Elder abuse is a common issue that has plagued older individuals for decades in healthcare and home settings. This abuse has a significant impact on the elder’s quality of life. The risk factors associated with elder abuse will be stated in this paper. Mental health plays a large role in elder abuse and it will be discussed from the side of the victim and the side of the abuser. Also, there will be an example of a screening method used by health professionals to detect elder abuse.

Elder Abuse is defined as an older patient, usually 60 or older, who is neglected and or abused by a loved one, health professional, or a caregiver. Usually in these instances, the elder is dependent on another individual and have certain illnesses. Elder abuse is not limited to only physical abuse. Risk factors including gender, ethnicity, and marital status will influence which elder is more likely to experience elder abuse compared to others. Mental health also plays a big role in elder abuse and the victim and abuser both likely suffer from psychological illnesses.

Different Forms of Elder Abuse

Elders are not only subjected to physical abuse but they are also exposed to financial abuse, sexual abuse, and psychological abuse (Pillemer et al., 2015). Examples of financial abuse include forcing elders to add individuals to their will, forcing them to give them their pension or retirement money, and in some cases selling the belongings of the elder without their permission. Many elders experience sexual abuse. Sexual abuse includes rape, sexual assault, and any other sexual contact that is considered non-consensual (Ananias & Strydom, 2014).

Risk Factors Associated with Elder Abuse

Various risk factors have an influence on whether an individual is likely to experience elder abuse. These factors include ethnicity, environment, gender, marital status, and loneliness. Elders who are nonwhite are more likely to experience elder abuse than individuals who are white. Also, African Americans have a greater risk of experiencing psychological and financial abuse more than any other ethnicity (Wang et al., 2015). Most elders are more likely to be abused if they live with an individual who has an alcohol or drug issue. Women are more likely to experience elder abuse than men overall. Although women are more likely to experience elder abuse, a study done by the World Health Organization reveals that elder men are more likely to be abused by spouses. Elder men are also most likely to be abused by their older children and family. Elder women who are married have a greater risk of experiencing abuse than women who are divorced or widowed. Furthermore, elders who do not live close to their families are more exposed to elder abuse. These individuals are at a greater risk because they resort to trusting in strangers. There are usually no family members around to notice or report the patterns of abuse (Ananias & Strydom, 2014).

Mental Health of Victims

The mental health of victims is affected greatly by elder abuse. Men and women who experience elder abuse in any form are at higher risk for experiencing psychological stress. Along with psychological stress, many elders develop Post Traumatic Stress Syndrome. These psychiatric illnesses can shorten the life of an elder significantly. It can also devalue their quality of life. Once elders start to experience abuse, some resort to drinking alcohol or using drugs. These traumatizing experiences leave elders to suffer with depression and anxiety for the last few years of their lives. They become consumed with depression and socially isolate themselves from others (Rosen, 2014). While some elders experience only physical abuse, many others experience psychological abuse. Psychological abuse happens when elders are being constantly threatened, insulted, harassed, intimidated, and humiliated. This is another factor that forces them into social isolation (Ananias & Strydom, 2014).

Mental Health of Abusers

There are a great number of reasons why an individual may subject an elder to abuse. Caregivers, which include healthcare professionals and family members, possess different characteristics that influence their behavior towards dependent elders. Caregivers and health professionals who are younger tend to be more abusive than older caregivers and health professionals. Many of them cannot handle the stress of taking care of a dependent individual. Most caregivers and health professionals themselves have psychological issues. Individuals tend to become abusive because of stress and exhaustion. Some elders are strictly dependent on their caregivers and it can cause lots of stress.

Screening Method

Healthcare professionals have developed many different screening methods and tools that can detect elder abuse once it is suspected. Many of the tools are questionnaires that are given to the elders. Not only do these questionnaires help detect elder abuse but they also help identify elders who are at risk of experiencing elder abuse in the near future. One example of a screening method is the Hwalek-Sengstock Elder Abuse Screening Test. This screening method was created to help health professionals detect the abuse. This screening method consists of 15 questions. The questions give information on whether an elder is lonely or sad often, if they have caregivers that abuse alcohol and drugs, if they feel uncomfortable at home, and if someone close to them has tried to harm them (Ries, 2018).

Conclusion

Elders suffer from physical, financial, sexual, and psychological abuse. Many factors including age, ethnicity, marital status, and loneliness influence whether an elder will be exposed to elder abuse. Elder abuse has a great impact on the elder’s mental health. It leaves them consumed with depression and anxiety for their final years of life.

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The news and media all over the place are crammed with the stories of domestic violence, drug abuse, child abuse even economic abuse. But there is another kind of abuse that gets very little attention, abuse that affects the lives of millions of elderly people all around the globe each and every day. It’s elder abuse?”a problem that very few people want to talk about or even recognize as a major issue. Elder abuse is a combined form of many other abuses, such as, physical abuse, emotional abuse, sexual abuse and financial abuse. Elder abuse is a huge problem due to lack of its proper education, lack of awareness, and insufficiency of nonprofit-organizations to help elders from this issue.

