Elder abuse is any action or inaction, committed by a person in a position of trust, that jeopardizes the health or well-being of an elderly person (over 65, in most states) or any adult who is dependent on others for their care. It may include:

• Physical Abuse. Any act(s) of violence or rough treatment causing injury or physical discomfort. May include the use of restraints.
• Psychological or Emotional Abuse. Any act, including confinement, isolation, verbal assault, humiliation, intimidation, infantilization, or other treatment which may diminish the victim's sense of identity, dignity, and self-worth.
• Financial Abuse or Exploitation. The misuse of the victim's funds and assets; obtaining property and funds without his or her knowledge and full consent or, in the case of someone who is not competent, not in his or her best interest.
• Sexual Abuse. Any sexual behavior directed towards an elder or dependent adult without his or her full knowledge and consent; e.g., sexual assault, sexual harassment, or use of pornography.
• Medication Abuse. Misuse of an elder's or dependent adult's medications and prescriptions, including withholding medication or overdosing.
• Violation of Civil/Human Rights. Denial of an elder's or dependent adult's fundamental rights (according to legislation, the Charter of Rights and Freedoms, or the U.N. Declaration of Human Rights); for example, withholding of information; denial of privacy, denial of visitors, restriction of liberty or censorship.
• Neglect. Active Neglect ~ Intentionally withholding basic necessities or care. Passive Neglect ~ Failure to provide basic necessities and care because of a lack of experience, information, or ability.(1)

Approximately four percent of elders experience moderate to severe abuse each year, with women at greater risk. Clinicians often overlook elder mistreatment because there are no brief, easy-to-use, and well-validated screening tools. The elderly voluntarily disclose abuse at home only about a third of the time. More often this comes to light through inspection of the patient's physical appearance, the social service evaluation of the patient's living conditions, or reports of neighbors and non-abusive relatives.(2)

The National Aging Resource Center on Elder Abuse (now the National Center on Elder Abuse) estimated that 820,000 elders became victims of elder abuse in 1994, excluding self-neglecting elders. Adding self-neglecting elders raised the number of victims to 1.86 million.(3)

It is also expected that the number of reported cases will grow. The nation's elderly population is growing at a much greater rate than any other segment. As people live longer, frailty and vulnerability increase, along with the potential to become victims of abuse, fraud and exploitation. In addition, recent initiatives by government agencies and by professional organizations have expanded awareness of elder abuse and fostered increased reporting. The National Center on Elder Abuse reports that there was a 106 percent increase in the number of reported cases between 1986 and 1994, from 117,000 to 241,000.(3)

More than two-thirds of elder abuse perpetrators are family members of the victims, typically serving in a caregiving role.(4)

Experts note that there are some signs of abuse, neglect or exploitation which might alert family members, concerned friends or professionals to the possibility of problems. No one should jump to conclusions, but signs and symptoms should be taken seriously. What sometimes seems to be self-neglect often turns out to be elder abuse. Among the signs to watch for:

• Discrepancies between a person's standard of living and his/her financial assets, or a depletion of assets without adequate explanation. Money or personal items such as eyeglasses, jewelry, hearing aids, or dentures are missing without explanation.
• Malnourishment and inadequate physical care, including dehydration or lack of food, poor hygiene, urine sores, or bed sores, or over-sedation.
• Physical injuries, such as bruises, burn marks, welts, rope burns, tufts of hair missing, broken bones, none of which can be adequately explained.
• Withdrawn, apathetic, fearful, or anxious behavior, particularly around certain persons. The victim may suddenly and without explanation express a desire not to visit or receive visits from family or friends.
• Medical needs not attended to.
• Sudden, unexplained changes in the victim's living arrangements, such as a younger person moving in to "care for" them shortly after meeting.

It is frequently very difficult to detect abuse. Typically, abusive behavior occurs in private and the victim may be unwilling or unable to describe the attacks. When reports are made, they are frequently not believed.

As with other victims of abuse, elders and dependent adults who've been abused are often as traumatized or severely distressed by the violation of trust as by the direct effects of the abuse. Individual therapy, often conducted at home, can help heal these wounds by providing a safe place to tell the story of abuse and support the return of hope and trust.

Prevention programs designed to reduce the incidence, as well as treatment approaches to care for the victims, of elder abuse generally work on many levels and populations. Such programs can include:

• Abuse central registries (for information about abusers and their victims)
• Caregiver programs (to educate and support caregivers)
• Counseling Programs (for victims and abusers)
• Criminal background checks (on caregivers)
• Outreach programs (to reduce isolation among elders and caregivers)
• Public education (on prevalence and prevention)(6)

Primary prevention is aimed at identifying abused elders and elders at risk of abuse and preventing abuse from occurring. Secondary prevention efforts include assessing existing cases of elder abuse for future risk and reducing any.(7)

As with other abuse, reporting abuse is the single most important step you can take. Contact the local police and/or your community Adult Protective Services office. A list of state reporting phone numbers can be found at the National Center on Elder Abuse web site.

4. "What Is Elder Abuse?" 2002. National Center on Elder Abuse. http://elderabusecenter.org/basic/index.html