How to Spot Signs of Elder Abuse

Patricia Speck, DNSc

Approximately one in 10 older people in the United States has experienced physical, sexual, psychological or financial abuse, according to the National Center on Elder Abuse.

Physical abuse is defined as the intentional use of physical force that results in illness, injury, pain or functional impairment.

"Unexplained bruises, cuts, burns and bedsores are signs of physical abuse," said Patricia Speck, DNSc, a board-certified family nurse practitioner who specializes in forensic nursing, family and sexual violence at the UAB School of Nursing. "If you notice sudden changes in behavior, particularly when the suspected abuser is around, that is a sign that you should seek help for your loved one."

Speck says health care providers should suspect abuse if they see subdural hemorrhages and eye, nose and mouth injuries.

"Nurses should particularly look for signs of intentional injuries, such as contusions of lips, cheeks, soft palate, facial fractures, missing hair, particularly in odd places and not where you would expect to see balding," Speck said. "Bruising and skin tears in odd places, like the abdomen or under the arm or in the crotch, are also common signs.

"If there is an injury to an older person who is in a wheelchair, you would look for friction burns on the abdomen or wrists, different patterns in bruising and skin tears."

While the majority of sexual assault cases to older adults occur in the community, many are reported from institutions, and in most cases the perpetrator is known by the victim.

Speck says signs of sexual abuse include unexplained venereal diseases, genital infections, and bleeding and tearing in the genital area. They also include bruises to the buttocks and around the inner and outer thighs.

Psychological abuse is one of the most common types of abuse. Suspected signs include unusual changes in behavior or sleep, fear or anxiety, sadness, and isolation.

"Isolation is one of the worst symptoms of psychological abuse," Speck said. "Many older people who are being abused by a loved one don't want to tell other people what their son or daughter is doing to them because it is their child. This leaves the victim feeling alone and depressed."

Speck says control is a major issue in psychological abuse.

"The abuse could come in the form of insults and degradation, but it could also be less obvious to see," Speck said. "For example, if a caretaker keeps a walker or wheelchair just out of reach of the person so they can't get up. Another example might be withholding glasses or dentures from the patient so they can't eat or see."

Common signs of abuse may occur when one notices that the patient is unwilling to communicate when a certain person is in the room or nearby.

Financial abuse is defined as the illegal or impromptu use of an elder's funds, property or assets. Examples include forging an older person's signature, coercing an older person into signing documents, such as a contract or will, and the improper use of power of attorney.

Speck says financial abuse is common among seniors, especially those with cognitive impairment. However, despite their mental state, the best thing to do is believe them when they complain of missing funds. Disregarding complaints about financial abuse will cause the victim to feel shame for not being believed and will also create fear when it comes to reporting future instances of abuse.

Neglect is another form of elder abuse, and according to Speck, there are three types of neglect -- physical, emotional and self.

"Physical neglect is defined as failing to attend to a person's medical hygiene, nutrition and dietary needs," she said. "It may also involve not giving them their medications or not changing their bandages on time.

"We often see emotional neglect when an older person is infantilized by their caregiver. Abandonment is also a common problem, where someone is left at an emergency department or the hospital."

Self-neglect is a growing concern and appears when a person chooses not to be treated by a health care provider. Signs of self-neglect include attempted suicide, withdrawal, anxiety, psychosomatic ailments such as stomachaches and headaches, and difficulty sleeping. The older person may desire to be alone, but social support is important to his/her health.

If you see signs of abuse, Speck says the best thing to do is to be gentle and listen. When communicating with an older person who you suspect has been abused, make sure the person knows what you are saying. If a document is involved, make sure the letters are large enough so they can read the print.

Also, use trauma-informed care principles of safety and transparency to communicate with them in a place where they feel comfortable.

If you suspect abuse, talk with them when the two of you are alone. Offer to take him/her to get help. Many communities have Coordinated Community Responses to Elder Abuse, with a variety of services.

To report abuse, neglect and exploitation of elders or vulnerable adults in Alabama:

  • Call 911 if that person is in immediate, life-threatening danger.
  • Call the hotline at 1-800-458-7214 to report abuse, neglect and exploitation of elders
  • For services to support elder persons in your community, call 1-800-677-1116, the Eldercare Locator (a public service of the U.S. Administration on Aging), to speak with someone who will connect you to services for older adults.


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