Elder abuse is a widely growing problem all around the globe due to its lack to proper education. Many elderly people are abused in their houses from their own family, relative’s homes, public places and even in facilities accountable for their care. Elder abuse occurs when elderly people loses their ability to take care for themselves and there is increased reliance on family or caregiver. Elder abuse can take many different forms such as, physical abuse, emotional/psychological abuse, sexual abuse, financial trickery/material exploitation. Physical abuse is use of force like pushing, kicking or slapping. Emotional or psychological abuse to elders occurs when they are threatened, insulted and verbally abused. Sexual abuse is forcing the elders to watch pornographic material or touching them without their permission. Eder people suffer financial abuse when they are forced or tricked to sign their properties or give money away their money.

Another reason why elder abuse is hidden yet growing problem is due to lack of its awareness. Many people in America (age 60+) are suffering from elder abuse; "more than half a million reports of elder abuse reach authorities every year, and millions more cases go unreported" (Helpguide.org). Elder abuse is an issue worldwide, yet it’s not very trendy because elder people do not have energy to voice out their problems and ask for help. Studies show how victims of elder abuse are twice more likely to die early than people who are not sufferers of elder abuse. Estimated 2 in every 5 American age 60 + suffers from elder abuse which is about 19 million people only in U.S. And this number gets bigger when looked at the entire world because elder abuse is not an issue limited to just United States, about 900 million people age 60+ are the victims of elder abuse all around the globe. And if nothing is done, this number is projected to "2 billion" people by 2050 (World Health Organization). This shows how important it is for us to step up today because if nothings done, you could be a victim of elder abuse one day.

Scarcity of non-profit organizations that helps victims of elder abuse is another reason why elder abuse is a largely growing problem. Although not very many non-profit organizations for elder abuse exists but "INPEA Make a Difference" is one of the very few organizations that helps victims of elder abuse not only in United States but also internationally. INPEA Make a Difference stands for International Network for the Prevention of Elder Abuse, this organization works under the United Nations and supports to raise awareness to this problem by educating individuals and by camping all around the world to help people suffering from this problem. INPEA also provides advice and resources to professionals, researchers, advocates and families around the globe by providing individual assistance via helpline, websites and social media.

In conclusion, elder abuse is a giant problem which affects the lives of millions of elder people every day. It’s a growing problem that no one seems to care about, but as students we can help by spending more time with elders. Even saying "hi" to the elderly person can contribute largely to making their lives a bit more colorful and joyful. Engage in small conversation with elders, ask their name and learn about their experience. These little things can improve the life of an elderly person by a lot. Students can contribute more by helping elders with walking, eating and caring for minor health problems. Students can also help by raising awareness to the issue through social media such as, Facebook, Instagram, and Snapchat.

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Each year, about 1 in 10 adults over the age of 60 experience abuse, neglect, and or financial exploitation. Unfortunately, this statistic is an underestimate due to the fact that many victims are afraid or incapable to report the violence. Elder maltreatment has become a prevalent problem as the number of elders in our population increases. It is seen in all races, religion and educational backgrounds, and socioeconomic groups. As a type of domestic violence, elder abuse may lead to serious physical injuries and long-term psychological concerns. Elder maltreatment can be classified into these categories: physical abuse, sexual abuse, neglect, family abuse, and institutional elder abuse.

The Cleveland Clinic Journal of Medicine state that according to the American Medical Association, abuse and elder maltreatment is defined: Abuse is an act or omission that results in harm or threatened harm to the health of welfare of an elderly person. Abuse includes the intentional infliction of physical or mental injury; sexual abuse; or withholding of necessary food, clothing, and medical care to meet the physical and mental needs of an elderly person by one having the care, custody, or responsibility of an elderly person (Ahmad and Lachs, 2002). Each state defines abuse differently from one another as well as different approaches to the situation and consequences. This makes it difficult to come up with a definitive definition of what elder abuse is, how it should be handled, and prevention strategies.

Victims of elder abuse range between those older than 75 years, often older than 80 years old. In 2004, the National Center on Elder Abuse found that two thirds of victims are women even though men and women appear to have the same rates. They also found that 33% of the abusers were the adult children of the elder in addition to the spouse and other family members. 77% of the abused elderly came from Caucasian background (Teaster et al., 2007). Research found that the victims have personal relationship with the offender and are also dependent on that person (Collins, 2006). The maltreatment usually occurs at the home of the victim or the offender, but in other cases it can occur in institutions such as in a nursing home. About 35% of the offenders have some sort of psychological disorder or are substance abusers (Pillemar and Finkelhor, 1989). Understanding the victim and abuser play a crucial role in detecting and preventing elder abuse.

