Warning signs: elder abuse and neglect

Aging, Spring, 1996

These are some of the common warning signs of abuse or neglect. Not all of these, by themselves, indicate that mistreatment or self-neglect is occurring. However, if several are seen in combination, there may be cause to suspect something is wrong. Report your suspicions by calling Adult Protective Services in your county. If the number is not listed in the phone book, call the nearest county or city Office on Aging or the police department to find out the number.

Indications of Physical Abuse

Multiple injuries in various stages of healing

Bruises from hitting, shoving, slapping, pitching, or kicking

Discoloration causing bilateral stripes on upper arms or clustered on other body parts

Burns caused by cigarettes, caustic, hot objects

Friction from ropes, chains or other physical restrains

Fractures, sprains, lacerations and abrasions

Injuries caused by biting, cutting, poking, punching, whipping or twisting of limbs Disorientation, stupor or other effects of deliberate overmedication

Behavioral Indications of Physical Sexual Abuse (Victim)

Easily frightened or fearful

Exhibiting denial

Agitated or trembling

Hesitant to talk openly

Implausible stories

Extreme upset when assisted with bathing or other physical caregiving

Depression or poor self-esteem

Eating disturbances (overeating or undereating) compulsive behavior

Sleep disorders (nightmares. fear of sleep, excessive sleeping)

Indicators of Neglect

Neglected bedsores

Skin disorders or rashes

Untreated injuries or medical problems

Poor hygiene

Hunger, malnutrition, dehydration

Pallor, sunken eyes or cheeks

Inadequate supply of food

Absence of, or failure to provide, prescribed medication

Lack of clean bedding or clothing

Inadequate heating

Unsanitary or unsafe living conditions

Lack of required dentures, hearing aids or eyeglasses

Frequently trips to the emergency room with undefined illnesses or complaints

Indicators from Caregivers

Verbal berating, harassment. or intimidation

Threats of punishment or depriving of essential needs

Isolating a person from friends and other family members

Treating the individual like an infant

Leaving a person alone for long periods of time

Withholding affection to gain compliance

Unwillingness to comply with service providers in planning for care

Obvious absence of assistance, attitude of indifference or anger toward the victim

Giving a person no privacy

Denying a person the right to make decisions

Suspicious Explanations

Common explanations in physical abuse cases:

"The injury was an accident."

"The victim fell"

"There was no abuse -- she/he bruises easily."

Common explanations for financial abuse cases:

"It was a gift."

"She owed me the money."

"He gave me permission to have, use, borrow it."

"I was going to give it back."

Common explanations in neglect cases:

"She refuses to eat anything."

"He refuses services."

(Based on information taken from "Innovative Training Package for Detecting and Aiding Victims of Domestic Elder Abuse," developed by the Police Executive Research Forum for the Department of Justice, and on "Guidelines for Investigation of Elder and Dependent Adult Abuse" by the Office of the Attorney General of the State of California, Mary Joy Quinn and Susan Tornita. Elder Abuse: Causes, Diagnosis and Treatment, New York: Springer, 1986. Some indicators also drawn from material prepared by the Nebraska Domestic Violence Sexual Assault Coalition, May 1993.)