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