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Elder Abuse FAQs

Types of Elder Abuse:

Elder Abuse Reporting:

Victims of Elder Abuse:

APS:

Guardianship and Conservatorship:

Planning for Incapacity:

Elder Abuse and Long-term care facilities:

Elder Abuse and Criminality:

Multidisciplinary Teams:

Self-Neglect:

Society's Response to Financial Exploitation:

What to do if you suspect elder abuse: http://www.aoa.gov/AoA_programs/Elder_Rights/EA_Prevention/WhatToDo.aspx

Warning Signs (by type of abuse)1

Financial Exploitation

Signs and symptoms of financial or material exploitation include but are not limited to:

  • sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder;
  • the inclusion of additional names on an elder's bank signature card;
  • unauthorized withdrawal of the elder's funds using the elder's ATM card;
  • abrupt changes in a will or other financial documents;
  • unexplained disappearance of funds or valuable possessions;
  • substandard care being provided or bills unpaid despite the availability of adequate financial resources;
  • discovery of an elder's signature being forged for financial transactions or for the titles of his/her possessions;
  • sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions;
  • unexplained sudden transfer of assets to a family member or someone outside the family;
  • the provision of services that are not necessary; and
  • an elder's report of financial exploitation.

Physical Abuse

Signs and symptoms of physical abuse include but are not limited to:

  • bruises, black eyes, welts, lacerations, and rope marks;
  • bone fractures, broken bones, and skull fractures;
  • open wounds, cuts, punctures, untreated injuries in various stages of healing;
  • sprains, dislocations, and internal injuries/bleeding;
  • broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained;
  • laboratory findings of medication overdose or under utilization of prescribed drugs;
  • an elder's report of being hit, slapped, kicked, or mistreated;
  • an elder's sudden change in behavior; and
  • the caregiver's refusal to allow visitors to see an elder alone.

Neglect

Signs and symptoms of neglect include but are not limited to:

  • dehydration, malnutrition, untreated bed sores, and poor personal hygiene;
  • unattended or untreated health problems;
  • hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water);
  • unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing); and
  • an elder's report of being mistreated.

Emotional Abuse

Signs and symptoms of emotional/psychological abuse include but are not limited to:

  • being emotionally upset or agitated;
  • being extremely withdrawn and non communicative or non responsive;
  • unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking); and
  • an elder's report of being verbally or emotionally mistreated.

Sexual Abuse

Signs and symptoms of sexual abuse include but are not limited to:

  • bruises around the breasts or genital area;
  • unexplained venereal disease or genital infections;
  • unexplained vaginal or anal bleeding;
  • torn, stained, or bloody underclothing; and
  • an elder's report of being sexually assaulted or raped.

Abandonment

Signs and symptoms of abandonment include but are not limited to:

  • the desertion of an elder at a hospital, a nursing facility, or other similar institution;
  • the desertion of an elder at a shopping center or other public location; and
  • an elder's own report of being abandoned.

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What is Elder Abuse?

Elder abuse is a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. 2

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What is Elder Polyvictimization?

Elder polyvictimization 4 refers to different forms of elder abuse occurring at the same time. Between 10% and 40% of older adults experience polyvictimization. 5

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How Common Is Each Type of Elder Abuse?

A nationally representative study found the following 1-year prevalence rates: 5.2% for financial exploitation; 5.1% for neglect; 4.6% for emotional abuse; 1.6% for physical abuse; 0.6% for sexual abuse. 8

Excluding self-neglect, studies of substantiated Adult Protective Services cases found neglect to be the most common form of elder abuse, followed by psychological, financial, physical, and sexual abuse. 9

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How Common is Elder Polyvictimization?

Elder polyvictimization is defined as an older adult experiencing two or more forms of abuse simultaneously. 10 International studies (China, 11 Spain, 12 Finland, 13 and India 14) find between 10.5% and 50% of respondents experienced polyvictimization.

Across several Adult Protective Services studies, it was estimated 30% to 40% of older adults experience multiple forms of victimization by the same offender. 15

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Does Elder Abuse Occur in Other Countries?

“Yes.” However, it is unclear whether prevalence rates across countries reflect actual variations or whether prevalence rates are due to differences in data gathering methodology.

