What is Elder Abuse, and How Can You Address It During Fieldwork?

Macadey Sanders, Salt Lake Community College

The prevalence of elder abuse is so widespread that 1 out of 10 older adults over the age of 60 who lives at home experiences some type of abuse (Connolly et al., 2014). For every 1 case of elder abuse that is reported, 23 cases are unreported (Connolly et al., 2014). Approximately 90% of perpetrators are older adults’ family members (Muehlbauer & Crane, 2006). This article describes the effects of elder abuse, the types of elder abuse, risk factors and signs of abuse, and how OT students and practitioners can take action against elder abuse.

Elder abuse negatively impacts older adults’ well-being. Society as a whole is also negatively impacted because elder abuse can create barriers for older adults to be active members of their community. For example, an older adult can lose financial assets due to caregivers’ misuse of funds or theft. The National Center on Elder Abuse reports that older adults in the United States lose more than $2.6 billion each year (U.S. Department of Health and Human Services, n.d.). Additionally, those experiencing elder abuse are three times more likely to die a premature death than their peers (Connolly et al., 2014). Elder abuse also damages self-esteem, increases emotional pain and embarrassment, and causes physical harm to older adults (Arcierno et al., 2010; Anetzberger, 2012; Burnes et al., 2017; Muehlbauer & Crane, 2006). As mandated reporters of abuse, occupational therapy practitioners and students should be knowledgeable about elder abuse. Here are some things occupational therapy students should know prior to fieldwork to combat elder abuse.

Different Types of Abuse

Elder abuse is defined by the World Health Organization as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (Ho et al., 2017).There are five types of elder abuse: physical, emotional, sexual, financial, and neglect.

Physical abuse includes hitting, pushing, feeding by force, and restraining. Emotional abuse could be threats, yelling, and purposeful embarrassment. Sexual abuse can include unwanted sexual contact or forced watching of pornography. Financial abuse is when someone uses or steals an older adult’s money or assets, including hiding funds and forging signatures. Neglect includes neglect from others, self-neglect, and abandonment. Neglect from others can include caregivers not adequately providing for an older adult’s needs (e.g., hygiene, assistive devices, food, etc.) or withholding social interaction from an older adult. Self-neglect is when an older adult does not take care of themselves. Abandonment is when a caregiver leaves an elder somewhere, usually in a public place, without planning to come back for them (Day et al., 2015; Rzeszut, 2017; Watson, 2013).

Risk Factors and Signs of Abuse

There are many potential causes and risk factors that put older adults at risk for abuse. For example, an older adult's lack of social support or low cognition could increase the risk for abuse. These factors can increase stress for the caregiver, increasing the likelihood of abuse. Perpetrators may have been exposed to violence, experienced feelings of inadequacy, be impacted by a mental health condition, be unemployed, or have difficulty with substance abuse, which can all contribute to an increased risk of abusing an older adult (Acierno et al., 2010; Anetzberger, 2012; Muehlbauer & Crane, 2006).

If you suspect elder abuse, look for signs of physical injury, such as bruising, weight loss, bed sores, and poor hygiene. Social withdrawal, forged signatures, and large amounts of money taken from an older adult’s bank account are also signs of elder abuse. As a fieldwork student, you may notice an older client wears dirty clothes, has a distinct body odor, or has new bruises at each occupational therapy session. You may also notice that one of your older clients starts to complain about not having enough money for groceries or new clothes, when this wasn’t the case a few weeks earlier. These signs can indicate that elder abuse is occurring and that your involvement as an OT practitioner is needed.

Taking Action During Fieldwork

Education is critical when it comes to preventing elder abuse. Educate yourself on the different types and factors leading to elder abuse, like those mentioned above. Pay careful attention to how your older adult clients are treated. As a fieldwork student, you can learn about the policies and procedures for reporting abuse at your fieldwork site and in your state. As an AOTA member you must adhere to the Occupational Therapy Code of Ethics; in this instance, “beneficence requires taking action by helping others…by promoting good, by preventing harm, and by removing harm” (AOTA 2015, P. 6913410030). If you are unsure whether a client is experiencing abuse or if you see abuse, talk with your fieldwork educator and supervisor. Addressing abuse is a team effort, so work with other professionals, such as social workers, other members of the rehab team, nurses, physicians, and case managers.

OT practitioners are required to report suspected abuse. If you suspect elder abuse in a non-emergency situation, you must report it to your local adult protective services. As a fieldwork student, always notify and involve your supervisor. If there is immediate danger, call 911. More information can be found on the National Center on Elders Abuse’s website at https://ncea.acl.gov. Always remember that it is part of occupational therapy’s role to intervene and assist older adult clients whenever abuse is suspected.

Macadey Sanders is a second-year student in the Occupational Therapy Assistant Program at Salt Lake Community College. She hopes to work with the geriatric population, as well as the pediatric population receiving feeding intervention.

References

Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. (2010). 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, 100(2), 292–297.

American Occupational Therapy Association. (2015). Occupational therapy code of ethics (2015). American Journal of Occupational Therapy, 69(Suppl. 3), 6913410030p1–6913410030p8. https://doi.org/10.5014/ajot.2015.696S03

Anetzberger, G. J. (2012). An update on the nature and scope of elder abuse. Generations, 36(3), 12–20.

Burnes, D., Henderson Jr, C. R., Sheppard, C., Zhao, R., Pillemer, K., & Lachs, M. S. (2017). Prevalence of financial fraud and scams among older adults in the United States: A systematic review and meta-analysis. American Journal of Public Health, 107(8), e13–e21. https://doi-org.libprox1.slcc.edu/10.2105/AJPH.2017.303821

Connolly, M.T., Brandl, B., & Breckman, R. (2014). The Elder Justice Roadmap: A stakeholder initiative to respond to an emerging health, justice, financial and social crisis. https://www.justice.gov/file/852856/download

Day, M. R., Mulcahy, H., Leahy-Warren, P., & Downey, J. (2015). Self-neglect: A case study and implications for clinical practice. British Journal of Community Nursing, 20(3), 110–115. https://doi-org.libprox1.slcc.edu/10.12968/bjcn.2015.20.3.110

Ho, C. S., Wong, S.-Y., Chiu, M. M., & Ho, R. C. (2017). Global prevalence of elder abuse: A metaanalysis and meta-regression. East Asian Archives of Psychiatry, 2, 43.

Muehlbauer, M., & Crane, P. A. (2006). Elder abuse and neglect. Journal of Psychosocial Nursing & Mental Health Services, 44(11), 43.

Rzeszut, S. M. (2017). The need for a stronger definition: Recognizing abandonment as a form of elder abuse across the United States. Family Court Review, 55(3), 444.

U.S. Department of Health and Human Services, Administration for Community Living (n.d.).Welcome to the National Center on Elder Abuse. https://ncea.acl.gov/

Watson, E. (2013). Elder abuse: Definition, types and statistics, and elder abuse (mistreatment and neglect) laws. Journal of Legal Nurse Consulting, 24(2), 40–42.