Elder Abuse and Neglect

Aging can present many challenges, as seniors may have to manage multiple medical conditions while remaining mobile and handling routine day-to-day tasks. Unfortunately, they may have to protect themselves from abuse and exploitation, as well. Data reveals that between one in five and one in ten older adults are abused, exploited, or neglected in the United States. These figures are likely gross underestimates as studies have found that only about one in 24 cases are reported. 

Elder abuse is a particularly worrisome concern as the population of older adults continues to grow at an unprecedented rate, and the number of older adults who live with Alzheimer's disease and require specialized care is expected to more than double by 2050. Elder abuse is a crime, and increasing awareness can help in its prevention.

 

Elder abuse includes intentional acts or the passive failure to act that will likely cause harm or has caused harm to an older adult. Seniors living at home or in licensed health care facilities, such as memory care and assisted living communities, are vulnerable to actions that are considered elder abuse. Examples include physical, sexual, and/or emotional abuse, along with neglect, deprivation, and financial exploitation.

Unintentionally failing to provide for a senior's basic needs is considered neglect, while intentionally denying an older adult necessities such as medical care, physical assistance, or medications is categorized as willful deprivation. Financial exploitation is the improper use or denial of access to an older adult's assets and resources by another person. 

Abuse may also include unpleasant experiences such as verbal threats, insults, physical violence, and sexual abuse. Unfortunately, abusive caregivers may even restrict visitors as a way to prevent social interaction and demoralize their charges while concealing the severity of the situation.

Abuse and neglect of elderly patients can take many forms, both subtle and severe. Examples of elder abuse include back-handed remarks that belittle seniors, intimidation through verbal threats, and resorting to physical or sexual violence. Perpetrators may even take seniors' money, property, and personal items or fail to provide older adults with necessities to ensure their basic needs are met, jeopardizing their well-being.

Physical abuse occurs when a caregiver intentionally or recklessly uses force to inflict bodily harm. Abusers may become physical to coerce or punish an individual through physical pain and suffering. 

Signs of physical abuse may include the following:

• Bruises
• Burns
• Observable injuries
• Mentions of pain
• Damaged equipment or personal items

Common signs of physical abuse include bruises, burns, broken bones, and complaints of pain that do not relate to a known medical diagnosis or accident, such as a fall. These issues may affect seniors' quality of life and mobility. Damaged eyeglasses and broken medical equipment or personal items are also important warning signs. Additionally, caregivers may isolate seniors or prevent visitors from being alone with the victim to conceal these activities.

Emotional abuse is intended to inflict psychological harm or distress. Abusers may insult seniors to humiliate them and undermine their self-worth. They may also scream, use vulgar language, and make verbal or nonverbal threats.  

Signs of emotional abuse include the following:

• Depression
• Mood changes
• Fear
• Uncontrollable crying
• Avoidance of direct eye contact
• Caregivers repeatedly answering questions addressed to seniors

Victims of emotional abuse may be prone to depression, changes in mood, fear, or excessive crying. If a senior doesn't make eye contact with anyone or if caregivers always answer questions meant for the senior, this may be an indicator of possible abuse. Giving someone the silent treatment in this context may also be considered a form of physiological abuse. 

Friends and family members should be concerned if caregivers make nasty comments or don't listen to seniors' opinions and requests, especially regarding their personal care. Caregivers may also threaten seniors with nursing home placement or prevent them from seeing visitors.

Vulnerable adults may be forced to engage in unwanted physical contact or sexual interactions, including direct personal contact like fondling, rape, and penetration. Abusive caregivers may take inappropriate photos of seniors or make them view pornographic materials. They may also harass seniors by making inappropriate sexual comments.

Signs of sexual abuse include the following:

• Bruising
• Dirty or damaged underwear
• Sexually transmitted diseases or infections
• Pain when sitting or walking
• Fear when in the presence of a specific person

Instances of sexual abuse may be detected due to bruising, soiled or damaged undergarments, sexually transmitted infections, and pain when sitting or walking. Other signs of elder abuse include the expression of fear or withdrawing only when in the presence of a certain person. Evidence of explicit materials in a senior's room or reports made by the senior of inappropriate treatment are also warnings that family and friends should not ignore.

Financial abuse may happen only once or can occur repeatedly over time. It may involve unauthorized bank withdrawals, forged checks, fraudulent property transfers, misused benefit checks, and/or confiscated valuables. Scams targeting seniors cost older adults $28 billion each year and can be hard to spot with the use of advanced technology such as artificial intelligence. 

