Elder Abuse: The Hidden Crime

Topic 1: Introduction

Screen 1: Introduction

This lesson will discuss the topic of Elder Abuse in the United States. There are eight topics in this lesson. They are:

  1. Introduction to Elder Abuse
  2. Elders in Our Communities
  3. Elder Abuse in Our Communities
  4. Why Does Abuse Happen?
  5. The Types of Elder Abuse
  6. Preventing Elder Abuse
  7. The Resources for Elder Abuse
  8. Credits.

This lesson opens with a woman sitting in an easy chair reading a newspaper. The headline reads “Elder Abuse, The Hidden Crime”. The woman is thinking aloud, “In Maine?” “Do I know an elder who is abused?” “I didn’t know …people abused elders?” “What do I know about elder abuse?”

Screen 2: Pre-Quiz

What do you know about elder abuse? Read the following statements and decide whether they are true or false.

  1. Most elder abuse occurs in institutions.
  2. Substance abuse by elders is rare.
  3. Elders are often dependent on their abuser for care.
  4. It is easy to identify elder abuse.
  5. Given resources, most elders will report abuse.
  6. Aging is stigmatized in the United States.

Think about your answers. Here is a review of whether these statements are true or false.

  1. It is a false statement that most elder abuse occurs in institutions.
  2. It is a false statement that substance abuse by elders is rare.
  3. It is a true statement that elders are often dependent on their abuser for care.
  4. It is a false statement that it is easy to identify elder abuse.
  5. It is a false statement that given resources, most elders will report abuse.
  6. It is a true statement that aging is stigmatized in the United States.

How did you do on that quiz?

To learn more about elder abuse please continue this lesson.

Screen 3: Engagement

The development of this lesson was made possible by funding from the Maine Community Policing Institute.

This lesson is an opportunity to learn more about the hidden crime of elder abuse in Maine and in the United States.

Complete this lesson to learn more about:

  • The victims’ lives.
  • The circumstances of their abuse.
  • What can be done to help victims of elder abuse.

Screen 4:  The Learning Objectives:

After completing this lesson, the community member will be able to:

  • Differentiate myth from fact in six statements about elder abuse.
  • Differentiate between negative and positive images of aging.
  • Identify four elders who are vulnerable to abuse.
  • Identify three risk factors that contribute to elder abuse.
  • Recognize at least five signs of abuse or neglect.
  • Identify three barriers that prevent many elders from reporting abuse.
  • Identify two community resources that should be used to report suspected elder abuse.

Screen 5: Understanding Navigation

Navigating this lesson is easy. Simply learn the meaning of the following icons and follow any additional directions that are given to you.

On the upper left is a Locator Line that will tell you where you are in each topic. The number that is darker is the number of the screen that you are currently viewing.

The Topics list, located down the left hand side of each screen, lists the topics of the lesson. You can move to any topic by clicking on it.

The Home icon, located on the left side of the title “Community Safety Center”, will take you to your law enforcement agency home page.

The Index icon, located on the right side of the title “Community Safety Center”, will take you to the Community Safety Center Index.

The Previous icon, the first icon located on the upper right side of the navigation toolbar, will take you to the previous screen.

The Next icon, the second icon located on the upper right hand side of the navigation tool bar, will take you to the next screen.

The green button is used throughout the lesson to indicate that you should click for further information.

Topic 2: Elders in Our Communities

Screen 1:  Introduction to Topic

This topic addresses the following questions:

  • Are elders respected in America?
  • What challenges do elders face?
  • Who is vulnerable to elder abuse?

Screen 2: Are Elders Respected in America?

How elders are treated by other people depends on the cultural view of aging.

  • People fear aging in the United States; being old is not viewed as a desirable state.
  • There are prevalent negative attitudes about elders such as “no longer physically attractive”, “unproductive”, “overly use health care funds”, “sickly”, and “inconvenient”.
  •  It is difficult for many people to recognize any advantage of being older in our culture; some are unable to appreciate the contributions previously and currently made by elders.

