
Research indicates that older adults from all walks of life can be victims of abuse – men and women from all racial
ethnic and economic groups. Seniors who are alert, full of life and independent despite advancing age may fall
victim to abuse. Likewise, elders who are more dependent on others because they are physically or mentally frail
also experience abuse. According to the National Elder Abuse Incidence Study and other research, more than half
of reported elder abuse victims are women, possibly because they often live longer than men. Among these
reported cases, elders aged 80 and older and those with physical or mental impairments are more likely to be
abused than are others.
Many senior victims are relatively isolated from society with little, if any, outside support. They are often dependent
on their abusers and are reluctant or even too embarrassed to complain. Victims may have mixed feelings about
their abusers and thus find it difficult to consider removing themselves from the abuser’s grasp.
Remember – any elder may fall victim to abuse!
WHO ARE THE ABUSERS?
Abusers are family members, caregivers, strangers, men and women. In more than half of reported cases the
abusers are male, according to the National center on Elder Abuse.
Family members are most often the abusers outside healthcare facilities. They may continue abusing elders even
after the person has entered a long-term care facility or a hospital. You should keep careful records if any patient
or resident develops injuries routinely after a visit from a certain family member. This may reveal a pattern of
abuse you need to assess.
Strangers can also be abusers, particularly in instances of assault or financial abuse. Be on the lookout for con
artists or anyone who appears out of place in or around the facility. Report suspicious activity to security or your
Anyone can be an abuser in healthcare facilities. In one study, forty percent of the healthcare staff who
participated in the survey admitted committing psychological abuse in the preceding year, while ten percent
admitted to physically abusing residents.
WHY DO ABUSE AND NEGLECT OCCUR?
Abuse and neglect can arise from misunderstanding or ignorance. Sometimes people feel frustrated with the
elderly, because they don’t really understand the effects of aging. They fail to give elders the extra tie they may
need to process information, respond to questions or perform tasks. These people may not mean to abuse
anyone, but they do. Several risk factors that have been identified as contributors to abuse and neglect follow.
- A caregiver’s pattern of dealing with stress is important. Caregivers with an abusive history may continue
that behavior at work. Some caregivers, particularly those with little or no formal training or support, can be
overwhelmed by the strain of caring for a dependent elder.
- Seniors who are abusive to their caregivers compound the stress factor. Some seniors may have abrasive
personalities, or they may have Alzheimer’s disease and so lack self-control. It’s important to step away from
the patient or resident if you feel angry or extremely frustrated. Return only after you’ve calmed down.
- Unresolved conflicts between family members or an elder’s history of abusive relationships are warning signs.
- Mental illness, alcoholism or drug abuse – in elders or caregivers – signal the potential for abuse and
- Inadequate building and grounds security can leave an elder vulnerable to abuse from strangers.
Whatever the cause, elder abuse and neglect are NEVER acceptable.
WHAT ARE THE WARNING SIGNS?
When should you suspect abuse or neglect? Many times, the possible victim can’t or won’t help you uncover the
truth. You need to be aware of the common warning signs of abuse and neglect and be on the lookout for them.
Physical abuse should be suspected when the described cause of injuries is inconsistent with medical findings, or if
the elder and caregiver give contradictory accounts. Physical evidence may include bruises, welts, lacerations,
fractures, burns, rope or restraint marks. Injuries in various stages of healing can indicate ongoing abuse. Genital
injuries may be symptomatic of sexual abuse. Laboratory results that indicate over- or under-medicating or
unexplained venereal disease should cause suspicion. Signs of neglect may include dehydration, malnutrition,
decubitus ulcers, poor personal hygiene or lack of compliance with medical regimes.
- You may be encountering psychological abuse or neglect in patients or residents who are extremely withdrawn,
depressed or agitated, behaving childishly or activing indifferently toward others. Financial abuse or neglect
should be considered if the senior appears to be receiving an inadequate level of care despite adequate financial
resources. Also be suspicious if the elder seems vague about his or her finances or has suddenly transferred
assets or control of them to someone else.
WHAT SHOULD BE DONE IF ABUSE OR NEGLECT IS SUSPECTED?
Any time you suspect abuse or neglect you must take action. It is your ethical and legal responsibility. Follow your
company’s assessment and reporting policies, which are designed to protect elders. When necessary, the proper
authorities will conduct a complete investigation. Here are some general guidelines.
- Intervene immediately when you see abuse or neglect, even when you just suspect it. Your primary concern
is to protect the victim. Take immediate steps to ensure the elder’s safety.
- Any time abuse is witnessed, it must be documented and further investigated. The incident must be
recorded accurately. The sooner it is documented, the more reliable the information. A report must be
written detailing victim and witness statements and should be signed by all parties. The incident must be
reported to the proper people.
- When abuse or neglect is suspected, the elder should be assessed without the suspected abuser present.
Questions should be direct, but not threatening or judgmental. The interviewer should encourage the
suspected victim to talk about the situation, including their relationship with the person who may be the
abuser. The elder should be asked directly if someone hurt them, or threatened them, or took anything
without asking and who it was. Then, anyone who may have seen what happened are interviewed. Any
differences between what the elder reports and what others are saying must be noted. All interviews must be
- A health assessment must also be conducted. The medical history helps to assess when, where and how
any injuries occurred and whether any inconsistencies exist between descriptions of events and physical
evidence. Physical evidence must be collected and documented in writing. Remember that bruises alone do
not confirm abuse, as the elderly often have frail, this skin which bruises or tears easily. Accurate, detailed
and objective records are crucial. Patient’s exact words should be noted in quotations.
- You must report the suspected abuse to the designated person in your company and directly to an
appropriate agency. Every state has an office of protective services to guide you. You may be required by
state law to report observe or suspected elder abuse. Failure to report can result in a claim of negligence.
Most states will not release the names of people who report elder abuse or neglect.
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