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Institutional Abuse - Abuse, Elder


Overview, Causes, & Risk Factors

Elder abuse is the mistreatment of an older person. It may occur while the person is living alone, with others, or in an institution.

  • Domestic elder abuse refers to mistreatment by someone who has a special relationship with the elder. This person could be a spouse, sibling, child, friend, or other caregiver.
  • Institutional abuse refers to mistreatment of someone living in a facility for older persons. This includes nursing homes, foster homes, group homes, or board and care facilities where staff is paid to provide care.
  • Self-neglect occurs when the behavior of an older person living alone threatens his or her own health or safety.
  • There are four common types of elder abuse.

  • Physical abuse is pain or injury inflicted on purpose by a caregiver. It may include slapping, pushing, pinching, beating, physical restraint, or sexual assault.
  • Psychological or emotional abuse is mental suffering inflicted intentionally by a caregiver. It may include humiliation, intimidation, threats, and destruction of belongings.
  • Financial abuse is improper or illegal use of the resources of an older person without consent. It may include the sale of a home or belongings.
  • Neglect is failing to provide reasonable care. For example, a person may be abandoned or denied food or healthcare.
  • What are the causes and risks of the injury?

    A study by the National Center for Elder Abuse found there were nearly 300,000 reports of domestic elder abuse in 1996. This was a 150% increase over the previous 10 years! Plus, the study noted that for each incident reported, as many as another 13 may have gone unreported.

    Psychological, social, and economic factors all contribute to elder abuse. One or more of these issues may trigger it:

  • Caregiver stress. Caring for older, frail people can be time-consuming and very stressful. The stress is greater when the older person is mentally or physically impaired.
  • Cycle of violence. Some families act more violent than others. Violence is a learned behavior passed down from parents to children. In these families, abusive behavior is the normal response to tension or conflict. Spouses are also one of the most common elder abusers. In these cases, the elder abuse is often a continuation of a pattern of spousal abuse started years earlier.
  • Impaired mental or physical health. Elders in poor health are more likely to be abused than those in good health. Abuse tends to occur when an older person's mental or physical health worsens and stress rises.
  • Personal problems of the abuser. Adult children who abuse their parents may suffer from mental disorders, alcohol dependence, drug abuse or addiction, and financial problems. They may have just finished raising their children and now find themselves tied down again taking care of a parent.
  • The typical victim of elder abuse is a widowed, white woman. In her mid-70s or older, she lives on a fixed income. However, it's vital to note that victims do not have to fit the typical picture. Elder abuse happens in all ethnic groups, races, and economic groups.

    The abuser is often a spouse or adult child. Two-thirds of abusers are family members, most of them serving in the caregiving role. Often, the victim does not report the abuse. He or she may:

  • fear revenge by the abuser
  • feel embarrassed
  • worry about being put into an institution

  • Symptoms & Signs

    What are the signs and symptoms of the injury?

    Elder abuse takes many forms. It may leave visible injuries, such as cuts and bruises, or less visible emotional scars. Signs and symptoms of mistreatment vary with the type of abuse.

    With physical abuse, a person may have:

  • broken bones, sprains, or dislocations
  • broken eyeglasses
  • bruises, black eyes, cuts, and rope marks
  • open wounds, cuts, punctures, or untreated injuries in various stages of healing
  • internal injuries
  • sudden changes in behavior
  • Other changes one might see with physical abuse include:

  • lab findings of a medicine overdose
  • a caregiver who refuses to let visitors see an elder alone
  • reports from the elder of being hit, slapped, kicked, or mistreated
  • With emotional abuse, a person may:

  • be emotionally upset or agitated
  • be very withdrawn, not talkative, or not responsive
  • behave in unusual ways, such as by sucking, biting, and rocking
  • report being verbally or emotionally mistreated
  • With financial abuse, there may be:

  • a sudden change in a bank account
  • cashing an elder's checks without permission
  • new names added to the elder's bank signature card
  • unauthorized withdrawal of the elder's funds using an ATM card
  • changes in a will or other financial document
  • unexplained disappearance of funds or valuable possessions
  • unpaid bills despite available funds
  • the elder's report of financial exploitation
  • With neglect, a person may:

  • have signs of dehydration, malnutrition, or untreated health problems
  • have bedsores
  • have poor personal hygiene
  • be living in conditions that are not safe, sanitary, or clean
  • wear inappropriate or inadequate clothing
  • lose weight

  • Diagnosis & Tests

    How is the injury recognized?

    The signs listed above often point to elder abuse.


    Prevention & Expectations

    What can be done to prevent the injury?

    Campaigns and education to raise awareness of the problem and its warning signs may help prevent elder abuse. Most states have a confidential hot line open 24 hours a day to report suspected abuse.

    People can help by:

  • asking directly about signs of possible abuse
  • supporting the victim and talking to help him or her feel less alone
  • showing concern, so that the person knows there is someone to turn to if he or she wants help

  • Treatment & Monitoring

    What are the treatments for the injury?

    Treatment depends on the type of abuse. Any physical injuries should be treated. If possible, the victim needs to be separated from the abuser. Emergency care is provided when physical injuries have occurred.

    When suspected abuse is reported to the proper government agency for adult protective services, it will arrange to help protect the victim. Many different programs and services may be offered, such as:

  • respite care for the caregiver
  • adult day care
  • housing assistance
  • meal programs
  • Untreated elder abuse may continue to grow worse. If the abuse is severe, it can lead to death.

    What are the side effects of the treatments?

    In cases of domestic abuse, an elder may need to leave the home. He or she may have to live with someone else or in a nursing home to be safe.

    What happens after treatment for the injury?

    Once the abuse has been stopped, ongoing care of the elderly person continues in a safe place. Ongoing monitoring by the elderly person's doctor and the correct government agency should continue.


    Attribution

    Author:Gail Hendrickson, RN, BS
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:05/26/02
    Reviewer:Karen Preston, PHN, MS, CRRN
    Date Reviewed:09/04/01

    Sources

    "Abuse of the Elderly" www.crha-health.ab.ca/hlthconn/items/elder-ab.htm

    "Is this Elder Abuse?" www.urbanext.uiuc.edu/elderabuse

    "Elder Abuse Prevention" www.aoa.dhhs.gov/factsheets/abuse.html

    "What is Elder Abuse?" www.gwjapan.com/NCEA/basic

    National Center on Elder Abuse, 1225 I Street, N.W., Suite 725, Washington, D.C. 20005; (202) 898-2586 (voice)


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