ELDER ABUSE RECOGNITION AND PREVENTION

As the population of older Americans grows, so does the hidden problem of elder abuse, exploitation, and neglect. For every case of elder abuse and neglect that is reported to authorities, experts estimate that there may be as many as five cases that have not been reported. Most elder abuse and neglect takes place at home. The great majority of older people live on their own or with their spouses, children, siblings, or other relatives-not in institutional settings. When elder abuse happens, family, other household members and paid caregivers usually are the abusers. Although there are extreme cases of elder abuse, most of the abuse is subtle, and the distinction between normal interpersonal stress and abuse is not always easy to discern.

There is no single pattern of elder abuse in the home. Sometimes the abuse is a continuation of long-standing patterns of physical or emotional abuse within the family.

Elders who are ill, frail, disabled, mentally impaired, or depressed are at greater risk of abuse, but even those who do not have these obvious risk factors can find themselves in abusive situations and relationships.

Elder abuse is the infliction of physical, emotional, or psychological harm on an older adult. Elder abuse also can take the form of financial exploitation or neglect of an older adult by the caregiver.

Physical abuse can range from slapping or shoving to severe beatings and restraining with ropes or chains. When a caregiver or other person uses enough force to cause unnecessary pain or injury, even if the reason is to help the older person, the behavior can be regarded as abusive. Physical abuse can include hitting, beating, pushing, kicking, pinching, burning, or biting. It can also include such acts against the older person as over-or under-medicating; depriving the elder of food, or exposing the person to severe weather.

Emotional or psychological abuse can range from name-calling or giving the "silent treatment" to intimidating and threatening the individual. When a family member, a caregiver, or other person behaves in a way that causes fear, mental anguish, and emotional pain or distress, the behavior can be regarded as abusive. Emotional and psychological abuse can include insults and threats. It can also include treating the older person like a child and isolating the person from the family.

Coercion and threats can include threatening to hurt the person; withholding basic support and rights; terminating the relationship and threatening to leave the person unattended; reporting noncompliance with a program; using more intrusive equipment; pressuring the person to engage in fraud and other crime; and using consequences and punishments to gain compliant behavior.

Caregiver neglect can range from caregiving strategies that withhold appropriate attention from the individual to intentionally failing to meet the physical, social, or emotional needs of the older person. Neglect can include failure to provide food, water, clothing, medications, and assistance with the activities of daily living or help with personal hygiene.

Sexual abuse can range from sexual exhibition to rape. Sexual abuse can include inappropriate touching, photographing the person in suggestive poses, forcing the person to look at pornography, or any unwanted sexualized behavior. Sexual abuse is not often reported as a type of elder abuse.

Financial exploitation can range from misuse of an elder's funds to embezzlement. Financial exploitation includes fraud, taking money under false pretenses, forgery, forced property transfers, purchasing expensive items without the older persons' permission. It includes the improper use of legal guardianship arrangements, powers of attorney, or conservatorships.

Sometimes older adults harm themselves through self-neglect or because of alcohol or drug abuse. One of the most difficult problems family members face is achieving a balance between respecting an older adult's autonomy and intervening before self-neglect becomes dangerous.

Older adults who show signs of dementia may become abusive as part of the disease process, and the object of the abuse may be another older adult, for example, a spouse who is caring for the impaired elder. Although the behavior can be explained by the impairment, it is still unacceptable.

Elder abuse is a complex problem that can emerge from several different causes, and that often has roots in multiple factors. Family situations that can contribute to elder abuse include discord in the family created by the older person's presence, a history and pattern of violent interactions within the family, or the stresses on family members who care for the older adult, and lack of knowledge of caregiving skills.

Intergenerational and marital violence can persist into old age and become factors in elder abuse. In some instances, elder abuse is simply a continuation of abuse that has been occurring in the family over many years. If a woman has been abused during a 50-year marriage, she is not likely to report abuse when she is very old and in poor health.

Sometimes, a woman who has been abused for years may turn her rage on her husband when his health fails. If there has been a history of violence in the family, an adult child may take the opportunity to "turn the tables" on the abusing parent by withholding nourishment or by overmedicating the parent.

Family stress is another factor that can trigger elder abuse. When a frail or disabled older parent moves into a family member's home, the lifestyle adjustments can be staggering.

In some instances, the financial burdens of paying for health care for an aging parent or living in overcrowded quarters can lead to stress that can trigger elder abuse.

Sometimes, there may be marital stress between an older couple when they must share a home with their adult children. Or, the new living arrangements could cause tension between an adult child and his or her spouse.

Social isolation can provide a clue that a family may be in trouble, and it also can be a risk factor for abuse. Social isolation can be a strategy for keeping abuse secret, or it can be a result of the stresses of caring for a dependent older family member. Isolation makes it harder for outsiders to see and intervene in a volatile or abusive situation to protect the older person and to offer help to the abuser.

Where to report:

Suspected cases of elder abuse should be reported in North Dakota to the county Adult Protective Services Agencies, which are located in the regional human service agencies or to local law enforcement agencies.

American Psychological Association.

Public Interest Directorate

750 First Street NE

Washington, DC 20002-4242

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