Health Letter, January 2015
By Azza AbuDagga, M.H.A., Ph.D.
As a society, we are — and we should be — aware of domestic violence and child abuse. But are we as aware of elder abuse? Although it is a common problem in our society, elder abuse does not garner the headlines as other forms of abuse do – but it can be just as devastating.
According to The Elder Justice Roadmap, a recently released report funded by the Department of Justice and the Department of Health and Human Services (HHS), one out of every 10 Americans age 60 or older experiences abuse or neglect each year. The report also cites statistics showing that only one in 23 cases of elder abuse is reported to social services agencies, law enforcement or legal authorities who have the capacity as well as the responsibility to assist older adult victims.
Elder abuse may lead to physical injuries, including broken bones, sores and bruises, as well as mental health problems such as depression. Victims of elder abuse are twice as likely to be admitted to a hospital and have three times the risk of premature death compared with older adults who are not abused. According to the road map, the cumulative toll of elder abuse is not fully known.
What is elder abuse?
The National Center on Elder Abuse, part of HHS, defines elder abuse as intentional or neglectful acts that lead or may lead to harm of a vulnerable elder. The abuser is commonly a person who is in a position of trust, such as a spouse, family member or caregiver. Elder abuse occurs most often at home, but it also occurs in institutions such as nursing homes and hospices.
The following are various types of elder abuse:
- Physical abuse, such as hitting or slapping.
- Sexual abuse, including nonconsensual sexual contact.
- Emotional abuse, such as yelling or verbal threats.
- Caregiver neglect, which includes refusal or failure to fulfill caregiver obligations to meet the basic needs of an elder, such as food, clothing, housing and medical care.
- Financial exploitation, such as unauthorized or improper use of the elderly person’s money or assets.
- Self-neglect, when the elderly person is unable or fails to take adequate care of his or her own needs, which puts him or her at risk of abuse by others.
Risk factors for elder abuse 
Older adults may be at risk of being abused if they have:
- Memory problems (such as dementia, which is a group of brain diseases that cause a gradual and long-term decrease in the ability to think and remember things, affecting a person’s daily functioning).
- Physical disabilities.
- Depression, loneliness or lack of social support.
- Addiction to alcohol or other substances.
- Aggressive behavior (verbal or physical).
Family members or caregivers may be at risk of committing elder abuse if they:
- Feel overwhelmed or resentful.
- Have a history of substance abuse or history of abusing others.
- Are dependent on the older adult for housing, financial support or other needs.
The road map
The Elder Justice Roadmap is a strategic planning document that resulted from the input of more than 700 elder justice experts from around the country, including direct service providers, policymakers and other government officials. The road map will inform the Elder Justice Coordinating Council — an institution established in 2009 as part of the Affordable Care Act — and others as they take action to prevent and combat elder abuse.
One of the primary goals of the report is to increase awareness of the problem. Widespread awareness is critical because elder abuse is a complex issue that requires a coordinated response by a range of individuals and agencies who need to be educated enough to recognize abuse and respond appropriately. Individuals who require training include aging services personnel and volunteers, health care workers, justice and legal system personnel, mental health service providers and victim services providers.
Additionally, the road map recommends training individuals who do not specialize and are not trained in elder abuse issues (such as police officers, bank tellers, letter carriers and faith workers). These individuals are likely to witness elder abuse, and their involvement is critical to preventing, detecting and reporting such abuse.
Among the road map’s other priorities are:
- To provide better support and training for the tens of millions of caregivers and service providers — paid and unpaid — who care for the elderly to help them identify, report and prevent abuse.
- To make policy decisions in response to elder abuse, including implementing elder justice provisions of existing laws (such as the Elder Justice Act and the Older Americans Act) and introducing new, relevant laws where needed.
- To invest in research to better understand elder abuse issues as they relate to both victims and perpetrators, which could eventually lead to more effective abuse prevention strategies and improved responses to abuse.
Preventing and reporting elder abuse 
If there is an older person in your life who may be vulnerable to abuse, be alert for warning signs. These can include a victim’s withdrawal from usual activities or unexplained bruises, or caregiver anger.
You might be reluctant to get involved, but it is important to speak up about suspected abuse. Intervene by calling the Elder Care Helpline provided by the Administration on Aging at 800-677-1116. Your name remains confidential when you call. You do not need to prove abuse in order to make a report; a person from your state or local Adult Protective Services will go to the home and interview the older adult to determine if he or she needs assistance.
If you are worried that you might become an abusive family member or caregiver, talk to a health care professional and get help from local support groups. Accept help from family and friends. Seek counseling and other support if you are dealing with an instance of elder abuse and feeling stressed or depressed.
 Connolly MT, Brandl B, Breckman, R. The Elder Justice Roadmap: A Stakeholder Initiative to Respond to an Emerging Health, Justice, Financial and Social Crisis. 2014. https://www.citizen.org/sites/default/files/ejrp_roadmap.pdf. Accessed November 18, 2014.
 Acierno R, Hernandez MA, Amstadter AB, et al. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. American Journal of Public Health. 2010;100(2):292-297.
 New York City Department for the Aging, Elderly Crime Victims Resource Center, Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University. Under the Radar: New York State Elder Abuse Prevalence Study. 2011. https://www.ncjrs.gov/nas/content/live/citizenimportations/abstract.aspx?ID=258421. Accessed November 19, 2014.
 National Center on Elder Abuse. Red Flags of Abuse. https://www.citizen.org/sites/default/files/ncea_redflags_web508.pdf. Accessed November 21, 2014.
 Connolly MT, Brandl B, Breckman R. The Elder Justice Roadmap: A Stakeholder Initiative to Respond to an Emerging Health, Justice, Financial and Social Crisis. 2014. https://www.citizen.org/sites/default/files/ejrp_roadmap.pdf. Accessed November 18, 2014.
 HHS Press Office. DOJ and HHS Call for Action to Address Abuse of Older Americans Elder. July 9, 2014. https://www.hhs.gov/news/press/2014pres/07/20140709a.html. Accessed November 19, 2014.