The East Central Florida Memory Clinic Newsletter

Suffering in Silence: Recognizing and Preventing Elder Abuse

As the demographics of our population shift toward an increase in the elderly population, the incidence rate of elder abuse is expected to rise. One estimate places the incidence rate at 1.5 million per year, however the exact prevalence of cases is unknown. In fact, many cases of abuse are not reported as a result of shame, embarrassment, or as a result of a fear of being put in an institution and not being believed. Understanding elder abuse can heighten our awareness and therefore aid in the prevention of future cases. It is important for both professionals as well as lay persons to be able to recognize elder abuse as it takes different forms and occurs across settings such as in the family, in the homes of caregivers or in residential institutions such as assisted living facilities or nursing homes. 

At the highest risk for elder abuse are those who have mental or physical disabilities and those who are both financially and emotionally dependent on their caregivers. While there are no reliable
indicators that can predict who is likely to perpetrate abuse, most cases occur in families where there has been a previous pattern of domestic violence or a history of mental, emotional or substance abuse problems. Other possible causes include caregiver stress as a result of various overwhelming life changes such as added economic difficulties or living arrangements. In residential institutions, abuse is more common when staff are underpaid, overwhelmed, or under qualified. 

There are several types of elder abuse that occur. One of the most commonly reported types is physical abuse. This includes any pain or injury inflicted on an elderly person such as by hitting, pushing, or by unreasonable restraints. Other examples include deprivation of nourishment, sexual molestation, overmedication, or confinement. Another type of abuse is financial or the misuse or theft of an elderly person's money or property which was put in a caregiver's trust. Financial abuse can take the form of fraud, forgery, withholding money or coercion of the elderly person to sell property or possessions. In addition, other abuse can be psychological or emotional. 

This form of abuse is the infliction of mental suffering such as by verbal assault, threats, humiliation, removal of decision making power, or by isolation. Furthermore, neglect is a form of abuse that may be an unintentional failure to take care of an elderly person's needs without the intent of harm, as well as can be active neglect, or intentional failure to provide a reasonable amount of care. Neglect can be denial of medication, food, or hygiene, as well as deliberate failure to provide an elderly person with his or her necessities. 

There are several signs and symptoms of abuse reported by the administration of aging that can alert family, friends, and professionals:

• Inadequate physical care such as bruises, welts, broken bones, or injuries that are repetitive and not adequately explained by the caregiver or the victim.
• Depletion of money or missing items such as jewelry with out explanation.
• A change in living arrangements or the person's living situation is not commensurate with their financial status or assets.
• Behavioral signs include: disorientation, withdrawal, trembling, clinging, or lack of eye contact.
• Psychological signs include: anxiety, hyper vigilance, ambivalence, passivity, shame or confusion.
• Signs of restraints (bruises or welts) or signs of malnourishment (loss of weight).
• Time lags between injuries and medical treatment or history of emergency room or doctor shopping.
• Unusual banking activity such as switching accounts or large withdrawals.
• Changes in social environment: recent acquaintances or care providers may isolate the elderly person from close friends and family.
• Caregiver indifference or anger toward the elderly person.

Victims of elder abuse suffer in silence as abuse is difficult to detect and often occurs in private. Many victims are unwilling or are even unable to describe the abuse. Professionals as well as lay people can provide a warm and empathetic attitude toward elder adults in order to create an environment in which they feel safe in disclosure and can discuss possible alternatives to their situation. If elder abuse is suspected, family members or friends can follow through by visiting the person intermittently to monitor the situation and let the abuser know they are being observed. If abuse suspected, you must notify the abuse hotline, or one can notify the police, and a complete investigation will be conducted in order to assess the situation. Care should be taken so as not to aggravate the situation. Every state has adult protective services and most have hotlines available to report suspected mistreatment of abuse. 

In Florida, the Elder Abuse Hotline is 1-800-96-ABUSE. It is available 24 hours a day, 7 days a week.

Kristine Cangelosi, M.A.

East Central Florida Memory Clinic
3661 S. Babcock Street; Melbourne, FL 32901
Phone (321) 768-9575 Fax (321) 725-1998
info@ecfmdc.org