1. R u n n i n g H e a d : E L D E R A B U S E | 1
Elder Abuse
Tahmina Mahmud
Lesley University
Author Note
This paper was prepared for CPSYC 3901.01 taught by Professor Howe on December 12, 2016.

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Introduction
As an intern at Windsor House Adult Day Health Program, I worked directly with
elderly individuals on a daily basis. My responsibilities included providing companionship to
the clients, as well as conducting activities including morning exercise, nail painting, and
crafts. Over the course of the semester, I had the opportunity to talk to many men and women
about their life stories. Their stories inspired me to want to learn more about their
experiences, specifically with elder abuse. While elder abuse is a major issue in today’s
society, it is a topic that not many people are willing to discuss openly. In this paper, I hope
to bring light to the experiences hundreds of thousands of older persons experience each year.
I will begin by explaining the various types of elder abuse, using statistics that demonstrate
the severity of the phenomenon. Then, I will discuss the perpetrators, the characteristics that
make elderly people vulnerable, and the warning signs of elder abuse. Finally, I will analyze
the relevant laws and prevention strategies.
Elder Abuse
Elder abuse is defined as, “Any knowing, intentional, or negligent act by a caregiver
or any other person that causes harm or a serious risk of harm to a vulnerable adult”
(Administration on Aging). Research shows that 1 in 10 Americans over the age of 60 will
experience some form of elder abuse in their life. It is estimated that nearly 5 million elderly
individuals are abused each year, but unfortunately less than 1 out of every 14 cases of abuse
is reported to authorities (Roepk-Buehler & Dong, 2015). Elder abuse can take shape in a
variety of forms, including physical, sexual, emotional, exploitive, and neglectful abuse.
Physical abuse refers to hitting punching, slapping, burning, kicking, restraining, false
imprisonment, and giving excessive or improper medication. Psychological/Emotional abuse
is shouting, swearing, frightening, humiliating, name calling, blaming, general disrespect, and
ignoring. Financial abuse refers to illegal or unauthorized use of person’s property, money,

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pension book or other valuables including changing the person's will to name the abuser or
by evicting from their own home. Elderly individuals often become victims of financial
scams. Sexual abuse refers to forcing a person to take part in any sexual conduct without
consent or may also include cases where elder is no longer able to give consent
(Administration on Aging). For example, an elderly individual with Dementia cannot legally
give consent. Neglect is depriving a person of food, heat, clothing, or comfort or essential
medication and needed services. This deprivation maybe intentional (active neglect) or
happen out of lack of knowledge or resources (passive neglect) (Douglass, 1983).
Elderly people are likely to experience neglect from family members failing to ensure they
have good nutrition, proper clothing, and transportation to needed appointments. This neglect
often borders elder abuse.
Perpetrators of Elder Abuse
Studies show that it is family members, care givers, and residential facilities that are
most often the perpetrators of elder abuse. This is likely due to the fact that most victims are
dependent on their abuser for basic needs, including financial, emotional, and physiological
stability. It is estimated that in almost 90% of elder abuse and neglect incidents, the
perpetrator is a family member. Specifically, 66% of perpetrators are adult children or
spouses. Compared to cases of self-neglect, elder abuse cases where an individual is
victimized by a perpetrator “may experience more perceived stress given that he or she has
less perceived control over the situation… which has been associated with poor mental health
outcomes such as depression and anxiety” (Roepk-Buehler & Dong, 2015, p.1821).
Based on research studies most of the times elder abuse occurs when caregivers
violate the trust and takes advantage of elderly people in the nursing home while they are
under their care. The reason nursing elder abuse is so high is because caregivers might
believe that they will not be punished since elderly person who are easily confused and