Physical abuse is the willful act carried out with the intent of causing physical pain or injury. Physical abuse includes slapping, hitting, kicking, blunt force trauma, force-feeding, overmedication, improper medication, and improper use of physical restraints (Collins, 2006). Up to 14% of elder abuse is physical resulting in more death than those seen in younger patients. Elders are most likely to be victims of "accidental" trauma that includes scratches and bruising on the body as well as injuries to the eye, nose, or mouth. Worrisome traumatic injuries include areas that are uncommonly impacted during regular daily activities such as the inner thigh, inner wrists, palms and soles, and back of neck. Head trauma is connected to severe cases of physical abuse leading to high morbidity and mortality rates. Other types of physical abuse can be seen with patterned burns that are inflicted to the elderly. Forcibly pulled hair can lead to swelling of the scalp and multiple patches of baldness. Choking is a result of force-feeding that can result in the caretaker becoming impatient. Withdrawing medication is another form of physical abuse that leads to improper medical care of the elderly. Physical abuse is considered as the most severe form of elder abuse and most of the time gets overlooked.

Sexual abuse is another form of maltreatment and is the most unreported type of abuse (Collins, 2006). Sexual abuse consists of nonconsensual sexual activity or contact with an elderly person. This includes forced sexual activity, touching, or fondling with a nonconsensual individual or an incompetent individual (Ahmad and Lachs, 2002). Elders sometimes cannot communicate their disapproval or consent due to their mental illness or dementia. Since sexual abuse is the most unreported, it makes it difficult to evaluate the incidence of a sexual assault in elder victims. Sexual assault most often times happen at the home of the elderly and women are usually the victims (Teaster and Roberto, 2004). Vaginal and rectal bleeding must be examined to rule out underlying diseases but also to rule out sexual assault. Unfortunately, sexual abuse investigation is low and is usually not performed (Collins and Presnell, 2006). Signs of elder abuse include gait problems, development of sexually transmitted infections, bleeding from the genitals or anus, agitation, or engagement in inappropriate sexual activities. Often times, elderly victims of sexual abuse have medical problems that impair their communication, confusion, or loss of memory that can affect with the ability of the elder to report the maltreatment.

Neglect has become the most common form of elder abuse. Neglect is the failure of a caregiver to provide basic care and meet the physical needs and mental well being of the elderly. Neglect can either be passive, active, or self. Passive neglect is when the failure to provide care is unintentional. Active neglect is the intentional failure for the caregiver to meet the needs of the elderly (Ahmad and Lachs, 2002). Examples of neglect include poor hygiene, failure to provide adequate food and water, clothing, shelter, or medical care. Lack of proper diet is seen in cases of elderly patients with decreased or loss of body mass, persistent infection, decreased protein, albumin, and iron (Collins, 2006). Dehydration has also become a problem in the elderly. A caregiver may withhold water simply to reduce the number of times to change the bedding and clothing of the patient. Renal metabolism and thirst sensation are already altered with age making elders become susceptible to dehydration (Ayus and Arieff, 1996). A common physical finding of elder abuse is decubitus ulcers. Decubitus ulcers are also called bedsores that are injuries to the skin and underlying tissues resulting from persistent pressures on the skin. They usually occur on skin that covers bony areas of the body such as the hips, tailbone and ankles. Poor hygiene may accelerate the breakdown of the skin and induce infection (Collins, 2006).

Self-neglect or self-abuse is when the elderly threatens his or her personal safety or health. It involves the failure of the individual to provide the basic care he or she needs. Progressive cognitive impairment and insufficient support system can contribute to self-neglect when the individual is incompetent to care for him or herself (Ahmad and Lachs, 2002). This could result in harm of their physical well-being such as anemia and malnutrition. Diogenes syndrome is an extreme form of self-neglect and is seen in patients who live alone. It is when the individual has social withdrawal, lack of shame, rejection to accept help, hoarding of items, or domestic squalor (Ahmad and Lachs, 2002). Self-neglect is examined by state agencies and clinicians, caregivers, and family members should be aware of the disorder.

Another common form of elder maltreatment is family abuse. Family abuse of is someone who has a relationship with the elderly such as a spouse, a sibling, child, friend, or caregiver. The abuse happens at the home of the elderly or at the abusers home. Financial exploitation is the biggest common factor of elder abuse. It encompasses theft or fraudulent expenditure of an older adult’s money or material possessions and the use of the undue influence to surrender or achieve legal authority over assets. Victims of elder financial abuse are typically white, widowed females aged 70 to 89 years (Gibson and Qualls, 2012). Undue influence involves blackmail and extortions of violence to rob money of the individual. In 2009, a New York City jury convicted Anthony Marshall, the son of the late philanthropist Brooke Astor. He was convicted on 14 of 16 counts for financially exploiting his mother of first and second-degree grand larceny, scheme to defraud, possession of stolen property, and conspiracy. Marshall was sentenced to three years in New York State prison for grand larceny (Peltz, 2009). The effects of financial exploitation on older adults are devastating and results in the loss of trust in others, loss of security, depression, feelings of fear, shame, guilt, anger, and worthlessness. Professionals should be able to identify the red flags and interfere in cases of financial manipulation to protect the elderly.

