Elder mistreatment refers to harm or the threat of harm to an older person by another person. It includes abuse and neglect.

Older people can be mistreated by having harmful things done to them (abuse) or by having necessary things withheld from them (neglect). Elder mistreatment is a growing problem as the number of older people increases.

Each year in the United States, thousands of older people are mistreated. The perpetrator of mistreatment is usually a family member, most often an adult child or spouse who is the older person's caregiver. Sometimes professional caregivers, such as home health care workers or employees of nursing homes and other institutions, mistreat older people.

Any older person, regardless of health, can be mistreated. However, mistreatment is more likely when older people

• Are physically frail, often because of disabling chronic disorders
• Are socially isolated
• Have dementia or confusion

Mistreatment is also more likely when the perpetrators

• Are financially dependent on or living with the older person
• Abuse alcohol or drugs
• Have a psychologic disorder, such as schizophrenia
• Have been violent before
• Have stress, such as financial problems or a family death
• Lack skills and resources, making caregiving frustrating
• Have a disorder (such as dementia) that makes them (even if they were previously mild-mannered) agitated or violent

Caregivers are often overwhelmed by the demands of care, have inadequate preparation or resources, or do not know what is expected of them (see Provision of Care: Avoiding Caregiver Burnout). They may also become increasingly socially isolated, sometimes increasing their resentment and making mistreatment more likely. Many caregivers do not intend to mistreat the person, and some may not even know that they are mistreating the person.

Many older people who are mistreated do not seek help for various reasons. They may be physically unable to do so. Or they may be afraid of being harmed further, of being abandoned, or of being forced into a nursing home. If the perpetrator is the caregiver, older people may feel too dependent on or want to protect the perpetrator, who may also be their adult child. They may feel ashamed.

The signs of mistreatment can be difficult to distinguish from other problems. For example, if an older person has a hip fracture, health care practitioners may be unable to distinguish whether the cause is physical abuse or osteoporosis, falls, or both (which are much more common causes). Also, if older people are confused, they may not have their complaints of abuse taken seriously, so the abuse goes unrecognized.

For all these reasons, doctors, nurses, social workers, friends, and family members often do not recognize mistreatment.

When to Suspect Mistreatment
When older people have certain problems or make certain changes, family members and friends, as well as health care practitioners, should be aware that mistreatment may be the cause. These problems include the following: Poor hygiene or an unpleasant odor Pressure sores Weight loss and a dry mouth Missing eyeglasses, hearing aids, or dentures Multiple bruises, bruises in places not usually injured by accident (such as the buttocks), or bruises in the shape of objects (such as an iron or belt) Rope marks Broken bones Scratches and cuts Anxiety, depression, or withdrawal and passivity Sudden financial changes (such as changes in a will, loss of money or other assets, or addition of names to an older person's bank card) The caregiver's behavior may also suggest mistreatment, as in the following: Not letting the older person speak Treating the older person like a child Giving implausible explanations for injuries

Last full review/revision February 2009 by Mark S. Lachs, MD, MPH