Detecting Elder Abuse—Even the Unlikely Signs

Elder abuse is more common than you think. This is because anyone who interacts with older people can be a potential abuser, and there are many types of abuse and a variety of settings where it can occur.

One in every 10 older people experiences some kind of abuse in the US, but only one out of every 23 cases are actually reported. These figures are expected to increase due to the growing aging population that coincides with the retirement of all baby boomers in the future.

Caregivers must learn ASAP how to spot warning signs of elder abuse, even the most subtle ones, to protect this vulnerable population.

Abuse comes in many forms and is not always as obvious as bruises and wounds. Some signs of physical abuse go unnoticed because they are hidden by clothes, and perpetrators do not always appear abusive. They do not abuse everyone they come in contact with and may appear nice or even charming to other people.

What are the different types of elder abuse and their warning signs?

Physical abuse such as hitting, beating, pushing, and burning. A patient will have bruises, wounds, pressure marks, burns, or marks from an instrument used to harm them. Bruises and wounds in different stages of healing are a strong indication that physical mistreatment is happening on a regular basis.

Other unlikely forms of physical abuse include the inappropriate use of drugs to sedate or harm the elder and restraining or locking them in a room against their will. The patient may appear drowsy or frequently asleep. They may also show signs of disease that are actually side effects of medications or reveal signs of trauma, such as rocking back and forth.

Emotional abuse such as humiliation, intimidation, blaming, instilling fear, blackmailing, and cursing. Emotional abuse can make the elder victim withdraw from socialization, or become tearful, irritable, and agitated.

Other unlikely forms of emotional abuse include ignoring a patient and forbidding them to talk to or mingle with friends or other family members.

Sexual abuse is any forceful sexual act without the older patient’s consent. A patient will show bruises or wounds on the breasts, upper inner thighs, and genital areas.

Other unlikely forms of sexual abuse include forcing a patient to look at pornographic materials and videos or watch actual sex acts, or forcefully undressing them.

Neglect is the most common type of abuse and comprises more than half of all reported cases. Neglect can be unintentional, such as when a family caregiver is juggling two jobs and caring for a family of their own and therefore cannot attend properly to the patient’s needs. Signs of neglect include pressure sores, leaky or soggy incontinence pads, poor hygiene, and unsanitary living conditions.

Other unlikely forms of neglect include malnutrition, dehydration, weight loss, and missed medications, treatments, and doctor’s appointments.

Financial exploitation such as stealing from a patient, misusing their money, and the unauthorized disposal of a patient's property. Abusers forge an elder patient's signature or use fake IDs and documents to steal from them.

Other unlikely forms of financial abuse include giving to fake charities, fraudulent investments, and other scams.

Some caregivers are the abuser themselves, which is very dangerous. The patient can no longer rely on the person entrusted with their care, who has taken advantage of their weakened state and inability to defend themselves. Caregivers should be aware of this possibility and consider that another healthcare worker may be abusing their patient. However, most caregivers are in a very good position to stop the wrongdoing early in its tracks by recognizing the warning signs of exploitation and mistreatment and following protocols on reporting elder abuse.

The main challenge of reporting elder abuse is that you must ask for the patient’s permission before doing so, unlike child victims where reporting is mandatory. If you witness or suspect abuse in older patients, to talk to them in private. Tell them that you can be trusted and ask if anything is wrong. Tell the patient you are worried and that you know where to get help. Lastly, be there for them when they need you.