A large majority of elder maltreatment occurs in institution that include their own home or at a nursing home. A nursing home is a residential facility for individuals who need nursing care and any associated medical or psychosocial services (Collins, 2006). The offenders in this case involve staff members, other residents, or visitors. Abusive staff members tend to be younger, uneducated, inexperienced individuals in working in a nursing home environment who are discontented with their jobs (Ahmad and Lachs, 2002). Most nursing home patients suffer from dementia and are incapable to voice their abusive condition or request for help (Collins, 2006). In 2016, a hidden camera showed a nursing home employee hitting an elderly woman in the head. The camera showed that the aide used her hand, elbow, and a hairbrush to land blows and captured the elderly woman being pulled up from the floor by her hair. The employee was terminated and pending charges as the facility administrators pledged to review, train, and supervise their employees (Nursing Home Abuse Guide, 2016). Some of these victims are unable to speak of the violence they face as the perpetrator may threaten them. A nursing home promises the older adult safety and security but in some instances becomes a place of vulnerability and danger that should not be tolerated.

In conclusion, while most elders will die of natural causes, others face violence and become victims of homicide. By becoming acquainted of the situations elders face at home or at institutions, elder maltreatment may be accurately reported or ruled out. With the increasing number of elders, we can only anticipate an increase of elder abuse. Unfortunately, no federal statues exist to stop and prevent elder maltreatment. Only accurate diagnosis and documentation will we be able to bring appropriate attention to this increasing problem. Elder maltreatment is a serious form of domestic violence that needs to be scrutinized upon.

Work Cited

1. Ahmad, M., & Lachs, M. S. Elder abuse and neglect: What physicians can and should do. Cleveland Clinic Journal of Medicine. 2002; 69(10), 801-808.
2. Ayus J. C., Arieff A.I. Abnormalities of water metabolism in the elderly. Semin Nephrol. 1996; 16, 277??“288.
3. Collins, K. A. Elder Maltreatment. Arch Pathol Lab Med. 2006; 130, 1290-1296.
4. Collins K. A., Presnell S. E. Elder homicide: a 20 year study. Am J Forensic Med Pathol. 2006; 27:183??“187.
5. Gibson, S., Qualls, S. A Family Systems Perspective of Elder Financial Abuse. Journal of the American Society on Aging. 2012; 36(3), 26-29.
6. Peltz, J. Advocates: NYC Astor Case a Win on Financial Abuse. The Associated Press. 2009.
7. Pillemer, K., Finkelhor, D. Causes of elder abuse: caregiver stress versus problem relatives. Am J Orthopsychiatry. 1989; 59:179??“187.
8. Teaster, P., Dugar, T., Mendiondo, M., Abner, E., & Cecil, K. (2007). The 2004 Survey of State Adult Protective Services: Abuse of Vulnerable Adults 18 Years of Age and Older. National Center on Elder Abuse. 2007; 1-39.
   https://ncea.acl.gov/resources/docs/archive/2004-Survey-St-Audit-APS-Abuse-18plus-2007.pdf
9. Teaster P., Roberto K. Sexual abuse of older adults: APS cases and out- comes. Gerontologist. 2004; 44:788??“796.
10. http://www.nursinghomeabuseguide.org/nursing-home-abuse-in-hopkins-caught-on-camera/?

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People think about abuse and rarely think about elder abuse when in reality it is just as prominent as abuse in any other age group. Abuse is defined as to intentionally hurt or maltreat a person or animal (Source 2). Just like child abuse or domestic abuse, elder abuse comes in all different forms: sexual, physical, emotional or psychological, neglect, and financial. The elderly are an easy target for caregivers to abuse and often times those being abused are too afraid to tell anyone about the harm that is being done to them (Source 1). Not all elderly persons are at risk for abuse but there are factors that will increase their risk. An elder living with a caregiver raises their chances of being abused because there is more of an opportunity for social contact between the two, which can result in agitation between the elder and their caregiver; when tensions raise too high, the caregiver can snap, ending in physical or emotional harm of the elder.

In connection with living arrangements, if an elder is isolated from other people besides their own family, the ability for the caregiver to abuse is much higher. If there is no one who can spot the abuse that is occurring and report it, then the abuse can continue on without anything stopping the abuser. Studies have shown that those who have high social contract are less likely to be abused. An obvious reason for abuse of the elderly is the decline of cognitive abilities in the elderly, including dementia. Illnesses such as dementia can leave a person to be confused about where they are at, who they are with, and what is going on around them. Because of this confusion, caregivers can become agitated with the one they are caring for, and in some cases, lash out and harm the individual with the mental illness. Lastly, if a caregiver is abusing substances such as alcohol or drugs, the caregiver is more likely to steal money or objects to sell in order to buy the substances they depend on. Financial abuse is one of the most popular types of elder abuse (Source 3).

The elderly are at risk for abuse because as people age they tend to start depending on people more and more especially for everyday needs such as driving, cooking, bathing, and other activities that occur on a daily basis. Slowed motor and cognitive skills cause the elderly to be at more risk for injury or poor personal hygiene making them more dependent on others for help. Neglect is a common form of abuse because caregivers feel overwhelmed by the demands of the one in their care. This is especially true when the caregiver has other responsibilities such as taking care of children, working, or going to school. Other elders that are at risk are those who have excess money or valuable items in their home. Children, grandchildren, or even neighbors are all potential threats to a senior’s finances. These people have the ability to coarse or threaten a senior citizen to give them money, or they may steal valuable items from their home such as paintings, jewelry, or even prescription pills to sell and make a profit (Source 4).

