The definition of elder abuse adopted by the World Health Organization (WHO) is “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes significant harm or distress to the older person.
Frequently this harm is done to the older person when there is an “expectation of trust” on the part of the older person toward their abuser. Thus, it includes harm by people the older person knows or with whom they have a relationship, such as a spouse, partner or family member, a friend or neighbor, or people that the older person relies on for services. Many forms of elder abuse are recognized as types of domestic violence or family violence since they are committed by family members. Paid caregivers have also been known to prey on their elderly patients’; consequently, elder abuse is also defined as a personal act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult.
An elderly person is anyone who has attained their sixty-fifth birthday.
CATEGORIES OF ELDER ABUSE
The categories of elder abuse that are generally recognized by legal and healthcare organizations are as follows:
Physical abuse is when excessive force is used against an elder person that results in bodily injury, pain, or impairment. It includes assault, battery, and inappropriate restraint. Assault is defined as a crime of trying or threatening to hurt someone physically, while the battery is defined as intentionally or recklessly causing offensive physical contact or bodily harm (as by striking). Physical abuse may also include violent acts such as striking (with or without an object or weapon), hitting, beating, scratching, biting, choking, suffocation, pushing, shoving, shaking, slapping, kicking, stomping, pinching, and burning. Physical abuse is also improper restraining and false imprisonment/confinement. Physical abuse is generally the intentional use of force to control the victim.
The perpetrators of physical abuse may be strangers, family members, acquaintances, or caretakers (employed by the family to care for the elderly person). Physical abuse that is perpetrated by spouses or intimate partners to gain power and control over the victim is generally investigated as domestic violence. Perpetrators are likely to be unmarried and live with their victims. Some perpetrators have alcohol or substance abuse problems.
Psychological/Emotional abuse occurs when someone causes the elderly victim emotional anguish or undue stress. A common theme is when a perpetrator identifies something that matters to an elderly person and then uses it to coerce them into a particular action. It may take verbal forms such as yelling, name-calling, ridiculing, criticizing, accusations, and blaming, or non-verbal forms such as ignoring, silence treatment, shunning or withdrawing affection. A caregiver may ignore the elder or isolate him or her from family members, friends, or daily activities. Their rights may be systematically ignored, limited, or taken from them even if they are capable of communication and can think, act and care for themselves. Psychological abuse can happen in the home, or a facility, such as a nursing home. Symptoms of emotional/psychological abuse include but are not limited to:
- When a victim is being emotionally abused they generally exhibit a state of anguish, pain, or distress through verbal or nonverbal acts.
- A person withdrawing within themselves (being withdrawn and non-communicative or non-responsive);
- Unusual behavior traits such as sucking, biting, rocking; moaning; excreta.
Financial abuse is the illegal or unauthorized use of a person’s property, money, or other valuables (including changing the person’s will to name the abuser as heir). It may be obtained by deception, coercion, misrepresentation, undue influence, or theft. This includes fraudulently obtaining guardianship or the use of a power of attorney. Other forms include deprivation of money or other property or eviction from their own home. The elderly are sometimes victims of financial abuse from people within their families:
- Their signature is forged for financial transactions;
- Coerced or influence to sign over deeds, wills, or power of attorney;
- Deceived into believing that money is exchanged for the promise of lifelong care.
When a family member engages in financial abuse of the elderly they may feel justified, for instance, they are taking what they might later inherit or have a sense of “entitlement” due to a negative personal relationship with the older person. Or they may take money or property to prevent other family members from getting the money or for fear that their inheritance may be lost due to the cost of treating illnesses.
Researchers have estimated that there may be 5 million elderly citizens of the United States subject to financial abuse each year. The following are examples of the scams that are run:
- Worthless “sweepstakes” run by strangers that elderly persons must pay into to collect winnings (drilling for oil offshore is a common one);
- Fraudulent investment schemes (again the victim must invest seed money to qualify for the big payoff);
- Predatory lending (a lending practice that imposes unfair or abusive loan terms on a borrower)
Sexual abuse is forcing a person to take part in any sexual activity without his or her consent, including forcing them to participate in conversations of a sexual nature against their will; There may also include situations where the person is no longer able to give consent (dementia)
Neglect is depriving a person of proper medical treatment, food, clothing or comfort, or essential medication and depriving a person of needed services to force certain kinds of actions, financial and otherwise. Neglect can include leaving an at-risk elder unattended. The deprivation may be intentional (active neglect) or happen out of a lack of knowledge or resources (passive neglect).
Hybrid financial exploitation (HFE) is financial exploitation that co-occurs with physical abuse and/or neglect. Researchers have concluded that HFE victims are generally more likely to live with and fear the abusive individual, to perceive the abusive individual as a caretaker, and to have a longer duration of abuse.