Screen 3: An Exercise

Many views of aging in America are marred by stereotyping the aging process. Can you identify those stereotypes?

Which of the following portrayals are stereotypes?

  1. Elderly toothless man.
  2. Elderly woman reading to a young girl.
  3. Elder male talking on the telephone to a younger man.
  4. Elderly woman, bent over and walking with a cane.
  5. Old wrinkled woman with cranky expression on her face.
  6. Elderly couple embracing and talking on the phone.
  7. Old man with unfocused eyes who looks sleepy.
  8. Elder woman with blue hair standing with hands on her hips.

Answer: The negative stereotypes include:

  • #1 The elderly toothless man.
  • #4 Elderly woman, bent over and walking with a cane.
  • #5 Old wrinkled woman with cranky expression on her face.
  • #7 Old man with unfocused eyes who looks sleepy.
  • #8 Elder woman with blue hair standing with hands on her hips.

Answer: The positive portrayals are:

  • #2 Elderly woman reading to a young girl.
  • #3 Elder male talking on the telephone to a younger man.
  • #6 Elderly couple embracing and talking on the phone.

How many of the stereotypes did you identify?

Screen 4:  What Challenges do the Elderly Face?

It is true that as people age they face many challenges, however, not all elders face every challenge. It is important that people recognize when elders are faced with a challenge and provide the necessary assistance or supports.

The challenges that the elders face include the following.

Isolation is common among elders who are frail, chronically ill, widowed or divorced and live alone. They do not participate in activities with other people.

Depression in elders is not easily recognized and when it exists, it maybe due to a medical condition or a psychological condition. Suicide is more common in older people than in any other age group.

Self-neglect occurs when elders fail to provide themselves with whatever is necessary to prevent physical or emotional harm or pain. This occurs for a variety of complicated reasons including physical or mental deterioration and their reluctance to ask for help.

Medications must be used wisely. Elders are at risk to misuse medications because they may be taking a number of prescriptions that could interact with each other. They also may use other substances such as alcohol.

Dementia is a medical condition that affects the way the brain works. It affects all aspects of mind and behavior, including memory, judgment, language, concentration, visual perception, temperament, and social interactions. Dementia is not a normal outcome of aging.

Substance abuse is more common among elders than most people realize. In some cases it may be a long standing problem. In others it may be that the elder turned to drugs and/or alcohol to cope with challenges of isolation or physical pain.

Screen 5:  Who is Vulnerable to Elder Abuse?

Elders are people older than 65 years. Elders who are abused frequently have three things in common.

  • Older: usually among the oldest of the elders, often over 75 years.
  • Frail: physically and/or mentally frail or unwell.
  • Dependent upon other people (caregivers, paid staff, family members) for their care.

Screen 6:  Elders in Our Community

Unlike many other cultures, the U.S. stigmatizes the aging process. Elders in the U.S. are not always respected for the wisdom and experience they have gained while aging.

Aging can bring challenges due to physical and mental changes that occur in some people. However, it is important to remember that most people age gracefully and are faced with minimal challenges.

Some of the elderly are vulnerable to abuse. They are usually the oldest of the elderly population, unwell and/or frail, and dependent on others for their care.

Topic 3: Elder Abuse in Our Communities

Screen 1:  Introduction to the topic.

This topic addresses the following questions:

  • Who are the victims?
  • How often does it happen?
  • What is abuse?
  • Where does it occur?
  • Who are the abusers?

Screen 2:  Who are the Victims of Elder Abuse?

The aging population in the United States is growing and many of these elders continue to live in a family setting with relatives. People over 65 represent over 15% of the population in Maine.

About 7% of male and 17% of female elders live with their children, siblings, or other relatives and not with a spouse. The number who live in family settings decreases with age. As elders become more frail they may require a residential setting that offers nursing assistance.

Elders who have reached a point where they can no longer live independently are particularly vulnerable to mistreatment by family, caregivers or others.

Screen 3: How Often Does It Happen?

It is estimated that approximately 1 million cases of elder abuse occur annually in the United States.

