How can I recognize signs of elder abuse?
Here are some common signs of abuse that an older adult may show. Please note that some of the symptoms listed below contain graphic descriptions of injuries related to sexual abuse. However, because the older adult might not be able to report the abuse, it’s important to watch out for these signs that may indicate sexually abusive behavior.
- Physical abuse:
- bruises, especially when bruises are grouped in one area or in regular patterns; black eyes; welts;
- open wounds, cuts, punctures, or other untreated injuries at different stages of healing;
- sprains, dislocations, or internal injuries/bleeding;
- broken eyeglasses/frames;
- signs of being restrained, like rope marks;
- laboratory findings of medication overdose or under-utilization of prescribed drugs;
- sudden changes in behavior;
- partner’s/caregiver’s refusal to allow visitors to be alone with the older adult; or
- the older adult’s report of being physically abused or mistreated.
- Sexual abuse:
- bruises around the breasts or genital area;
- unexplained venereal disease or genital infections;
- unexplained vaginal or anal bleeding;
- changes in behavior, such as showing fear or becoming withdrawn when a specific person is around;
- evidence of pornographic material being shown to an older adult with diminished capacity;
- blood found on sheets, linens, or clothing; or
- an older adult’s report of being sexually abused or assaulted.
- Emotional/psychological abuse:
- being emotionally upset, agitated, or in fear of a specific person, usually the abuser;
- being extremely withdrawn, non-communicative, or non-responsive;
- unusual behavior, such as sucking, biting, rocking;
- witnessing a caregiver controlling or isolating an older adult;
- exhibiting a change in sleeping patterns or eating habits;
- personality changes, such as apologizing excessively;
- depression or anxiety; or
- the older adult’s report of being verbally, emotionally, or psychologically mistreated.
- Financial abuse/exploitation:
- sudden changes in bank accounts or banking practices, including unexplained withdrawals of large sums of money by a person accompanying the older adult;
- unexpectedly including other people on an older adult’s bank account;
- unauthorized withdrawals of the older adult’s funds using his/her ATM card;
- abrupt changes in a will or other financial documents;
- unexplained disappearance of funds or valuable possessions;
- bills left unpaid despite the availability of adequate financial resources;
- forged signatures on financial transactions or on the title of the older adult’s car, home, etc.;
- relatives claiming the rights to an older adult’s property or possessions;
- unexplained sudden transfer of assets to a family member or someone outside the family;
- misuse of the older adult’s money for services that are not needed; or
- an older adult’s report of financial abuse or exploitation.
- Neglect and abandonment:
- dehydration, malnutrition, untreated bed sores, or poor personal hygiene;
- unattended or untreated health problems;
- hazardous or unsafe living conditions/arrangements, for example having improper wiring, no heat, or no running water in the residence;
- unsanitary and unclean living conditions, like dirt, fleas, lice, soiled bedding, fecal/urine smell, inadequate clothing, etc.;
- abandoning the older adult at a hospital, nursing facility, or other similar institution, or at a shopping center or other public location; or
- an older adult’s report of being neglected or abandoned.1
Signs of elder abuse could be mistaken for normal issues with aging. For instance, a person may think an older adult has simply changed with age if s/he used to be outgoing and talkative, but now startles easily or avoids eye contact. However, since many symptoms of elder abuse may, in fact, overlap with symptoms of aging or medical issues, such as dementia, frailty, or other problems related to age, signs of abuse may need to be compared to the older adult’s typical behavior, and considered in light of his/her mental and physical health.
If you are concerned that an older adult is being abused, or if you are an older adult who is being abused/neglected, there are organizations and people who care and can help. Please consider the following options:
- tell your doctor, a friend, or a family member you trust;
- locate help near you through this Eldercare Locator from the US Administration on Aging; or
- contact the local Adult Protective Services office.
1 “Red Flags of Elder Abuse,” US Department of Justice
How common is elder abuse among older adults?
The National Counsel on Aging reports that one in ten Americans aged 60+ have experienced some form of elder abuse. However, only one in fourteen cases of elder abuse are reported to the authorities. In almost 60% of elder abuse and neglect incidents, the perpetrator is a family member and most likely an adult child or spouse. Other times, abuse happens in institutions, such as residential care, hospitals, and day care facilities.1
However, there are several reasons that it may be hard for researchers to get completely accurate elder abuse statistics. For instance, like many victims of abuse, older adults may be unwilling to report their abuse because they are scared the abuse will get worse. Some victims of elder abuse are unable to report their abuse or are not believed when they do report it because of their physical or mental condition.2
What are the risk factors for elder abuse?
There may be certain risk factors that make a caregiver more likely to commit elder abuse in both the home and in professional care environments, such as:
- current and untreated mental illness;
- current abuse of alcohol;
- lack of patience;
- having a “short temper;”
- lack of preparation and training for caregiving responsibilities;
- caregiving from an early age;
- lack of coping skills;
- exposure to abuse as a child;
- financial or emotional dependence on a vulnerable older adult;
- a history of disruptive behavior;
- lack of social and institutional support;
- lack of formal services in the community for caregivers, like respite care or frequent breaks or shift changes at a nursing home;
- an environment that tolerates or accepts aggressive behavior;
- lack of administrative or community oversight for healthcare personnel, guardians, or other people responsible for an older adult’s care;
- isolation from friends, family, or a support network;
- negative or unsympathetic beliefs about older adults and aging; or
- under-staffing, staff burnout, and stressful working conditions.1
1 This information was adapted from the Centers for Disease Control and Prevention.