A Caregiver’s Guide to Understanding, Recognizing, and Preventing Elder Abuse

The Centers for Disease Control and Prevention (CDC) 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 risk of harm to an older adult.”

Because the relationship between an older adult and their caregiver is one of implicit and complete trust, elders expect to be treated compassionately. They place their needs and health in the hands of their caregiver. When caregivers exploit that trust in a way that harms the elder, it’s abuse.

It’s worth noting that the CDC includes “failure to act” as a form of elder abuse in its definition. Caregivers who ignore or neglect their duties are also abusive, even if they did not commit or plan to commit intentional harm. This act of neglect can be just as damaging as purposefully hurting or manipulating an older adult.

Elder abuse can take many forms. Perpetrators may take advantage of finances, be emotionally abusive, or even get physically abusive with elders. Individuals may experience multiple forms of abuse at the same time or at different points in their lives. Because there are so many forms of abuse, it’s likely that no two people will have the exact same experience with it.

As experts continue to learn more about elder abuse, the definition may be expanded to include more types. Currently, the NCEA recognizes seven forms of elder abuse:

Physical elder abuse occurs when caretakers use physical force on an older adult that might or could be expected to result in bodily harm, pain, injury, or impairment. This can include hitting, shoving, slapping, kicking, biting, shaking, beating, or burning the victim.

Perpetrators may use their own body or an object to physically harm the victim. Physical abuse can also take the form of punishments, force-feeding, giving drugs without knowledge or consent, and restraining the victim.

Also called “psychological abuse,” emotional elder abuse involves using verbal or nonverbal (but not physical) means to cause pain, anguish, or distress in the victim. This can encompass, but is not limited to, insults, verbal threats or assault, humiliation, harassment, or intimidation.

Being treated like a child, social isolation, or refusing to speak to the senior as a punishment are all examples of psychological abuse.

Neglect can encompass any situation in which the caretaker ignores or does not meet all the elder’s care needs. Often, this form of abuse takes place when the caretaker doesn’t provide the necessities that an elder individual needs to live, such as food, water, shelter, medications, hygiene, clothing, personal safety, or comfort.

Abandonment is the desertion of an elder by their caretaker. Abandonment can occur when a caretaker leaves the older adult at a location outside of the home or suddenly abdicates their post altogether.

Self-neglect is a type of elder abuse wherein the elder behaves in a way that threatens their own health or safety. This often takes the form of an older adult who either refuses or fails to provide themselves with the necessities they need to live. As such, it is the responsibility of a caregiver to remedy the situation or report noncompliance to the proper authorities for assistance.

Financial abuse involves taking advantage of an older adult’s finances and using their property or assets in an illegal, unauthorized, or improper way. This can take several forms, such as overcharging them for services or a purchase, coercing them into a financial arrangement that doesn’t benefit them, stealing money or belongings from them, or forging their signature on financial or legal documents. It can also include abusing the benefits of being someone’s power of attorney or conservator for personal or financial gain.

Sexual abuse is defined as having nonconsensual sexual contact with an older adult, whether by force or coercion. Examples of sexual abuse include unwanted advances, touching, taking nude photographs of the elder without knowledge or consent, coerced nudity, or sexual assault. If someone is unable to provide consent, any form of sexual contact is sexual abuse.

Elder abuse is common. You should never assume that it won’t happen to you, your family members, or your patients. Abuse can happen to anyone, and as the senior population continues to grow, it will likely become more of an issue.

To better illustrate the scope of the problem:

• Only about one in 14 cases of elder abuse are reported to the authorities.
• The perpetrators of elder abuse are the victim’s family members in 60% of reported cases. Perpetrators are most likely to be adult children or spouses.
• Different studies have uncovered conflicting results about the most common form of elder abuse. While one study found that financial abuse was most frequently reported, another study reported neglect to be the most common form of elder abuse.
• 2% of staff members at institutions like nursing homes, hospitals, and long-term care facilities committed some form of elder abuse in the past year.
• It’s estimated that financial abuse costs elderly victims over $2.6 billion each year.
• The elderly population is expected to increase, as are the numbers of abuse victims. By 2050, there could be as many as 320 million victims of elder abuse globally.
• A lack of social support, a mental impairment such as Alzheimer’s disease or dementia, and previous traumatic experience are risk factors for elder abuse.
• Victims of elder abuse are three times more likely to be hospitalized or die prematurely than seniors who are not abused.

