By Michael Friedman, L.M.S.W., Joy Solomon, Esq. and Malya Kurzweil Levin, Esq.
A son with power of attorney for his mother, who suffers from dementia, becomes impatient to inherit her assets. He begins to help himself.
A daughter takes her mother into her home after she suffers a stroke, but screams at her when she soils her diapers and threatens to throw her out if she does not keep herself clean.
A grandson, who is addicted to drugs, visits his grandmother, takes her cash, steals her jewelry, and—when she tries to stop him—hits her and knocks her to the floor.
A home care worker ignores the needs of the disabled man she is supposed to care for whenever her favorite TV shows are on—most of the time—and often forgets to give him medication that he needs to take regularly.
Each of the above situations is a case of "elder abuse," a widespread and growing problem currently affecting an estimated 3 to 4 million older people in the United States each year. (i) Without adequate preventive measures, this number could double over the next 20 years as the "elder boom"—the fastest growing segment of the U.S. population—swells to 71.5 million Americans over the age of 65 and 9.6 million over the age of 85. (ii)
There is much that our society needs to do to prevent and respond to elder abuse. But one critical intervention depends on all of us. We can be on the lookout for elder abuse, and we can report it when we suspect it is taking place.
What is elder abuse and what are the signs that an older person is a victim of abuse?
It is important to know that elder abuse is not only physical brutality. The term "elder abuse" refers to several different types of mistreatment of older adults, including physical, sexual, psychological, and financial abuse as well as neglect of the basic needs of a person who needs help to live safely in the community. It is generally perpetrated by someone who occupies a position of trust in the life of the victim.
Here are some key signs to be on the lookout for:
• Injuries that are unexplained/incompatible with explanations
• Any injuries that reflect an outline of an object, for example, a belt, cord or hand
• Torn or bloody clothing
• Scratches, blisters, lacerations or pinch marks
• Burns caused by scalding water, cigarettes, or ropes
• Poor hygiene including uncombed or matted hair, body odor, or foul breath
• Inappropriate clothing for weather
• An untreated medical condition
• Malnourishment or dehydration
Behavioral warning signs:
• Agitation, trembling, confusion, and/or disorientation
• Emotional distress like crying and/or depression
• Withdrawn or emotionless
• Social isolation
• Family members or caregivers restrict the older adult's contact with others
• Older adult is not permitted to speak with others without the family member or caregiver present.
Signs of possible financial abuse/exploitation:
• Confusion about finances and transactions
• Deviations from usual banking patterns
• Requests for additional ATM cards or first time use of ATM card
• Opening a joint account, changing power of attorney, changing account beneficiary, or opening inappropriate investments
• Sudden property transfers or changes to will
• New authorized signers on signature cards
• Mail redirected to a new address
• Checks written out of numerical order
• Flurry of bounced checks/overdraft fees or low balances
• Frivolous guardianship proceedings
Obviously, not everyone is in a position to observe all of these different signs of possible abuse. Some will only be observable by medical personnel, bank personnel, or legal advisors. But many of these signs are observable by family members who care; by friends and neighbors; by building personnel in apartment houses, condo complexes, senior housing, or assisted living facilities; and by service providers ranging from hair dressers and barbers to people who deliver meals on wheels.
Realization of the fact that many more people are in a position to identify signs of elder abuse than formal health and social service providers has led to the development of "community gatekeeper" programs to teach people who come into regular contact with vulnerable older adults to identify signs of elder abuse and to report it. (iii) These programs exist in many parts of the country.
One particularly interesting example is a program recently initiated by the Harry and Jeanette Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale to train doormen and other building personnel to identify signs of abuse and to call it in when they are suspicious. In an era where people who live in close proximity for decades remain strangers, building service workers are the eyes and ears of many big cities. The training's goal is to help these professionals understand the critical role they occupy, as well as providing direction and resources on how to act appropriately based on the knowledge they accumulate.
What can you do? If you are concerned about an older person, make a call to report your suspicions. But where? That varies from location to location around the country. You can always call the local police or the local Adult Protective Service. Or you can check on the Internet or by telephone with several national resource centers that can steer you to the best place in your community.
It may not be easy in your community to get effective action, but elder abuse will go unchecked if you don't try. Stay alert and make a call!
National Center on Elder Abuse
National Committee for the Prevention of Elder Abuse
The National Adult Protective Services Resource Center
(i) Institute of Medicine. Elder Abuse and Its Prevention: Workshop Summary. October 18, 2013.
(ii) U.S. Administration on Aging, "Projected Future Growth of The Older Population," posted in 2013.
(iii) Bartsch, D, et al. "Outcomes of Senior Reach Gatekeeper Referrals: Comparison of the Spokane Gatekeeper Program, Colorado Senior Reach, and Mid-Kansas Senior Outreach," in Care Management Journals • Volume 14, Number 1 • 2013.
This article originally appeared on March 14, 2014, on Michael B. Friedman’s Huffington Post blog (under Healthy Living). Michael B. Friedman has worked in the field of mental health for over 40 years as a direct service provider, an administrator, a government official and as an educator. He is an adjunct associate professor at the Columbia University School of Social Work and at the Mailman School of Public Health. Joy Solomon is the Director and Managing Attorney and Malya Kurzweil Levin is Staff Attorney for The Harry and Jeanette Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale in NYC.
Image: jcmunt (MorgueFile).
Professor Friedman: We Need "Assertive" Mental Health Services