Major Types of Elder Abuse

Courtesy of the National Center on Elder Abuse

Physical Abuse
Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include but is not limited to such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse.

Signs and symptoms of physical abuse include but are not limited to:

• bruises, black eyes, welts, lacerations, and rope marks;
• bone fractures, broken bones, and skull fractures;
• open wounds, cuts, punctures, untreated injuries in various stages of healing;
• sprains, dislocations, and internal injuries/bleeding;
• broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained;
• laboratory findings of medication overdose or under utilization of prescribed drugs;
• an elder's report of being hit, slapped, kicked, or mistreated;
• an elder's sudden change in behavior; and
• the caregiver's refusal to allow visitors to see an elder alone.
  

Sexual Abuse
Sexual abuse is defined as non-consensual sexual contact of any kind with an elderly person. Sexual contact with any person incapable of giving consent is also considered sexual abuse. It includes, but is not limited to, unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.

Signs and symptoms of sexual abuse include but are not limited to:

• bruises around the breasts or genital area;
• unexplained venereal disease or genital infections;
• unexplained vaginal or anal bleeding;
• torn, stained, or bloody underclothing; and
• an elder's report of being sexually assaulted or raped.
  

Emotional or Psychological Abuse

Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant; isolating an elderly person from his/her family, friends, or regular activities; giving an older person the "silent treatment;" and enforced social isolation are examples of emotional/psychological abuse.

Signs and symptoms of emotional/psychological abuse include but are not limited to:

• being emotionally upset or agitated;
• being extremely withdrawn and non communicative or non responsive;
• unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking); and
• an elder's report of being verbally or emotionally mistreated.
  

Neglect

Neglect is defined as the refusal or failure to fulfill any part of a person's obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care.

Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder.

Signs and symptoms of neglect include but are not limited to:

• dehydration, malnutrition, untreated bed sores, and poor personal hygiene;
• unattended or untreated health problems;
• hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water);
• unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing); and
• an elder's report of being mistreated.
  

Abandonment

Abandonment is defined as the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.

Signs and symptoms of abandonment include but are not limited to:

• the desertion of an elder at a hospital, a nursing facility, or other similar institution;
• the desertion of an elder at a shopping center or other public location; and
• an elder's own report of being abandoned.
  

Financial or Material Exploitation

Financial or material exploitation is defined as the illegal or improper use of an elder's funds, property, or assets. Examples include, but are not limited to, cashing an elderly person's checks without authorization or permission; forging an older person's signature; misusing or stealing an older person's money or possessions; coercing or deceiving an older person into signing any document (e.g., contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.

Signs and symptoms of financial or material exploitation include but are not limited to:

• sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder;
• the inclusion of additional names on an elder's bank signature card;
• unauthorized withdrawal of the elder's funds using the elder's ATM card;
• abrupt changes in a will or other financial documents;
• unexplained disappearance of funds or valuable possessions;
• substandard care being provided or bills unpaid despite the availability of adequate financial resources;
• discovery of an elder's signature being forged for financial transactions or for the titles of his/her possessions;
• sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions;
• unexplained sudden transfer of assets to a family member or someone outside the family;
• the provision of services that are not necessary; and
• an elder's report of financial exploitation.
  

Self-neglect

Self-neglect is characterized as the behavior of an elderly person that threatens his/her own health or safety. Self-neglect generally manifests itself in an older person as a refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions.

The definition of self-neglect excludes a situation in which a mentally competent older person, who understands the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her health or safety as a matter of personal choice.

Signs and symptoms of self-neglect include but are not limited to:

• dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene;
• hazardous or unsafe living conditions/arrangements (e.g., improper wiring, no indoor plumbing, no heat, no running water);
• unsanitary or unclean living quarters (e.g., animal/insect infestation, no functioning toilet, fecal/urine smell);
• inappropriate and/or inadequate clothing, lack of the necessary medical aids (e.g., eyeglasses, hearing aids, dentures); and grossly inadequate housing or homelessness.