Older Adult Abuse: Warning Signs and Reporting Information

Older adult abuse can happen anywhere. It can happen at a long-term care facility or the older person’s home. Several factors increase the risk of elder abuse. These include mental illness, social isolation, a lack of mobility, and a lack of financial resources.

The U.S. Department of Justice estimates that about one in 10 adults over 65 are abused each year. This can include vulnerable adult abuse, such as the abuse of adults with disabilities.

Types of mistreatment people over 65 can experience include:

• Physical abuse
• Sexual abuse
• Psychological abuse
• Emotional abuse
• Financial abuse
• Financial exploitation
• Neglect
• Self-neglect

Sometimes, the only person in a position to help is the one committing the abuse. The abuser can include professional caregivers, healthcare professionals, nursing home staff, friends, or even close family members. Older adults often feel trapped and alone when the abuser is someone they trust.

There are several ways you can help prevent mistreatment and suspected abuse. One way is by reporting suspected elder abuse cases to law enforcement authorities or social services. To do so, you’ll have to know the warning signs.

This article lists the typical signs of older adult abuse. You’ll also learn how to report suspected abuse and what you should know if you are a mandated reporter.

If something feels wrong, getting legal help now can protect your loved one before potential abuse escalates. Find an attorney near you.

Older Adult Abuse Cases Are Underreported

Older adult abuse is even more challenging because only about one in 23 cases are reported to authorities. This trend of underreporting by victims of abuse can be due to several factors:

• An older adult’s unwillingness or inability to report the perpetrator (who is often a family member or friend)
• Challenges with pointing fingers when the perpetrator is a trusted individual like an adult child or an attorney
• Mental impairment or a lack of understanding of the abuse

Cases are difficult when the best person to report the abuse is the perpetrator. Caregivers and healthcare providers are often “mandated reporters” who must report abuse. When they are the abuser, their victims may not get the help they need.

However, there are signs of elder abuse that others can observe. Medical professionals who regularly interact with elderly people often see the first warning signs.

Physical Abuse

If you can identify the common signs of physical elder abuse, you might save someone’s life.

Physical abuse is the intentional use of force that results in pain, physical injury, or impairment to an older victim.

It can include:

• Striking (with or without an object)
• Shaking or inappropriately restraining a victim
• Intentionally giving inappropriate medications to a victim
• Force-feeding a victim
• Other abusive acts or mistreatment

Signs of Physical Abuse in Older Adults

Domestic violence or physical abuse typically leaves signs on the body. These may be hidden or purposefully placed under clothing or unseen areas:

• Bruising (multicolored bruising can mean bruising over time)
• Lacerations, punctures, or welts
• Sprains, dislocations, fractures, or broken bones
• Burn marks
• Recurring or unexplained injuries
• Poorly treated or untreated injuries
• Injuries in areas usually covered by clothing
• Poor skin condition/hygiene
• Broken eyeglasses
• Hair loss
• Dehydration or malnutrition
• Weight loss
• Soiled clothing or bedding
• An unclean environment (smells of feces or urine)
• Depression or withdrawal
• Hesitation to talk openly
• Fearfulness of caregivers
• Confusing or contradictory statements or accounts of injuries
• Unexplained agitation
• Denial of injuries

Sudden changes to someone’s physical appearance, mood, or actions are a warning sign to loved ones and medical care professionals.

Sexual Abuse

Sexual abuse refers to sexual contact with an older person that is non-consensual. An older person who lacks mental capacity cannot grant consent.

Sexual abuse of older adults includes forced nudity or taking sexually explicit photographs, unwanted touching, sexual battery, or rape.

Signs of Sexual Abuse in Older Adults

• Torn or stained undergarments
• Bruising on the breasts or genitals
• Unexplained bleeding from the genital or anal area
• Difficulty walking or sitting
• Unexplained genital infections or sexually transmitted diseases
• Unusual behavior (withdrawn or overly aggressive)
• Inappropriate interactions between the victim and the perpetrator

Psychological Abuse or Emotional Abuse

Psychological or emotional abuse is the intentional infliction of anguish, pain, or distress through either verbal or non-verbal conduct.

Signs of Psychological or Emotional Abuse in Older Adults

• Unexplained weight loss or gain
• Increased levels of stress (higher blood pressure)
• Increased health problems
• Problems sleeping
• Depressed, withdrawn, or confused
• Visibly fearful in the presence of the perpetrator
• Non-responsive
• Displays unusual behavior or nervous tics (rocking, biting, scratching, etc.)

Financial Abuse or Exploitation

Older adult financial abuse or exploitation is the illegal or improper use of an older person’s assets and financial resources.

This can include manipulating an older person’s bank accounts, real property, or other financial interests. It also includes pressuring an older person to take action, such as signing estate planning documents. It includes identity theft, fraud, and phone or email scams.