Characteristics of Abused Elders:

  • The median age of an abused elder is 78 years.
  • 66 % Caucasian; 19% African-American, 10% Hispanic, less than 1% Native American/Alaskan Native.
  • 68% female, 32% male.

Screen 4:  What is Elder Abuse?

Elder abuse generally refers to any form of maltreatment of an older person by someone who has a special relationship with the elder.

Broadly defined, there are three basic categories of elder abuse.

  • Domestic Elder Abuse is any form of abuse that occurs either in the older person’s home or in the home of the caregiver.
  • Institutional Elder Abuse is any form of abuse of an elder that occurs in residential facilities.
  • Self-Neglect or Self-Abuse is when the elder is unable or unwilling to care for his/herself; it occurs in any setting, although most frequently in a domestic setting.

Screen 5:  Who are the Abusers?

Domestic Elder Abusers are spouses, siblings, children, friends, or caregivers. Adult children are the largest category of abusers (47%), followed by spouses (19%), other relatives (9%), and grandchildren (8%). In over 90% of elder abuse cases in Maine, the abuser was a relative.

Institutional Elder Abusers include paid caregivers. This abuse generally occurs in nursing homes, foster homes, group homes and board and care facilities by persons who have a legal or contractual obligation to provide the elder with care and protection.

Screen 6:  An Exercise

Here are brief introductions to six elders. After reading each one, decide whether or not you believe that they are vulnerable to being abused.

Elder #1:  Alice, 72, lives in a residential care home that has high staff turnover. Alice had a stroke 3 years ago and requires assistance to dress, to walk, and to eat. She has some difficulty talking since the stroke. Is she vulnerable to abuse?

Answer: Yes, Alice is vulnerable to abuse. She is dependent on others for care.

Elder # 2: Alfred, 80, has been depressed since his wife died 6 months ago. Despite taking numerous medications he has been drinking more and more heavily. His only son has become quite frustrated with his father’s drinking and depression. Is Alfred vulnerable to abuse?

Answer: Yes, Alfred is vulnerable to abuse. He is depressed and drinking. His son is frustrated with his behavior and depression.

Elder #3: Vera, 92, lives independently in the home she and her deceased husband built 45 years ago. She visits regularly with her family and friends, volunteers at the community center, and plays Beano every Thursday night. Is Vera vulnerable to abuse?

Answer: No, Vera lives independently.

Elder #4:  Julio, 70, lives with his nephew in the nephew’s family home. He immigrated to the U.S. 35 years ago and built a dry cleaning and alteration business that is now managed by the nephew. Julio continues to work on occasion but has a hard time concentrating and often asks the nephew to take him “home to Cuba”. Is Julio vulnerable to abuse?

Answer: Yes, Julio is vulnerable to abuse. He is dependent on others for care and showing signs of dementia.

Elder #5:  Marie, 83, lives with her daughter and son-in-law and is bedridden. Unfortunately, there are no funds for in-home assistance. Marie’s daughter and son-in-law are both employed outside the home. Every evening Marie’s daughter finds that she must change and bathe her mother no matter how tired she feels. Is Marie vulnerable to abuse?

Answer: Yes, Marie is vulnerable to abuse. She is dependent on her daughter for physical care.

Elder #6: James, 78, has lived with his son for the past 10 years. He is a retired police officer and is currently employed part time as a security officer at a warehouse. He believes that he is a burden on his son; therefore, he is seeking an apartment in a residence for seniors. Is James vulnerable to abuse?

Answer: No, James is not vulnerable to abuse.

Topic 4: Why Does Abuse Happen?

Screen 1:  Introduction to the topic.

This topic addresses caregiver stress, impairment of dependent elder, the family cycle of violence and personal problems of abusers.

Screen 2:  Caregiver Stress

Caring for frail elders is difficult and stress-producing. It is even more difficult if the caregivers have additional stressors in their lives. Caregivers find themselves overwhelmed by the responsibility of taking care of an older person. They can feel guilty about their frustration and/or their inability to provide necessary resources. This is particularly true when any of the following conditions are present.

