What is Elder Abuse?
Elder abuse is a widespread issue that involves both social and health aspects. In simple terms, elder abuse involves any action or failure to act that hurts an older person or puts them at risk. This is usually done by someone they trust or by an outsider who targets them based on their age or disability. There are five main types of elder abuse: physical abuse, emotional or psychological abuse, sexual abuse, financial exploitation, and neglect. Often, victims suffer from more than one type of abuse at the same time.
Physical abuse of the elderly includes any use of physical force intended to cause pain, disability, or injury. Examples of this could be hitting, inappropriate restraint, pulling hair, forced feeding, pinching, pushing, and any other action purposely used to harm.
Emotional or psychological abuse can take the form of threats, harassment, intimidation, yelling, isolating, or treating an older person like a child. As a result, older people may become depressed, anxious, avoid social interactions, live in fear, and lose hope.
Sexual abuse involves unwanted sexual actions that the victim is either forced into or unable to understand or consent to. This could involve acts such as rape, forced nudity, explicit photography, inappropriate exposure, and unwanted touching. Sadly, sexual abuse often goes unnoticed and is underreported compared to other types of abuse, because of societal misconceptions about elder sexuality and barriers that victims face when reporting the abuse.
Neglect, which could be either intentional or accidental, is when a caregiver neglects their duty to the older person. This could mean not providing adequate food, water, clothing, medication, or assistive devices like hearing aids, glasses, or walkers. Signs of neglect might include the person being underweight, dehydrated, poorly groomed, wearing dirty clothes, having overgrown nails, or suffering complications from poorly managed health conditions.
Financial exploitation involves taking or misusing an older person’s resources, such as money, property, and other assets, to the detriment of the victim or for the benefit of the abuser. This could involve theft, forgery, unjust changes to a will, overcharging, using the victim’s assets without consent, or forcing them into financial decisions against their best interest.
Elder abuse has heartbreaking and costly effects on both the victim and society, but it often goes unnoticed or unreported. Health care professionals have a unique opportunity to notice and stop elder abuse, as they might be the only people an older adult interacts with outside of their home. For this reason, it’s crucial that everyone on the health care team is aware of the risk factors and signs of elder abuse, as well as the systems in place to help victims and families.
What Causes Elder Abuse?
Elder abuse is a complex issue involving various personal and societal factors. It’s important to consider specific traits of both victims and abusers, society’s attitude towards the elderly, and the surrounding environment.
Victims who are more likely to experience elder abuse are often those who heavily rely on caregivers due to physical, emotional, psychological, or financial needs. The belief is that this extra burden on caregivers can sometimes lead to elder abuse. Another problem is that victims might not report their abuse, often due to reasons like physical or cognitive limitations, fear of repercussions, embarrassment, accepting abuse as part of life, blaming themselves, or not knowing where to seek help.
Abusers often exhibit characteristics like substance abuse, a past of violence, financial dependency on the elderly person, mental illness, personality disorders, and strained relationships with the elderly. These factors can intensify the challenge of caregiving and potentially trigger abuse.
Society and the environment can also play a role in elder abuse. High crime rates can, unfortunately, make violence seem normal. Limited community resources can put extra strain on caregivers and victims. Societal beliefs that elderly people are unlikely to be victims of abuse can also be a problem. Health care professionals often lack the proper training to identify and manage elder abuse. Similarly, caregivers, including those in nursing homes, may not know how to handle aggressive patients, like those with dementia. This lack of knowledge and skills can create environments that allow abuse to continue.
Risk Factors and Frequency for Elder Abuse
Elder abuse is a serious problem that is seen worldwide, occurring in an estimated 5-10% of older adults in the U.S. Often, the person causing the harm is someone who the older person knows well. This can include family members, friends, neighbors, caregivers, or staff members at healthcare or long-term care facilities. The most common types of abuse include neglect, psychological abuse, and financial exploitation. Physical and sexual abuse still happen but are less common.
