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Signs an Elder May Be a Victim of Abuse

Updated on June 30, 2016

On average, 10,000 Americans turn sixty five everyday. By 2050, the population of citizens 65 and older will account for 20% of the total number of Americans. The upside to this equation is that medical advances are allowing people to live longer. The unintended consequence is that many of our elderly are not living well and are vulnerable to abuse by caretakers, family and friends. Because of the work of a few dedicated pioneers in the field, you can learn signs of abuse and may be able to keep a loved one safe.

What is Elder Abuse?

First, one must understand what elder abuse is. The "Elder Justice Roadmap" report defines elder abuse as,

“physical, sexual, or psychological abuse, as well as neglect, abandonments, and financial exploitation of an older person by another person or entity, that occurs in any setting (e.g. home, community, or facility), either in a relationship where there is an expectation of trust and/or when an older person is targeted based on age or disability.”

This comprehensive definition exceeds the parameters included in most state laws and encompasses both social work and health care aspects. However, even a complete description of what elder abuse includes does not mean that doctors, nurses, social workers and advocates can easily identify abuse.


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Complexities of Recognizing Elder Abuse

Being the former Executive Director of a local family foundation afforded me the opportunity to also serve as Director of the Coordinated Response to Elder Abuse (CREA.) The community-wide effort to create a seamless response to elder abuse involved $3.4 million from the foundation and more than twenty organizations including the Family Safety Center, Crime Victims Center, local law enforcement and a major community hospital. A substantial portion of the grant funds were to be spent on training and curriculum development for these groups of social workers, police, doctors, nurses and in a variety of medical facilities throughout the community.

It seemed understandable that an inexperienced social worker or a police officer might not recognize the signs of abuse, but naively I believed a doctor would easily identify signs of physical abuse, sexual abuse or neglect. Not so. Our hospital team informed us that most emergency room doctors and nurses have little or no geriatric training and in the "hustle and bustle" of emergency room medicine signs can be mistaken for something else.

When a person ages they begin to lose muscle and body mass and the propensity to bruise increases. Older patients are many times prescribed blood thinners or other medications with side effects that include bruising.

It is not uncommon for the elderly who are frail or suffering from illness to eat and drink less and become malnourished or dehydrated. Elderly who are confined to a bed or immobile can develop pressure sores in spite of the best efforts of caretakers to relieve pressure by regularly moving the patient.

Further complicating awareness of abuse, is the mental capacity of the elder person. On the one hand, a growing incidence of dementia leads many medical professionals and others charged to help these individuals to conclude that the patient is unable to know what happened or did not happen. On the other hand, elderly persons are, of course, adults. Unless professionally determined to be mentally incapable of making decisions for themselves, an elderly person may spend his or her assets is any way they choose, even if their choices may not seem wise. Consequently, financial exploitation can be difficult to detect.

Like other types of abuse, elder abuse is about the perpetrator maintaining power and control. Just like other victims, an elder abuse victim may be wary of articulating what they have endured for fear of reprisal from the perpetrator. Subtle signs may be present, but without explanation from the victim or a witness, it can be hard for medical professionals and law enforcement to know for sure.


Warning Signs

Despite complexities, it is always better to be safe than sorry when is comes to suspected abuse. Most states require mandatory reporting of suspected abuse. Here is a partial list of some of the most common indicators that an older person you know may be a victim of abuse.

  • Physical -- signs of restraint such as rope marks on wrists or feet; black eyes; bruising in unusual places such as inner thigh, buttocks; bruising or other injury not consistent with the victims' abilities; untreated injuries
  • Sexual -- pain around genitals or breasts; unexplained vaginal or anal bleeding.
  • Emotional -- emotionally upset or agitated; withdrawn or unwilling to communicate.
  • Neglect -- poor hygiene; untreated pressure sores; filthy living conditions; unexplained malnourishment and/or dehydration.
  • Financial -- sudden inability to pay bills or buy food; drastic changes in will or other financial documents; unusual interest by a family member, caretaker or friend in the victims' personal assets.

(SOURCE: National Clearinghouse on Abuse in Later Life)

June 15th marked World Elder Abuse Awareness Day. Yet, most states and communities and the federal government are failing to dedicate sufficient resources to train and educate citizens and prosecute the offenders. Everyday citizens can save the lives or assets of an older person by being aware of the elderly around them, informed about the warning signs and vigilant about communicating suspicions to authorities.

Dr. Laura Mosqueda on Forensic Markers of Elder Abuse



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