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
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,
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
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
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
bruises, black eyes, cuts, and rope marks
open wounds, cuts, punctures, or untreated injuries in various stages
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
have poor personal hygiene
be living in conditions that are not safe, sanitary, or clean
wear inappropriate or inadequate clothing
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
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:
for the caregiver
adult day care
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.
Author:Gail Hendrickson, RN, BS
Editor:Crist, Gayle P., MS, BA
Reviewer:Karen Preston, PHN, MS, CRRN
"Abuse of the Elderly"
"Is this Elder Abuse?"
"Elder Abuse Prevention"
"What is Elder Abuse?"
National Center on Elder Abuse, 1225 I Street, N.W., Suite 725, Washington,
D.C. 20005; (202) 898-2586 (voice)