The United Kingdom had an overall rate of 2.6%: 1.1 % neglect, 0.7% financial, 0.4% psychological, 0.4% physical, and 0.2% sexual abuse in 2013. 16

A study from rural China had an overall rate of 36.2%: 15.8% neglect, 2.0% financial, 27.3% psychological, 4.9% physical (sexual abuse was not reported) in 2013. 17

A study from Germany had an overall rate of 3.1%: 2.7% neglect, 1.3% financial, 0.8% psychological, 3.4% physical (sexual abuse was not reported). 18

A study from Ireland had an overall rate of 2.2%: 0.3% neglect, 1.3% financial, 1.2% psychological, 0.5% physical, and 0.05% sexual abuse. 19

A study from Mexico had an overall rate of 10.3%: 0.98% neglect, 2.61% financial, 6.2% psychological, 3.3% physical, and 0.82% sexual abuse. 99

A study from Korea had an overall rate of 6.3%: 2.4% neglect, 4.1% financial, 4.2% psychological, 1.9% physical, and 3.6% verbal abuse. 20

A study from Spain had 16% neglect, 4.7% financial, 15.2% psychological, 0.1% physical (an overall rate and sexual abuse were not measured). 21

A study from The Netherlands had an overall rate of 5.6%: 0.2% neglect, 1.2% financial, 3.2% verbal, 1.2% physical (psychological and sexual abuse were not measured). 22

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How Do Forms of Elder Abuse Differ?

The warning signs for each type of abuse are distinct.100

Studies generally find specific risk factors associated with each form of elder abuse. 23

Although these distinctions are important, different types of elder abuse are related to one another. For example, self-neglect increases the likelihood a person will be financially exploited.101

Also, two or more different forms of elder abuse can occur at the same time (referred to as polyvictimization).

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How Do States Define “Elder”?

The definition of “Elder,” as defined by states, typically falls within the following three categories 24:

  • Age-based (regardless of vulnerability)
    In California, the statute defines elder as a person age sixty-five years or older. 25

  • Vulnerability-based (regardless of age)
    Minnesota law defines a vulnerable adult as any person 18 years of age or older who possesses a physical or mental infirmity … and because of the dysfunction or infirmity and the need for assistance, the individual has an impaired ability to self-protect from maltreatment. 26

  • Age-and-vulnerability-based
    In Florida, an elder is defined as a person 60 years of age or older who is suffering from the infirmities of aging as manifested by advanced age or organic brain damage, or other physical, mental, or emotional dysfunction, to the extent that the ability of the person to provide adequately for self-care or protection is impaired. 27

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In What Setting Does Elder Abuse Occur Most Frequently?

Contrary to stereotypes, fewer than 4% of persons age 65 and older reside in a long-term care facility. 28 Given that the vast majority (96.9%) of older Americans reside in domestic (community) settings, it is not surprising that the majority (89.3%) of elder abuse reported to Adult Protective Services occurs in the home. 29

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Does Elder Abuse Only Occur Once?

There are cases in which a form of elder abuse occurs only once. 44 However, many cases are long-term and ongoing. 45

One study found physical abuse and financial exploitation co-occurring but physical abuse and/or neglect cases had longer histories than financial exploitation and neglect cases. 46

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Who is Responsible for Responding to Reports of Elder Abuse in the Community?

In most states, Adult Protective Services is responsible for responding to reports of elder abuse. Law enforcement may be involved in criminal cases.

Reports to Adult Protective Services can be anonymous. Competent older adults can refuse an Adult Protective Services investigation or services.6

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Who is Responsible for Responding to Reports of Elder Abuse in a Long-Term Care Facility?

In most states, elder abuse in long-term care facilities is handled by local Long-Term Care Ombudsmen7.

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Who Reports Elder Abuse to Adult Protective Services?

According to the National Center on Elder Abuse, the following groups reported elder abuse: physician/health care provider (22.5%), family member (16.3%), private/voluntary service provider (15.1%), friend/neighbor (7.7%), APS/aging worker (6.0%), anonymous person (4.9%), law enforcement (4.7%), elder victim (3.8%), unrelated caregiver (3.3%), unknown (1.1%), other (13.4%).30

A national survey of reports to Adult Protective Services found the most common sources of reports were from family members (17.0%), followed by social services workers (10.6%), friends and neighbors (8.0%), and self-reporters (6.3%).31

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Is Elder Abuse Underreported?

