In this article: Definitions of Elder Abuse Why Does Elder Abuse Occur and Who Are the Perpetrators? Is Elder Abuse a Crime? Help Is Available Hotlines

Federal definitions of elder abuse, neglect, and exploitation appeared for the first time in the 1987 Amendments to the Older Americans Act. These definitions were provided in the law only as guidelines for identifying the problems and not for enforcement purposes. Currently, elder abuse is defined by state laws, and state definitions vary considerably from one jurisdiction to another in terms of what constitutes the abuse, neglect, or exploitation of the elderly. In addition, researchers have used many different definitions to study the problem.

Broadly defined, however, there are three basic categories of elder abuse: domestic elder abuse, institutional elder abuse and self-neglect or self-abuse. In most cases, state statutes addressing elder abuse provide the definitions of these different categories of elder abuse, with varying degrees of specificity.

Domestic elder abuse generally refers to any of several forms of maltreatment of an older person by someone who has a special relationship with the elder (e.g., a spouse, a sibling, a child, a friend, or a caregiver in the older person's own home or in the home of a caregiver.)

Institutional abuse, on the other hand, generally refers to any of the above-mentioned forms of abuse that occur in residential facilities for older persons (e.g., nursing homes, foster homes, group homes, board and care facilities). Perpetrators of institutional abuse usually are persons who have a legal or contractual obligation to provide elder victims with care and protection (e.g., paid caregivers, staff, professionals).

The Definitions of Elder Abuse

Definitions and legal terminologies vary from state to state in regards to the types of domestic elder abuse that the National Center on Elder Abuse recognizes as well as their signs and symptoms:

Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include but is not limited to such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, the inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse.

Signs and symptoms of physical abuse include but are not limited to:

• bruises, black eyes, welts, lacerations, and rope marks
• bone fractures, broken bones, and skull fractures
• open wounds, cuts, punctures, untreated injuries in various stages of healing
• sprains, dislocations, and internal injuries/bleeding
• broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained
• laboratory findings of medication overdose or under utilization of prescribed drugs
• an elder's report of being hit, slapped, kicked, or mistreated
• an elder's sudden change in behavior
• the caregiver's refusal to allow visitors to see an elder alone

Sexual abuse is defined as non consensual sexual contact of any kind with an elderly person. Sexual contact with any person incapable of giving consent is also considered sexual abuse. It includes but is not limited to unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.

Signs and symptoms of sexual abuse include but are not limited to:

• bruises around the breasts or genital area
• unexplained venereal disease or genital infections
• unexplained vaginal or anal bleeding
• torn, stained, or bloody underclothing and
• an elder's report of being sexually assaulted or raped.

Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant isolating an elderly person from his/her family, friends, or regular activities giving an older person the "silent treatment" and enforced social isolation are examples of emotional/psychological abuse.

Signs and symptoms of emotional/psychological abuse include but are not limited to:

• being emotionally upset or agitated
• being extremely withdrawn and non communicative or non responsive
• unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking)
• an elder's report of being verbally or emotionally mistreated.

Neglect is defined as the refusal or failure to fulfill any part of a person's obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care. Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder.

Signs and symptoms of neglect include but are not limited to:

• dehydration, malnutrition, untreated bed sores, and poor personal hygiene
• unattended or untreated health problems
• hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water)
• unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing)
• an elder's report of being mistreated

Abandonment is defined as the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.

Signs and symptoms of abandonment include but are not limited to:

• the desertion of an elder at a hospital, a nursing facility, or other similar institution
• the desertion of an elder at a shopping center or other public location and
• an elder's own report of being abandoned.

Financial or material exploitation is defined as the illegal or improper use of an elder's funds, property, or assets. Examples include but are not limited to cashing an elderly person's checks without authorization/permission forging an older person's signature misusing or stealing an older person's money or possessions coercing or deceiving an older person into signing any document (e.g., contracts or will) and the improper use of conservatorship, guardianship, or power of attorney.

Signs and symptoms of financial or material exploitation include but are not limited to:

• sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder
• the inclusion of additional names on an elder's bank signature card
• unauthorized withdrawal of the elder's funds using the elder's ATM card
• abrupt changes in a will or other financial documents
• unexplained disappearance of funds or valuable possessions
• substandard care being provided or bills unpaid despite the availability of adequate financial resources
• discovery of an elder's signature being forged for financial transactions or for the titles of his/her possessions
• sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions
• unexplained sudden transfer of assets to a family member or someone outside the family
• the provision of services that are not necessary
• an elder's report of financial exploitation

Self-neglect is characterized as the behavior of an elderly person that threatens his/her own health or safety. Self-neglect generally manifests itself in an older person as a refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions. The definition of self-neglect excludes a situation in which a mentally competent older person, who understands the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her health or safety as a matter of personal choice.

