Photo by Tatiana Zanon on Unsplash
It’s no secret that aging brings with it a new set of challenges. Decreased physical ability, often increased isolation, and monetary struggles are just a few hurdles that elderly adults may face. Unfortunately, more invisible challenges can occur, including elder abuse.
Elder abuse is “an intentional act or failure to act that causes or creates a risk of harm to an older adult,” according to the Centers for Disease Control. Abuse of an older adult, who is defined as at least 60 years old, occurs at the hands of a caregiver or trusted person. A caregiver doesn’t have to be a family member. It could be someone to whom the care of an older adult has been given by family and loved ones, including nursing home staff.
About 10 percent of adults aged 65 and older experience some form of elder abuse in a year, according to the U.S. Department of Justice. Elder abuse can come in multiple forms, including:
- Physical abuse: This generally includes physical violence or behaviors that lead to the physical endangerment of older adults.
- Sexual abuse: The sexual exploitation of older adults or forcing an older adult to perform sexual acts or intercourse against their will.
- Emotional or psychological abuse: This can be verbal abuse; isolation; or attempts to frighten, control, or isolate.
- Neglect: Not getting the older adult what they need physically (such as food, water, shelter, clothes, and hygiene), emotionally (psychological needs such as community, attention, or emotional validation), or medically (failure to provide medical or mental health care or withholding medication).
- Financial abuse: Exploitation of elderly adults in regards to their finances. Generally a financial abuser takes advantage of the older adult for financial gain.
Many older adults experience more than one of these types at a time. Of these, psychological abuse, financial abuse and exploitation, and neglect top the list, according to both the Department of Justice and a 2017 study conducted by the National Library of Medicine.
What many don’t realize is that elder abuse occurs in high numbers at nursing homes. In fact, rates of abuse are often higher at such institutions, with the World Health Organization (WHO) reporting that 2 in 3 staff said they had committed abuse between 2023 and 2024. One in six adults over the age of 60 experienced abuse in a community setting in that same period, WHO reports. These are startling numbers, and it can be concerning for those who have loved ones in nursing homes or elderly care facilities or are considering these options. What can elders and those who love them do about this issue to feel secure?
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Notice the signs
Older adults are more vulnerable to abuse than many populations, particularly because of the increased likelihood of isolation and mental and physical impairment. Because of this, family and loved one’s are a first line of defense. Here are some signs that abuse may be going on, according to the National Center on Elder Abuse.
Physical signs of physical abuse, neglect, or mistreatment:
Many forms of abuse can leave physical evidence, even if the signs are not specifically from physical violence. Neglect, sexual abuse, and other forms of mistreatment can leave their own marks. Physical signs of abuse, whether from neglect, physical violence, or mistreatment, include:
- bruises
- bed sore
- broken bones
- cuts and abrasions
- burns
- welts
- unexplained weight loss
- facial or dental injuries
- falls that cause fractures or head injuries
- infection left to turn into sepsis
- unexplained sexually transmitted infections or diseases
Emotional and behavioral signs of abuse
Emotional and behavioral signs of abuse are likely more subtle than physical signs you might notice more easily. All forms of abuse can leave emotional or behavioral traces, and it is likely that any signs from emotional or psychological abuse will take the form of changes to mental health or behavior. These changes can look like:
- withdrawal from activities previously enjoyed or engaged in
- isolation from family or friends
- increased fear or anxiety
- unusual behavior or sleep changes
- changes in alertness
- frequent arguments between the older adult and caregiver
- depression that is out of the norm for the individual in question
Signs of financial abuse
Again, because of the increased likelihood of isolation and mental impairment, many older adults are vulnerable to financial exploitation at the hands of caregivers. Financial abuse can be spotted by:
- sudden changes in financial situation, such as unpaid bills, fraudulent signatures on financial documentation, or sudden changes to spending, wills, or financial documents.
You may also observe signs of abuse from staff members and perpetrators, including showing disrespect toward residents or a negative attitude, not responding to requests for assistance from residents, not responding to conflicts between residents, or improperly administering medications, to name a few. Some residents and visitors report actively witnessing physical violence of staff toward other residents.