Elderly individuals with dementia or other forms of cognitive impairment are the most at risk. They are nearly five times as likely to experience elder abuse compared to older adults without dementia. But they’re not the only ones at higher risk. There are other groups who experience a higher level of abuse. These include:
- Women
- People over the age of 80
- Minority populations
- Residents of long-term care facilities
- People with several health conditions at the same time
It’s hard to say if things like race, ethnicity, and gender are independent risk factors for elder abuse because the data varies. When other factors like social and economic status and health conditions are taken into account, the results are not consistent. However, one thing we do know is that women are more likely to be victims of sexual abuse than men. One big challenge is that estimating the true extent of elder abuse is difficult, as it’s thought that only about 5% of all cases are actually reported.
Signs and Symptoms of Elder Abuse
When a healthcare provider is screening a patient, it’s important to ask many questions to identify potential abuse. A single question won’t usually reveal enough information. Red flags to look out for include injuries without a clear cause, frequent injuries, a delay in getting treatment, not following the prescribed medical treatment, or frequently missed appointments. If any concerns arise, the healthcare provider should ask more specific questions depending on the type of suspected abuse. Information may need to be gathered not only from the patient, but also from family, caregivers, emergency medical services, law enforcement, home care services, case management, or the patient’s primary doctor.
If abuse is suspected, the caregiver should leave the room while further questions are asked. The healthcare provider should ask questions in a non-judgmental way and give the patient time to respond. This will make the patient feel more comfortable and thus more likely to confide in the healthcare provider. In emergency visits, it’s important to ask detailed questions about how the injury occurred and what events led up to the medical visit. This information can then be compared with the physical examination to check for any inconsistencies. It is also important that family members and caregivers not serve as translators in these sensitive cases. All findings should be precisely documented, as they may be used later as part of an investigation.
If abuse is suspected, a comprehensive physical examination should be conducted. This includes observing the patient’s interaction with their caregiver, and watching for signs of anxiety or avoidance behaviors like poor eye contact. Some physical signs of abuse might include bruises in various healing stages, specific types of bruises, bite marks, eye or mouth injuries, or bruises in typically protected areas, like the face, neck, ears, back, abdomen, or forearms.
Signs of neglect could include a patient looking malnourished or dehydrated, wearing dirty clothes, or having long toenails or fingernails. Presence of bedsores, also suggests neglect. If sexual abuse is suspected, a detailed and sensitive examination of the genitals and rectum must be done. Signs of sexual abuse can include injuries like bruises or tears, redness, swelling, incontinence, and symptoms of sexually transmitted diseases, such as abnormal discharge, sores, or strange odors.
Testing for Elder Abuse
When a doctor suspects an elder may have been mistreated, they examine them in detail, considering what type of abuse might have occurred and any injuries present. The doctor will look at the person’s overall health, daily functions, how any injuries might have occurred, and the results of any tests and imaging studies. All this information will help the doctor decide if the injuries could be due to abuse.
Elder abuse can be harder to detect than child abuse because there’s not as much research on what types of injuries might suggest mistreatment. Fires, fractures could be signs of abuse, such as broken ribs at the back, different stages of healing for various fractures, skull fractures, bleeding under the skull, bruises in the small intestine, and severe fractures when only a little force could have been used.
The doctor might order lab tests to check for signs of dehydration, malnutrition, infection, hormone-related conditions, a low red blood cell count, blood clotting disorders, and muscle breakdown. They may also check medicine levels to see if the person has been taking their medication as prescribed, and do a drug test to check for any harmful substances.
If scans or other types of imaging are performed, the doctor will give all the necessary information to the specialist who analyzes them, such as how the patient usually moves around, their overall health situation, and how the injuries were caused. This will help the specialist figure out if the injuries correspond to the cause described.
Another important point to consider is the elder’s ability to make their own decisions. If someone is mentally capable, even if they’re being abused, they have the right to stay where they are if they choose to. Simple tests like asking where and when it is, or using a basic memory and thinking skills test, usually aren’t enough to determine this. More thorough tools, like the Hopkins Competency Test, might be considered because they line up more closely with a mental health professional’s findings.
The doctor might also use screening tools designed to spot elder abuse or assess the risk of it happening in the future. The Elder Abuse Suspicion Index or the Elder Abuse Vulnerability Index are such tools. They can help identify who may be currently abused or at risk of it, and guide educational resources.