There are laws and regulations in place to help protect elders from abuse and to penalize perpetrators. The federal government has passed laws to bolster services that identify, prevent, and intervene in cases of elder abuse, such as the Elder Justice Act and the Older Americans Act.

While the Older Americans Act primarily provides funds for services that help seniors maintain independence, the Elder Justice Act is the first federal law to specifically finance elder abuse prevention and support programs.

Most of the policies that protect elders from abuse have been passed at the state level. All 50 states and the District of Columbia have some kind of legislation in place to address elder abuse. The nature and extent of these laws can vary between states: While some laws are included in criminal codes, other states embed their statutes into welfare or business codes. You should familiarize yourself with the laws in your state to understand what legal protections are in place for you, your loved one, or your patient.

The U.S. Department of Justice offers an in-depth look at the different statutes in place for each state. The NCEA also provides a state-by-state look at various resources and agencies available to seniors who have experienced elder abuse.

Despite the various pieces of legislation that exist to protect seniors, the best way to support older adults is to try and prevent elder abuse from happening in the first place.

It’s important to note that victims do not invite or ask for abuse, and caregivers can perpetrate abuse regardless of any steps you take to prevent them. There are a few things you can do, however, to help reduce the chances that you, a family member, or a patient might experience elder abuse:

• Don’t isolate seniors from friends or family. Encourage them to stay socially active, continue doing activities or hobbies they enjoy, and maintain a supportive community.
• Find a trusted caregiver or caregiving facility. Never give the responsibility of senior care to someone you haven’t fully vetted.
• Due to Alzheimer’s, dementia, and other age-related complications, it can often be difficult for seniors to manage their finances. As a precaution, families should see to it that there is full transparency on issues of financial and estate planning by someone the elder trusts.
• Talk to caregivers and doctors about elder abuse. Nursing home administrators and healthcare professionals are the first lines of defense against elder abuse and should be aware of your concerns, as well as how to identify any signs of abuse.

Learning how to identify the various signs of elder abuse is one of the most effective methods of prevention. Elder abuse tends to leave signs you can recognize if you are attentive and know what to look for. Nurse practitioners with an emphasis on gerontology are in a special position to identify abuse, but anyone who is close to a senior, as well as older adults themselves, should educate themselves on these signs.

The most important and unmistakable sign of elder abuse, regardless of the form it takes, is if seniors claim they are being abused. Seniors may not directly state that they are being abused, but they might discuss how they are being exploited or mistreated in some way. These claims need to be taken seriously, and you must believe older adults if they disclose any abuse to you.

Aside from direct reports, the signs of elder abuse can vary depending on the form of abuse being perpetrated.

Some of the most common signs of physical abuse — particularly if the senior cannot or will not explain how they occurred — include:

• Broken bones
• Bruises or welts
• Open wounds (like bedsores) or cuts
• Sprains or dislocations
• Internal injuries
• Broken glasses or possessions
• Evidence of restraints
• Evidence of improper medication use
• Sudden personality shift
• Abrupt changes in behaviors
• Caregivers refusing to let senior be alone with others

Emotional abuse can be more difficult to detect than physical abuse as there may not be any physical indication or evidence of it taking place. However, emotional abuse can be just as damaging, and seniors may still exhibit symptoms if they are experiencing it.

Some of the most apparent signs of emotional abuse come from an older adult’s mood and behavior. They may:

• Become unresponsive and withdrawn
• Be upset, agitated, or irritated easily
• Behave unusually or differently

These symptoms may begin to present themselves suddenly, so it is important to be especially wary if they materialize shortly after finding a new caregiver or senior living facility.

