Elder abuse is a common and frightening social problem, which unfortunately seldom seems to attract the attention they need. The victims very often do not report their abusers, and the cycle of violence and injury continues.
Home care aides are very often the health team members who have the most constant contact with members of society who are victims of elder abuse. Because an aide will see patients frequently and for long periods of time, he/she is in a unique position to detect the signs and evidence of elder abuse. All healthcare workers function as patient advocates and need to be prepared to know the signs of elder abuse. They also need to know when it may be appropriate to inquire further. When concerns are based on objective information that can be observed, documented, and verified, healthcare workers have a duty to report domestic violence or elder abuse to the proper persons or authorities, if required by law or the healthcare agency.
What is elder abuse? Most people answer this question simply by saying that elder abuse involves some sort of physical harm or violence but it is broader than that. The U.S., National Academy of Sciences defines elder abuse as follows: “Intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended), to a vulnerable elder by a caregiver or other person who stands in a trusted relationship to the elder, or failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.” Said another way, elder abuse includes acts that deliberately endanger the physical or emotional health of an elderly person. In the case of caregivers or fiduciaries, elder abuse includes a failure by these persons to provide the goods or services that are necessary to maintain the health or safety of the older individual in their care.
- Physical abuse is one aspect of the problem but elder abuse can take many forms. It may involve financial abuse, abandonment or neglect. It may also include physical, sexual or emotional abuse.
- Actual sexual contact does not have to happen for sexual abuse to occur. The victim may be forced to undress, watch pornography, listen to sexually explicit or suggestive language, or be subjected to unwanted sexual situations.
- Neglect is perhaps the most common form of elder abuse. In these cases, relatives or caretakers ignore the elder and deliberately neglect to provide for the basic emotional, comfort, safety, health care, or nutritional needs of the victim.
- Emotional abuse involves behavior that causes psychological pain and trauma but does not involve physical injury. This can include threats, ridicule, insults, embarrassment, intimidating or manipulative behavior, non-verbal threats, deliberately withholding attention, or forced isolation.
- An elderly person may find that people close to them are exploiting them financially. The abuser may be stealing money or valuables, forging signatures, or improperly accessing personal financial records.
- The elderly person might be struck, shoved, or restrained. A caregiver may also force an elderly person to take extra doses of his/her medication or take illicit drugs or alcohol. The elderly person may be deprived of medications or medical care, or chronic health problems may be ignored or neglected.
- Deserting an elderly person by someone who has the responsibility of providing for the physical care of that person is abandonment.
Signs of Elder Abuse
As a home care aide it is important to understand how to recognize when an elderly person is being abused.
- If the person cared for has burns, bruises, scars, or welts that cannot be explained, or has injuries that are obviously very old but are just being recently reported, that should raise a concern that abuse is happening. Other questions to ask are: Do they have an injury and explanation for its cause, as given by the victim, the caretaker, or a family member, that just does not make sense? Does the explanation for an injury given by the victim contradict the explanation given by the person who cares for them? Finally, if an elderly person with an injury does not want to talk about how the injury happened or seems evasive when questioned then that can be an indication abuse is happening.
- Elderly persons should be evaluated for signs of a sexually transmitted disease. Older adults can certainly be sexually active, but if this person has no partner or has been living alone, the presence of a sexually transmitted disease would be a strong indication of sexual abuse. Other signs of sexual abuse would be injuries to the genital areas or torn or bloodstained underclothing.
- If the elderly person is fearful or withdrawn, this should be a sign of trauma. Other signs include depression or avoidance of eye contact. Other signs of trauma include whether they had been cheerful and outgoing and changed to not seem as friendly or talkative. These could all be signs of emotional abuse. This could be especially true if these emotional issues are new for that person.
- There are many reasons why someone could be depressed or withdrawn. These emotions in an elderly person do not necessarily mean that he/she is being abused. But if these changes happen to an elderly person who is dependent on someone else and it is noticed that the elderly adult seems frightened or subdued when the caretaker or relative is present, the health worker should suspect the possibility of abuse.
- Elderly people may have multiple medical problems that affect their health and ability to care for themselves. There is no reason why they should not be healthy, clean, well-groomed, well-dressed, adequately dressed, and well-nourished. This is true even if they are dependent on someone for their basic needs. If a dependent, elderly person is dehydrated, dirty, poorly or inadequately dressed, living in unclean or unsafe conditions, or is obviously malnourished, they may be victims of elder abuse. The elderly person who is being physically abused may also show evidence that they are being overmedicated or not receiving the medications needed. Questions to raise are: Was a prescription for this person recently filled but the bottle is empty? Was the prescription filled a long time ago but there is a lot of medication left?
Financial Abuse or Exploitation
- It would be difficult for someone who is not legally responsible for the financial affairs of an elderly person to know if this type of abuse is taking place. Evidence that this is occurring would be drastic and sudden changes in someone’s financial status, an unexpected and unexplained inability to pay bills or buy the necessities of life, valuable items that go missing, or purchases of items the elderly person would unlikely buy, want, or need. If the elderly person is not well- nourished or has not been taking medications and reports that buying food and medications is simply too expensive, it is prudent to consider the possibility of elder abuse.
Sudden Changes in Health
- A sudden change in health is not uncommon in an elderly person but if this change is accompanied by emotional distress, injuries, or the change is unexpected for that person, then elder abuse may be happening.
Change in Relationships
- Tension between an elderly person and his/her relatives is important to note. Do the relatives or close friends of an elderly person refuse to allow exposure to health service personnel? Is the elderly person fearful or withdrawn when a relative or caretaker is present, but seems more comfortable when that person is absent? These are signs that elder abuse may be happening.
If elder abuse is occurring, it may be a healthcare worker’s duty and legal obligation to report it. It is very important, however, that there be a reasonable suspicion that abuse is happening. Deciding that an elderly person is being abused on the basis of feelings or intuition should be avoided. Suspicions of abuse should be based on objective information that can be observed, documented, and verified.
- Elder abuse and domestic violence are serious problems. With elder abuse, physical abuse is one aspect of the problem but elder abuse can take many forms. It may involve financial abuse, abandonment or neglect. It may also include physical, sexual or emotional abuse. This is also true for domestic violence; it may include physical, sexual or emotional abuse.
- Signs of elder abuse or domestic violence may be observed. The most sensible approach would be to follow the guidelines that have been developed by an employer or in the workplace. If required to ask a client about abuse, it should be done in a way that is non- confrontational, non-judgmental, and supportive.
- Healthcare workers should not decide that someone is being abused on the basis of feelings or intuition. Suspicions should be based on objective information that can be observed, documented, and verified. When there is a reasonable suspicion that elder abuse or domestic violence is happening, healthcare workers are obliged to report the abuse to the proper authority.
- Remember to always bring your concerns to the office.