Signs and symptoms of self-neglect include but are not limited to:

• dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene
• hazardous or unsafe living conditions/arrangements (e.g., improper wiring, no indoor plumbing, no heat, no running water)
• unsanitary or unclean living quarters (e.g., animal/insect infestation, no functioning toilet, fecal/urine smell)
• inappropriate and/or inadequate clothing, lack of the necessary medical aids (e.g., eyeglasses, hearing aids, dentures) and
• grossly inadequate housing or homelessness.

Elder abuse, like other types of domestic violence, is extremely complex. Generally a combination of psychological, social, and economic factors, along with the mental and physical conditions of the victim and the perpetrator, contribute to the occurrence of elder maltreatment. Although the factors listed below cannot explain all types of elder maltreatment because it is likely that different types (as well as each single incident) involve different casual factors, they are some of the causes researchers say are important.

Caregiver stress: Caring for frail older people is a very difficult and stress-provoking task. This is particularly true when older people are mentally or physically impaired, when the caregiver is ill-prepared for the task, or when the needed resources are lacking. Under these circumstances, the increased stress and frustration of a caregiver may lead to abuse or willful neglect.

Impairment of dependent elder: Some researchers have found that elders in poor health are more likely to be abused than those in good health. They have also found that abuse tends to occur when the stress level of the caregiver is heightened as a result of a worsening of the elder's impairment.

Cycle of violence: Some families are more prone to violence than others because violence is a learned behavior and is transmitted from one generation to another. In these families, abusive behavior is the normal response to tension or conflict because they have not learned any other ways to respond.

Personal problems of abusers: Researchers have found that abusers of the elderly (typically adult children) tend to have more personal problems than do non-abusers. Adult children who abuse their parents frequently suffer from such problems as mental and emotional disorders, alcoholism, drug addiction, and financial difficulty. Because of these problems, these adult children are often dependent on the elders for their support. Abuse in these cases may be an inappropriate response by the children to the sense of their own inadequacies.

About two-thirds of elder-abuse perpetrators are family members of the victims, typically serving in a caregiving role. Adult children are the most frequent abusers of the elderly, and this category experienced the biggest increase in its composition of the total reports: 30.1 percent in 1990 to 36.7 percent in 1996. Other family members and spouses ranked as the next most likely abusers of the elderly. Other family members made up 16.1 percent of all reports in 1990 and 10.8 percent of all reports in 1996, while spouses made up 15.9 percent of all reports in 1990 and 12.6 percent in 1996.

Depending on the statute of a given state, elder abuse may or may not be a crime. However, most physical, sexual, and financial/material abuses are considered crimes in all states. In addition, depending on the type of the perpetrator's conduct and its consequences for the victims, certain emotional abuse and neglect cases are subject to criminal prosecution. However, self-neglect is not a crime in all jurisdictions, and, in fact, elder abuse laws of some states do not address self-neglect.

When domestic elder abuse occurs, it can be addressed - if it comes to the attention of authorities. Although each state has a different system to address elder abuse, the following are some of the agencies that have been established by federal, state and local governments to help:

In most states, the APS (Adult Protective Services) agency, typically located within the human sevice agency, is the principal public agency responsible for both investigating reported cases of elder abuse and for providing victims and their families with treatment and protective services. In most jurisdictions, the county departments of social services maintain an APS unit that serves the need of local communities.

However, many other public and private agencies and organizations are actively involved in efforts to protect vulnerable older persons from abuse, neglect, and exploitation. Some of these agencies include: the state unit on aging the law enforcement agency (e.g., the police department, the district attorney's office, the court system, the sheriff's department) the medical examiner/coroner's office hospitals and medical clinics the state long-term care ombudsman's office the public health agency the area agency on aging the mental health agency and the facility licensing/certification agency. Depending on the state law governing elder abuse, the exact roles and functions of these agencies vary widely from one jurisdiction to another.

Although most APS agencies also handle adult abuse cases (where clients are between 18 and 59 years of age), nearly 70 percent of their caseloads involve elder abuse. The APS community is relatively small compared with the groups working for other human service programs, but it is composed of a few thousand professionals, nationwide.

In most jurisdictions, either APS, the Area Agency on Aging, or the county Department of Social Services is designated as the agency to receive and investigate allegations of elder abuse and neglect. If the investigators find abuse or neglect, they make arrangements for services to help protect the victim.