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Recognizing Signs of Elder Abuse, Neglect, or Abandonment in Your Visually Impaired Clients

by Audrey Demmitt, R.N., VisionAware Peer Advisor

Older woman with support cane talking to health care professional

Approximately 1 in 10 Americans aged 60+ have experienced some form of elder abuse. The Center for Disease Control and Prevention defines elder abuse as an "intentional act or failure to act by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a serious risk of harm to an older adult." It can happen to anyone-no matter the person’s sex, race, culture or creed and it can happen in the person’s home, a family member’s home or in assisted living or nursing care facilities. According to the National Council on Aging, two thirds of perpetrators are adult children or spouses; both men and women caregivers.

Different Forms of Elder Abuse or Mistreatment

  • Physical Abuse—non-accidental use of force that results in physical pain, injury, or impairment. Such abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement.
  • Emotional or Psychological Abuse—speaking to or treating elderly persons in ways that cause emotional pain or distress, including:
    • Intimidation through yelling or threats
    • Humiliation and ridicule
    • Habitual blaming or scapegoating
    • Ignoring the elderly person
    • Isolating an elder from friends or activities
    • Terrorizing or menacing the elderly person
  • Sexual Abuse—contact with an elderly person without the elder's consent. Can involve physical sex acts, showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress.
  • Elder Neglect or Abandonment—failure to fulfill a caretaking obligation. It can be intentional or unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does.
  • Financial Exploitation—involves unauthorized use of an elderly person's funds or property, either by a caregiver or an outside scam artist.
  • Healthcare Fraud—Carried out by unethical doctors, nurses, hospital personnel, and other professional care providers. Examples of healthcare fraud and abuse regarding elders include:
    • Not providing healthcare, but charging for it
    • Overcharging or double-billing for medical care or services
    • Getting kickbacks for referrals to other providers or for prescribing certain drugs
    • Over-medicating or under-medicating
    • Recommending fraudulent remedies for illnesses or other medical conditions
    • Medicaid fraud

Risk Factors that Contribute to the Problem

There are risk factors for both the victims of abuse and the abusers. Who is most likely to be abused and who is more likely to be an abuser? Considering these factors can help us understand the problem, identify vulnerable individuals, and treat the core issues appropriately.

Elder Risk Factors

  • The intensity of an elderly person’s illness, dementia or disability
  • Social isolation; i.e., the elder and caregiver are alone together almost all the time
  • The elder’s role, at an earlier time, as an abusive parent or spouse
  • A history of domestic violence in the home
  • The elder’s own tendency toward verbal or physical aggression

Caregiver Risk factors

  • Inability to cope with stress (lack of resilience)
  • Depression, which is common among caregivers
  • Lack of support from other potential caregivers
  • The caregiver’s perception that taking care of the elder is burdensome and without psychological reward
  • Substance Abuse

It’s important to remain alert to the signs. Elder abuse is a complex issue and the suffering is often in silence. If you notice changes in personality, behavior, or physical condition, you should start to question what is going on.

Warning Signs of Elder Abuse

  • Physical abuse: Bruises, pressure marks, broken bones, abrasions, burns
  • Emotional abuse: Unexplained withdrawal from normal activities, a sudden change in alertness, or unusual depression; strained or tense relationships; frequent arguments between the caregiver and older adult
  • Financial abuse: Sudden changes in financial situations
  • Neglect: Bedsores, unattended medical needs, poor hygiene, unusual weight loss
  • Verbal or emotional abuse: Belittling, threats, or other uses of power and control by individuals

What Is Self-Neglect?

Sometimes elders or adults with disabilities neglect their own care, which can lead to illness or injury. Signs of self-neglect can include:

  • Hoarding of objects or animals to the extent there are safety and health risks to the individual, the household or the community.
  • Inability to provide adequate food, fluids and nutrition for oneself
  • Inability or refusal to take essential medications or to seek medical treatment for serious illness
  • Leaving a burning stove unattended
  • Poor hygiene
  • Not wearing suitable clothing for the weather
  • Confusion
  • Inability to attend to housekeeping

Self-neglect is one of the most frequently reported concerns brought to adult protective services. Oftentimes, the problem is related to declining health, isolation, Alzheimer’s disease or dementia, or drug and alcohol dependency.

What Is Adult Protective Services?

Adult Protective Services (APS) is a social services program provided by state and local governments nationwide. They serve seniors and adults with disabilities who need assistance. APS workers frequently serve as first responders in cases of abuse, neglect or exploitation, working closely with professionals such as physicians, nurses, paramedics, firefighters and law enforcement officers.

How APS Can Help

Some seniors and adults with disabilities face abuse or neglect by others and need trained professionals to advocate on their behalf. Others may simply be struggling with daily living activities and benefit from in-home support services to maintain their health and independence. APS helps by assessing each individual’s unique needs, then developing a service plan to maintain his/her safety, health and independence.

If an older adult is in immediate, life-threatening danger, call 911. Anyone who suspects that an older adult is being mistreated should contact a local Adult Protective Services office, Long-Term Care Ombudsman Program, or the local police.

Note: According to the APS Survey, 49 states currently have mandatory reporting statutes for elder abuse. Many professionals are required to report suspected mistreatment and some states require all citizens to report suspected abuse. A call to APS is not to get someone in trouble; it is to get someone help. Check the National Center for Elder Abuse website to learn more.

Be Alert and Observant

Professionals who work with older persons can forestall abuse by being alert and observant. You may be able to refer a consumer to needed resources. And in some situations, you may even save a life by acting quickly and knowledgeably.

Additional Information

Dealing with Crime or Disability

Don't Let Consumer Fraud Fool You

Recognizing Elder Abuse and Knowing Your Rights

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