Elder abuse happens anywhere and everywhere. About 1 in 10 elderly persons has experienced some type of abuse (Source 5). Most of elder abuse occurs in their own home and the abuser is most commonly their own family member, however it happens in medical facilities also. Seniors are often placed in care facilities because they, nor the family can take care of them. There are different types of facilities for the elderly depending on their level of independence. All care facilities are similar in the fact that there is a nurse and a nursing assistant to help them with their care. Most often the abuse that occurs in care facilities is done to those who can do little for themselves and rely heavily on the workers. This type of stress on the caregivers can create resentment toward the one needing the care causing the caregiver to neglect the elderly. Again and gain abuse takes place because there is too much pressure on the caregiver and they end up feeling exhausted and frustrated by the task at hand.

There are easy ways to prevent the abuse of the elderly and there are steps that family or friends can take if they suspect that someone is being abused. To avoid abuse, the elderly should not be isolated from their family, friends, or the community because isolation makes it easy for one person to manipulate, intimidate, threaten, or harm them. To minimize the isolation family or friends should involve their elderly in activities such as religious services or family events. Not only will this minimize the potential for abuse, but it will also help the elderly stay healthy by interacting socially with other people. People should also be aware of who is visiting their elderly. Even neighbors can become abusive and manipulate the old into giving them money or even changing their will to incorporate them. If in a care facility, one sure way to make sure that your elderly are receiving the proper care is to visit frequently and when there, treat the staff with the utmost respect; it has been proven that if family is involved with the care of an elderly person in a care facility, they will be taken better care than if they were left alone (Source 6).

Also, if someone themselves feels overwhelmed by the chore of taking care of an elderly family member, there are centers called “respite facilities”. These Facilities offer a caregiver temporary relief from the demands of the elderly. Taking care of a family member can become a full-time job for most and it can become too much, especially if the caregiver has to meet other demands such as a job or caring for a family. Respite facilities let a caregiver drop off the one in their care and let other, qualified people care for that person for either only a couple hours, or the whole day. The ability to relinquish their caregiving duties helps the caregiver relax for a short amount of time, resulting in the less likelihood of any abuse to occur (Source 7).

The best way to end elder abuse is to be able to spot the signs of it. Many people who are experiencing abuse will stop taking care of themselves in many different forms such as not eating, bathing, socializing, and all of these behaviors will have serious impacts on their health. If being mistreated, the elderly will show differences in their physical appearance like sunken eyes and cheeks and untreated bed sores. Behavior indicators of abuse include depression, withdrawal, and overall fear to either talk to other or participate in social activities (Source 8). It is important to know the signs of abuse in order to stop the abuse in its tracks. Without intervention of some kind, abuse tends to go one for months or even years.

Elder abuse is a growing problem especially in the U.S.A. and not many people are even aware that it occurs both in the home and in healthcare facilities. Due to the age of the victim, people often think that they are not vulnerable and cannot be manipulated or harmed in any sort of way, however, many people do not understand that the mind and body deteriorates are people age, making them prime targets for abuse. Not only are the elderly vulnerable physically, they are also vulnerable mentally. Abuse is also mental as well as physical and abusers can manipulate the minds of the elderly, making them fear for their lives or their families lives if they report the abuse. No one should have to go through life living in fear and those who have elders in their life need to learn to protect them.

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In the next 12 years the number of people over the age of 65 years old is projected to double because by year 2030 the millions of baby boomers born between 1946-1964 will become senior citizens ages 66-85. According to statistics and surveys it is said that as many as 2 million Elderly Adults are abused or neglected each year. (NBC News, 2018). Due to the coming onset of elderly adult this is a huge opportunity for current and future social workers to focus on advancing their knowledge in this area. In my paper I will explore what elder abuse is and how we can help using Strength Based Perspective.
Increasingly Elder Abuse is gaining attention of the medical fields, social work field as well as the government. It is the most recent "discovered" type of family abuse. Any act of abuse is uncalled for and wrong especially when it is done to people who are unable to defend themselves. My research has shown me that the awareness of this type of abuse in on the rise and it is important for social workers to gain continuous training in this area to help these people to live out the remainder of their lives free of abuse. The largest issue social workers face with elder abuse is the elder had the right to self-actualization and tends to display great resistance.

On June 14, 2012, World Elder Abuse Awareness day was held in the White House and President Obama proclaimed its importance and the needs to advance the field of elder abuse. (whitehouse.gov, 2018). When reading this proclamation by President Obama I like the way he describes our elders: these people are parents, grandparents, siblings, spouses, aunts, uncles, friends and neighbors. Abuse doesn’t discriminate race, gender, or culture anyone can be victim. These people could be someone that you and I love. It is good to know that the United States government is recognizing the need for awareness for this abuse that has gone on far too long. In my research I could only find articles that state elder abuse has been found an increasing problem in the U.S. since the 1970’s, however, if I had to guess it has probably gone on since the beginning of time. I say that it because elderly people have too much pride to announce their embarrassments, guilts and shame of these horrendous acts done to them usually by someone they love, instead they show great resistance and hide behind an emotional wall.
In a study with 200 physicians whom gave their elderly patients a questionnaire survey to determine barriers and strategies on elder abuse only 65% of the surveys came back and the findings for the reasons why elders do not report were: denial of abuse, resistance to intervention, not knowing where to call for help, lack of protocols to assess and respond to abuse, lack of guidelines about confidentiality, fear of reprisal, and lack of knowledge of the prevalence and definition of elder abuse. (Krueger, Patterson, 2018).

