Each year hundreds of thousands of older persons are abused, neglected and exploited by
family members and others. Many victims are people who are frail and vulnerable and cannot
help themselves and depend on others to meet their most basic needs.
Legislatures in all
50 states have passed some form of elder abuse prevention laws. Laws and definitions of
terms vary considerably from one state to another, but all states have set up reporting
systems. Generally, adult protective services (APS) agencies receive and investigate
reports of suspected elder abuse.
National Elder Abuse Incidence Study
Reports to APS agencies of domestic elder abuse increased 150 percent between 1986 and
1996. This increase dramatically exceeded the 10 percent increase in the older population
over the same period.
A national incidence study conducted in 1996 found the following:
- 551,011 persons, aged 60 and over, experienced abuse, neglect and/or self-neglect in a
- Almost four times as many new incidents of abuse, neglect and/or self-neglect were not
reported as those that were reported to and substantiated by adult protective services
- Persons, aged 80 years and older, suffered abuse and neglect two to three times their
proportion of the older population; and
- Among known perpetrators of abuse and neglect, the perpetrator was a family member in 90
percent of cases. Two-thirds of the perpetrators were adult children or spouses.
Generally Accepted Definitions
Physical abuse is defined as the use of physical force that may result in bodily
injury, physical pain, or impairment. Physical abuse may include but is not limited to
such acts of violence as striking (with or without an object), hitting, beating, pushing,
shoving, shaking, slapping, kicking, pinching and burning. In addition, the inappropriate
use of drugs and physical restraints, force-feeding and physical punishment of any kind
also are examples of physical abuse.
Signs and symptoms of physical abuse include but are not limited to:
- bone fractures, broken bones and skull fractures;
- bruises, black eyes, welts, lacerations and rope marks;
- open wounds, cuts, punctures and untreated injuries in various stages of healing;
- sprains, dislocations and internal injuries/bleeding;
- broken eyeglasses/frames, physical signs of being subjected to punishment and signs of
- laboratory findings of medication overdose or under utilization of prescribed drugs;
- an elder's report of being hit, slapped, kicked or mistreated;
- an elder's sudden change in behavior; and
- the caregiver's refusal to allow visitors to see an elder alone.
Sexual abuse is defined as non-consensual sexual contact of any kind with an elderly
person. Sexual contact with any person incapable of giving consent is also considered
sexual abuse. It includes but is not limited to unwanted touching, all types of sexual
assault or battery, such as rape, sodomy, coerced nudity and sexually explicit
Signs and symptoms of sexual abuse include but are not limited to:
- bruises around the breasts or genital area;
- unexplained venereal disease or genital infections;
- unexplained vaginal or anal bleeding;
- torn, stained, or bloody underclothing; and
- an elder's report of being sexually assaulted or raped.
Emotional or psychological abuse is defined as the infliction of anguish, pain or
distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is
not limited to verbal assaults, insults, threats, intimidation, humiliation and
harassment. In addition, treating an older person like an infant; isolating an elderly
person from his/her family, friends, or regular activities; giving an older person the
"silent treatment;" and enforced social isolation are examples of
Signs and symptoms of emotional/psychological abuse include but are not limited to:
- being emotionally upset or agitated;
- being extremely withdrawn and non-communicative or non-responsive;
- unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking); and
- an elder's report of being verbally or emotionally mistreated.
Financial or Material Exploitation
Financial or material exploitation is defined as the illegal or improper use of an
elder's funds, property, or assets. Examples include but are not limited to cashing an
elderly person's checks without authorization/permission; forging an older person's
signature; misusing or stealing an older person's money or possessions; coercing or
deceiving an older person into signing any document (e.g., contracts or will); and
improperly using conservatorship, guardianship, or power of attorney.
Signs and symptoms of financial or material exploitation include but are not limited to:
- sudden changes in bank account or banking practice, including an unexplained withdrawal
of large sums of money by a person accompanying the elder;
- the inclusion of additional names on an elder's bank signature card;
- unauthorized withdrawal of the elder's funds using the elder's ATM card;
- abrupt changes in a will or other financial documents;
- unexplained disappearance of funds or valuable possessions;
- substandard care being provided or bills unpaid despite the availability of adequate
- discovery of an elder's signature being forged for financial transactions or for the
titles of his/her possessions;
- sudden appearance of previously uninvolved relatives claiming their rights to an elder's
affairs and possessions;
- unexplained sudden transfer of assets to a family member or someone outside the family;
- the provision of services that are not necessary; and
- an elder's report of financial exploitation.
