Elder abuse: How to spot warning signs, get help, and report mistreatment

Every person, no matter how old, deserves to be safe from harm by those who live with them, care for them, or have daily contact with them. Yet, approximately one in 10 people aged 60 and older who live at home experience abuse, including mistreatment and exploitation, according to the Centers for Disease Control and Prevention. Some evidence even indicates that the prevalence of abuse of older people in both the community and in institutions has increased during the COVID-19 pandemicopens in new window.

Over time, elder abuse can harm an individual’s physical and psychological health, destroy social and family ties, and cause devastating financial loss. Research also suggests that older people who have been abused tend to die earlieropens in new window than those who have not been abused, even in the absence of chronic conditions or life-threatening disease.

There is no single pattern of elder abuse. It’s a complex problem that can stem from multiple causes, such as a history of violent interactions within the family, lifestyle adjustments, and tensions that can arise as a result of new living arrangements. A caregiver's personal problems—for example, caregiver stress, mental or emotional illness, addiction to alcohol or other drugs, job loss, or other personal crises can lead to the abuse of an older person. Certain societal attitudes may also contribute to violence against older people and make it easier for abuse to continue without detection or intervention. For example, older people are often regarded as insignificant, leading society to fail to recognize the importance of assuring dignified, supportive and nonabusive life circumstances for every older person. These factors include the devaluation of and lack of respect for older adults and society's belief that what goes on in the home is a private, “family matter.”

Elder abuse can take many different forms, including:

• Physical abuse , which can range from slapping or shoving to severe beatings and restraining with ropes or chains. When a caregiver or other person uses enough force to cause unnecessary pain or injury, even if the reason is to help the older person, the behavior can be considered abusive. Physical abuse also encompasses behaviors such as hitting, beating, pushing, shoving, kicking, pinching, burning or biting. It also includes the inappropriate use of medications and physical restraints and physical punishment of any kind.
• Verbal, emotional or psychological abuse, including yelling, swearing, threatening, making insulting or disrespectful comments or repeatedly ignoring the older adult. Psychological abuse involves any type of coercive or threatening behavior that sets up a power differential between the older adult and his or her family member or caregiver. It can also include treating the older person like a child and isolating the person from family, friends, and regular activities.
• Sexual abuse, which includes inappropriate touching, photographing the older adult in suggestive poses, forcing the person to look at pornography, and any unwanted sexualized behavior.
• Financial abuse and exploitation, which can range from misuse of an older person's funds to embezzlement. It can include forging checks, taking someone else's retirement or Social Security benefits, or using a person's credit cards and bank accounts without their permission. It also includes changing names on a will, bank account, life insurance policy, or title to a house without permission.
• Caregiver neglect, which can be intentional or unintentional, and involves intentionally failing to meet the physical, social, or emotional needs of the older person. Neglect can include failure to provide food, water, clothing, medications, and assistance with activities of daily living or help with personal hygiene.

Like other forms of abuse, elder abuse is a complex problem, and it is easy for people to have misconceptions about it. The truth is that:

• Most elder abuse and neglect takes place at home. The majority of older adults live in the community, either on their own or with their spouses, children, siblings, or other relatives, rather than in institutional settings. As a result, the home is where most abuse happens. Family members commit elder abuse in nearly 6 out of 10 casesopens in new window , according to the National Council on Aging.
• Anyone can be vulnerable. Older individuals who are frail, alone, or depressed as well as those with a physical disability or mental illness are vulnerable to abuse. Even those who are not affected by these more visible risk factors can find themselves in abusive situations and relationships. Elder abuse affects people across all socioeconomic groups, cultures, races, and ethnicities.

While many of these symptoms may be the result of disease conditions or medications, their appearance should prompt further investigation to determine and remedy the cause. Cues that cannot be explained medically may signal elder abuse.

• Unexplained bruises, burns, cuts, or scars
• Lack of basic hygiene, adequate food and water, or clean and appropriate clothing
• Lack of medical aids (glasses, walker, teeth, hearing aid, medications)
• Sunken eyes or unexplained weight loss
• Untreated bedsores
• Dismissive attitude or statements about injuries
• Unreasonably fearful or suspicious
• Lack of interest in social contacts
• Unexplained or uncharacteristic changes in behavior
• Unexplained vaginal or anal bleeding
• Venereal diseases or vaginal infections
• Signs of insufficient care or unpaid bills despite adequate financial resources
• Large withdrawals from bank accounts or other unusual ATM activity

If you suspect someone you know is being abused or neglected, don't let your fear of meddling in someone else's business stop you from reporting your suspicions. Your first step should be to try and talk with the older adult when the two of you are alone. You could tell them that you think something might be wrong and that you're worried and offer to take them to get help.

