Many older people who are abused do not seek help for various reasons. They may feel ashamed and be reluctant to tell others about the abuse. They may be unable to tell others because the perpetrator limits phone calls or access to visitors and health care practitioners. If the perpetrator is the caregiver, older people may feel too dependent on or want to protect the perpetrator, who may also be their adult child. They may be afraid of being harmed further, of being abandoned, or of being forced into a nursing home.
Older people should never think that abuse is part of being old or dependent. Being mistreated threatens their personal dignity and sense of well-being and can even cost people their life. Family members and friends can help by maintaining close ties with an older person.
Older people who are worried about abuse can take steps to make it less likely to happen, such as the following:
Not living with someone who has a history of violent behavior or substance abuse
Keeping in touch with friends and former neighbors, especially if they have to move to a caregiver’s house
Staying connected with social and community organizations (increasing the chances that abuse, if it occurs, is noticed)
Insisting on legal advice before signing any documents related to where they will live or who controls their finances (the local Area Agency on Aging can refer people for legal help)
If older people believe they are in danger, they can call an elder abuse hotline for immediate help. A list of all state laws about elder abuse and telephone numbers to call to report abuse are available at the National Center on Elder Abuse (855-500-3537 or www.ncea.acl.gov). The National Association of Area Agencies on Aging (202-872-0888 or US Aging) is another good source of information and referral. If older people do not feel endangered but still want help, they can talk about it with their doctor, social worker, or other health care practitioner.
Relatives, friends, and acquaintances have a responsibility to help if they know of or strongly suspect abuse, as do health care practitioners. Directly confronting the perpetrator is not recommended because it can worsen abuse. Instead, the situation should be reported. Reporting suspected or confirmed abuse or neglect is mandatory in all states if the abuse occurs in an institution and in most states if it occurs in a home. Every state has laws that protect and provide services for vulnerable, incapacitated, or disabled people. Every state also has laws protecting people who report suspected abuse from being sued for doing so. To report abuse, people can contact the following:
In most states: The state social service department (Adult Protective Services)
In a few states: The state unit on aging
For abuse within an institution: The local long-term care ombudsman's office or the state department of health
Telephone numbers for these agencies and offices in any part of the United States can be found by calling the Eldercare Locator (800-677-1116 or www.eldercare.gov) or the National Center on Elder Abuse (855-500-3537 or www.ncea.acl.gov) and giving the person's county and city of residence or zip code.
If Elder Abuse Is Confirmed
An interdisciplinary team (including doctors, nurses, social workers, lawyers, law enforcement officials, psychiatrists, and other practitioners) is the best option for providing successful care.
If the person is in immediate danger, health care practitioners may suggest admission to a hospital, intervention by law enforcement, or relocation to a safe home.
If the person is not in immediate danger, steps to reduce risk are taken but are less urgent. The choice of intervention depends on the perpetrator’s likelihood of causing harm.
In general, interventions need to be tailored to each situation. Interventions may include:
Medical assistance
Education (such as teaching victims about abuse and available options to help them and helping them devise safety plans)
Psychologic support (such as short-term or long-term psychotherapy for the victim and possibly family members to discuss depression and the effects of trauma)
Law enforcement and legal interventions (such as arrest of the perpetrator, restraining orders, and legal advice, including protection of assets)
Alternative housing (such as sheltered senior housing and placement in a nursing home)
Referral to services that provide basic support (such as transportation and food assistance) and reduce social isolation
If victims are competent to make decisions, they should help determine their own intervention. If they are not, the interdisciplinary team should make most decisions. Decisions are based on the severity of the violence, the victim’s previous lifestyle choices, and legal ramifications. Often, there is no single correct decision. A practitioner should carefully monitor each case.
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 dedicated to the prevention of elder mistreatment, including advice and resources to professionals, researchers, advocates, and families