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isolated form their own family (W. Malmedal et al.. 2015, p. 3). Another example, when
elderly suffers from dementia or other cognitive diseases, these types of abuse can damage
their psychological well-being. For instance, when elderly first enter the nursing home, they
often feel more emotionally vulnerable. Since elderly people are vulnerable it is very easily to
mistreat at the nursing home by caregivers. Therefore, they feel emotional pain, distress, and
fearful most of the time due to verbal abuse that elderly receive form their caregivers. One of
the reason caregivers at the assisting living house is because they have the authority and
power over the elderly. Moreover, elderly people may not know how to respond or report the
verbal abuse.
According to the research studies finding is that most victims of sexual abuse in
nursing homes were “cognitively impaired (dementia, Alzheimer’s, stroke, and brain injury),
had a psychiatric diagnosis and/or were physically frail (wheelchair, bedridden, paralyzed,
and reduced mobility), and had somatic illnesses” (W. Malmedal et al. 2015). Elderly women
most often at higher risk of sexual abuse or sexual assaults then men. According to research
studies, many of the cases were reported that elderly women are six times more likely than
men to be sexually abused. Even though, elderly women percentage is high, men are also
targeted of sexual abuse and sexual assaults by their caregivers as well. As a result, both men
and women nursing home patients are victims of sexual abuse, but majority time only women
reported.
Characteristics of Elderly Individuals
The elderly are considered to be vulnerable because they are at a developmental stage
where there is greater reliance on others to get things done. At this point, many individuals
don't have the mental capacity or knowledge they need in order to know right from wrong,
especially in cases of abuse (Dong, 2015). Further, elderly people have a lack of control over
their own lives due to their inability to thrive independently. They cannot do many of their

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daily tasks by themselves, including grocery shopping and cleaning, which makes them even
more dependent on others. Since they are unable to do things by themselves and often have to
depend on others to survive each day, the situation becomes more problematic.
When elderly have major health issues, research shows that it is easier to harm them.
Due to physical restrictions and lack of mental wellbeing, they become vulnerable in this
stage of their life. Furthermore, the physical strength, general knowledge and many other
circumstances make elderly people helpless. Elder abuse is more likely to happen to those
who do not have good support from family, friends, neighbours or social services (Roepke-
Buehler & Dong, 2015). Therefore, some elderly people, as they age, become confused
(Nursing Home Abuse Guide, n.d.). They might forget to eat or take care themselves. Some
elderly become slower in their ability to do things and will stop preparing good nutritious
meals. Many elderly individuals are faced with the dilemma of standing up to the abuse, but
risking the support the abuser provides them.
There are many times they cannot defend themselves against harm, on both an
individual and institutional level. Physical deteriorations, including sickness, memory loss
and a weaker immune system, play a role in the prolonged abuse. Due to weakening mental
capacity, elderly people are more easily tricked by their abuser. They are also financially
vulnerable as they no longer work and often rely on family and state benefits for monetary
support.
Warning Signs
Research has shown that “it is frequently very difficult to detect abuse. Normally,
abusive behavior occurs in private and the victim may be unwilling or unable to describe the
attacks. When reports are made, they are frequently not believed” (National Adult Protective
Services Association, 2016). Some of the most noticeable warning signs are physical, and
result from neglect or inadequate care either by the self or caregiver. There are many

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instances when elderly individuals become sick due to absence of care or not having the
proper diet, which may lead to rapid weight loss or weight gain. When elderly individuals
look or behave in a way that is noticeably different, this may be a warning sign of abuse.
These physical warning signs range from bruises, to malnutrition and dehydration (Nursing
Home Abuse Guide). There are many signs and symptoms that may seem to indicate abuse,
neglect or exploitation. It is often a good idea to err on the side of caution and alert family
members, concerned friends or professionals to the possibility of abuse. The signs and
symptoms should be taken seriously for elderly individuals’ safety purpose; many cases that
seem to be self-neglect often turns out to be elder abuse. However, even if there are warning
signs present, individuals should avoid jumping to conclusions until all the facts are gathered.
Another category of warning signs has to do with elderly individual’s mental
capabilities. Elderly individuals who have Alzheimer’s or Dementia are a vulnerable
population that is most likely to experience elder abuse, likely because they cannot tell
anyone when they become victims of abuse. Research studies show that there are many cases
of abuse with Alzheimer’s patients that go unreported and uncounted because victims are
often unable to communicate or tell anyone about the abuse. Moreover, patients with
Alzheimer’s are more likely to suffer abuse than other residents of a nursing home. Elderly
individuals with Alzheimer’s disease are easier targets due to their inability report (Nursing
Home Abuse Guide, n.d.).
In our society, it is very common for people to depend on their family for financial,
emotional, and physical support when they get older. However, since family members are
often too busy with their own lives to adequately care for an elderly individual, they are left
to take care of themselves. Older individuals who are experiencing nursing home abuse and
lack familial support systems are more likely to suffer long term due to the fact they have
nowhere else to go (Douglass, 2001).

