1. Elder Abuse and Neglect
Barbara J. Chromy

2. What is elder abuse?
 an all-inclusive term representing all types of
mistreatment or abusive behavior toward
older adults (Wolf, 2000, p.7)
 further defined as acts of commission
(intentional behavior) and omission (failure to
act)
 self-neglect is the most common form of elder
abuse and the most difficult to detect and
treat (Levine, 2003 and Reynolds Welfel et al., 2000)

3. Types of Abuse
 Physical
 Psychological
 Sexual
 Material
 Violation of Rights
 Medical
 Abandonment
 Neglect
 Self-neglect

4. Forms of Abuse
Physical - hitting, pushing, slapping, punching,
restraining, pinching, force-feeding, physical
restraint
Psychological - verbal aggression, intimidation,
threats, humiliation
Sexual - any kind of non-consensual sexual
contact

5. Forms of Abuse (continued)
Material - theft of cash or personal property,
forced contracts, misuse of income or other
financial resources
Violation of Rights - deprivation of any
inalienable right such as voting, assembly,
speech, privacy, personal liberty
Medical - withholding medication or
overmedicating

6. Forms of Abuse (continued)
Abandonment - desertion of an elderly person for
whom one has agreed to care for, “dumping” a
cognitively impaired elder at an emergency
room with no identification
Neglect - failure to provide necessary physical or
mental care of an elderly person
Self-neglect - behavior that threatens one’s own
health or safety

7. Indications of Abuse
Physical - multiple fractures or bruises at various
stages of healing, burns, patterned injuries,
patchy hair loss, frequent visits to ER, delay in
seeking medical treatment for injuries
Psychological - withdrawn behavior, wasting or
failure to thrive, depression
Sexual - genital injury, vaginal or rectal bleeding,
bruises, chipped teeth, sexually transmitted
disease or infestations

8. Indications of Abuse (continued)
Material - unexplained loss of income, assets,
possessions, not eating, missed utility
payments
Violation of Rights - isolation, failure to attend
church services or community events as one
did previously
Medical - no improvement in condition for which
one was prescribed medication, blood tests
indicate greater or lower than expected levels
of medications, sleepiness, groggy

9. Indications of Abuse (continued)
Abandonment - isolation, not seen outside home,
disrepair or unkempt environment, missed
medical or other appointments or
engagements, wandering, being left
somewhere to fend for self
Neglect - uncared for appearance, inappropriate
clothing, failure to thrive, lack of medical or
dental care, isolation
Self-neglect – (similar to neglect)

10. Scope of the Problem
 estimates of the occurrence of elder abuse vary
widely— due in part to the variability in the
definitions used to measure and report abuse
 “mistreatment of adults, including abuse, neglect,
and exploitation, affects more than 1.8 million
older Americans” (Pavlik, Hyman, Festa, Bitondo, and Dyer,
2001, p. 45)
 self-neglect accounts for one-third to one-half of
all abuse cases (Gray-Vickrey, 2000, 2004; Levine, 2003; Paris,
2003)

11. Distribution of Abuse
 distribution of abuse according to sex was
reported by Wolf (2000) to be almost equally
divided between males and females
 Some studies indicate that females are more
often victims of elder abuse (Bratteli2003, Pavlik et al.,
2001)
 Patterns of abuse are similar among African
Americans, Latinos, Caucasians, and Asians
(Cavanaugh & Blanchard- Fields cited in Etaugh & Bridges, 2004)

12. Perpetrators of Abuse
 elder abuse can be perpetrated by nearly
anyone including paid or volunteer
caregivers, medical and long-term care
employees, family members, significant
others, and in some cases strangers such as
a person who befriends an elderly person for
the purpose of exploiting them (Reynolds Welfel et
al., 2000)

13. Greatest Risk Factors for Causing
Abuse in North Dakota
 being male
 under age 60
 being related
 history of mental
illness
 recent decline in
mental health
 abusing alcohol
 primary caregiver
 lives with or has
access to the adult
they abuse
 change in family
roles from being
cared for to being
the care provider
 prior history of
violence
 (Bratteli, 2003)

14. Theories Explaining Elder Abuse
 affects of caregiver
stress (situational
model)
 dependency of elder
on caregiver
(exchange theory)
 mental or emotional
disturbance of
caregiver
(psychopathology)
 repeated cycle of
violence (social
learning theory)
 power imbalance in
relationships
(feminist theory)
 marginalization of
the elderly within
society (political
economic theory)

15. Risk Factors for Being Abuses
 Poor health
 Inability to perform
activities of daily
living
 Cognitive impairment
 Living with others
(living alone
increases risk for
financial and self-
abuse)
 Social isolation
 Depression,
confusion, substance
abuse or
dependence
 Mental or physical
impairment (stroke,
incontinence,
Alzheimer’s)
 Being female
 Over age 85

16. Risk Factors for Perpetrating Abuse
 History of family violence
 Disruptive behavior on behalf of the care
recipient
 Mental illness
 Alcohol or drug abuse or dependence
 Caregiver dependence

17. Perpetrating Risk Factors (continued)
 Stress
 Physical or emotional exhaustion
 Low social integration and/or unemployment
 Lack of community supports
 Insufficient income for basic needs

