In the struggle to raise awareness of domestic violence and abuse, mental, physical and emotional abuse of women and men, and of violence towards children, one segment of the population is often left behind. The elderly and infirm, often left in the care of strangers or ill-equipped family members, are among our most vulnerable.

We have all seen the horror stories of seniors in seriously under-staffed facilities where they receive little or no personal attention, are drugged into submissive stupors, or forcibly confined for the convenience of the staff. What of those unfortunates who suffer neglect and abuse at the hands of their own families?

Victims of elder abuse may suffer in silence for years with no-one ever recognizing their plight. They may be too ashamed to admit that their own child or grandchild, a person they helped to raise, is abusing them. They may have abused the person who now has the care and keeping of them, and so are afraid of further retaliation. Unable to fend for themselves any longer because of age or infirmity, they may be afraid of abandonment if they speak out.

Some sobering statistics from the website for the North Carolina Division of Aging and Adult Services:

"Each year, more than two million vulnerable and older adults are victims of abuse, neglect, and exploitation. Research has shown that older adults who are abused, neglected and exploited are three times more likely to die within ten years than those who are not.

According to national statistics, elder abuse is grossly under reported because vulnerable and older adults who are being abused find it very difficult to tell anyone due to shame and fear. Elder Abuse affects men and women of all ethnic backgrounds and social status; it occurs in private residences and in facilities.

In 2008 there were more than 15,300 reports of abuse, neglect or exploitation of vulnerable and older adults made to North Carolina's 100 county departments of social services. Reports are made not only by doctors and other professionals but by family members and concerned citizens in our communities.

Anyone who suspects that a vulnerable or older adult is in need of protection is required by North Carolina General Statute (GS 108A-102) to report this information to the department of social services in the county where the adult resides."

Caregivers in institutions can experience incredible stress levels. Nursing home staff may tend towards abusing their charges if they lack proper training, have too many duties and responsibilities, are unsuited to care-giving, or are working in poor conditions.

In many cases the abuse is not intentional. Caregivers, especially relatives in the position of primary caregiver, find themselves pushed beyond their capabilities or psychological resources.

They may not mean to yell, or strike out, or ignore the needs of the elders in their care, but in spite of their best intentions, the abuse happens.

As well, there are risk factors involving the seniors that conspire to put them at greater risk of abuse. These factors include:

• The severity of their existing illness or dementia
• Isolation - they are alone with the caregiver most of the time
• The elder’s role as a formerly abusive parent or spouse
• A history of domestic violence in the home
• Their own tendency toward verbal or physical aggression

There are two red flags that could be signaling some form of elder abuse.

The first is frequent arguments between the caregiver and the elderly person.

Even if the caregiver tries to brush off your concern with excuses or tells you their charge is becoming senile and difficult, don't automatically believe their side of the story.

The second sign to watch for is changes in the personality or behavior of the elderly person.

At first, these changes may appear to be symptoms of dementia or signs of the elderly person’s increasing frailty.

In fact, many of the signs and symptoms of elder abuse do overlap with symptoms of mental deterioration, but that doesn’t mean you should dismiss them out of hand solely on the caregiver’s say-so.

If you suspect someone is a victim of elder abuse, report it immediately. Some states have enacted legislation that makes it an offense to not report cases of suspected abuse.

If you are an elder who is being abused, neglected, or exploited, you must tell at least one person. Tell your doctor, a friend, or a family member who can help. There are people and agencies who can and will help you.