Elder Abuse and NeglectHow to Recognize It

How to Report ItHow to Prevent It

StatisticsEvery year an estimated 2.1 million elders

are victims of abuse or neglect. For every case reported, at least 5 are not reported. Some experts say only 1 in 14 cases are reported. (National Center on Elder Abuse)

90% of elder abuse incidents are by known perpetrators.

Those age 80 and older are abused at 2 – 3 times the rate of other elders. (Bureau of Justice Statistics)

Types of Elder MistreatmentAbuse – emotional, physical, or sexual harm

or injuryNeglect – withholding care or services

resulting in harm or injuryExploitation – misuse of a person’s financial

or medical information

Warning Signs & Symptoms of AbusePhysical abuse – fractures, bruises, cuts, etc.Emotional abuse – anxiety, depression,

moodiness, isolationSexual abuse – venereal disease, bloody

clothing, bruising in genital area

Physical Abuse10.7% of reported cases in the 2004 Survey

of State Adult Protective Services involved physical abuse. (National Center on Elder Abuse)

Older persons are more susceptible because of their frailty and decreased physical ability.

Emotional AbuseMakes up 14.8% of reported cases.A diminished ability to cope with stress, as

well as the state of “chronic loss” that accompanies aging, makes elders more susceptible.

Sexual AbuseAccounts for 1% of reported cases.Since elders are often physically frail, they

can be more easily subdued by physical force.

NeglectIntentionalUnintentionalSelf-neglect

Signs of NeglectPoor personal hygieneSigns of over-medication or under-medicationInadequate supervisionMalnutritionUnsafe or unsanitary living conditions

Statistics57.6% of all cases reported involve neglect.

20.4% involve caregiver neglect, and 37.2% are self-neglect.

Self-NeglectCauses

Depression – affects 15% of all adults over 65Unexpressed rage, frustration, or griefAlcoholism or substance abuseSacrificing for family at the expense of own

needsMental or physical illness or impairment

Self-NeglectHow to Help

Involve the elder in determining the cause – ask, “What would make life meaningful again?”

Medical interventionHelp them get involved in a group activity.Intervene with caution when it involves

sacrificing for others, and use professionals when necessary.

ExploitationPrimarily financial or materialMay be by a known or unknown perpetratorAccounts for 14.7% of all reported cases

Types of Financial ExploitationHome equity fraudTelemarketing fraudHealth fraudSlammingCrammingLegal

How to Avoid Financial ExploitationNever give account numbers or credit card

numbers over the phone unless you called the company.

Check all bank and credit card statements.Check telephone bill each month.Have an attorney or trusted persons look

over any documents before you sign them.

Healthcare Fraud and AbuseCarried out by unethical doctors, nurses, and

other professional care providersMay involve

Charging for care not providedOvercharging or double-billingOver or under-medicatingRecommending fraudulent remedies or

treatments

How to Avoid Healthcare FraudSeek recommendation from others when

choosing a doctor or care professional.Check your statements.Be wary of any treatment available from only

one provider or supplier.

Risk Factors for Elder AbuseRisk factors for caregiverRisk factors for elder

Risk Factors for the CaregiverPoor coping skillsLack of support from family/friendsDepressionIsolationSubstance abuseFeeling the care is burdensome and without

reward

Risk Factors for the ElderIsolationDepressionIntensity of elder’s illness or dementiaElder’s role earlier in lifeHistory of domestic violence in the homeElder’s tendency toward aggression

Brief Abuse Screen for the Elderly Purpose: To help practitioners assess the likelihood of abuse. Instructions: Please respond to every question (as well as you can

estimate) concerning all clients ______ years or over who are caregivers (give regular help of any kind) or care receivers:

1. Is the client an older person who has a caregiver? ___Yes ____No 2. Is the client a caregiver of an older person? ____Yes _____No 3. Do you suspect abuse? (see also #4 and #5)

i) By a caregiver (comments)_________________________ ______________________________________________________________________ 1 2 3 4 5 No, not at all only slightly, doubtful possibly, somewhat probably, quite likely

yes, definitely

ii) By a care receiver or other (comments)______________________________________ ____________________________________________________________________________ 1 2 3 4 5 No, not at all only slightly, doubtful possibly, somewhat probably, quite likely yes,

definitely

Brief Abuse Screen for the Elderly4. If any answer for #3 except “no, not at all,” indicate what

kind(s) of abuse(s) is(are) suspected. i) physical________ ii) psychosocial_____ iii) financial ____ iv) neglect_________(includes passive and active)5. If abuse is suspected, about how soon do you estimate that

intervention is needed?__________________________________________________1 2 3 4 5 Immediately within 24 hrs 24-72 hrs 1 week 2 or more weeks

Copyright © The Gerontological Society of America. Reprinted by permission of the publisher.

Reis, M., & Nahmiash, D. (1998). Validation of the indicators of abuse (IOA) screen. The Gerontologist, 38(4), 471-480, Figure 2.

Who Reports?Mandated reporters are required by law to

report suspected abuse, neglect, or exploitation of endangered or impaired adults.

Mandatory reporters include hospital personnel, nurses, social workers, case managers, home health workers, and employees of facilities that provide care.

As a mandated reporter you are shielded from legal action and only need to report suspicion, not proof.

Reporting ThresholdEvery mandated reporter must have their

own “reporting threshold”No burden of proof is necessaryNeed a “reasonable suspicion”

Physical evidence?Pattern of behavior?Witnessed event?

Who Do I Call?If it occurs in a facility, notify the

administration or ombudsman.Notify the social worker.Call Adult Protective Services hotline.

1-800-482-8049When elder is in immediate danger, or a

welfare check needs to be done, call law enforcement.

What Information Do I Give APS?The victim’s name, address, age, phone

number, sex and raceA description of the problemName, address, and phone number of the

person you suspect of abuse (if not self-neglect)

Names of others who may have more information

What Will APS Do?They have 72 hours from the time of the call

to respond.If the person is endangered and lacks

capacity (demonstrates a lack of capacity to understand the nature and consequences of remaining in the situation), APS can take action.

Philosophy of APSThe adult client is the only person they are

charged to serve.The adult client is in charge of decision

making until he/she delegates responsibility voluntarily or the court grants responsibility to another.

Case Studies

Preventing Elder Abuse and NeglectCaregiverConcerned friend or family memberElder

How to Prevent as a CaregiverSeek help from family, friends, or local

respite agencies.Utilize the Adult Day Care.Take care of yourself.Seek counseling.Find a support group.Use stress reduction practices.Get help for substance or alcohol abuse.

How to Prevent as a FriendWatch for warning signs. Report suspected

abuse.Watch for financial abuse.Call and visit as often as you can.Give the caregiver a much needed break.Get to know your elderly neighbors.

How to Prevent as an ElderMake sure your finances and legal affairs are

in order.Seek help for depression.Keep in touch with family and friends. Avoid

becoming isolated.Seek help from others.If you are unhappy about your care, speak

up.

ResourcesNational Center on Elder Abuse

www.ncea.aoa.govArkansas Adult Protective Services

www.aradultprotection.comThe National Center for Victims of Crime

www.ncvc.org