Signs of Financial Abuse or Exploitation

• New “best friends”
• Family or friends who were distant now are more involved
• Suspicious signatures on accounts
• New names added to accounts or property titles
• Recently signed legal documents that an older person cannot explain
• Recent (and perhaps many) revisions to an estate plan
• Withdrawals or transfers that an older person cannot explain
• Possessions go missing
• Mail for an older adult’s various financial accounts has been redirected to a new address
• Unpaid bills and notices of default or eviction
• New and unnecessary services are provided
• Services seem inadequate when compared with the size of an older adult’s estate
• Confusion and lack of understanding about financial arrangements
• The constant need to consult another person before making financial decisions
• Embarrassment or feelings of guilt
• Increased levels of stress and anxiety
• Isolation from loved ones (from pressure by the perpetrator or self-isolation)

Neglect and Self-Neglect

Neglect is a caregiver’s refusal to provide the necessary care for an older person. It is intentional or unintentional. It can happen in the older person’s home or assisted living facility.

But elder self-neglect is the lack of necessary care for an older adult without any third-party perpetrator — the neglect results from the older person’s own action or inaction.

Signs of Neglect or Self-Neglect in Older Adults

• Poor personal hygiene (dirty nails/skin, matted or lice-infested hair, presence of feces or urine)
• Bedsores or skin rashes
• Untreated infections or unattended injuries
• Dehydration or malnutrition
• Weight loss
• Unsanitary living conditions (foul odors, animal/insect infestations, piles of trash)
• Unsafe living conditions (inadequate plumbing, heating/air, ventilation, disrepair)
• Lack of food in the home
• Inadequate or unclean clothing
• Lack of medical aids (hearing aids, glasses, dentures)
• Unpaid bills
• Emotionally detached
• Refusal to seek outside help
• Self-destructive
• Inadequate or inconsistent sleep
• Sudden loss of appetite that is not related to any medical conditions

How Do I Report Older Adult Abuse?

If you suspect elder abuse, it’s important to report it immediately. Abuse reporting helps prevent serious harm to the victim’s health or assets.

Even if you’re unsure whether such abuse is occurring, reporting your suspicions is an important first step.

The resulting investigation can:

• Determine whether an older adult is being abused
• Provide the adult with helpful information about abuse
• Bring awareness to loved ones and assisted living facility staff (which may protect the older adult from abuse in the future)

Every state also has its own Adult Protective Services (APS) agency, which receives and investigates reports of elder abuse. They also conduct investigations and work closely with local law enforcement agencies if criminal activity is uncovered.

Unlike typical investigations, APS investigations involve agents trained to deal with older victims. They can provide additional support services to victims of abuse.

For a list of Adult Protective Services agencies near you, contact your local social services agency or see the APS locator provided by the National Adult Protective Services Association (NAPSA). Your local long-term care ombudsman is also a great advocate for long-term care facility residents.

If you or someone you know is suffering from elder abuse, you can also use the hotlines below:

• The National Elder Fraud Hotline: 1-833-372-8311
• The Eldercare Locator Helpline: 1-800-677-1116

If you suspect an older loved one is experiencing abuse and are unsure how to proceed, legal help is available. An attorney can help connect you with the right reporting agencies and advise on further legal action.  If you suspect financial exploitation, they can also help protect an older adult’s assets or finances. Find an attorney near you.

How To Complete an Elder Abuse Reporting Form

A report of elder abuse doesn’t need to be a formal, written report. All that is typically required is a telephone call to your local APS or social services agency.

Important information to include in a verbal or written report would be:

• The names and relationships of the parties and the person reporting
• The age and condition of the victim (physical health and mental state)
• Your specific observations and concerns of mistreatment (including dates of events and a timeline, if possible)
• Any concerns of immediate harm
• Any knowledge of mental illness or undue influence
• Any assets of the victim that may be subject to exploitation
• The location of the victim and the best way to contact them
• Other potential witnesses and their contact information
• Any relevant documents you may have (such as copies of emails, letters, powers of attorney, wills, or trusts)

You can ask the agency for an estimated timeline for their investigation. It is also helpful to ask for a description of their services.

Elder Abuse Mandated Reporters

Depending on your state’s reporting laws, healthcare professionals and long-term care providers in frequent contact with older adults may be required by state law to report suspected abuse. This list typically includes medical personnel, police, nursing home employees, social workers, or clergy.

Under federal law, the Elder Justice Act (EJA) requires reporting by anyone working in or with a long-term care facility that receives $10,000 or more in federal funds. In addition, any business that cares for the elderly and accepts Medicare or Medicaid must follow federal regulations on elder care.

Individuals required to report elder abuse suspicions will typically face penalties for failing to do so.

Mandatory reporting has a positive impact on states with expanded reporting requirements. These states have generally seen increases in cases of elder abuse investigated by law enforcement.

Taking Action for Older Adult Abuse: Get Legal Help

There may also be legal remedies available to victims of older adult abuse. Abuse laws vary by state, so you should contact an attorney specializing in elder abuse law.

The right attorney can help with all types of issues involving an elderly loved one. FindLaw’s directory of elder law attorneys can get you started. Enter your city or ZIP code for a list of qualified legal professionals near you. Because state laws are relevant for most legal issues, your attorney should be licensed in your state.