18. Protective Measures
 Stay sociable and active
 Stay involved with neighbors, friends, church
or community activities
 Get regular medical and dental care
 Open and post your own mail
 Increase social network as you age
 Have friends visit you at home
 Have a “best friend” with whom you can
confide in
 Keep in touch with old friends if you move

19. Protective Measures (continued)
 Keep your possession organized
 Tell someone you trust where your important
paperwork and bank account information is
kept
 Have checks direct deposited into your
account
 Use an answering machine to screen phone
calls
 Don’t leave cash or valuables visible
 Notify the police if you will be away from home
for an extended time period

20. Protective Measures (continued)
 Consult with an attorney
 Make arrangement for the future such as
power of attorney
 Get legal advise before making/signing
agreements regarding your care or
possessions
 Be aware of your financial situation

21. Protective Measures (continued)
 Know where to ask for help
 Find out about community resources before
you need them such as rape and abuse
hotlines, senior centers, and adult protective
services
 mental health service centers
 crisis centers
 private counselors
 clergy
 local police

22. Detection and Treatment Barriers
 detection of elder abuse is difficult because
denial is an integral feature of abuse, victims
may feel too ashamed to disclose
maltreatment or believe they are to blame for
or deserve the abuse
 dependence on an abuser can make a victim
reluctant to report for fear of how he/she will
survives without the perpetrators help

23. Detection/Treatment Barriers (continued)
 victims may not define their situation as
abuse especially in a dysfunctional family
environment where violence or mistreatment
has been “normalized” (Brown et al., 2004, Levine,
2003)
 cognitive, auditory, speech, visual
impairments, isolation or restraint may make
reporting impossible for the victim of elder
abuse

24. Detection/Treatment Barriers (continued)
 ageism can negatively affect detection of
elder abuse as it is common to view the
elderly as confused or demented, to trivialize
elders’ complaints, and to adhere to the
perception that elder abuse doesn’t exist
 physical injuries may be masked by clothing
or by isolating the victim

25. Detection/Treatment Barriers (continued)
 fast paced medical services and heavy
caseloads of social service providers may not
allow time for adequate assessment
 basic lack of information of where to turn for
help impedes the intervention and treatment
for both perpetrator and victim of abuse

26. Recommendations
 further research using standardized
definitions and subtypes of elder abuse would
provide a better picture of the scope of the
problem
 improved reporting guidelines along with
increasing the number of agencies and their
funding is essential.

27. Recommendations (continued)
 Greater understanding of the causation of
elder abuse could lead to the development of
effective treatment programs for abusers
 defining elder abuse in its own terms rather
that modifying guidelines from child abuse
legislation would improve the understanding
of elder abuse as a phenomenon separate
and unique from child abuse

28. References
 Bratteli, M. (2003). Caregiver abuse, neglect and
exploitation: The journey through caregiving. North
Dakota State University.
 Brown, K., Streubert, G., & Burgess, A. (2004).
Effectively detect and manage elder abuse. The
Nurse Practitioner, 9 (8), 22-33.
 Etaugh, C. & Bridges, J. (2004). The psychology of
women: A lifespan perspective (2nd
Ed.). Boston, MA:
Pearson Education, Inc.
 Gray-Vickrey, P. (2000). Protecting the older adult:
Learn how to assess the visible and invisible
indicators and what to do if you recognize abuse in
an older patient. Nursing, 30 (7), 34-38.

29. References (continued)
 Gray-Vickrey, P. (2004). Combating elder abuse:
Here’s what to look for, what to ask, and how to
respond if you suspect that an older patient is a
victim. Nursing, 34 (10), 47-51.
 Kapp, M., (2004). Family caregivers’ legal concerns.
Family Caregiving, (winter) 2003-2004, 49-55.
 Lachs, M., & Pillemer, K. (2004). Elder abuse:
Seminar. www.thelancet.com, 364 (October), 1263-
1272.
 Levine. J. (2003). Elder neglect and abuse: A primer
for primary care physicians. Geriatrics, 58 (10), 37-
45.
 Paris, B. (2003). Abuse and neglect: So prevalent yet
so elusive (editorial). Geriatrics, 58 (10), 10.

30. References (continued)
 Pavlik, B., Hyman, D., Festa, N., & Bitondo Dyer, C.
(2001) Quantifying the problem of abuse and neglect
in adults—analysis of a statewide database. Journal
of the American Geriatrics Society, 49, 45-48.
 Reynolds Welfel, E., Danzinger, P., & Santoro, S.
(2000). Mandated reporting of abuse/maltreatment of
older adults: A primer for counselors. Journal of
Counseling & Development, 78 (summer), 284-292.
 Wolf, R., (2001). Introduction: The nature and scope
of elder abuse. Generations, Summer, 6-12.

31. Resources
 Aitken, L. & Griffin, G. (1996). Gender issues in elder
abuse. Thousand Oaks, CA: Sage Publications, Ltd.
 Journal of elder abuse & neglect. Haworth
Maltreatment & Trauma Press.
 Quinn, M. & Tomita, S. (1997). Elder abuse and
neglect: Causes, diagnosis, and intervention
strategies (2nd
Ed). New York, NY: Springer Publishing
Company.
 Tatara, T. (1999). Understanding elder abuse in
minority populations. Philadelphia, PA:
Brunner/Mazel (a member of the Taylor & Francis
Group).