Signs of financial abuse may include:

• Missing items or valuables
• Strange financial transactions
• Repeated withdrawals
• Forged checks
• Changes in spending
• Missing benefits checks

Financial abuse can occur suddenly or over a long period. Look out for missing items or valuables, unusual financial transactions, frequent withdrawals, forged checks, or changes in spending patterns. In some cases, financial exploitation may not be detected until seniors receive eviction notices or calls from debt collectors related to unpaid bills. 

Fraudulent property transfers and missing government benefit checks are also important warning signs. Eventually, seniors may lack the money needed to pay for essential items, such as food and home maintenance.

Neglect occurs through passive actions, such as ignoring caregiving duties. This form of abuse differs from the willful deprivation of basic goods and services. However, in both cases, seniors aren't provided the goods, services, or support they need to ensure their health and safety. Caregivers may even abandon seniors at home or in public for extended periods. These forms of abuse can have a detrimental effect on seniors' health, hygiene, and living conditions.

Signs of neglect and abandonment include the following:

• Weight loss, malnutrition, and/or dehydration 
• General decline in health
• Poor hygiene
• Dirty bedding or clothing
• Unfixed home maintenance issues
• Increasing clutter or disorganization
• Discontinued use of glasses, hearing aids, or dentures
• Pressure sores or skin infections
• Observed or reported desertion of a senior at or away from home

Seniors undergoing neglect may experience sudden weight loss, dehydration, malnutrition, and a decline in overall health. Poor hygiene, soiled bedding or clothing, unaddressed plumbing issues, and increasing clutter are other potential key signs. Seniors may also lack access to food, water, and prescribed medications. 

Visitors should recognize if seniors have developed health complications like pressure sores or skin infections or do not have their eyeglasses, hearing aids, or dentures. In cases of abandonment, seniors may be left on their own without the necessary support.

Health care fraud by unscrupulous medical professionals typically involves wrongfully collecting money from insurance companies and beneficiaries. This occurs through excessive testing, billing for missed appointments or services that were not provided, or falsely up-coding to more expensive services than the ones given.

Health care fraud costs Americans billions of dollars each year. As a result, people have filed lawsuits to combat the problem. In the summer of 2024, several entities providing hospice services were prosecuted and ordered to pay millions for the submission of false claims and collection of overpayments.   

Warning signs of health care fraud include:

• Duplicate bills
• Charges for products or services not received
• Unexpected claims from health care providers
• Charges for inadequate levels of care

Seniors and their loved ones should take the time to review medical bills and the explanation of benefits provided by their insurance companies. Some billing issues can be traced back to clerical errors, but other mistakes intentionally defraud seniors, insurance companies, and government agencies. 

To protect yourself and your loved ones, watch out for duplicate bills, charges for products or services that were never received, and claims from unfamiliar health care providers. You should also be concerned if your loved one isn't receiving adequate care but receives bills for these services.

Older adults often depend on others to meet their daily needs. This dependence allows abusive individuals to engage in tactics that give them undue power and control over other people's lives, including their finances. Elder abuse is part of a complex cycle that's often rooted in childhood experiences and challenging family dynamics. 

Studies show that caregivers who were abused as children are more likely to perpetrate elder abuse as adults, particularly against their parents. Here are a few of the reasons why elder abuse is such a common yet underrecognized and underreported problem.

Cognitive impairments, such as Alzheimer's disease and dementia, greatly increase the likelihood of abuse. It's estimated that as many as 23% of dementia patients experience physical abuse versus about 3%-14% of the general senior population, as reported by older adults, their proxies, and staff. Further, anywhere from around 28%-62% of dementia patients are subject to psychological abuse, while about 12%-33% of the general senior population experience the same. 

Individuals with memory impairments are more likely to experience multiple forms of co-occurring abuse, along with self-neglect and wandering. Additionally, combative behaviors may pose a challenge for untrained caregivers who do not know how to respond. Furthermore, dementia patients may have difficulty managing their daily affairs, which increases the risk of financial exploitation.

Caregiver burnout increases the frequency of elder abuse. Individuals who have little to no support when caring for a family member are more likely to perpetrate abuse and engage in questionable behaviors. Stress, depression, and issues with drug or alcohol dependence are common among individuals who perpetrate abuse. Daily responsibilities may become overwhelming when a family member's condition deteriorates or their needs change. 

On the other side of the coin, seniors may become more vulnerable to abuse as their care needs increase. Individuals who have difficulty getting to the bathroom, for example, may be more likely to experience harsh comments or physical violence than independent, mobile seniors. Similarly, older adults with disabilities who may require additional support are much more likely to experience interpersonal violence than seniors without disabilities.