  • Elder is mentally impaired.
  • Elder is physically impaired.
  • Caregiver is ill-prepared for the task of caring for a frail older person.
  • Necessary resources are lacking

Screen 3:  Impairment of Dependent Elder

Research has demonstrated that elders who are in poor health are more likely to be abused than those in good health.

Poor health dramatically increases the likelihood of abuse by a caregiver.

Abuse tends to occur when the stress level of the caregiver increases as the elder’s impairment worsens. This is particularly true when the caregiver is not prepared to give the level of care that is required by the impairment.

Screen 4:  Family Cycle of Violence

Some families are more prone to violence than others. Violence is a learned behavior that is transmitted from one generation to another.

In these families, abusive behavior is the normal response to tension or conflict.

They resort to violence because they have not learned any other ways to respond to stressful situations or conflict.

Screen 5:  Personal Problems of Abusers

Abusers of the elderly (typically adult children) tend to have more personal problems than do non-abusers. Because of these problems, these adult children are often dependent on the elders for their support.

Adult children who abuse their parents frequently have problems such as:

  • Mental and Emotional Disorders
  • Alcoholism
  • Drug Addiction
  • Financial Problems

When children feel inadequate they are more likely to abuse their elderly parents.

Alcohol is involved in nearly 50% of the reported elder abuse cases.

Screen 6: An exercise

Here are four situations involving elders and their children. Identify the three situations where there are risk factors that could contribute to abuse occurring.

#1: Jack, 79, lives with his 55 year old daughter who has alcoholism. Is there any risk for Jack to be abused?

Answer: Yes! Jack is elderly and he lives with a daughter who has alcoholism.

#2: Joline checks on her independent, but elderly mother everyday after work. Is there any risk for Joline’s mother to be abused?

Answer: No! There is no apparent risk here.

#3: Robert cares for his father who now has dementia; his father was abusive to Robert as a child. Is there any risk for Robert’s father to be abused?

Answer: Yes! There is a family history of violence.

#4: Janet, mother of 5 children, also cares for her 89 year old bedridden mother. Is there any risk for Janet’s mother to be abused?

Answer: Yes! Janet is at risk for caregiver stress. She cares for her 5 children as well as for her elderly mother who is seriously impaired and dependent upon her.

Topic 5: The Types of Elder Abuse

Screen #1:  Introduction to the topic

There are a number of ways that elders can be abused.

Elder abuse isn’t easily identified. There are physical signs and behavioral changes that can indicate the possibility of abuse. In some cases the abuse may be recognized by the behavior of the caregiver.

Screen #2:  Physical Abuse

Physical abuse is using physical force that causes bodily injury, physical pain, or impairment. It may include such acts as striking, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching and burning.  It also includes inappropriate use of medication and restraints.

  • Physical Signs: bruises, black eyes, welts, rope marks, fractures, sprains, broken eyeglasses, medication overdoses, signs of being restrained.
  • Behavioral Signs: elder’s report of abuse, fearful behavior, other sudden changes in behavior.
  • Caregiver Sign: refusal to allow visitors to see the elder alone.

Screen #3:  Sexual Abuse

Sexual abuse is sexual contact of any kind with a non-consenting elderly person. Sexual contact with any person incapable of giving consent is also considered sexual abuse. This includes unwanted touching, rape, sodomy, coerced nudity, and sexually explicit photographing.

  • Physical Signs: bruising or other trauma, unexplained sexually transmitted diseases, unexplained sexually transmitted infections, torn or stained underclothing.
  • Behavioral Signs: elder’s report of being sexually assaulted or raped.
  • Caregiver Signs: flirtations and coyness can be possible indicators of inappropriate sexual relationship.

Screen #4:   Emotional and/or Psychological Abuse

Emotional or psychological abuse is inflicting anguish, pain or distress through verbal or nonverbal acts such as verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant; isolating the person from the family, friends, or regular activities; and enforcing social isolation may be emotional/psychological abuse.