Due to certain medical conditions that may cause a loss of cognitive activity during the aging process, elderly patients who are at risk of neglect or abandonment by their caregivers may not always understand the danger they are in. Concerned family or friends should be on the lookout for the following signs:

• Unsanitary living conditions
• Untreated bed sores
• Overall poor health
• A cluttered living space
• A senior left unattended in public
• A senior left at a hospital or caregiving facility

Generally, anything that indicates an older adult’s health or care needs are not being met fully can be a sign of neglect or abandonment. If something feels wrong, it probably is wrong and requires further investigation.

If you suspect that an elderly loved one is being taken advantage of financially by their caregiver, there are certain telltale signs and patterns that can be identified to determine whether they are at risk. These include:

• Unexplained or unknown financial transactions or transfers
• Disappearance of assets or possessions
• Changes to a will or other legal documents
• Use of senior’s debit or credit card without permission
• Forged signatures on documents and checks
• Caregivers charging for or selling unnecessary services
• Distant relatives or friends suddenly reappearing in the senior’s life
• Giving the elder poor or substandard care when they can afford better care

Sexual abuse may be easier to spot than other forms, simply because there is a higher probably of physical evidence supporting its occurrence. Some of the warning signs of sexual elder abuse include:

• Unexplained STDs or genital infections
• Bruising on breasts or genitals
• Stained or torn undergarments
• Nude or inappropriate photographs of the senior
• Sudden difficulties with walking or sitting
• Inappropriate interactions with the caregiver

In addition to being able to identify signs of abuse, it’s important to choose a care facility in a thoughtful and informed manner. Not only should you research facilities that fit your budget and suit the needs of your elder, you should do your best to find a senior living facility that’s highly recommended and treats all residents with kindness and respect. The right facility should have:

• A well-trained staff that understands and can identify elder abuse
• Operating procedures to prevent elder abuse perpetrated either by family members or staff
• A history of reporting and disciplining elder abuse committed by employees
• Positive testimonies about the quality of care from current residents in the facility
• No promotion or advertising of unnecessary services or care options
• As many opportunities for resident independence as possible

While there is no way to eliminate the threat of elder abuse completely, these factors can indicate that a senior living facility provides quality, individualized care and takes claims of elder abuse seriously.

If you have suspicions that you, a family member, or a patient might be suffering from elder abuse, don’t hesitate to report it to the authorities. If someone is in immediate danger, call 911. In all other cases, you can report abuse to the caregiver facility, a medical professional, or the police.

If you are personally experiencing elder abuse, tell someone. You don’t have to call the police yourself; you can confide in a trusted friend or family member and ask them to call for you. You may also choose to report it to a medical professional who is required by law to notify the authorities as a mandated reporter. Keep in mind that in certain states, all persons are mandated reporters and are therefore obligated to tell the police.

Additional places you can report elder abuse include:

• The Eldercare Locator
• Adult Protective Services
• The Elder Justice Initiative

You don’t have to find proof of abuse to report it. You may be asked to share the name, contact information, and address of the victim, as well as details of the abuse. You might also have to give your name and contact information, but the authorities taking the report aren’t allowed to divulge your identity to either the abuser or the victim.

Avoid confronting the abuser, as you may put the senior in additional danger. Instead, report your concerns immediately and provide as much support to the older adult as possible. Intervention can be difficult, but it’s better to do so sooner rather than later. Seniors are a vulnerable group, and it’s vital for them to receive proper care.

Met Life Mature Market Institute, “Broken Trust: Elders, Family and Finances”

National Center for Biotechnology Information, “Elder Mistreatment”

National Center for Biotechnology Information, “Elder Mistreatment in the United States: Prevalence Estimates From a Nationally Representative Study”

National Center for Biotechnology Information, “Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the National Elder Mistreatment Study”

National Council on Aging, “Older Americans Act”

New York City Department for the Aging, “Under the Radar: New York State Elder Abuse Prevalence Study”

Office for Victims of Crime, “Elder Abuse Infographic”

The Tennessean, “Elder abuse is spiraling in the age of Covid-19“

U.S. Centers for Disease Control and Prevention, “Preventing Elder Abuse”

U.S. Department of Justice, “State Elder Abuse Statutes”

World Health Organization, “Fact Sheet: Elder Abuse”