Every state has a service designated to receive and investigate allegations of elder abuse and neglect, also known as Adult Protective Servicesopens in new window. In addition, the Eldercare Locatoropens in new window is a nationwide service sponsored by the U.S. Administration on Agingopens in new window that connects older Americans and their caregivers with information on services for older adults. If you know the zip code of an older person being abused, the website can refer you to the appropriate agency in the area to report the suspected abuse.

Don’t put the older adult in a more vulnerable position by confronting the abuser yourself unless you have their permission and are able to help the person experiencing abuse immediately by moving them to a safe place.

If you feel you are being abused or neglected, help is available. If you can safely talk to someone about the abuse, such as your physician, a trusted friend, or a member of the clergy, who can remove you from the situation or find help for the abuser, do so at once. Your physician has a legal obligation to report the abuser and help you find safety.

You can also contact Adult Protective Servicesopens in new window, and they will help you find safety and find help for the person who is abusing you. In addition, the Eldercare Locatoropens in new window is a nationwide service sponsored by the U.S. Administration on Aging that connects older Americans with information on senior services. You can put in your zip code and the website will refer you to the appropriate agency in your area to report the abuse. To speak with someone for support, hotlines such as National Domestic Hotlineopens in new window and the Institute on Aging's Friendship Lineopens in new window (for people 60+ and adults living with disabilities) are available toll-free. You can also contact the Centers for Medicare and Medicaid Servicesopens in new window if you suspect healthcare fraud.

If you feel you have been abusive or are in danger of abusing an older person in your care, one solution may be to find ways of giving yourself a break and relieving the tension of having total responsibility for an older person who is dependent on you. Area Agencies on Agingopens in new window are a local resource for services that might help family caregivers find respite and in-home help with difficult care tasks such as bathing, dressing, and cooking.

If you recognize that abuse, neglect, or violence is a way you often solve problems, you will need expert help to break old patterns. Talk with someone who can help—a trusted friend or family member, a counselor, or your pastor, priest, or rabbi. If alcohol or drugs are a problem, consider contacting Alcoholics Anonymousopens in new window or some other self-help group. You can also contact a professional, such as a counselor, psychologist, or therapist who specializes in helping people change destructive behaviors. To find a competent therapist, ask your physician or your health plan representative for a recommendation. APA can help you find a local psychologist through its Psychologist Locatoropens in new window.

The first and most important step toward preventing elder abuse is to recognize that no one should be subjected to violent, abusive, humiliating, or neglectful behavior. In addition to promoting this social attitude, individuals can take positive steps such as educating people about elder abuse, increasing the availability of respite care, promoting increased social contact and support for families with dependent older adults, and encouraging counseling and treatment to cope with personal and family problems that contribute to abuse.

Education is the cornerstone of preventing elder abuse. Media coverage of abuse in nursing homes has made the public knowledgeable about —and outraged by —abusive treatment in those settings. However, as most abuse occurs in the home by family members or caregivers, there needs to be a concerted effort to educate the public about the special needs and problems of older adults and the risk factors for abuse.

Respite care is an essential way to help reduce caregiver stress, and as a result, prevent elder abuse. Every caregiver needs time alone, free from the worry and responsibility of looking after someone else’s needs, and having someone else care for an older adult, even for a few hours each week, is crucial. Respite care is especially important for caregivers of people suffering from Alzheimer’s disease or other forms of dementia, or of older people who are disabled. The National Institute on Agingopens in new window and other organizations offer a variety of resources on finding and paying for respite care.  

Social contact and support can be a boon to older adults and to family members and caregivers as well. When other people are part of the social circle, tensions are less likely to reach unmanageable levels. Many times, families in similar circumstances can band together to share solutions and provide informal respite for each other. In addition, when there is a larger social circle, abuse is less likely to go unnoticed.

Counseling for behavioral or personal problems in the family or for the individual with mental health and/or substance abuse problems can play a significant role in helping people change lifelong patterns of behavior or find solutions to problems emerging from current stresses. If there is a substance abuse problem, treatment is the first step in preventing violence against the older individual. In some cases, a nursing home may be a more appropriate living environment than living with someone who is not equipped emotionally or physically to handle the responsibility. Even in situations in which it is difficult to tell whether abuse has really occurred, counseling can be helpful in alleviating stress.

This free online resource is an updated and condensed version of APA’s 2013 document Elder Abuse and Neglect: In Search of Solutions (PDF, 681KB)opens in new window created by the organization’s Committee on Aging.