Neglect is defined as the refusal or failure to fulfill any part of a person's
obligations or duties to an elder. Neglect may also include failure of a person who has
fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care
services) or the failure on the part of an in-home service provider to provide necessary
care. Neglect typically means the refusal or failure to provide an elderly person with
such life necessities as food, water, clothing, shelter, personal hygiene, medicine,
comfort, personal safety, and other essentials included in an implied or agreed-upon
responsibility to an elder.
Signs and symptoms of neglect include but are not limited to:
- dehydration, malnutrition, untreated bed sores, and poor personal hygiene;
- unattended or untreated health problems;
- hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no
- unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled
bedding, fecal/urine smell, inadequate clothing); and
- an elder's report of being mistreated.
Abandonment is defined as the desertion of an elderly person by an individual who has
assumed responsibility for providing care for an elder, or by a person with physical
custody of an elder.
Signs and symptoms of abandonment include but are not limited to:
- the desertion of an elder at a hospital, a nursing facility, or other similar
- the desertion of an elder at a shopping center or other public location; and
- an elder's own report of being abandoned.
Self-neglect is characterized as the behavior of an elderly person that threatens his/her
own health or safety. Self-neglect generally manifests itself in an older person as a
refusal or failure to provide himself/herself with adequate food, water, clothing,
shelter, personal hygiene, medication (when indicated), and safety precautions. The
definition of self-neglect excludes a situation in which a mentally competent older
person, who understands the consequences of his/her decisions, makes a conscious and
voluntary decision to engage in acts that threaten his/her health or safety as a matter of
Signs and symptoms of self-neglect include but are not limited to:
- dehydration, malnutrition, untreated or improperly attended medical conditions, and poor
- hazardous or unsafe living conditions/arrangements (e.g., improper wiring, no indoor
plumbing, no heat, no running water);
- unsanitary or unclean living quarters (e.g., animal/insect infestation, no functioning
toilet, fecal/urine smell);
- inappropriate and/or inadequate clothing, lack of the necessary medical aids (e.g.,
eyeglasses, hearing aids, dentures); and
- grossly inadequate housing or homelessness.
Why Does Elder Abuse Occur and Who are the Perpetrators?
Elder abuse, like other types of domestic violence, is extremely complex. Generally a
combination of psychological, social, and economic factors, along with the mental and
physical conditions of the victim and the perpetrator, contribute to the occurrence of
elder maltreatment. Although the factors listed below cannot explain all types of elder
maltreatment because it is likely that different types (as well as each single incident)
involve different casual factors, they are some of the causes researchers say are
Caring for frail older people is a very difficult and stress-provoking task. This is
particularly true when older people are mentally or physically impaired, when the
caregiver is ill-prepared for the task, or when the needed resources are lacking. Under
these circumstances, the increased stress and frustration of a caregiver may lead to abuse
or willful neglect.
Impairment of Dependent Elder
Some researchers have found that elders in poor health are more likely to be abused than
those in good health. They have also found that abuse tends to occur when the stress level
of the caregiver is heightened as a result of a worsening of the elder's impairment.
Cycle of Violence
Some families are more prone to violence than others because violence is a learned
behavior and is transmitted from one generation to another. In these families, abusive
behavior is the normal response to tension or conflict because they have not learned any
other ways to respond.
Personal Problems of Abusers
Researchers have found that abusers of the elderly (typically adult children) tend to have
more personal problems than do non-abusers. Adult children who abuse their parents
frequently suffer from such problems as mental and emotional disorders, alcoholism, drug
addiction, and financial difficulty. Because of these problems, these adult children are
often dependent on the elders for their support. Abuse in these cases may be an
inappropriate response by the children to the sense of their own inadequacies.
Who Are the Abusers?
More than two-thirds of elder abuse perpetrators are family members of the victims,
typically serving in a caregiving role.
Is Elder Abuse a Crime?
Depending on the statute of a given state, elder abuse may or may not be a crime. However,
most physical, sexual and financial/material abuses are considered crimes in all states.
In addition, depending on the type of the perpetrator's conduct and its consequences for
the victims, certain emotional abuse and neglect cases are subject to criminal
prosecution. However, self-neglect is not a crime in all jurisdictions, and, in fact,
elder abuse laws of some states do not address self-neglect.
