Elder abuse refers to harm or the threat of harm to an older adult by another person.
Older adults can be abused by having harmful things done or said to them or by having necessary things withheld from them. Abuse usually becomes more frequent and severe over time. Abused older adults have injuries, poor physical health, psychological damage, repeated hospitalizations, financial loss, and premature death more often then nonabused older adults.
Each year in the United States, thousands of older adults are abused or neglected. The perpetrator is usually a family member, most often an adult child who is the older adult's caregiver. Sometimes professional caregivers, such as home health care workers or employees of nursing homes and other institutions, abuse older adults.
Worldwide, as many as 1 in 6 people who live in the community and who are age 60 and older experience abuse. About 12% of these people experience more than one type of abuse.
Reports of elder abuse increased during the COVID‐19 pandemic, possibly due to increased vulnerability of victims and more stress or triggers affecting abusers due to social isolation, financial hardships, and poor mental health. Also, rates of physical and emotional abuse were significantly higher, and victims were more likely to experience several forms of abuse.
Caregivers are often overwhelmed by the demands of care, have inadequate preparation or resources, or do not know what is expected of them. They may also become increasingly socially isolated, sometimes increasing their resentment and making abuse more likely. Many caregivers do not intend to abuse the person, and some may not even know that they are abusing the person.
Common types of elder abuse include physical abuse, sexual abuse, psychological abuse, neglect, and financial abuse. Many forms of abuse often happen in combination.
Physical abuse is the use of force to harm or to threaten harm. Examples are striking, shoving, shaking, beating, restraining, and force-feeding. Possible indications of physical abuse include unexplained injuries or injuries that are not treated adequately, rope burns and other rope marks, broken eyeglasses, and scratches, cuts, and bruises. A caregiver’s refusal to allow an older adult to have time alone with visitors or health care professionals can raise concerns about physical abuse.
Sexual abuse is sexual contact without consent or by force or threat of force. Examples are intimate touching and rape. Bruises around the breasts and genital area or unexplained bleeding from the vagina or anus may indicate sexual abuse. However, sexual abuse does not always result in physical injuries.
Psychological abuse is the use of words or actions to cause emotional stress or anguish. It may involve:
Issuing threats, insults, and harsh commands
Ignoring the person (for example, by not speaking for a long time or after being spoken to)
Treating the older adult like a child (infantilization), sometimes with the goal of encouraging the person to become dependent on the perpetrator
People who are psychologically abused may become passive and withdrawn, anxious, or depressed.
Neglect is the failure to provide food, medications, personal hygiene, or other necessities. Some older adults neglect themselves (called self-neglect). Others are neglected by their caregivers. Necessities may be withheld intentionally or simply be forgotten or overlooked by irresponsible or inattentive caregivers. Abandonment is another form of neglect in which caregivers stop their care efforts without assuring replacement caregivers or care services are in place. Signs of neglect include:
Weight loss because of undernutrition
Dry skin and mouth because of dehydration
Unpleasant odor from inadequate bathing
Pressure sores on the buttocks or heels from being left to sit or lie in one position too long
Missing necessary aids, such as eyeglasses, hearing aids, or dentures
Missing scheduled doctor appointments or not being taken for care when disorders are obviously worsening
Some caregivers are unaware that their treatment of an older adult has crossed the line from being less than ideal to being neglect. These caregivers may lack a sense of what constitutes adequate and appropriate care, or they may have very different notions of what conduct is and is not acceptable. Sometimes neglect results from desperate circumstances, such as financial difficulties, despite the caregiver’s best intentions. Sometimes willing caregivers are unable to provide adequate care because of their own physical limitations or mental impairment. For example, caregivers may be unable to bathe the older adult or to remember to give the person a medication.
Financial abuse is the exploitation of a person's possessions or funds for the benefit of another person or to the detriment of the older adult. It includes:
Swindling or tricking an older adult to hand over money or assets
Stealing from an older adult without their knowledge
Pressuring an older adult to distribute assets
Managing an older adult's money irresponsibly
Caregivers may spend most of an older adult's income on themselves and provide only a minimum amount for the older adult.
Restricting an older adult’s freedom to make important life decisions, such as whom to socialize with and how to spend money, is sometimes considered another form of abuse.
Risk Factors for Elder Abuse
Any older adult, regardless of health, can be abused. However, abuse is more likely when older adults:
Are physically frail, often because of disabling chronic disorders
Have problems doing daily tasks
Have difficulty communicating
Are socially isolated
Have dementia, confusion, or another form of mental impairment
Abuse is also more likely when the perpetrators:
Are financially dependent on or living with the older adult
Abuse alcohol or drugs
Have a psychological disorder, such as schizophrenia
Have been violent before
Have a troubling history with the older adult such as past family violence
Have stress, such as financial problems or a family death
Lack skills and resources, making caregiving frustrating
Have a disorder (such as dementia) that makes them agitated or violent (even if they were previously mild-mannered)
When to Suspect Elder Abuse
Doctors, nurses, social workers, friends, and family members often do not recognize the signs of abuse. The signs can be difficult to distinguish from other problems. For example, if an older adult has a hip fracture, health care professionals may be unable to distinguish whether the cause is physical abuse or osteoporosis, falls, or both (which are much more common causes). Also, if older adults are confused, they may not have their complaints of abuse taken seriously, so the abuse goes unrecognized.
When older adults have certain problems or make certain changes, family members and friends, as well as health care professionals, should be aware that abuse may be the cause. These problems include the following:
Poor hygiene or an unpleasant odor
Pressure sores
Weight loss and a dry mouth
Missing eyeglasses, hearing aids, or dentures
Many bruises, bruises in places not usually injured by accident (such as the buttocks), or bruises in the shape of objects (such as a utensil, stick or belt)
Rope marks
Broken bones
Scratches and cuts
Anxiety, depression, or withdrawal and passivity
Sudden financial changes (such as changes in a will, loss of money or other assets, or addition of names to an older adult’s bank card)
The caregiver’s behavior may also suggest abuse, as in the following:
Not letting the older adult speak
Treating the older adult like a child
Giving implausible explanations for injuries
If health care professionals suspect abuse, they interview the older adult alone as well as the possible perpetrator. They may interview other people who know the older adult, sometimes alone.
Health care professionals may use questionnaires designed to identify elder abuse. They may ask general questions about feelings of safety as well as direct questions about possible mistreatment. Clinicians also thoroughly examine the person to check for signs of abuse. Imaging and blood tests may be needed to identify signs and/or complications of abuse and, if signs are present, to document the abuse.
Health care professionals also evaluate the older adult's circumstances, including the following:
Social and financial resources to determine whether financial abuse is occurring and to help plan management so that the older adult is protected (for example, by arranging a different living arrangement or hiring a professional caregiver).
Mood to check for depression, anxiety, anger, and fear
The ability to do daily activities
Any physical limitations that interfere with self-protection
If help with daily activities is needed, health care professionals determine whether the current caregiver has sufficient emotional, financial, and intellectual ability for the task. Otherwise, a new caregiver needs to be identified.
More Information
The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.
National Institute on Aging: Elder Abuse: Information and links to additional resources for older adults and caregivers regarding signs, prevention, and long-term affects of elder abuse
National Center on Elder Abuse (NCEA): Guidance from the NCEA, a national resource center in the United States dedicated to the prevention of elder mistreatment, including advice and resources to professionals, researchers, advocates, and families (855-500-3537)
