The Issue of Elder Abuse and Neglect

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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