What to do if you suspect abuse
The issue of elder abuse is a big one, and understanding that it occurs is an important step toward prevention and response. So what comes next? When you know it can occur and can spot the signs, what can you do? The good news is that older adults, bystanders, and loved ones are not powerless if they observe or suspect abuse. You can take action in a variety of ways. Here are a few.
In the event of a life threatening emergency, call 911.
This one is a no-brainer if your loved one or another resident is in immediate physical danger. While this doesn’t necessarily stop the abuse in the long-run, the priority is immediate safety.
Change nursing homes if needed.
This may seem like an obvious step, but you and your older adult loved one have the right to receive the care you want, regardless of whether or not you’ve been able to substantiate your suspicion of abuse. If you or your loved one are uncomfortable, it is your right to be able to choose an alternative care facility.
Enlist the help of a local ombudsman for nursing homes.
An ombudsman is an official often appointed by the government whose job it is to respond to complaints and concerns against businesses, institutions, etc. These complaints are usually reported by citizens. Most states have a local ombudsman as part of the States’ Long-Term Care (LTC) Ombudsman program. Nursing home ombudsman programs are designed to identify and respond to resident concerns and complaints regarding nursing home and long-term care facilities treatment and conditions. An ombudsman can also advocate on behalf of residents to government agencies and in legal and administrative matters. This is an especially good option if you aren’t sure about your suspicions of abuse, as all reporting is confidential. You can find out more through the Administration for Community Living and the National Long-Term Care Ombudsman Resource Center.
Report it.
You can also report abuse to law enforcement, Adult Protective Services, your state licensing agency, or local reporting agency. You can find out more about who to report to here.
Preventing abuse
Before abuse reaches a life altering or threatening point, there are ways to either prevent it entirely or cut it off at the start.
- Listen to your loved one’s concerns. The biggest expert on their own situation is the elderly person. If an older adult confides in you about their worries or discomfort, it is important to listen empathetically. Resist any urge to be dismissive and ask them questions about their life at the facility.
- Recognize the signs of abuse. Noticing these signs early can make a huge difference to your loved one’s safety.
- Understand how abuse signs and regular signs of aging differ (for example, decreases in mental functioning due to cognitive decline can create disinterest in previous activities or a lack of engagement, which is different than withdrawal seen as a sign of abuse).
- Check in on your loved one regularly. You can’t recognize signs of abuse or listen if you aren’t there. Being present is important, both for preventing abuse and for increasing their overall well-being.
If you are an older adult, here are some ways you can protect yourself and decrease the likelihood of vulnerability to abuse:
- Take care of your physical health. The more you take care of your physical health, the more likely it is that you will keep yourself from a situation where you are more vulnerable.
- Open and send your own mail. Entrusting this to someone you don’t fully trust, or even someone you do, increases the likelihood of being taken advantage of and having your private information exposed or exploited.
- Do not give personal information over the phone. Similar to the last tip, giving out personal info on the phone risks leaking of your private information. Many legitimate institutions will never request information over the phone, so refusing to give info on the phone keeps you from being defrauded.
- Connect with friends and family and stay active in the community. The more people you have that you can connect with and share your concerns, the more of a social and safety buffer you have against abuse.
- Have your own phone. This increases your ability to call for help and decreases isolation.
- Know your rights. You will be in a better position to know when you’re being exploited and when to seek legal help.
- Direct deposit your checks. This ensures your money is going into your account, not someone else’s. It also protects your personal information.
- Review your will periodically. That way, you can keep track of whether or not changes have been made fraudulently and without your permission.
You’re not alone in the issue of elder abuse, and there are lots of organizations and institutions in place to offer help and support if family or friends feel inaccessible, or even if they are. Here is a list of resources for where to go for help and learn more about the prevention of elder abuse:
- National Long-Term Care Ombudsman Resource Center
- Administration on Community Living Legal Assistance
- Nursing Home Abuse Center
- Eldercare Center for identifying local reporting agencies
- National Council on Aging