  • Behavioral Signs: being upset or agitated; withdrawn, non-communicative or non-responsive; unusual sucking, biting, rocking behaviors; elder’s report of being verbally or emotionally mistreated.
  • Caregiver Signs: attitudes of indifference or anger, blames the victim, unwarranted defensiveness; threatens, harasses, and/or insults the elder.

Screen 5:  Neglect—the most frequent type of elder abuse

Neglect is the refusal or failure to fulfill any part of a person’s obligations or duties to an elder. It may include failure of a person who has financial responsibility to provide care for an elder or the failure of an in-home service provider to provide necessary care. It typically means failure to provide life necessities such as water, clothing, food, shelter, personal hygiene, medicine, comfort, personal safety and other essentials.

  • Physical Signs: dehydration, malnutrition, untreated bed sores, poor personal hygiene, untreated health problems, hazardous or unsafe living conditions, unsanitary or unclean living conditions.
  • Behavioral Signs: elder’s report of being mistreated or neglected.

Screen 6:  Abandonment—the least common abuse

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

  • Physical Signs: desertion of an elder at a hospital, nursing facility, institution, shopping center, other public locations.
  • Behavioral Signs: elder’s own report of being abandoned or deserted.
  • Caregiver Signs: unable to explain absence of elder.

Screen 7:  An exercise

Select five (5) signs of elder abuse or neglect from the following list of eight.

  • Bruises
  • Healthy
  • Good Hygiene
  • Elder Report
  • Withdrawn
  • Desertion at a hospital
  • Caregiver denial
  • Contentment

Answer:  Bruises, Elder Report, Withdrawn, Desertion at a hospital, Caregiver denial.

Topic 6: Preventing Elder Abuse

Screen #1:   Introduction to the topic

This topic addresses understanding the barriers, public education and what can you do?

Screen #2: Understanding the Barriers

Elders often don’t report their abuse because they:

  • are dependent on the abuser.
  • fear backlash from the abuser.
  • fear losing contact with a family member.
  • feel guilty about their need for care.
  • feel ashamed that their child or spouse is an abuser.
  • are afraid they will be placed into institutional care.
  • don’t believe that their problem is important enough.
  • are unaware of the resources for victims of abuse.

Screen #3:  Public Education

People need to know that elder abuse is a crime.

  • Recognize that the treatment of elders they know may be unacceptable or even criminal.
  • Anyone can report suspected elder abuse.
  • Laws make it mandatory for many professionals to report elder abuse.
  • Resources are available for reporting abuse and assisting the victims of elder abuse.

Screen #4:  What Can You Do About Elder Abuse?

  • Be aware of the signs of abuse.
  • Listen and talk to elders in private. Let them know that you care and are willing to help them.
  • Verify any information from the caregiver that the elder “is confused”.
  • Know the resources that are available to help victims.
  • Be willing to make the report if the elder is too frightened or otherwise unable to report the abuse themselves.
  • Recommend that your friends and family view this lesson and use the Community Safety Center for information and resources.

Screen #5:  An Exercise

Here are four situations. Identify three situations in which there are barriers that commonly prevent elders from reporting abuse.

#1 Situation: Elizabeth, 72, lives with son’s family. Son is easily frustrated by Elizabeth’s need for help to eat and sometimes he doesn’t feed her. He is a town official.

Are there any barriers that would prevent Elizabeth from reporting his abuse?

Answer: Yes, Elizabeth is ashamed that her son, a town official, abuses her.

#2 Situation: Gladys, 80, shares her home with her grandson and his verbally abusive wife. She helps to care for their two children while parents are working. She enjoys her time with her great-grandchildren.

Are there any barriers that would prevent Gladys from reporting this abuse?

Answer: Yes, Gladys fears the potential loss of contact with her great grand-children.

#3 Situation: Robert, 93, lives in his own apartment attached to his daughter’s house. He is independent. In fact, some say that he helps daughter Alice, 69, more than she is able to help him.