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Relevant Laws
According to the United States Department of Justice, “The federal government and
states, the District of Columbia, and some territories all have laws to protect older adults from
physical abuse, neglect, financial exploitation, psychological abuse, sexual abuse, and
abandonment” (2016). Those in charge of laws regarding elder abuse have been taking many
preventive steps in order to further protect this group of people who often lack protections in
various for legal matters. In recent years, there have been several laws passed and amended
that give elderly individuals a voice. Many facilities including nursing homes and adult day
cares have been made aware of these laws and regulations, as well as the penalties that could
result if the law was not followed. Three of the most salient laws that currently exist include:
The Elder Justice Act of 2009, The Older Americans Act, and Elder Abuse Victims Act of
2009.
The Elder Justice Act has is a part of the Affordable Care Act, and has to do with
funding programs that take aim at developing and implementing strategies to decrease the
likelihood of elder abuse, neglect, and exploitation. The Older Americans Act was created to
support various home and community-based services that meet the needs of elderly
individuals. For example, Meals-on-Wheels is a program that provides prepared meals to
people who may not be able to cook for themselves. Finally, the Elder Abuse Victims Act is a
legislative effort designed to address the crimes against the elderly, specifically in terms of
strengthening efforts to criminally prosecute perpetrators of abuse. However, it has not yet
been enacted into law. According to the Center for Elders and the Courts, “federal and state
laws address elder abuse, neglect and exploitation, but state law is the primary source of
sanctions.” While some existing federal laws relate specifically to elder abuse and neglect,
none provide broad regulatory mechanisms for state or local programs established

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specifically to support services for these victims. This legal gap is a direct result of the lack
of funding and services within this area of social policy.
Prevention Strategies
While elder abuse is considered to be growing at alarming rates, it is considered to be
a problem with various solutions. While there are many prevention strategies that can target
elder abuse, one plan that has gained national recognition was created collaboratively by the
U.S. Department of Justice and Department of Health and Human Services. According to the
plan’s “Elder Justice Roadmap”, there are five priorities critical to understanding and
reducing elder abuse and to promoting health, independence, and justice for older adults.
These prevention strategies mainly focus on the general and deeper understating to reduce
and prevent elder abuse, since this has an impact on everyone and is escalating as a major
concern around the elderly population.
The first priority is awareness, which has to do with increasing public awareness of
elder abuse, a multi-faceted problem that requires a holistic, well-coordinated response in
services, education, policy, and research. The second priority is brain health, which has to do
with conducting research and enhancing focus on cognitive (in)capacity and mental health –
critical factors both for victims and perpetrators. The third priority is caregiving. This is the
idea that we should provide better support and training for the tens of millions of paid and
unpaid caregivers who play a critical role in preventing elder abuse. The fourth priority is in
the economic sphere, and has to do with quantifying the costs of elder abuse, which is often
entwined with financial incentives and comes with huge fiscal costs to victims, families, and
society. The fifth and final priority is expanding resources. The idea is that we should
strategically invest more resources in services, education, research, and expanding knowledge
to reduce elder abuse (U.S. Department of Justice & Department of Health and Human
Services, 2014).

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References
Center for Elders and the Courts (n.d.) Basics: Elder Abuse Laws. Retrieved from
http://www.eldersandcourts.org/elder-abuse/basics/elder-abuse-laws.aspx
Dong, X. Q. (2015). Elder abuse: Systematic review and implications for practice. Journal of
The American Geriatrics Society, 63(6), 1214-1238. doi:10.1111/jgs.13454
Douglass, R. L. (1983). Domestic neglect and abuse of the elderly: Implications for research
and service. Family Relations, 32(3), 395-402.
Iverson, M., Kilvik, A., & Malmedal, W. (2015). Sexual abuse of older residents in nursing
homes: A focus group interview of nursing home staff. Nursing Research and
Practice. 1-6.
Nursing Home Abuse Guide. (n.d.). Nursing Home Abuse Guide. Retrieved from
http://www.nursinghomeabuseguide.org
Roepke-Buehler, S. K., & Dong, X. (2015). Perceived stress and elder abuse: A population-
based study of adult protective services cases in Chicago. Journal Of The American
Geriatrics Society, 63(9), 1820-1828. doi:10.1111/jgs.13613
U.S. Department of Health and Human Services. (2016). Administration for Community
Living. Retrieved from https://aoa.acl.gov/Aging_Statistics/Profile/2014/index.aspx