Detecting Abuse in the Elderly
on December 2, 2013 by in Aging, All Posts

Raising the bar on improving care to the elderly also means raising the bar on improving our skills in detecting abuse in this population.  According to the Department of Health and Human Services’ National Center on Elder Abuse, each year hundreds of thousands of older persons are abused, neglected, and exploited.  Many victims are people who are older, frail, and vulnerable, cannot help themselves, and depend on others to meet their most basic needs.  However, we also know that many cases go unreported; the National Research Council estimates that only one in 14 cases of elder abuse ever comes to the attention of authorities.

Elder abuse, now unlawful in all 50 states, is a term referring to 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.  Abuse may come in the form of physical, sexual, or emotional abuse, neglect, exploitation, or abandonment.  Neglect can be active (or intentional), passive (unintentional), and even of oneself (where the person’s failure to perform essential self-care acts threatens his or her own health or safety).

Unfortunately, many health care providers may not detect elder abuse because of lack of training on detecting abuse, let alone the fact that many older adults may be reluctant to report abuse themselves because of fear of retaliation, lack of physical and/or cognitive ability to report, or because they don’t want to get the abuser (the vast majority of whom are family members) in trouble.

The Canadian National Initiative for the Care of the Elderly (NICE) has developed a series of tools and screening measures for detecting, intervening in, and preventing abuse of seniors, some of which were referenced for this post.

Professionals and intake workers can follow suspicions about possible abuse by asking questions of the older adult such as:

  • Are you afraid of anyone at home?
  • Has anyone forced you to do things you didn’t want to do?
  • Has anyone tried to take advantage of you?
  • Has anyone ever failed to help you take care of yourself when you needed help?
  • Have you ever signed any documents that you didn’t understand or didn’t want to sign?
  • Do you make decisions for yourself or does someone else make them for you

Similarly, caregivers can be questioned to detect abuse risk:  Does the caregiver find it difficult to manage the care recipient’s behavior?  Does the caregiver feel like he or she is forced to act out of character or do things s/he feels badly about?  Does the caregiver sometimes feel it necessary to be rough with the care recipient, or reject or ignore, or yell at the older adult?   Is the caregiver often so tired that s/he cannot meet the needs of the other person?

When are caregivers at risk for possible abuse?  Caregivers with any of the following may be particularly at risk for possible mistreatment:  behavior problems, mental or emotional difficulties; financial dependence; alcohol or substance abuse problems; has reluctance about or inexperience in being a caregiver; or has family or marital conflicts.

jmc cas cropped 150x150 Detecting Abuse in the Elderly

Our Blog Author

As health care professionals, it is important to be ever vigilant about possible cases of elder abuse, to sharpen our skills in detecting it, and report it when it is suspected.  To report elder abuse, contact the Adult Protective Services agency in the state where the older adult resides.

Thanks for your interest in the CoHealth blog series, CoHealth Matters.  To learn more about our resources and behavioral health services with older adults, visit us at


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