Treatment Options for Elder Abuse
The first step in treatment should concentrate on addressing the immediate health concern or injury. However, it’s also important to focus on the social and psychological elements of elder abuse. This can involve arranging in-home healthcare services, meal delivery, transportation for medical visits, insurance setup, or linking the elder with services like adult daycare or senior centers.
Protecting the patient is crucial if they are in immediate danger. This may necessitate calling for law enforcement or hospital security, the involvement of social workers and the hospital’s legal team, and possibly emergency guardianship application.
One of the key management steps to tackle elder abuse is to report it. Reporting should be done even when abuse is only suspected and not confirmed. Reporting triggers the relevant bodies like Adult Protective Services to further investigate the situation, which can help the individual get the assistance they need.
Healthcare professionals are often in the position of mandatory reporters for suspected elder abuse, though the specifics can vary by state. Despite this, many potential elder abuse cases remain unreported. This could be due to worries about loss of control by the physician, erosion of trust from the patient, unexpected negative impacts, subtle indications of abuse, and the threat of the abuser retaliating against the victim.
What else can Elder Abuse be?
When diagnosing elder abuse, it’s crucial to think about other possible causes for the observed signs and symptoms. For example, the senior citizen might be showing certain behaviors or physical conditions due to other reasons, not because they are abused.
They could be having:
- Cancer
- Depression
- Metabolic disturbances
- Infections
- Hormonal imbalances
- Substance abuse problems
- Dementia
- Dental problems
These conditions might manifest in ways that suggest neglect, such as weight loss, anxiety, or appearing withdrawn. Additionally, specific conditions or treatments like anticoagulants (medications that prevent blood clots), cancer, prolonged bed rest, skin thinning, and weak bones might cause bruising or fractures. These physical signs may wrongly be seen as symptoms of physical abuse.
What to expect with Elder Abuse
Identifying and acting promptly on elder abuse is crucial, not only to ease the immediate physical and emotional distress, but also to prevent any long-term consequences. Elder abuse is linked to a notable increase in both disease and death rates. Besides, it often results in higher levels of emotional distress, more frequent hospitalizations, more emergency department visits, a greater need for hospice care, as well as placement in long-term care facilities.
Possible Complications When Diagnosed with Elder Abuse
Elder abuse has several negative effects, not just on the victim, but also on their caregivers and the broader society. When an older adult is abused, they are likely to suffer from both physical and mental health issues, such as post-traumatic stress disorder (PTSD) and poorly controlled chronic diseases. They might also face high medical bills, reduced wellbeing, a breakdown in their relationships, and tragically, even an early death.
The caregivers of elder abuse victims can also experience hardships. They may find the responsibility of care burdensome, leading to reduced productivity, the inability to work, and financial strain. Lastly, elder abuse puts a strain on society as well. The immediate cost of care, the load on nursing homes, and the usage of community, legal, and law enforcement resources all represent significant societal complications.
The impacts of elder abuse can be categorized as follows:
- Victim: physical and mental health problems, PTSD, poorly managed chronic disease, high medical costs, decreased life quality, impaired relationships, premature death.
- Caregivers: high care burden, reduced productivity, inability to work, financial strain.
- Society: direct cost of caretaking, burden on nursing facilities, use of community, legal, and law enforcement resources.
Preventing Elder Abuse
Reducing elder abuse can be tough because it often goes unnoticed and underreported. To tackle this issue, there should be campaigns that educate health care workers, caregivers, patients, and the community about the commonality, risk factors, and symptoms of elder abuse. Information about resources available to help should also be shared widely. By enhancing local resources, we can offer stronger support to both victims and their families.
By identifying risk factors and providing family support, we might be able to lower abuse rates. This, in turn, could decrease the load on emergency services, hospitals, and long-term care facilities while also reducing medical care costs.
Long-term care facilities can help prevent abuse by making sure they are adequately staffed, fostering a peaceful environment, ensuring their staff feel valued, and by providing extra training to staff on managing challenging or aggressive residents.
