Abuse of the elderly--the hidden agenda. I. The caretakers and the categories of abuse.

An overview of the problem of abuse of the elderly is presented in an effort to guide future research. Categories of caretakers for the aged include formal (i.e., institutional settings) and informal (e.g., family, neighbors, sitters). Data are presented from a task force report on the status of nursing homes in the State of Texas. Categories of abuse are discussed under four divisions: physical, psychologic, material, and fiscal. Deliberate physical abuse by formal caretakers was the least common; physical neglect was far more common, e.g., the development of decubitus ulcers, inadequate nutrition, improper medication, and vermin infestation. Psychologic abuse was most frequent in the area of benign neglect, with patients regarded as "going to die anyway." A tendency toward infantilization by formal caretakers was observed. Material abuse included primarily theft, chiefly of personal items rather than medication items. Fiscal abuse included embezzlement of patients' trust funds, improper charges for service, failure to notify the State of the death or departure of a patient, abuse for drugs, and artificial upgrading of Medicaid recipients' classifications. Possible causes of abuse are reviewed.