What is Elder Abuse? According to the CDC (Centers for Disease Control and Prevention) elder abuse is defined: "Elder abuse is an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult. (An older adult is defined as someone age 60 or older.)" (Cdc.gov, 2018) In my own words I would define elder abuse as any act of physical abuse, verbal/emotional abuse, neglect, financial abuse, and sadly it can also be sexual abuse toward any elderly person, especially those whom are no longer mentally capable or able bodied enough to defend themselves. As all of us grow older our bodies become more frail, we lose the energy we once had, our memories get cloudy, our bones get brittle, our overall muscle mass decline and we tend to need to depend on others to do a lot of things for us, that perhaps we once could ourselves. Eventually all of us will become "elder’s". With the exception of a small percentage of extremely healthy elder’s the majority of us are going to need to have helpers in our lives. It is so important that we raise elder abuse awareness and train people to be on the lookout for the signs.

Physical Abuse some physical signs that may trigger suspicions of elder abuse could be: unexplained signs of bruises, scars, open wounds, broken bones, reports of drug overdose, broken glasses, signs of restraint such as rope or tape marks on wrists or ankles, and caregiver refusal to leave anyone alone with the elder. (Helpguide.org, 2018). If we delve deeper into the Physical abuse it can happen from the elder's spouse, children, nurse/caregiver or even friends. Parent abuse is probably the most common type of abuse and typically has addiction attached to it as well as the adult child not having their own financial stability. This may also be the abuse that would have the most resistance from the elder reporting the abuse themselves, what mother or father really wants to report & put their own child in jail? Spousal abuse tends to be something that has most likely occurred on and off the whole relationship. Spousal abuse could also be the result of a lifetime of abuse, the women after suffering abuse for many years may turn on the husband to repay the abuse, she suffered, or spousal abuse could happen in a second marriage. Nurse/caregiver abuse usually happens by a paid staff whom is directly responsible for the elder patient, it is unknow how often this occurs, but it is believed to happen when the caregiver has become stressed out or has burnout on the job, or the elder is difficult and the staff is untrained on how to handle the patient with care. There are also random acts of violence that can occur with elders, mugging can happen on the street, home burglaries elders can be targeted because the attackers see them as an easy target. (Research-paper.essayempire.com, 2018)

Verbal/Emotional Abuse signs would be suspicions or witnessing caregiver behaviors of belittling, threatening, or controlling the elder. Behaviors of the elder would be things like skittish movements, or dementia type behaviors such as rocking, mumbling to themselves and thumb sucking. (Helpguide.org, 2018). Verbal and emotional abuse can scar any person, and while it may not have physical signs doesn’t make it any less important.

Neglect signs would be things like unusual weight loss, malnutrition, dehydration, untreated physical problems, being left dirty or unbathed, soiled clothing or bedding, unsafe living condition (bills not paid/utilities turned off), elder left alone in a public place. (Helpguide.org, 2018). Neglect actually shows up in 2 different forms, neglect from others and self-neglect. Neglect from others including caregivers and family members can be unintentional things like the granddaughter forgot to go by grandma's house to check on her and in it resulted in grandma not eating for 2 days and she stayed in bed in her soiled linens, OR it could be intentional, a caregiver has too much stress, and doesn’t really care about the elderly person and intentionally forgets to do things for them. Self-neglect is when an elder might be lonely after the passing of a spouse, so they stop taking their medications, stop socializing with people, stop eating correctly perhaps in hopes they may die sooner to be with their loved one, this form of neglect is not illegal, but I think it probably occurs often and worthy of mentioning.

Financial Abuse signs: large withdrawals taken from the elder's bank account. Sudden changed in their financial situation, personal items or money missing from their home/room, sudden changes in the will, beneficiary changes, power of attorney changes, insurance policy changes. (Helpguide.org, 2018). Typically, financial abuse will occur with someone close to the elder, a child or a relative. Sometimes elders need someone to take care of their finances for them, maybe because their vision has weakened, or they can no longer drive themselves to run errands, and they believe they can trust their loved ones, but all too often the loved ones will take advantage of their new role and steal money from their mom, grandma, grandpa, aunt ect...this abuse again is usually one of the elder's children that may have no financial security and addiction issues, but it really can happen in any kind of relationship. Another rising form of financial abuse is spam telephone calls, people target elderly people, they call them and say they are a relative, trapped in another country and need the elderly person to wire money to them asap, I would like to think the news/media has raises enough awareness of this, but unfortunately there are still many out there who will innocently fall for this scandal
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Sexual Abuse signs would be torn, stained or bloody clothing (especially under garments), unusual private area bleeding, or bruises in or near the genital or breast areas. (Helpguide.org, 2018). According to the National Center on Elder Abuse (2005), elder sexual abuse is "non-consensual sexual contact of any kind with an elderly person" (National Center on Elder Abuse, 2006, p. 1). This type of abuse bothers me to my core, any kind of sexual abuse is horrific, but children and elders are both not able to defend themselves and in the case of an elder they might just be plain to embarrassed or frightened to report it.

