Table of Contents

About This Course

1. Introduction to Elder Abuse
2. The Basics of Elder Abuse
3. Substance Use and Other Risk Factors
4. Screening and Assessment
5. Intervention and Treatment
6. Preventing Elder Abuse

Supplements
Case Studies
References
Resources

Out of the Shadows
Uncovering Substance Use and Elder Abuse

Defining Abuse and Neglect

Researchers have identified "unclear and inconsistent definitions" of elder abuse as a barrier toward increasing understanding of the problem. For example, there is some debate as to whether all forms of abuse and neglect should be considered under the same rubric. State laws vary as to whether "self-neglect" is included in the definition of elder abuse. Some researchers define the withholding of personal care as physical abuse; others define it as neglect. Abuse also can be defined in terms of actions, such as hitting, or in terms of the injuries that result, such as cuts or burns. ref

Elder abuse generally has two characteristics: ref

1. An injury or deprivation has occurred to the older adult.
2. Someone else bears responsibility for causing the injury or deprivation or failing to prevent it.

The 1998 National Elder Abuse Incidence Study includes the following types of abuse in its definition:

• Physical Abuse
• Sexual Abuse
• Emotional/Psychological Abuse
• Neglect and Abandonment
• Financial Exploitation
• Self-Neglect
• Medication Abuse
• Violation of Rights

Physical Abuse

Physical abuse is 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, shaking, slapping, kicking, and burning
• Unwarranted administration of drugs and physical restraints or force-feeding
• Physical punishment

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Sexual Abuse

Sexual abuse is nonconsensual sexual contact of any kind with an elderly person. It includes, but is not limited to:

• Unwanted touching
• All types of sexual assault or battery such as rape, sodomy, and coerced nudity
• Sexually explicit photographing

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Emotional/Psychological Abuse

Emotional or psychological abuse involves inflicting anguish, emotional pain, or distress. Emotional or psychological abuse includes, but is not limited to:

• Verbal assaults, insults, and threats
• Intimidation, humiliation, and harassment
• Physically or socially isolating an elderly person from family, friends, or regular activities
• Giving an older person the "silent treatment"

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Neglect and Abandonment

Neglect is the refusal or failure to fulfill any part of a person's obligations or duties to an elder. Neglect of an older adult may be shown by someone who has fiduciary responsibilities to care for an elder, such as a family member or guardian, or by an in-home service provider hired to provide necessary care. Neglect can be active -- a willful failure to provide care, or it can be passive -- an unintentional failure to provide care due to inadequate knowledge or illness on the part of the caregiver. Neglect typically means:

• The refusal or failure to provide an elderly person with such life necessities as food, water, clothing, and shelter
• The refusal or failure to provide personal hygiene, medicine, comfort, personal safety, and other essentials included as a responsibility or an agreement

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

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Financial Exploitation

Financial exploitation is the illegal or improper use of an elder's funds, property, or assets. Examples include, but are not limited to:

• Cashing checks without authorization or 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 a document (e.g., contracts or a will)
• The improper use of conservatorship, guardianship, or power of attorney

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Self-Neglect

Self-neglect is characterized as behaviors of an elderly person that threaten his/her own health or safety. The definition of self-neglect excludes a situation in which a mentally competent older person (who understands the consequences of his or her decisions) makes a conscious and voluntary decision to engage in acts that threaten his or her health or safety. Self-neglect generally manifests itself as:

• An older person's refusal or failure to provide himself or herself with adequate food, water, clothing, shelter, and safety
• Refusal or failure to maintain personal hygiene
• Misuse of medications or mixing medications with alcohol.

Other forms of elder abuse not included in the National Elder Abuse Incidence Study, but relevant to this course, include: ref

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Medication Abuse

Medication abuse can include:

• Misuse of an older adult's medication and prescriptions, such as withholding medication or overmedicating
• Theft or illegal use of an older person's medications
• Mixing alcohol and medications

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Violation of Rights

Violation of rights refers to denial of an elderly person's fundamental rights, such as:

• Withholding information
• Denying privacy (personal or financial)
• Denying visitors
• Censoring mail

If doubt exists about the capability of an older adult to make informed decisions about his or her life, he or she should be referred to an appropriate medical professional.

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Subsequent modules include more detailed information about these various forms of elder abuse.