This Tip Sheet is designed as a reference when responding to inquiries about elder abuse, neglect, and exploitation. Many times, the inquiries pose some hard‐to-answer questions, and this Tip Sheet pulls together what is known about elder abuse to provide suggestions on how you could respond. Remember that in addition to questions about the topic in general, you should be able to answer this question: “What are you and others doing about the problem?” Doing a quick inventory of your state, local, and/or organization’s efforts in this area will help you be prepared for such a question.
What is elder abuse?
According to the National Center on Elder Abuse, elder abuse refers to intentional or negligent acts by a caregiver or “trusted” individual that causes (or potentially causes) harm to a vulnerable elder.
Most common categories of abuse are:
- Neglect
- Physical abuse
- Sexual abuse
- Financial abuse and/or exploitation
- Emotional or psychological abuse (including verbal abuse and threats, neglect, etc.)
- Abandonment
- Self-neglect (an individual’s neglect of their own basic needs such as eating, hygiene, etc.)
Each state defines elder abuse differently. (You may wish to look up how your state defines abuse in your state’s statutes. For assistance, contact the NCEA.)
According to available data, neglect is the most common type of elder abuse. There is some debate over whether mistreatment by strangers, rather than by a person in a trust relationship to the victim such as spouse, child, or friend, also constitutes elder abuse, neglect, or exploitation.
Who is at risk for elder abuse, neglect, and/or exploitation?
Elder abuse can happen to anyone: a loved one, a neighbor, and, when we are old enough, it can even happen to us. Elder abuse affects seniors across all socio‐economic groups, cultures, and races.
Elder abuse can occur anywhere care occurs:
- The individual’s own home
- Their family’s home (if the individual is receiving family caregiving)
- Nursing homes, assisted living facilities, and other institutional settings
Hospitals and hospices
Based on available information, women and “older” elders (80 years old and older) are more likely to be victimized, and mistreatment is most often perpetrated by the victim’s own family members.
What are some common risk factors?
Common risk factors for elder abuse for seniors include:
- Dementia and other behavioral problems
- Mental health problems
- Substance abuse issues
- Social isolation
Poor physical health, which increases an individual’s vulnerability
Risk factors among caregivers include:
- The inability to cope with stress (lack of resilience)
- Depression (common among caregivers due to stress related to caregiving duties)
- Lack of support in caregiving
- Substance abuse
- Poor or inadequate preparation or training for caregiving responsibilities
- Assumption of caregiving responsibilities at an early age
- High levels of hostility
How can I prevent elder abuse?
Protective factors reduce the risk of elder abuse and neglect. While research is still needed to determine the efficacy of each of the protective factors listed below, there are still recommended practices to prevent elder abuse:
- Strong communication between elder’s family and the caregiver
- Strong support system in place for caregiver, particularly if they are a family caregiver stepping into a caregiving role for the first time
- Monitoring systems for elder and signs of abuse
- Regular visits by family members
How big is the problem of elder abuse?
Unfortunately, we simply do not know for certain. Although there has been relatively little research on incidence and prevalence of elder abuse, a recent study indicated that approximately 11 percent of US elders surveyed had experienced some type of abuse or potential neglect during the previous year. It is important to note that this survey did not include elders with dementia, a segment of the population believed to be at even greater risk for mistreatment, or elders living in long‐term care facilities.
(Acierno, R. et al. 2010. “Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study.” American Journal of Public Health, Vol. 100, 292‐297.)
According to the best available estimates, approximately 700,000 to 3.5 million older Americans are abused, neglect, or exploited each year. (Bonnie and Wallace, ed., 2003. Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America. Washington, DC: National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect.)
Research suggests that elder abuse is significantly under‐identified and under‐reported, and that as few as 1 in 6 cases of elder abuse come to the attention of authorities. (National Elder Abuse Incidence Study. (1998.) Washington, DC: National Center on Elder Abuse at American Public Human Services Association.)
The most recent national statistics for Adult Protective Services programs indicate that, in 2003, there were approximately 381,430 reports of elder abuse, neglect, or exploitation to APS across the country. (The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and Older. 2006. National Center on Elder Abuse.)
Even when suspicions are reported, the outcomes of the cases are difficult to track.
Why does elder abuse remain such an “invisible” problem?
Like other forms of interpersonal violence, elder abuse usually occurs behind closed doors. Many victims are reluctant to report abuse because they may:
- Feel ashamed and embarrassed, especially if a family member is the abuser
- Worry that they will be forced to live in a nursing home (this sometimes happens)
- Feel guilty or somehow to blame
- Be in denial that the abuse is occurring
- Be unaware that what they are experiencing is abuse or neglect
- Be afraid that if they report it, the abuse will worsen
Be afraid that their abuser will get “in trouble”
Some victims are unable to speak out due to dementia or other impairments, or may not be believed when they do due to other physical or mental health problems or even medications. The validity of their accusations may be brought into question due to the victim’s age and health conditions.
Although this theory hasn’t been researched, there are indications that a culture of ageism and a fear of growing old may keep older people marginalized and undervalued in our society, hence their problems remain invisible or are viewed as unimportant.
Who is required by law to report elder abuse?
Each state has its own reporting requirements, and many professionals who work closely with elders are considered “mandatory reporters” by state statues. (You may wish to look up who in your state is designated by state statue as a mandated reporter. For assistance, contact the NCEA.)
Unfortunately, many mandated reporters may not make reports, as they may not receive regular training and education to accurately distinguish the signs of “normal” aging from elder abuse, or may be in denial about the prevalence of elder abuse and therefore not look for or identify suspicious activities.
If you suspect your loved one is being abused or neglected, contact your local Adult Protective Services or law enforcement if you require immediate assistance. Although a situation may have already been investigated, if you believe circumstances are getting worse, continue to speak out. If you believe that an elder is in a life-threatening situation, contact 911 or the local police or sheriff’s department.
How is elder abuse being addressed in society?
Public awareness and grassroots involvement are a growing necessity to create change. Visibility of the issue helps to:
- Increase the identification and reporting of abuse by the public, professionals, and victims themselves
- Provide older victims with a safe environment to speak out and tell their stories
- Begins long‐term prevention by raising awareness among students and young people.
Additionally, enhanced services for victims are being used to help prevent abuse and provide additional services to reduce isolation (a key risk factor in abusive situations). These services also offer more effective intervention, elder shelters, and in-home help and medical attention targeted to at-risk seniors.
Where can I find more information?
Visit the website of the National Center on Elder Abuse/NCEA: www.ncea.aoa.gov, or contact us by email: ncea‐info@aoa.hhs.gov, by phone: 302‐831‐3525, or by mail: National Center on Elder Abuse c/o University of Delaware Center for Community Research and Service 297 Graham Hall Newark, DE 19716. Together, we have the power to prevent elder abuse.
This document was produced for the National Center on Elder Abuse (NCEA) by the University of Delaware and was supported in part by a grant from the Administration on Aging, U.S. Department of Health and Human Services (DHHS) (90‐ AM‐3146-03). Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official Administration on Aging or DHHS policy.