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Types of Elder Mistreatment

by Daniel B. Kaplan, PhD, MSW, Barbara J. Berkman, DSW, PhD

Older people may be abused, neglected, or both.

Abuse

Abuse can be physical, sexual, psychologic, or financial. Older people may be subjected to one or more of these types of abuse.

Physical abuse is the use of force to harm or to threaten harm. Examples are striking, shoving, shaking, beating, restraining, and force-feeding. Possible indications of physical abuse include unexplained injuries or injuries that are not treated adequately, rope burns and other rope marks, broken eyeglasses, and scratches, cuts, and bruises. A caregiver’s refusal to allow an older person to have time alone with visitors or health care practitioners can raise concerns about physical abuse.

Sexual abuse is sexual contact without consent or by force or threat of force. Examples are intimate touching and rape. Bruises around the breasts and genital area or unexplained bleeding from the vagina or anus may indicate sexual abuse. However, sexual abuse does not always result in physical injuries.

Psychologic abuse is the use of words or actions to cause emotional stress or anguish. It may involve

  • Issuing threats, insults, and harsh commands

  • Ignoring the person (for example, by not speaking for a long time or after being spoken to)

  • Treating the older person like a child (infantilization), sometimes with the goal of encouraging the person to become dependent on the perpetrator

People who are psychologically abused may become passive and withdrawn, anxious, or depressed.

Financial abuse is the exploitation of a person's possessions or funds. It includes

  • Swindling

  • Pressuring an older person to distribute assets

  • Managing an older person's money irresponsibly

Caregivers may spend most of an older person's income on themselves and provide only a minimum amount for the older person.

Restricting an older person’s freedom to make important life decisions, such as whom to socialize with and how to spend money, is sometimes considered another, more subtle form of abuse.

Neglect

Neglect is the failure to provide food, drugs, personal hygiene, or other necessities. Some older people neglect themselves (called self-neglect—see Self-Neglect in Older People). Others are neglected by their caregivers. Necessities may be withheld intentionally or simply be forgotten or overlooked by irresponsible or inattentive caregivers. Some caregivers are unaware that their treatment of an older person has crossed the line from being less than ideal to being mistreatment. These caregivers may lack a sense of what constitutes adequate and appropriate care, or they may have very different notions of what conduct is and is not acceptable.

Sometimes neglect results from desperate circumstances, such as financial difficulties, despite the caregiver’s best intentions. Sometimes willing caregivers are unable to provide adequate care because of their own physical limitations or mental impairment. For example, caregivers may be unable to bathe the older person or to remember to give the person a drug.

Older people who are neglected may lose weight because of undernutrition, and their skin and mouth may become dry because of dehydration. They may have an unpleasant odor if they are inadequately cleaned. Pressure sores may develop on the buttocks or heels if people with limited mobility are left to sit or lie in one position too long. Necessary aids, such as eyeglasses, hearing aids, or dentures, may be missing. People may miss scheduled doctors appointments or not be taken for care when disorders are obviously worsening.