ELDER ABUSE

Elder abuse is defined as an intentional or neglectful act by a caregiver or trusted individual that leads to or may lead to harm of a vulnerable older adult. Elder abuse is a problem estimated to affect up to 1.2 million older adults annually in the United States. Only 1 in 10 cases of elder abuse, however, are ever reported. Elder abuse can lead to early death, harm one’s physical and psychological health, destroy social and family ties, and cause devastating financial loss (CDC, 2020c; Kane et al., 2018).

Various types of elder abuse include:

• Physical abuse: Use of force to threaten or physically injure an older person, including acts such as hitting, kicking, pushing, slapping, and burning
• Emotional/psychological abuse: Verbal or nonverbal attacks, threats, rejection, isolation, or belittling acts that cause mental anguish, fear, or distress
• Sexual abuse: Sexual contact that is forced, tricked, threatened, or otherwise coerced, including sexual harassment
• Exploitation: Theft, fraud, misuse or neglect of authority, and use of undue influence as a lever to gain control over an older person’s money or property
• Neglect: Failure or refusal to provide for an older person’s basic needs of food, water, shelter, clothing, hygiene, essential medical care, safety, or emotional needs
• Abandonment: Leaving an older adult who needs help alone without planning for their care
  (NCEA, 2020)

Recognizing Elder Abuse

Many older adults are reluctant and/or ashamed to report mistreatment, or they are afraid if they do, it will get back to the abuser and make the situation worse. However, in cases of suspected or known abuse, further screening can be done with validated tools such as the Elder Assessment Instrument (EAI) (Fulmer, 2020).

Clinicians must be aware of the signs and symptoms that signal an older adult may be experiencing abuse.

• Physical abuse may cause injuries such as broken bones, bruises, scratches, burns, or multiple injuries in various stages of healing.
• Signs of sexual abuse may include bruising of breasts or the genital area, genital infections, or vaginal or anal bleeding.
• Possible indicators of economic abuse may include lack of appropriate clothing or grooming, patient complaints of missing clothing or jewelry, or sudden appearance of previously uninvolved relatives.
• Signs of neglect may include pressure injuries, poor hygiene, torn or dirty clothes, malnutrition, contractures, and lack of needed healthcare appliances or supplies.

Reporting Elder Abuse

Texas law requires anyone who suspects abuse, neglect, or exploitation of a person 65 years or older or an adult with disabilities to report it to the Texas Department of Family and Protective Services (DFPS). If an older adult is suspected to be in immediate, life-threatening danger, an individual should call 911. Reporting suspected abuse makes it possible for an individual and their family to get help.

A person who reports abuse in good faith is immune from civil or criminal liability. Anyone who does not report suspected abuse can be held liable for a misdemeanor or felony. DFPS keeps the name of the person making the report confidential. Reports can also be made anonymously according to the provisions of Texas state law.

To report suspected elder abuse, neglect, or exploitation:

• Call 911 or the local law enforcement agency for any emergency or life-threatening situation that must be dealt with immediately.
• Call the Texas Abuse Hotline (800-252-5400) 24 hours a day, 7 days a week, if the situation is urgent and needs to be investigated within 24 hours.
• Call the Texas Health and Human Services Commission (800-458-9858) to report suspected abuse occurring in nursing facilities, assisted living facilities, day activity and health services, home health and hospice agencies, and intermediate care facilities.
• Report online through the secure website at txabusehotline.org (however reports cannot be submitted via email)
  (TX DFPS, 2020; TX HHS, 2021b)

Timeframes for investigating reports are based on the severity of the allegations. Anyone convicted of elder abuse in Texas will be convicted of a felony in the first degree which earns a prison sentence of up to 10 years and a fine of up to $10,000 (TX DFPS, 2020).

(See also “Resources” at the end of this course.)