Emmalee Miller, age 82, is brought into the Emergency Department by a concerned neighbor. The patient is a widow with mild Alzheimer's dementia, who used to live alone in her own house until about three months ago, when her unemployed son came to live with her. The frail elderly woman has a disheveled appearance with tattered soiled clothing. She acts frightened and withdrawn. A physical examination reveals that Mrs. Miller is dehydrated, malnourished, and mentally confused. The nurse notes a 10 cm purple hematoma on the left side of her face, numerous bruises in various stages of healing on her lateral right arm and on her posterior torso, and three dime sized burned areas on her upper inner thigh. The nurse strongly suspects elder abuse.
Frail, dependent elders are highly vulnerable to anyone who might take advantage of them. Elder abuse is any action or inaction that results in harm/ loss or endangers the welfare of people age 65 and above. Elder mistreatment is a general term for abuse, neglect, and exploitation. It can include physical abuse or neglect, psychological abuse, financial or fiduciary abuse, self-neglect, or the inappropriate use of medications, restraints, or confinement.
Like Emmalee, the 'typical' abused elder is a female over the age of 75, who is socially isolated, suffers from chronic health conditions, is in the lower socioeconomic strata, and lives with her abuser(s). Common characteristics of abusers are as follows: family member (majority of cases); male; impairments such as mental illness and substance abuse; poor social network; history of family violence; legal/ financial issues; and, dependent on the older adult. The most frequently identified perpetrators are adult children, followed by a spouse, long term care facility staff, or other relatives.
Elder abuse/ mistreatment is the least reported form of domestic violence. The prevalence of elder mistreatment is difficult to accurately gauge since many cases go unreported. It is estimated that for every one case of elder abuse reported to authorities, about five more go unreported. One reason may be that normal and common age-related changes mask or mimic markers of abuse. The best available data indicate that each year between 1 and 2 million older Americans are injured, neglected, exploited, or otherwise mistreated by someone on whom they depended for care or protection. The number of cases of elder mistreatment will undoubtedly increase over the next four decades, as the population ages.
Laws vary from state to state, but elder abuse may be broadly categorized as:
Any action that results in physical pain, injury, or impairment is considered physical abuse. An estimated 0.5 to 4.3 percent of older adults are physically abused annually. This includes, but is not limited to: striking, beating, handling with unnecessary roughness, purposeful injury, unreasonable physical restraint, sexual assault, and deprivation of food or water.
The most common form of elder mistreatment is neglect. Neglect is the failure to take care of the needs of an elderly person. This includes, but is not limited to: failure to provide nourishment, hydration, hygiene, clothing, shelter, medical care, and protection from injury. Self-neglect is common among frail elders who live alone. Indicators of self-neglect are malnourishment, dehydration, falls, poor hygiene, and inadequate clothing.
Psychological (Emotional) Abuse
This can be difficult to identify and prevent. In psychological abuse, an elderly person is treated in a way that causes emotional pain or distress. This can range from extremes of verbal abuse, coercion, and accusation to more subtle tactics such as manipulation, intimidation, withholding attention, and a general lack of patience and respect. Emotional abuse is damaging in that it wears away the elderly individual's self-confidence, self-worth, and self-esteem. Frail, dependent elders often have little means to defend themselves from the constant humiliation and verbal assaults.
Sexual elder abuse is non-consensual sexual contact with an elderly person without the elder's consent. Such contact can involve unwelcome sexual touching, physical sex acts, forcing an older person to view pornography or watch sex acts, and making an elder undress against her will.
Financial (Fiduciary) Abuse
In these tough economic times, crimes and financial exploitation against vulnerable older adults are among the fastest growing in the country. Many seniors across the U.S. suffer financial abuse at the hands of friends, family members, telemarketers, unscrupulous TV evangelists, people they meet on the Internet, and financial services employees. Financial abuse or exploitation is misappropriation of an elder's property or identity by means of trickery, manipulation, or exploitation. This includes, but is not limited to: making unauthorized withdrawals from an elderly person's account, cashing an elderly person's Social Security check and keeping part or all of it, forcing an elderly person to suddenly change her will, falsifying claims, or diverting funds and assets. Financial exploitation by a family member is reported annually by 5 to 6 percent of older people.
This is harsh treatment of elderly patients by healthcare personnel. Most of the time, this type abuse is not intentional, but results from frustration and lack of self-control on behalf of harried healthcare workers. Caring for the needs of frail dependent older adults can be unrelentingly stressful. When staffing is inadequate, the frustration can grow to a boiling point, manifesting in many harmful ways. This includes, but is not limited to: excessive force in treatment, intimidation by yelling or humiliation, ignoring a patient's needs, rushing a patient through a meal, inappropriate use of medications, restraints, or confinement, and depriving an elderly patient of food, water, and medications.
Part 2 of this two-part series will discuss ways to identify elder abuse, common presentations, and mandatory reporting requirements. Please stay tuned.
Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
What Is Elder Abuse?