Elder Abuse

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Have you ever worried whether an elderly person is really all right?

Sometimes it's a loved one we're worried about -- we're concerned about whether she's being treated well by her caregiver, friends, or family members. Sometimes it's just a worry about a senior we know casually -- someone we see around the neighborhood, at church or synagogue, or at local gatherings. We wonder whether we should worry; we wonder whether we should say something.

The fact is, far too many of our elders are not all right. The Senate Special Committee on Aging says there are as many as 5 million victims every year, while the National Center on Elder Abuse cites recent studies that estimate that up to 3 to 5 percent of the elderly population in the U.S. have suffered abuse.

Elder neglect, mistreatment, and abuse isn't always easy to spot. Some signs are obvious, some not so much. The New York City Elder Abuse Center defines elder abuse as an act that causes harm or distress to an individual 60 years or older. It happens most often in relationships based on trust. And it can be intentional or unintentional. Elders with cognitive impairment are particularly vulnerable, both because dementia behaviors can be extremely frustrating to caregivers, and because elders with dementia can lose the ability to recognize abuse and defend themselves.

Here are five signs to look for:

1. Signs of Physical Abuse

•Bruises

•Broken bones

•Burns

•Abrasions

•Pressure marks

•Hearing odd explanations for injuries -- "Oh, she ran into a wall."

Leslie Kernisan is a San Francisco geriatrician and the medical editor at Caring.com. She says many elderly patients are quiet, so you need to take them aside and ask them, "Does your caregiver ever yell at you or push you? Are you ever afraid?"

2. Signs of Neglect

•Dirty clothes

•Soiled diapers

•Bedsores

•Unusual weight loss

•A home that's unusually messy -- especially if it wasn't before

•Lack of medical aids, such as hearing aid, cane, glasses

If the elder is disabled, especially cognitively disabled, and needs help taking medication or getting dressed, it can be considered neglect if the caregiver is not providing assistance. Alternatively, passive neglect occurs when the abuse is unintentional, often as the result of an overburdened or untrained caregiver.

3. Signs of Verbal or Emotional Abuse

•Withdrawal and apathy

•Unusual behavior, such as biting or rocking

•Nervous or fearful behavior, especially around the caregiver

•Strained or tense relationship between caregiver and elder

•Caregiver who is snapping or yelling at the elder

•Forced isolation by the family member/caregiver

Emotional abuse is one of the most difficult problems to spot, since the victim may be unable to convey what's happening because of illness, dementia, or fear of being neglected. "The elderly person is unable to fight back," says Dr. Irene Deitch, professor emeritus of psychology at the College of Staten Island, part of the City University of New York.

Emotional abuse can range from a simple verbal insult to an aggressive verbal attack. It can also include threats of physical harm or isolation.

Deitch says verbal attacks include a caregiver or family member yelling or cursing at the person, or using phrases such as, "I can't wait till you die and I have my life back again."

Often in cases of emotional abuse, Deitch adds, a spouse or adult child will isolate the senior, not allowing calls or visitors, so no one else gets a sense of what's happening in the house.

4. Signs of Sexual Abuse

•Bruises around the breasts

•Bruises around the genital area

•Evidence of venereal disease

•Vaginal or rectal bleeding

•Difficulty walking or standing

•Depressed or withdrawn behavior

•Flirtation or touchiness by the caregiver

We don't even want to think about it, but it happens. Attackers look for vulnerable people to victimize. Seniors can be perceived as easy to overpower. They may also be less likely to report abuse because of their dependency on others for care.

5. Signs of Financial Exploitation

•Bills not being paid

•Money disappearing and unaccounted for

•Caregiver taking money for a purchase that doesn't arrive

•Unusual purchases that your loved one didn't used to make

•Increased use of credit cards

•More frequent withdrawls of cash

•Adding someone new to bank accounts or credit cards

Caregiving is expensive, and it's often something families haven't planned for -- factors that lay the groundwork for explosive family dynamics around money. On Caring.com, many users ask questions about family conflict, especially where one family member appears to be taking financial advantage of an elder.

Financial exploitation can also happen when a professional caregiver takes advantage of the elder. This is why background checks are especially important when hiring a professional caregiver.

What to Do if You Suspect Elder Abuse
The NCEA recommends calling 911 immediately if you believe an elderly friend, relative, or neighbor is in immediate, life-threatening danger.

If the danger is not immediate but you suspect that abuse has occurred or is occurring, relay your concerns to the local adult protective services agency, long-term care ombudsman, or police.

Ken Onaitis, director of elder abuse and police relations at New York City's Carter Burden Center for the Aging, points out that 80 percent of the calls the Burden Center receives come from neighbors or friends, not abuse victims.

To find the right helpline, hotline, or elder abuse resources in your local area, visit the National Center on Elder Abuse (NCEA).