Elder abuse is the maltreatment of older
adults by family members or
caregivers. It may include physical and sexual abuse, psychological abuse,
neglect, self-neglect, financial exploitation, and denial of adequate medical
treatment. Estimates are that people over age 65 are injured, exploited,
abused, or neglected by their caregivers and that only 1 in 14 elder
maltreatment cases are reported (Muehlbauer & Crane, 2006). Nearly 60% of
the perpetrators are spouses, 20% are adult children, and 20% are others such
as siblings, grandchildren, and boarders.
Most victims of elder abuse are 75 years or older; 60% to 65% are
women. Abuse is more likely when the elder has multiple chronic mental and
physical health problemsand when he or she is dependent on others for food,
medi-cal care, and various activities of daily living.
Persons who abuse elders are almost always in a caregiver position
or the elders depend on them in some way. Most cases of elder abuse occur when
one older spouse is takingcare of another. This type of spousal abuse
usually happens over many years after a disability renders the abused spouse
unable to care for himself or herself. When the abuser is an adult child, it is
twice as likely to be a son as a daughter. A psychiatric disorder or a problem
with substance abuse also may aggravate abuse of elders (Goldstein, 2005).
Elders are often reluctant to report abuse, even when they can,
because the abuse usually involves family members whom the elder wishes to
protect. Victims also often fear los-ing their support and being moved to an
No national estimates of abuse of elders living in institu-tions
are available. However, under a 1978 federal mandate, ombudsmen are allowed to
visit nursing homes to check on the care of the elderly. These ombudsmen report
that elder abuse is common in institutions (Goldstein, 2005).
The victim may have bruises or fractures; may lack needed
eyeglasses or hearing aids; may be denied food, fluids, or medications; or may
be restrained in a bed or chair. The abuser may use the victim’s financial
resources for his or her own pleasure while the elder cannot afford food or
medications. Abusers may withhold medical care from an elder with acute or
chronic illness. Self-neglect involves the elder’s failure to provide for
himself or herself.
Careful assessment of elderly persons and their caregiving
relationships is essential in detecting elder abuse. Often, determining whether
the elder’s condition results from deterioration associated with a chronic
illness or from abuse is difficult. Several potential indicators of abuse require
further assessment and careful evaluation. These indicators by themselves,
however, do not necessar-ily signify abuse or neglect.
The nurse should suspect abuse if injuries have been hidden or
untreated or are incompatible with the explana-tion provided. Such injuries can
include cuts, lacerations, puncture wounds, bruises, welts, or burns. Burns can
be cigarette burns, scaldings, acid or caustic burns, or friction burns of the
wrists or ankles caused from being restrained by ropes, clothing, or chains.
Signs of physical neglect include a pervasive smell of urine or feces, dirt,
rashes, sores, lice, or inadequate clothing. Dehydration or mal-nourishment not
linked with a specific illness also strongly indicates abuse.
Possible indicators of emotional or psychological abuse include an
elder who is hesitant to talk openly to the nurse or who is fearful, withdrawn,
depressed, and helpless. The elder also may exhibit anger or agitation for no apparent
reason. He or she may deny any problems, even when the facts indicate
Possible indicators of self-neglect include inability to manage
money (hoarding or squandering while failing topay bills), inability to perform
activities of daily living (per-sonal care, shopping, food preparation, and
cleaning), and changes in intellectual function (confusion, disorientation,
inappropriate responses, and memory loss and isolation). Other indicators of
self-neglect include signs of malnutrition or dehydration, rashes or sores on
the body, an odor of urine or feces, or failure to keep needed medical
appointments. For self-neglect to be diagnosed, the elder must be evaluated as
unable to manage day-to-day life and take care of himself or herself. Self-neglect
cannot be established based solely on family members’ beliefs that the elder
cannot manage his or her finances. For example, an older adult cannot be
consid-ered to have self-neglect just because he or she gives away large sums
of money to a group or charity or invests in some venture of which family
Warnings of financial exploitation or abuse may include numerous
unpaid bills (when the client has enough money to pay them), unusual activity
in bank accounts, checks signed by someone other than the elder, or recent
changes in a will or power of attorney when the elder cannot make such
decisions. The elder may lack amenities that he or she can afford, such as
clothing, personal products, or a television. The elder may report losing valuable
possessions and report that he or she has no contact with friends or relatives.
The nurse also may detect possible indicators of abuse from the
caregiver. The caregiver may complain about how difficult caring for the elder
is, incontinence, difficulties in feeding, or excessive costs of medication. He
or she may display anger or indifference toward the elder and try to keep the
nurse from talking with the elder alone. Elder abuse is more likely when the
caregiver has a history of family violence or alcohol or drug problems.
All 50 states in the United States, District of Columbia, Guam,
Puerto Rico, and the Virgin Islands have laws gov-erning adult protective
services. This covers elder citizens and, in most states, includes adults who
are considered dependent, disabled, or impaired and who must rely on others to
meet basic needs. These laws provide a system for defining, reporting, and
investigating abuse, as well as providing services to victims. However, abuse
reporting for elders or dependent adults is not mandatory in all states and
territories. Nurses should be familiar with the laws or statutes for reporting
abuse in their own states. Many cases remain unreported. The local agency on
aging can provide procedures for reporting abuse in accordance with state laws.
To find a local agency, call the national information center at 1-800-677-1116.
Elder abuse may develop gradually as the burden of care exceeds the
caregiver’s physical or emotional resources. Relieving the caregiver’s stress
and providing additional resources may help to correct the abusive situation
and leave the caregiving relationship intact. In other cases, the neglect or
abuse is intentional and designed to providepersonal gain to the caregiver,
such as access to the victim’s financial resources. In these situations,
removal of the elder or caregiver is necessary.