Elder Abuse

Elder abuse can be explained as a direct action, inaction, or negligence toward an older adult that harms or places them at risk of harm by a person in a position of presumed trust. This common problem has complex psychosocial and medical considerations. Abuse may also be committed by an outside individual targeting the victim based on age or disability. Elder abuse generally falls into 5 categories: physical abuse, emotional or psychological abuse, sexual abuse, financial abuse, and neglect. Victims often experience multiple forms of abuse simultaneously. Physical abuse of the older adult consists of intentionally inflicting physical force that may cause pain, injury, and disability to the victim. Means of physical abuse include but are not limited to hitting, restraining a person inappropriately, hair pulling, forcibly feeding a person, pinching, and pushing. Psychological or emotional abuse encompasses verbal threats, harassment, intimidation, yelling, isolation, and treatment of an older person like a child. This abuse may lead the older adult into depression, anxiety, withdrawal from social interactions, a constant state of fear, and hopelessness. Sexual abuse of the older adult is considered a nonconsensual sexual act where the victim is forced into the act against their will or cannot understand or consent to the sexual act. Examples of sexual abuse include rape, forced nudity, explicit photography, inappropriately exposing oneself to the victim, and unwanted touching. Sexual abuse is unidentified and underreported far more frequently than other forms of abuse. This discrepancy is likely multifactorial, enabled by society’s false perceptions of sexuality among the older adult population and barriers to the victim reporting the abuse. Neglect is unique in that it can be intentional or unintentional. This category generally represents a failure of the caregiver to fulfill obligations to the older adult. Forms of neglect include withholding nutrition, water, and appropriate clothing; failing to administer or refill medications; and providing inadequate assistive devices, such as hearing aids, glasses, or walkers. Neglect often manifests as being underweight or dehydrated, having poor personal hygiene, wearing dirty clothing, and having long toenails or fingernails. Neglect can also lead to complications from poorly controlled medical conditions. Financial exploitation encompasses the withholding or misusing of the older adult’s resources, including money, property, and other assets, to the detriment of the older adult and the perpetrator's benefit. This form of abuse may include directly stealing assets, forging the older adult’s signature on documents or checks, inappropriate changing of a will, overpaying for goods or services, using the older adult’s assets without their knowledge, or forcing them to make financial changes that are not in their best interest. Elder abuse has devastating and expensive effects on the victims and society as a whole, yet it often goes unidentified or unreported. Healthcare professionals are in a unique position to identify and intervene in elder abuse, as they may be the only contact the patients have outside of their homes. Therefore, all members of the healthcare team must be aware of the risk factors and signs of elder abuse, as well as the systems in place to assist victims and families.