Social isolation is a major risk factor for elder abuse. In fact, according to a National Center on Elder Abuse Research Brief, seniors with limited social support have more than triple the risk of being mistreated. Unfortunately, older adults may have health challenges or mobility issues that make it difficult for them to travel, which gives them limited opportunities to socialize. 

Seniors may also find that their social circle shrinks as long-time friends or neighbors pass away or move, resulting in fewer people to talk to about their concerns. Additionally, abusers often force seniors to endure greater degrees of isolation by locking them indoors or preventing them from visiting with friends or family members who may suspect that something is wrong.

Seniors may be unaware of what's going on with their finances or well-being until it's too late. They may also become desensitized to demeaning comments and insults or find themselves unwilling to speak up because they feel that they have no one else to rely on for their daily needs.

Possibly complicating the situation further, the National Council on Aging reports that at least 47% of elder abuse cases are perpetrated by family members. In other words, the people who take advantage of seniors are often the people they trust the most. However, abuse can also take place in institutional settings like nursing homes and assisted living facilities — one report indicates that 13% of abusers are medical caregivers unrelated to the victim. 

If you have a loved one in a long-term care facility who you suspect is being abused, the following resources can help:

• Adult Protective Services: Program Locator
• National Elder Fraud Hotline: 1-833-FRAUD-11 
• Eldercare Locator: 1-800-677-1116

The U.S. Department of Justice estimates that just one in 24 cases of elder abuse is reported. Taking the time to file a complaint is an important first step. In most states, health care workers, long-term care professionals, law enforcement officers, and clergy members are mandatory reporters, which means they're required to report instances of abuse within a fixed period, such as 24 hours. However, family, friends, and neighbors also have a duty to raise a red flag if they suspect abuse is occurring.

Most agencies accept anonymous complaints, so you don't have to reveal your identity. However, if you decide not to share your name and contact information, you will not be contacted for follow-up information, and you won't be alerted if the agency takes action. There are a few ways to report elder abuse, depending on the situation.

• Ombudsman: A long-term care ombudsman is a specially trained volunteer who handles complaints related to assisted living facilities and nursing homes. They may also interact with home health care agencies.
• Adult Protective Services: To report instances of elder abuse or neglect occurring outside of a licensed health care facility, call your state's adult protective services division. You can find this number by calling 211 or by selecting your location on the National Adult Protective Services Association website.
• Domestic Violence Hotlines: Make any reports of physical abuse to your state's domestic violence hotline or by calling the National Domestic Violence Hotline at (800) 799-7233.
• Emergency Services: If you're witnessing abuse currently or if someone is in danger, call 911 to request immediate assistance, including medical attention.
• Legal Assistance: Legal aid organizations and elder law attorneys can intervene in cases of abuse and/or domestic violence. They can assist with guardianship petitions and help seniors move to a safer location.

Health Care Fraud: Complaints involving Medicare fraud can be reported by calling (800) 633-4227. If your complaint involves another government-sponsored program, call the Office of Inspector General at (800) 447-8477.

Elder abuse is common among older adults and is expected to become a greater problem as the senior population grows. Abuse ranges in severity and may involve physical, sexual, and emotional harm, along with neglect, deprivation, financial exploitation, and/or abandonment. Abuse is most likely to be perpetuated against older adults by family members but can also involve medical caretakers at long-term care facilities or strangers.

• About abuse of older persons | Abuse of older persons. (2024). Centers for Disease Control
• Abuse of older people. (2024). World Health Organization
• Albert, S.M., et al. (2021). A prospective study on child abuse and elder mistreatment: assessing direct effects and associations with depression and substance use problems during adolescence and middle adulthood. National Library of Medicine
• Conrad, K.J., et al. (2019). Examining the role of substance abuse in elder mistreatment: results from mistreatment investigations. Journal of Interpersonal Violence
• Demographics of the aging population. (2024). Center for Elders and the Courts
• Dong, XinQi, et al. (2014) Elder abuse and dementia: a review of the research and health policy. National Library of Medicine
• Elder abuse. (2023). U.S. Department of Justice
• Elder abuse laws. (n.d.) Florida State University
• Get the facts on elder abuse. (2024). National Council on Aging
• Kindred and related entities agree to pay $19.428M to settle Federal and State False Claims Act lawsuits alleging ineligible claims for hospice patients. (2024) U.S. Department of Health and Human Services, Office of Inspector General
• Mather, Mark, et al. (2024). Fact sheet: aging in the United States. Population Reference Bureau
• Merica, Dan. (2024). Elderly Americans lose $28 billion a year to scams, and some are fighting back by learning to spot deepfakes, AI, and misinformation. Fortune
• Social isolation, loneliness, and elder maltreatment. (2024). National Center on Elder Abuse