Elder Maltreatment

How Elder Abuse Can Ruin the Golden Years

From financial manipulation through physical abuse and neglect, the elderly are a particularly vulnerable group, especially those struggling with dementia or Alzheimer’s disease.

Elder abuse is the exploitation of adults over age 60, including physical, sexual, and emotional abuse, neglect and abandonment, and financial exploitation (National Institute on Aging. Parallel to other types of abuse and maltreatment in different life stages: elder physical abuse includes hitting, slapping, pushing; emotional abuse is psychological (e.g., yelling, threatening, belittling, ignoring, restricting access to relatives or friends); sexual abuse is being forced to watch or engage in sexual acts; neglect and abandonment include not responding to the older person’s needs or leaving them alone without planning to meet needs. According to the NIA (2018), elder financial abuse is happening with increasing frequency and includes stealing money or belongings, forging checks, taking retirement and Social Security benefits, using the older person’s credit cards or bank accounts without authorization. In addition to these types of abuse and neglect, health care fraud occurs when doctors, hospital staff, and other healthcare workers overcharge, bill repeatedly for the same service, falsify claims to Medicaid or Medicare, or charge when care was not actually provided.

Each year approximately one in ten older adults in the United States are abused, neglected, or financially exploited, resulting in hundreds of thousands of cases.

There are a variety of negative consequences of experiencing elder abuse that often serve as signs that elder abuse is occurring: the older adult (1) has trouble sleeping; (2) seems depressed or confused; (3) loses weight for no reason; (4) displays signs of trauma, like rocking back and forth; (5) acts agitated or violent; (6) becomes withdrawn; (7) stops taking part in activities he or she enjoys; (8) has unexplained bruises, burns, or scars; (9) looks messy, with unwashed hair or dirty clothes; or (10) develops bed sores or other preventable conditions.

Victims of elder abuse have twice or three times the chances of dying prematurely than people who are not victims of elder abuse.

Choi and Mayer (2000, p. 6) underscore that elder maltreatment and abuse is a particularly difficult problem to discuss, prevent, and intervene in because:

“1) Elder maltreatment is largely a hidden problem, committed in the privacy of the elder’s home, mostly by his/her family members (Administration on Aging.

(2) Both abused elders and perpetrators often feel ashamed of abusive behaviors and thus hide the incidents from investigators. Victims fear losing their only social support, especially if the perpetrator is a relative, being forced into an institution, or future retaliation by the perpetrator(s).

(3) The victim’s mental and cognitive impairments and ill health and the resulting lack of cooperation may interfere with the identification and substantiation of abuse and neglect.

(4) Because of mental and cognitive impairments, ill health, and/or depression, abused and neglected elders may engage in self-neglecting behaviors, making it difficult to separate abuse and neglect by others from self-neglect.

(5) Even mentally lucid victims are often unaware of available resources.

(6) Elder abuse and neglect encompass a wide variety of maltreatment–physical, sexual, and emotional or psychological abuse, financial/material exploitation, passive or active neglect by caregivers, and self-neglect by the elder him/herself.”

The application of our bullying dynamic to elders is straightforward. The three components inherent in bullying are intent to harm, repetition in aggressive behavior, and power imbalance. Intent to harm can also be covert and subversive, as in situations of secret financial abuse or failure to attend to unmet needs for the elder person. One nuance with the intent to harm criterion when applied to elders is that it may be rationalized or minimized by perpetrators more readily than other forms of abuse: broken bones could be from osteoporosis, bruises and burns from absent mindedness, and financial loss may be due to mistaken memory that the victim is not recollecting correctly how much money he really had. Repetition is usually present because elders tend to become more vulnerable over time, making it easier to perpetuate the abuse with impunity. For example, a grandchild scamming their grandparent for money repeatedly or doctors ordering redundant tests. The grandchild will see their scheme as successful when they can get away with it once, resulting in brazen repetition. The doctor can easily manipulate the situation by convincing the patient that old age is the reason for excessive and expensive procedures.

The power dynamic emphasized in all of the reflections of the bullying dynamic clearly comes into play as older adults designate executors of their estate, health care proxies, beneficiaries, heirs in wills, and doctors who lead them through complicated health care situations. Loss of a spouse who was in charge of financial planning or home repairs, for example, may compound the older adult’s vulnerability and reliance on others. Illness, disability, frailty, and, in many situations, isolation may lead to a disempowered state for elders; reliance on others feeds into a profound power imbalance that can be manipulated by bullies.

There are two primary contexts in which bullying of elders takes place, institutional settings where elders are in the role of patient and community settings where elders try to maintain independence. In community settings, elders could live on their own or with family. Rates of community abuse may be profoundly underestimated because elders have to be both cognitively aware and willing to disclose highly sensitive information about victimization, often committed by loved ones. Independent community living may sustain the elder through routine interactions with family, neighbors, friends, service workers, and others. At the same time, social isolation of caregivers and older persons, and the ensuing lack of social support, is a significant risk factor for elder abuse by caregivers. Mounting losses of peers and spouses, along with growing demands from physical and mental concerns may undermine the elder’s sense of competence, heightening vulnerability to power imbalances.

A shared living situation is a risk factor for elder abuse and bullying by family members, yet it is not clear whether spouses or adult children of older people are more likely to perpetrate abuse. In certain circumstances, like that of Alzheimer’s Disease, the patient could be either the victim, the bully, or both. The patient could become particularly aggressive at certain times of the day and perpetrate physical, verbal, or emotional abuse against the spouse taking care of them. Similarly, the caretaking spouse may bully the patient into submission when the episodes begin. Both dynamics are present in times when chronic stress takes a particularly high toll on family relationships. Families can also abuse elders financially by changing names on a will, bank account, life insurance policy, or title to a house without permission from the older person (Payne & Strasser, 2012). This type of abuse is difficult to detect because the bullies, who are close family members, can claim that the elder gave permission and they simply must not remember due to aging and memory loss. An abuser’s dependency on the older person (often financial) also increases the risk of abuse. The family perpetrator may be the only link for the elder adult to receive needed treatment (i.e., driving to doctor’s appointments, to the Adult Day Care Center).