There is a broad consensus that elder abuse is underreported.42 A comparison of self-reported victimization to official reports concluded 1 in 24 cases of elder abuse is reported to authorities. However, there were vast differences depending on the type of abuse involved. One in 57 cases of neglect was reported, 1 in 44 cases of financial exploitation was reported, 1 in 20 cases of physical abuse/sexual abuse was reported, and 1 in 12 cases of psychological abuse was reported.43

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What is Mandatory Reporting?

Mandatory reporting statutes require certain groups to relay reasonable suspicions of elder abuse to designated authorities.47 With the exception of New York, all states and the District of Columbia have provisions for mandatory reporting, although they vary from state to state, with six states having universal mandatory reporting (i.e., any person who suspects elder abuse must report it).48

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Who are the Victims of Elder Abuse?

Victims of elder abuse differ in gender, age, health, mental capabilities, income, availability of support systems, and relationships with their family members.

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Who are the Elder Abuse Offenders?

Offenders can be family members, friends, neighbors, service providers, professionals, or strangers. Victim-offender relationships may differ by the type of abuse involved. Physical abuse offenders are more likely to be family members than strangers. Financial exploitation offenders include both family and nonfamily members. 32

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What are the Consequences of Elder Abuse?

The consequences of elder abuse can be devastating. 33 They include psychological problems such as depression, emotional problems such as loss of trust, social support, and disruptions in family relationships, 34 physical injury, 35 restrictions on and elimination of autonomy such as institutionalization36 or imposition of a guardianship, 37 changes in living arrangements,38 loss of assets including one's home, 39 hospitalization,40 and mortality.41 Consequences routinely lead to a diminished quality of life for abused older adults.

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Do Victims Decline (Refuse) Services?

A small percentage of Adult Protective Services clients decline investigation/services offered. Estimates across several small-scale studies are between 14% and 20%. 49 In a review of 128 cases from community service agencies in Quebec, Canada, 58% of victims and 47% of offenders declined help. 50 Using state-wide Adult Protective Services data, one study found that victims of physical abuse were more likely to decline services than victims of other forms of abuse. 51

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Are All Victims of Elder Abuse Placed in an Institution?

Community-residing elder abuse victims who come to the attention of Adult Protective Services are more likely to be institutionalized than those who do not. 64 Since the study did not differentiate the types of abuse experienced, it is unknown whether this finding holds true for victims of different forms of elder abuse.

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How Do I Respond to a Victim of Elder Abuse?

Many older adults are resistant to offers of assistance. Engage the victim by reassuring the person of your intention and concern. Offer to contact Adult Protective Services and assure the victim that adult protective services is tasked with providing protective measures to keep older adults safe. Remember the offender may be someone the victim loves and wants to protect. If a family member is involved, empathize with the victim rather than demonize the abuser.

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Why Doesn't a Victim Self-Report?

Similar to many victims of crime, 78 victims of elder abuse are unlikely to self-report. 79 They may not know who to ask for help 80, or they may be fearful of getting their abuser in trouble, 81 retaliation, 82 losing their independence or institutional placement, 83 or embarrassment and shame. 84

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Do All Victims of Elder Abuse have Dementia?

In 2002, the prevalence of dementia among individuals ages 71 and older was 13.9%, 87 with another 22.2% having some form of cognitive impairment without dementia. 88 Dementia is a risk factor 89, but more people without dementia experience elder abuse.

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What are Potential Outcomes of an Adult Protective Services Investigation?

The outcomes associated with an Adult Protective Services investigation may involve a change in living arrangement, separation from the offender, and guardianship. Outcomes differ depending on the type of abuse involved. 52

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What is Guardianship and Conservatorship?

Involuntary interventions such as court appointment of a substitute decision maker (guardianship 53) are legally authorized in most states if the client is exposed to a substantial risk of harm or if the client lacks the capacity to make an informed decision to accept or reject protective services. 54 Guardianship is governed by state law 55 and requires a formal determination of decision-making capacity. A petition is submitted to the court and the judge makes a determination regarding capacity. 56 Guardians may be public programs, 57 private non-profit or for-profit agencies, individual professional guardians, attorneys, family members or friends. The prevalence of older adults under guardianship is unknown 58 as is the extent of the misuse of guardianship. 59 Guardianship monitoring of some form — at least the filing of reports and accountings with the court — is required in all states. 60 Improvements in monitoring have been recommended. 61 Guardianship should be used as a last resort as it removes fundamental rights. 62 However, guardianship can be a necessary solution to elder abuse, offering vital protection for a victim who lacks decision-making capacity. Recent trends are toward limited guardianships in which a guardian has decision making power only in domains in which the older adult has diminished decision making capability. 63

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What are Some Possible Causes of Elder Abuse?