In addition, some U.S. state laws also recognize the following as elder abuse:
Abandonment: Elder abandonment is a form of abuse that occurs when a person who has assumed responsibility for providing care to an elderly individual deserts that individual. Also, it generally contains an element of intent to abandon or leave them unattended at a place for such a period as may likely endanger their health or welfare.
Rights abuse is denying the civil and constitutional rights of a person who is old, but not declared by a court to be mentally incapacitated. This is an aspect of elder abuse that is increasingly being recognized and adopted by nations.
Self-neglect is when any person neglects themselves by not caring about their health, well-being, or safety. Self-neglect (harm by self) is treated as conceptually different than abuse (harm by others). Elder self-neglect can lead to illness, injury, or even death. Common needs that older adults may deny themselves, or ignore are the following: Sustenance (food or water); cleanliness (bathing and personal hygiene); adequate clothing for climate protection; proper shelter; adequate safety; clean and healthy surroundings; medical attention for serious illness; essential medications. Self-neglect is often created by an individual’s declining mental awareness or capability. Some older adults may choose to deny themselves some health or safety benefits, which may not be self-neglect. This may simply be their personal choice. Caregivers and other responsible individuals must honor these choices if the older adult is sound of mind. In other instances, the older adult may lack the needed resources, as a result of poverty, or other social conditions.
Institutional abuse refers to physical or psychological harm, as well as rights violations in settings where care and assistance are provided.
Medical abuse occurs when elderly people are not given the proper care they need for their medical conditions and ailments
Example of elder neglect:
An 86-year-old man arrived at the emergency room from his son’s home with multiple bed sores all over his back and on his heels, and with severe dehydration. He had restraint marks on his wrist. His son said they felt like they had to restrain him or he would wander off during the night.
An abuser can be almost anyone that has contact with an elderly person. For example, a spouse, partner, relatives, neighbors, a paid caregiver, or any other individual with the intent to deprive a vulnerable person of their resources. Relatives include immediate and extended family, as well as adult children and their spouses or partners. Children and living relatives who have a history of substance abuse or have had other life troubles are of particular concern. The majority of abusers are relatives, typically the older adult’s spouse/partner or sons and daughters, although the type of abuse differs according to the relationship. In some situations, the abuse is “domestic violence grown old,” a situation in which the abusive behavior of a spouse or partner continues into old age. Perpetrators of elder abuse can include anyone in a position of trust, control, or authority. Family relationships, neighbors, and friends are all socially considered as relationships of trust, whether or not the older adult thinks of the people as “trustworthy”. Some perpetrators may “groom” an older person (befriend or build a relationship with them) to establish a relationship of trust. Older people living alone who have no adult children living nearby are particularly vulnerable to “grooming” by neighbors and friends who would hope to gain control of their estates. Within paid care environments, abuse can occur for a variety of reasons. Some abuse is the willful act of cruelty inflicted by a single individual upon an older person. With the aging of today’s population, there is the potential that elder abuse will increase unless it is more comprehensively recognized and addressed.
INDICATORS OF ELDER ABUSE
Early recognition of indicators of abuse is key to timely prevention and intervention of elder abuse. When elderly individuals exhibit certain characteristics it is a strong indication that they have been abused. In essence, they show signs of abuse whether it be physical, psychological, or other. Physical indicators are generally easier to detect and may include injuries such as broken bones and/or bruises. Whereas, behavioral abuses are more difficult to detect because many of them align themselves with normal aging characteristics. Many of the indicators listed below can be explained by other causes (e.g. a bruise may be the result of an accident) and no single indicator can be taken as conclusive proof. Rather, one should look for patterns of indicators that suggest an abuse situation.
Physical indicators include:
- Sprains, broken bones;
- Strap mark;
- Internal injuries with pain, bleeding, or limited functionality;
- Bilateral bruising to the arms or thighs;
- Bruises that encircle the arms, legs, or body (an indication that the individual may have been physically restrained)
- Mood/attitude swings (may be severe);
- Repetitive injuries that require frequent hospital visits;
- Unusual difficulty in making decisions;
- Unexplained injuries that do not “fit” with the observations;
- Multiple explanations of and for an injury;
Signs of sexual abuse in the elderly:
- Bruising on inner thighs
- Sexually transmitted diseases or infections
- Any sudden change in personality
- Acting overly compliant
- Odd comments about sex or sexual behaviors
- Agitation or aggression
- Scared or timid behavior
- Withdrawal and wanting to be alone
ELDER ABUSE PREVALENCE AND INCIDENCE
The Center for Elder Abuse reports the following:
- No one knows precisely how many elderly persons are being abused, neglected, or exploited. While evidence accumulated to date suggests that many thousands have been harmed, there are no official national statistics. There are several reasons:
- Definitions of elder abuse vary. It is difficult to pinpoint exactly what actions or inactions constitute abuse, and the problem remains greatly hidden;
- State statistics vary widely as there is no uniform reporting system;
- Comprehensive national data are not collected.