Are there any barriers that would prevent Robert from reporting abuse?

Answer: No, there is no obvious abuse or barrier here.

#4 Situation: Ted, 77, lives with his son, James, 58. They often play cards and drink beer on weekends. It is not unusual for them to argue and yell at each other. Ted loves living at home with James.

Are there any barriers that would prevent Ted from reporting abuse?

Answer: Yes, Ted fears backlash of violence from making the report or worse being moved to residential care.

Topic 7: Resources for Victims of Elder Abuse

Screen #1:  Introduction to the topic

Information will be provided about the following resources: Law Enforcement, Adult Protective Services, Attorney General’s Office, Legal Services for the Elderly and Long Term Care Ombudsmen.

Screen #2:  If I make a report of elder abuse, what happens?

Your first point of contact may be either your law enforcement agency or the Bureau of Elder Adult Services (BEAS).

When the report is made, BEAS investigates.

  • If they find evidence of institutional elder abuse, the case is passed to the Attorney General for further investigation and prosecution.
  • If they find evidence of domestic elder abuse, the case is passed either to a law enforcement agency for further investigation or directly to the District Attorney for further investigation and prosecution.

Screen #3:  Law Enforcement

If your first point of contact is with a law enforcement agency serving your area, they will take basic information and tell you what you should do.

Many Maine law enforcement agencies have adopted a community policing philosophy and approach and work with multidisciplinary groups that address the problems of elder abuse.

Working with the Attorney General’s Office, over 100 departments have designated an Elder Crime Contact Officer who has received special training about crimes targeted at the elderly and other elder issues.

Screen #4:  Adult Protective Services

In Maine, the Bureau of Elder and Adult Services provides or arranges for services to protect incapacitated and dependent adults (age 18 and over) in danger of abuse, neglect or exploitation.

To make a report or for more information, call:

Nationwide 24-hour, toll-free                         1-800-624-8404

TTY (during business hours)                         1-800-624-8404

TTY In-State (after hours)                             1-800-963-9490

TTY Out-of-State (after hours)                      207-287-3492

Screen #5:  The Attorney General’s Office

The Maine Attorney General is committed to the protection of Maine’s elder citizens. The Office has a full time investigator to help facilitate the prevention, reporting, investigation and prosecution of elder abuse, elder neglect, and financial exploitation.

If you are aware of an elder who is being abused or exploited, the Attorney General’s Office recommends that you contact:

Maine Department of Human Service’s Adult Protective

Hotline 1-800-624-8404.

Screen #6: Maine’s Legal Services for the Elderly

This organization provides free, high-quality legal assistance to socially and economically needy Maine residents age 60 and older.

Hotline:           1-800-750-5353 or 207-623-1797

Screen #7:  Long Term Care Ombudsmen Program

This program investigates and resolves complaints made on behalf of residents of Maine’s nursing, boarding, and adult foster homes and recipients of home care. Any person may ask for assistance from the Ombudsmen Program on behalf of these individuals.

Telephone:                                207-621-1079

Toll Free Statewide TTY:       1-800-499-0229

Screen #8:  An exercise

From the following list of four community resources, select the two primary community resources that should be used to report suspected elder abuse.

Law Enforcement Agency

Hospital Emergency Services

Next Door Neighbors

Bureau of Elder and Adult Services

Answer: Law Enforcement Agency and Bureau of Elder and Adult Services

Topic 8: Credits

You have completed the lesson on Elder Abuse.

This public education lesson supports the Maine Community Policing Institute’s vision of “Building safer communities through education.” The goal of this lesson is to provide  community members with basic information about Elder Abuse and the resources that are available in the State of Maine. Content of this Internet-based public education lesson is based upon training material developed by the Maine Community Policing Institute.

This project was supported by Cooperative Agreement # 1999DVWXK012 awarded to the Maine Community Policing Institute by the Office of Community Oriented Policing Services, U.S. Department of Justice. Points of view or opinions contained within this document are those of the author and do not necessarily represent the official positions or policies of the U.S. Department of Justice.