Among these basic signs and symptoms of the various types of abuse there are also the deeper signs that people closest to the elder may notice such as depression and anxiety when there has been no known history of these mental illness’ and no recent tragedies in the family that may have caused it.
Resistance in therapy is normal and to be expected. It is when a person/client is trying to avoid change. When a client's daily life patterns (homeostasis) are interrupted, even if the interruption is for the better sometimes it is easier to stay in the life that you know. Some forms of resistance might be: the client denies any abuse, refuses to discuss it, blames themselves, covers for their attacker, changes the subject, fears the attacker might harm them for discussing the abuse. As a therapist/helper is important to avoid being judgmental and to avoid countertransference during this resistance period, once the client gains trust in you they will slowly let down some barriers.

What is Strength Based Perspective in Social Work?
In our practice, the strength-based approach is an alternative to the more common used pathology-oriented approach to helping clients. Instead of placing the focus on the client’s problems, strength-based perspective focuses on the client's strength's, talents, abilities and resources. The helper using this approach will focus on identifying these strengths and assets to assist the client with their problems and goals (Saleeby, 2018).

The strength-based approach places value on the skills, knowledge & potential in the client and their community. This approach highlights the fact that client is the expert of their own life & the helper is there to explain choices and encourage people to make their own decisions. While focusing on the strengths, it does not mean that the helper ignores the client's challenges. It means that the helper collaborates with the client to help them to do things for themselves drawing on their strengths and assets. This practice is goal oriented, & it is important to set attainable goals. During Assessment it is also important to consider all resources that the client has at their disposal to counteract whatever difficult conditions they are facing as well as drawing on the resources in the community and the client's environment (family, peers, coworkers). Strength-based approach aims to create hope for the client. (Iriss, 2018)

Putting Strength-Based perspective into practice: When a client comes in for help, the helper should ask the client to think of some goals for their life. EXAMPLE: a goal for a woman who has been battered by her meth addict son whom lives with her might be: Her immediate goal would be to be safe, another goal might be to stay residing in her own home and for her son to get the help that he needs. The helper can then take these goals and begin to look for resources within the community or the client's environment to assist the client with those goals. The role of the helper is to extend the list of choices, clarify them, and to support the client in becoming confident enough to take the authority to direct the process. (Pdfs.semanticscholar.org, 2018)

Some example questions that could be asked in an interview with elder abuse might be: How have you managed to survive in this situation so far? Who are some people in your life that you can depend on? The last time you can remember your life going well, what was different than it is today? What special hobbies and talents do you have? What are some good things people might say about you? What types of things have you tried in the past that helped this situation? What kind of involvement in the community do you have? If you could have your life any way you wanted it, how would you see your life?
A positive, trusting relationship built between the helper and the client is very important to developing the next process, which is change. A personal and empathetic relationship provides a healing atmosphere. If immediate intervention is needed, the helper is mandated by law to be reported Elder abuse/neglect to APS (Adult Protective Services) Immediately for investigation. Another intervention might be training caregivers to seek self-care avoid compassion burnout. Once a relationship has been established with the client, an assessment has been made and the helper & client have decided on some attainable goals through strength-based perspective, the helper can begin to find resources for the client such as: income support, mental health services, in home supportive services, transportation, housing, as well as medical and legal services. If the victim requests help for their attacker, the helper can also provide referrals for them as well.

In conclusion, with the onset of so many baby boomers about to become elders, it is so very important to continue to raise awareness of Elder Abuse to prevent it. In case work there may be many different approaches to use with this type of client, but the Strength-Based Perspective focuses on the client's strengths and helps provide them hope for their future as well as give the elder client who will be most likely resistant to change the opportunity to create goals for themselves that the helper can help them to carry out. I believe this is a good practice to use with most clients, not just with the elderly and I intend to continue to learn about it.

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Introduction

With the steady increase in the elderly population in our country, there are also mounting new challenges, not just how to meet the needs of the elderly, but also for the families of these people. One such area, is the abuse that happens in the elderly population. The word abuse congers up a mind's eye image of bruises, but in fact, there are more ways in which the elderly are left vulnerable to different forms of abuse. This paper will help to define the types of abuse and mistreatment, what may possibly ignite the path of abuse and how we can combat it. This is an important part of helping the Social Working field to maintain the safety and well being of the elderly in our country as well as lending some understanding to the issue, and perhaps bringing light to some areas that are not as easily seen.