A wide variety of possible causes of elder abuse have been proffered — related to either the victim or the perpetrator — but very few explanations have been proven. The cause is complex.

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What are Warning Signs of Diminished Financial Capacity?102

Here are several warning signs of diminished financial capacity.

  • Memory Lapses
    Increasing memory lapses resulting in failure to fulfill financial obligations, such as failing to pay bills.

  • Disorganization
    Increasing disorganization and misplacement of financial and other documents at home, with associated failures, such as missing tax and other deadlines.

  • Declines in Checkbook Management Skills
    Changes in the ability to use a checkbook and check register to carry out everyday transactions.

  • Arithmetic Mistakes
    Noticeable declines in everyday math skills, such as those employed when making change to pay for things at the store or when computing an appropriate tip in a restaurant.

  • Conceptual Confusion
    Increasing confusion and loss of general knowledge regarding basic financial terms and concepts such as mortgage, will, or annuity.

  • Impaired Judgment
    Loss of judgment about financial investments and use of money, manifested frequently as a new and abiding interest in get-rich-quick schemes, as well as unfounded anxiety about the nature and extent of one’s personal wealth.

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What are Advanced Directives for Mental Illness and Dementia?

Older adults can prepare for a possible decline in mental health through a psychiatric advanced directive which allows competent persons to prepare instructions for their future mental health treatment or designate a health care agent to make decisions for them in the event of a psychiatric crisis. 65 This same approach can be used in preparing for the possibility of dementia. 66

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Should I Plan for Financial Incapacity?

The growing population of older adults, 67 the complexity of financial tools, 68 the low levels of financial literacy, 69 and the high rates of dementia 70 foreshadow financial disaster for some older individuals. 71 Much attention is paid to substitute health care decision making and end-of-life decision making, 72 but little attention is paid financial decision making until a crisis emerges. 73 Prior to declines in cognitive abilities, a family should engage in planning for the time when an older adult's financial capacity becomes impaired, 74 even if capacity never becomes an issue.

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Are Residents of Long-Term Care Facilities Abused?

Less than 5% of older adults reside in a long-term care facility, although the likelihood of residing in a long-term care facility increases with age: 1.3% of 65-74 year olds, 4.4% of 75-84 year olds, and 15.4% of 85 or older adults. Long-term care residents are generally female, frail, and cognitively impaired. All forms of elder abuse are observed in long-term care facilities. 75 In one study, 64.9% of complaints were for physical restraint, the most common form of maltreatment occuring in long-term care facilities, followed by 23.0% for neglect, with the remaining forms of abuse occurring in less than 15% of the complaints. 76

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Are Residents of Assisted Living and in-Home Family Care Abused?

Assisted living and in-home care are largely unregulated. Adult protective services and law enforcement are unlikely to be notified in these cases. 77

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Click here for information about financial exploitation in long-term care facilities.

Is Elder Abuse a Crime?

Elder abuse is a crime in every state. 85 However, older adults do not always define or recognize elder abuse behaviors as criminal. 86

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What is the Criminalization of Elder Abuse?

Elder abuse has been criminalized in our country over the past couple of decades. 90 However, not all scholars agree that criminalization has been beneficial for older victims. 91 Older adults tend to eschew the criminal justice system generally, and prosecution in particular. 92 To ensure our response to victims is appropriate and beneficial, it is important to engage victims in the criminal justice response. 93

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What is Restitution?

In a criminal trial, the judge may order an offender to pay restitution, a sum of money to help cover the cost of the damage to victim. 98

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What are Multidisciplinary Teams?

Elder abuse cases are complex and no one agency possesses all the skills necessary for investigating and responding to these cases. Therefore, multidisciplinary teams have been developed in which professionals from a range of disciplines collaborate when responding to a complaint of elder abuse. 94 A multidisciplinary team offers improved evidence-gathering techniques while providing support for a victim. The use of a multidisciplinary team enhances the likelihood of prosecution. 95

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What is Self-Neglect?

Self-neglect involves a senior or adult with disabilities who fails to meet personal physical, psychological or social needs and threatens the individual’s health, safety and well-being. It includes failure to provide adequate food, clothing, shelter and health care for one’s own needs. 96 Approximately a quarter of the cases reported to Adult Protective Services involves self-neglect. 97

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References