- In the absence of a large-scale, nationwide tracking system, studies of prevalence and incidence conducted over the past few years by independent investigators have been crucial in helping us to understand the magnitude of the problem.
- This fact sheet highlights some of the most widely used estimates of elder abuse prevalence and incidence in the United States today. Readers are strongly encouraged to consult the original studies for further information.
WHAT DO STUDIES SAY?
- Prevalence–According to the best available estimates, between 1 and 2 million Americans age 65 or older have been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection.
- Finding from “Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America. 2003. Washington, DC: National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect.”.
- Estimates of the frequency of elder abuse range from 2% to 10% based on various sampling, survey methods, and case definitions.
- Data on elder abuse in domestic settings suggest that 1 in 14 incidents, excluding incidents of self-neglect, come to the attention of authorities.
- Current estimates put the overall reporting of financial exploitation at only 1 in 25 cases, suggesting that there may be at least 5 million financial abuse victims each year. It is estimated that for every case of elder abuse, neglect, exploitation, or self-neglect reported to authorities, about five more go unreported.
ABOUT PREVALENCE AND INCIDENCE
Prevalence refers to the total number of people who have experienced abuse, neglect, or exploitation in a specified period while Incidence is the number of new cases identified or reported at a given point in time— usually one year.
Many factors affect actual prevalence and incidence. National estimates may vary, due to differences in research methods, sample sizes, and definitions across studies. Population‐based surveys of elder mistreatment occurrence are feasible and should be given a high priority.
The abuse of elders by caregivers is a worldwide issue. In 2002, the work of the World Health Organization brought international attention to the issue of elder abuse. Over the years, government agencies and community professional groups, worldwide, have specified elder abuse as a social problem. In 2006 the International Network for Prevention of Elder Abuse (INPEA) designated June 15 as World Elder Abuse Awareness Day (WEAAD) and an increasing number of events are held across the globe on this day to raise awareness of elder abuse, and highlight ways to challenge such abuse. The fundamental common denominator is the use of power and control by one individual to affect the well-being and status of another, older, individual.
The health consequences of elder abuse are very serious. Abuse can interrupt an elderly person’s quality of life by limiting their activities and increasing their dependence on caregivers. Other physical and emotional characteristics are:
- Restricted activities;
- Accelerated dependence;
- Increased anguish and stress;
- Premature mortality and morbidity;
- Increase rate of dementia;
- Premature Death;
In essence, the elder person’s way of life is negatively impacted by abuse. With the aging of today’s population, there is the potential that elder abuse will increase unless it is more comprehensively recognized and addressed.
FLORIDA STATUTE CHAPTER 415 and REPORTING ABUSE
The Florida Department of Children and Families is responsible for providing services to detect and correct abuse, neglect, and exploitation of vulnerable adults who, because of their age or disability, may be unable to adequately provide for their care or protection. In taking action to prevent further abuse, neglect, and exploitation, the department must place the fewest possible restrictions on personal liberty and the exercise of constitutional rights. The department’s actions must be consistent with due process and protection from abuse, neglect, and exploitation. Law enforcement takes the lead in all criminal investigations and prosecution.
It is crucial for us to all work together to end abuse. All abuse reports in Florida need to be made to the Florida Department of Children and Families.
Abuse Reporting Legislation
Florida has enacted legislation to protect adults as well. F.S., Chapter 415 states the Legislature recognizes that there are many persons in this state who, because of age or disability, need protective services. Such services should allow such an individual the same rights as other citizens and, at the same time, protect the individual from abuse, neglect, and exploitation. The Legislature intends to provide for the detection and correction of abuse, neglect, and exploitation through social services and criminal investigations and to establish a program of protective services for all vulnerable adults in need of them. It is intended that the mandatory reporting of such cases will cause the protective services of the state to be brought to bear to prevent further abuse, neglect, and exploitation of vulnerable adults.
F.S., Chapter 415 states that any person, including, but not limited to, any:
- Physician, osteopathic physician, medical examiner, chiropractic physician, nurse, paramedic, emergency medical technician, or hospital personnel engaged in the admission, examination, care, or treatment of vulnerable adults;
- Health professional or mental health professional
- A practitioner who relies solely on spiritual means for healing;
- Nursing home staff; assisted living facility staff; adult day care center staff; adult family-care home staff; social worker; or other professional adult care, residential, or institutional staff;
- State, county, or municipal criminal justice employee or law enforcement officer;
- An employee of the Department of Business and Professional Regulation conducting inspections of public lodging establishments under s. 032;
- Florida advocacy council member or long-term care ombudsman council member; or
- Bank, savings and loan, or credit union officer, trustee, or employee, who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or exploited shall immediately report such knowledge or suspicion to the central abuse hotline.