According to Kohl, Sanders and Blumenthal (2012) a United States Government study shows that elder abuse is on the rise and a widespread problem. With the baby boomer generation entering retirement age, the problem will continue to grow. According to Colby and Ortman (2014), the baby-boomer population began to turn 65 in 2011, and will continue to turn 65 until 2029, at which time the population of 65 and older adults will be 20% of the general population of the United States. It was also found that the population of those 65 and older will be larger than the population of those 18 and older (p.1). The cases of elder abuse and neglect will undoubtedly become more prevalent with the expected rate of aging as predicted by the U.S. Census. Giving seniors a safe and dignified environment to live and thrive in, should be no less a concern than it is for anyone else. The protective services for this population will most assuredly become a greater area of concern for the case workers that will be assigned to ensure that this generation of adults is treated with respect. Quality of life in older age is important.

Types of Abuse

Types of abuse have been defined by the WHO(World Health Organization) (2008). They were described as being categorized by acts of deliberate harm, either physical or psychological, sexual, financial and neglect. (as cited by Day, Boni. Evert and Knight, 2016 p. 1533). Another common definition of abuse given by the Who includes the following: " A single, or repeated act, or lack of appropriate action, occuring within any relationship where there is an expectation of trust which causes harm or distrust to an older person. (p.126) NASW, Alabama Chapter, also has a website dedicated to these same forms of abuse with explanation. According to Felton and Polowy (2015), the types of abuse that are a concern for social workers are physical, sexual, neglect, exploitation, emotional abuse, abandonment and self neglect. "Unresolved elder maltreatment is associated with major consequences, including increased risk of pre-mature death, hospitalization, emergency service use, nursing home placement, disability, chronic pain, financial ruin, psychological disturbance, and poor physical health" (Begle et al. 2014)

Types of Abuse

Physical abuse is considered to be any type of physical injury. It can be a bruise, a burn, a broken bone or fracture, abrasions or signs of restraint. It can be an act of deliberate intent to do harm to and individual. It is also described in the NASW website, as "inflicting physical pain, injury or impairment on an elderly person". (p.1)

Sexual abuse is defined as "non consensual sexual contact of any kind with an elderly adult" (NASW, 2015) (p.1). It isn't uncommon to hear of sexual abuse occurring in nursing homes as some of the elderly are cognitively impaired or physically incapable. It is not to say that it does not happen in their own homes by way of caregivers. NASW also give examples of sexual abuse signs to elders are as follows: "STD's , bruising to genital area and breast as well as blood on undergarments" (p.1).

Neglect is defined as "the failure by those responsible to provide food, shelter , health care or protection for an elderly person" (NASW, 2015) (P. 1) his could be by a care giver, a facility that the elderly is living in or by a family member who has accepted responsibility. There also is another concept of neglect, called self neglect which usually results from the aging adults mental or physical impairments (Moody & Sasser, 2018). One of the worst reports of neglect found while researching this paper was reported in an article that happened in 2011. A woman in a Southern Michigan nursing home had been coughing though out the night and when checked on in the morning, it was discovered that her tracheotomy was infested with maggots and caused her airway to become obstructed. There was no proof that her caregivers in the nursing home were ever charged for this atrocity (Kohl, Sanders & Blumenthal, 2011). Neglect can also have signs like dehydration, malnutrition, bed sores, weight loss and unsanitary conditions according to NASW (2105, p.1).

Exploitation, as defined by NASW (2015), involves the misuse or theft of property or funds that belong to an elderly person. As having experienced this first hand, it is hard to prove, especially if the victim has signed over power of attorney is unwilling to cooperate with Adult Protective Services. The fear of being abandoned and unable to care for one's self becomes a deterrent to cooperating as well as not wanting anyone to interfere in their lives (Moody & Sassuer, 2018) Warning signs given by NASW (2015) include: " a sudden change in finances, unpaid bills, large withdrawals from accounts and changes in one's will" (p.1).

Abandonment, as defined by NASW (2015) is the desertion of the elderly person by their caregiver of whom ever has accepted responsibility. They have also noted that it can be at a "hospital, public location or nursing home" (p.1) The worst type of abuse is most likely the mental abuse of elderly adults. Defined burns, Rizzo and Courtney, (2014) they found that emotional abuse, and" the negative views about older adults" was "the most hurtful " to them. Warning signs given by NASW (2015) included withdrawal, and changes in behavior of a caregiver that are threatening or controlling p.1).

After reading many articles on this subject, it seems to be that most are in agreement that quite often these types of abuse happen due to caregiver stress and burnout. The family members who care for these individuals, usually adult children or a spouse, are trying to balance their own lives, while looking out for the person in their care. There also was reference made by Moody & Sasser (2018) that it may be in relation to alcohol and substance abuse, a history of family violence, dependence on financial support as well as social isolation (p. 240)

NASW (2018) has noted that there are currently no Federal laws against elder abuse to protect them, but that all 50 states have laws that deal with maltreatment in regards to neglect, exploitation and abuse. One of the best ways that reporting of elder abuse is found is through mandated reporting from physicians, social workers, and emergency rooms. Adult Protective Services also offer a way to report incidents and assign a case worker to an individual that may be experiencing abuse in any form.

Conclusion

As stated earlier, every elderly adult deserves the same respect and life full of well being, and social workers are there to help insure that these needs are being met for the growing population of aging adults. Abuse of our elderly population is not as simple as we think, there is a spectrum of threats that they face that can mean the difference between life, and premature death.

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