For Help Regarding Elder Abuse
When domestic elder abuse occurs, it can be addressed if it comes to the attention of
authorities. Although each state has a different system to address elder abuse, the
following are some of the agencies that have been established by federal, state and local
governments to help:
Which State and Local Agencies are Helping Victims and Their Families Involved in Elder
In most states, the APS (Adult Protective Services) agency, typically located within the
human service agency, is the principal public agency responsible for both investigating
reported cases of elder abuse and for providing victims and their families with treatment
and protective services. In most jurisdictions, the county departments of social services
maintain an APS unit that serves the need of local communities.
However, many other public and private agencies and organizations are actively involved in
efforts to protect vulnerable older persons from abuse, neglect, and exploitation. Some of
these agencies include: the state unit on aging; the law enforcement agency (e.g., the
police department, the district attorney's office, the court system, the sheriff's
department); the medical examiner/coroner's office; hospitals and medical clinics; the
state long-term care ombudsman's office; the public health agency; the area agency on
aging; the mental health agency; and the facility licensing/certification agency.
Depending on the state law governing elder abuse, the exact roles and functions of these
agencies vary widely from one jurisdiction to another.
Although most APS agencies also handle adult abuse cases (where clients are between 18 and
59 years of age), nearly 70 percent of their caseloads involve elder abuse. The APS
community is relatively small compared with the groups working for other human service
programs, but it is composed of a few thousand professionals, nationwide.
Adult Protective Services
In most jurisdictions, either APS, the Area Agency on Aging, or the county Department of
Social Services is designated as the agency to receive and investigate allegations of
elder abuse and neglect. If the investigators find abuse or neglect, they make
arrangements for services to help protect the victim.
State Elder Abuse Hotlines
Many states have instituted a 24-hour toll-free number for receiving reports of abuse.
Calls are confidential.
Phone Directory for reporting abuse: http://www.gwjapan.com/NCEA/report/index.html
Local police, sheriff's offices, and prosecuting attorneys may investigate and prosecute
abuse, particularly in cases involving sexual abuse or assault. In states whose statutes
make elder abuse a crime, there may be a requirement to report suspected abuse to a law
Long Term Care Ombudsman Program
Since passage of the 1975 Older Americans Act, every state has had a long term care
ombudsman program to investigate and resolve nursing home complaints. The program has also
been working toward extension of services to board and care facilities and, in some areas,
to those who receive professional care at home. Check with your State Unit on Aging or
Area Agency on Aging to see if the long term care ombudsman program in your area can help
in any given instance.
Information and Referral
Every Area Agency on Aging operates an information and referral (I & R) line that can
refer people to a wide range of services for people 60 and older. I & R services can
be particularly helpful in locating services that can help prevent abuse and neglect.
National and State Information
Often people who want to help older relatives or friends don't live near them.
Long-distance caregivers can call a nationwide toll-free Eldercare Locator number (1-800-677-1116)
to locate services in the community in which the elder lives. In addition, some states
have established a statewide toll-free number to provide centralized aging services
information for residents of their states.
Medicaid Fraud Control Units (MFCU)
Every State Attorney General's Office is required by Federal law to have a MFCU to
investigate and prosecute Medicaid provider fraud and patient abuse or neglect in health
care programs which participate in Medicaid, including home health care services.
What Happens After You Report?
The APS agency screens calls for potential seriousness. The agency keeps the
information it receives confidential. If the agency decides the situation possibly
violates state elder abuse laws, the agency assigns a caseworker to conduct an
investigation (in cases of an emergency, usually within 24 hours). If the victim needs
crisis intervention, services are available. If elder abuse is not substantiated, most APS
agencies will work as necessary with other community agencies to obtain any social and
health services that the older person needs.
The older person has the right to refuse services offered by APS. The APS agency
provides services only if the older person agrees or has been declared incapacitated by
the court and a guardian has been appointed. The APS agency only takes such action as a
Sources: National Center on Elder Abuse,
Administration on Aging
- National Center on Elder
Numbers to Report Abuse
- The Elderly
- Elder Abuse and
Neglect Comprehensive information and resources by Linda Woolf, Webster
Abuse Links from The Elderly Place
- Sometimes a Bruise Is Just a Bruse:
Abuse and Alzheimer's Disease
- Financial Caregiving
- Legal & Financial Matters Channel