Reports of abuse, neglect, or exploitation of the vulnerable adult, including reports made to the central abuse hotline, and all records generated as a result of such reports shall be confidential and may not be disclosed except as specifically authorized by the Florida Statutes.
Legal Criteria for Reports
The Florida Abuse Hotline will accept a report on a vulnerable adult when:
There is reasonable cause to suspect that a vulnerable adult (a person 18 years of age or older whose ability to perform the normal activities of daily living or to provide for his or her care or protection is impaired due to disability or brain damage, or the infirmities of aging:
- is a resident of Florida or currently located in Florida
- is believed to have been neglected or abused by a caregiver in Florida; or
- is suffering from the ill effects of neglect by self and needs service, or
- is being exploited by any person who stands in a position of trust or confidence, or
- any person who knows or should know that a vulnerable adult cannot consent and who obtains or uses, or endeavors to obtain or use their funds, assets, or property.
- Reports of exploitation cannot be accepted after the vulnerable adult is deceased.
All reports are confidential. Access to these reports is limited by specific criteria in Chapter 415 of the Florida statutes. Florida Abuse Hotline Counselors will not acknowledge the existence of any report, will not acknowledge that they have previously spoken to a particular caller, nor will they release any information provided by a caller or any information contained in the report. No reports are released by the Florida Abuse Hotline other than to those persons specifically authorized under Chapter 415, F.S.
The Florida Abuse Hotline accepts reports 24 hours a day and 7 days a week of known or suspected child abuse, neglect, or abandonment and reports of known or suspected abuse, neglect, or exploitation of a vulnerable adult.
To make a report you can:
- Report online at https://reportabuse.dcf.state.fl.us/
- Call 1-800-962-2873
- Use 711 for Florida Relay Services
- FAX your report to 1-800-914-0004
If you suspect or know of a child or vulnerable adult in immediate danger, call 911.
Call (800) 962-2873.
Press 2 to report suspected abuse, neglect, or exploitation of the elderly or a vulnerable adult
Press 4 for information/referrals to other services in your local area.
Be prepared to provide specific descriptions of the incident(s) or the circumstances contributing to the risk of harm, including who was involved, what occurred, when and where it occurred, why it happened, the extent of any injuries sustained, what the victim(s) said happened, and any other pertinent information are very important.
Information callers should have ready includes:
- Name, date of birth (or approximate age), race, and gender, for all adults and children involved.
- Addresses or another means to locate the subjects of the report, including the current location.
- Information regarding disabilities and/or limitations of the victims (especially for vulnerable adult victims).
- Relationship of the alleged perpetrator to the child or adult victim(s).
- Other relevant information that would expedite an investigation, such as directions to the victim (especially in rural areas) and potential risks to the investigator, should be given to the Abuse Hotline Counselor.
To make a report, via fax, send a detailed written report with your name and contact telephone or FAX contact information using the Florida Abuse Hotlines fax reporting form to (800) 914-0004.
Web reporting should not be used for situations requiring immediate attention. Please contact the Hotlines toll-free reporting number if you believe a child or vulnerable adult is at imminent risk of harm.
Do not delay in contacting the Florida Abuse Hotline even if you do not have all of the necessary information. The hotline counselor can help make an assessment based on the available information and will decide if it is sufficient to accept a report for investigation.
You should have the following information:
- Date of birth (or approximate age)
- Address, including current location
- Information regarding disabilities and/or limitations for vulnerable adult victims
- Relationship of the alleged perpetrator to the child or adult victim
If you are placed on hold and the situation is an emergency or the victim is in imminent danger, you should hang up and dial 911, then follow up with the Abuse Hotline.
Elder abuse is a serious problem in the United States. When individuals that are incapable of taking care of themselves are victimized by the very people that are supposed to provide care the situation is troubling and needs correction. It’s painful when one recognizes that individuals are being hurt with very little concern or action from anyone. We need to strengthen our laws and then enforce them.
It is important to take into account the effects of traumatic stress on victims of abuse and on their ability to recount the abusive event. With the elderly, there is, at times, difficulty with them communicating what they are going through. Please be vigilant to recognize the signs of abuse. Victims frequently feel afraid of the offender or feel shame about the abuse. Many will be incapable of telling about their situation.
Senior years should be golden years without fear of what abuse a caregiver will do today.