Abuse can be physical, psychological, sexual, financial or in the form of neglect. While one may think that abuse involves doing something bad to another, it is also abusive not to do something that needs to be done. In fact, neglect is the most common form of elder mistreatment in domestic settings.
Self-neglect is the inability or refusal to provide for one's own essential needs. Self-neglect may be seen in a person with mental or physical impairment.
Neglect by others may be active or passive.
- Active neglect is intentional. It is the willful failure of a caregiver to fulfill his or her caregiving responsibilities.
- Passive neglect is unintentional. It is characterized by a situation in which the person is left alone, isolated or forgotten.
It is estimated that 1.5 million older persons are abused each year, yet only about one in every 14 cases is reported. There are a number of reasons why an older person wouldn't report abuse:
- Fear of reprisal
- Fear of being moved from his or her home
- Lack of knowledge about where to get help
Other forms of abuse
- Physical Abuse—Any act that causes pain or injury or places a person in fear of imminent serious bodily harm.
- Psychological Abuse—The willful infliction of mental or emotional anguish by threat, humiliation, intimidation, or other verbal or non-verbal abusive conduct.
- Sexual Abuse—Unethical or forced sexual relationship, frequently involving those who suffer from dementia or are non-verbal.
- Financial Abuse—Illegal or improper use of an older person's assets or resources, often involving persons who are single and isolated and have few social support.
- Untreated bedsores
- Untreated injuries or medical problems
- Poor hygiene
- Hunger, malnutrition, dehydration
- Absence of food, water, heat, prescribed medications
- Lack of clean bedding or clothing
- Unsanitary or unsafe living conditions
- Absence of dentures, eyeglasses, hearing aids, walkers, wheelchairs, and other needed items
The self-neglecting person usually lives alone with little or no social support. One would see the same signs as described above in Neglect, but symptoms might also include the following:
- Decreased mental and physical activity
- Bruises or welts
- Burns from cigarettes, appliances, hot water
- Fractures, sprains
- Disorientation or stupor from overmedication
- History of multiple hospitalizations due to injuries
- Sudden changes in sleeping or eating habits
- Feelings of helplessness or hopelessness
- Agitation or anger
- Sudden change in feelings of self-worth
- Attention or affection-seeking behaviors
- Painful urination/defecation, or retention
- Difficulty walking or sitting
- Torn, stained or bloody underclothing
- Genital or anal infection, irritation, discharge, bleeding, bruising, pain
Financial Abuse or Exploitation
- Nonpayment of bills
- Eviction or utility turn-off notices
- Changes to legal documents that the older person did not understand at the time of signing
- Missing assets or funds
- Suspicious signatures on checks
- Unusual banking activity (ATM withdrawal from the account of a bedridden victim; withdrawals or transfers affecting bank accounts)
- Suspected abuser's standard of living rises suddenly, without explanation
Being able to recognize and report suspected abuse is important but what we all want to do is prevent abuse.
- Stay sociable; keep in touch with family and friends; volunteer outside the home
- Ask friends to visit your home
- Have your own telephone to maintain your independence
- Post and open your own mail
- Take care of yourself; keep regular appointments
- If difficulties arise, talk with a trusted friend or family member
- Use direct deposit for Social Security and pension checks
- Get legal advice about arrangements for possible future disability through an advance directive.
- Review your will periodically
- Give up control of your property or assets only when you decide you can no longer manage them
- Review the suggestions offered by Project SAFE to protect your money and avoid becoming a victim of financial exploitation
Prevention Strategies for Families
- Maintain close ties with elderly family members.
- Discuss health care issues, decisions and alternatives with your loved ones.
- Use community resources such as home-delivered meals, adult medical day services, home care services, and transportation, as needs arise.
- Talk with your loved ones about your ability to provide long-term care, legal issues such as advance directive, alternative sources of care (nursing homes, assisted living facilities, and home care).
- Share caregiving responsibilities with others for your sake and the sake of the older person; don't overextend yourself.
- If you or another family member become overwhelmed by caregiving responsibilities, get help. Contact the local Maryland Access Point (MAP) to ask for sources of support.
If you suspect that an older person is being abused, reporting it could save a life. If a person lives in a nursing home or an assisted living facility and you suspect abuse, a report can be made to the local police and/or the Maryland Department of Health and Mental Hygiene at 410-402-8201. Reports can be made anonymously.
In Baltimore County you can reach the Ombudsman at 410-887-2594. The MAP Office can provide you with the phone number for the Ombudsman Program in other counties and Baltimore City.
Department of Social Services
You can report suspected abuse of individuals living in community settings to the local Department of Social Services. In Baltimore County call 410-853-3000, press “2”; the MAP Office can provide you with the phone number for the Department of Social Services in other counties or Baltimore City.