Elder abuse – the silent crime of a generation

June 15 is World Elder Abuse Prevention Day

By: J. Leslie Riseden

Special Contributor to

The Steel Country Bee

One would think that as Elder Abuse Awareness Day approaches, there would be more calls to aid our senior citizens, especially those who might be particularly vulnerable, according to the Association of Mature American Citizens. Instead, we are more likely to hear about the grandmother who fought off a mugger. Surprisingly, most estimates place elder abuse at more than one in every ten elders; however, it is estimated that for every case that is reported, another 22 go unreported.

Crimes against the elderly take the form of neglect, physical abuse, financial exploitation and sexual abuse, in that order. For some reason, people do not seem to want to talk about these issues. But, AMAC says, “we must bring this disgraceful crime wave out into the open if we, as a nation, hope to stem the tide.”

Experts from the U.S. Department of Justice and the Department of Health and Human Services have reported that knowledge about elder abuse lags as much as two decades behind the fields of child abuse and domestic violence. The need for more research is urgent and it is an area that calls out for a coordinated, systematic approach that includes policy-makers, researchers and funders.

The 2010 census recorded 40.3 million people age 65 or older, representing 13 percent of the total population. This “Boomer Generation” effect is projected to continue for decades. The U.S. Census Bureau estimates that, by 2050, the population aged 65 and over will double, to 83.7 million. People aged 85 and over numbered 5.9 million in 2012; that number is projected to reach 18 million by 2050.

Who is abusing our senior citizens?

According to a 2015 report in the New England Journal of Medicine, perpetrators are most likely to be adult children or spouses, are more likely to be male, and are likely to have history of past or current substance abuse. Additionally, those who abuse seniors are more likely to have mental or physical health problems themselves, and to have a history of trouble with the police. Abusers are likely to be socially isolated, to be unemployed or have financial problems, and to be experiencing major stress.

The most commonly documented physical impacts of elder abuse include: wounds and injuries (bruises, lacerations, dental problems, head injuries, broken bones, pressure sores); persistent physical pain and soreness; nutrition and hydration issues; sleep disturbances; increased susceptibility to new illnesses (including sexually transmitted diseases); exacerbation of pre-existing health conditions; and increased risks for premature death. According to the Journal of the American Medical Association, elders who experienced abuse, even modest abuse, had a 300 percent higher risk of death when compared to those who had not been abused.

How can I tell if a senior is being abused?

According to the Texas Department of Family and Protective Services (DFPS), the following descriptions are not necessarily proof of abuse, neglect, or exploitation. But there may be clues that a problem exists, and that a report needs to be made to law enforcement or Adult Protective Services.

Physical Signs

• Injury that has not been cared for properly

• Injury that is inconsistent with explanation for its cause

• Pain from touching

• Cuts, puncture wounds, burns, bruises, welts

• Dehydration or malnutrition without illness-related cause

• Poor coloration

• Sunken eyes or cheeks

• Inappropriate administration of medication

• Soiled clothing or bed

• Frequent use of hospital or health care/doctor-shopping

• Lack of necessities such as food, water, or utilities

• Lack of personal effects, pleasant living environment, personal items

• Forced isolation

Behavioral Signs

• Fear

• Anxiety, agitation

• Anger

• Isolation, withdrawal

• Depression

• Non-responsiveness, resignation, ambivalence

• Contradictory statements, implausible stories

• Hesitation to talk openly

• Confusion or disorientation

Signs by Caregiver

• Prevents elder from speaking to or seeing visitors

• Anger, indifference, aggressive behavior toward elder

• History of substance abuse, mental illness, criminal behavior, or family violence

• Lack of affection toward elder

• Flirtation or coyness as possible indicator of inappropriate sexual relationship

• Conflicting accounts of incidents

• Withholds affection

• Talks of elder as a burden

How are Texas elders faring?

According to DFPS, Texas now has more than 3.2 million residents age 65 or older. In Fiscal Year 2012, Adult Protective Services (APS) completed 87,487 investigations of abuse, neglect, or exploitation involving adults living at home. Of these, 59,595 (more than 68 percent) were validated. Neglect accounts for over 90% of the in-home cases that were validated.

The National Adult Protective Services Association identifies the most commonly reported types of neglect:

Physical neglect: includes failing to attend to a person’s medical, hygienic, nutrition and dietary needs, such as dispensing medications, changing bandages, bathing, grooming, dressing, or failure to provide ample food to maintain health.

Emotional neglect: includes causing emotional pain, distress or anguish by ignoring, belittling or infantilizing the needs of adults. This includes neglecting or discounting the emotional wellbeing of others, as well as actions to isolate adults from visits or contact by family and friends.

Abandonment: involves deserting the caregiving needs of an individual while neglecting to arrange sufficient care and support for the duration of the absence.

Financial neglect: involves disregarding a person’s financial obligations such as failing to pay rent or mortgage, medical insurance or invoices, utility and garbage bills, property taxes and assessments.

Self-neglect: involves seniors or adults with disabilities who fail to meet their own essential physical, psychological or social needs, which threatens their health, safety and well-being. This includes failure to provide adequate food, clothing, shelter and health care for one’s own needs.

In 2014, DFPS Region 004 (which is comprised of 23 northeast Texas counties, including Camp, Cass, Morris and Titus) reported a confirmed rate of 11.3 abused elders per 1000 adults, which is the same as the state average. The highest confirmed rates of elder abuse occurred in the Abilene Region (27.5) and Lubbock Region (24.0). The lowest reported occurrences were in the San Antonio Region (7.9) and the Austin Region (9.1).

In 2015, Texas APS received seven percent more allegations of abuse, neglect or financial exploitation than the previous year, but the total number of validated cases declined by 20 percent. The decline was primarily the result of a new structured approach to casework that APS began using in 2014 that includes new safety and risk assessments. "We're seeing the benefits of a much more sophisticated approach that helps caseworkers more accurately determine which clients are safe and which ones are at risk of ongoing abuse or neglect," says Beth Engelking, DFPS assistant commissioner for APS. "So now we are able to focus more services on the clients who really need those services."

What can I do?

It’s pretty simple, actually. State law requires anyone who suspects abuse, neglect, or exploitation to report it. You can do that by calling the Texas Abuse Hotline at 1-800-252-5400 or – if the situation does not require emergency action – file a complaint online at www.TxAbuseHotline.org. When reports are validated, and protective services are appropriate, APS caseworkers provide or arrange for services to alleviate or prevent further maltreatment, such as: • Financial assistance for rent and utility restoration • Social services • Health services • Referrals to the Texas Department of Aging and Disability Services (DADS) for guardianship services • Referrals to other state or community services.

If you or someone you know is in a life-threatening situation or immediate danger, call 9-1-1 or the local police or sheriff. For further information, contact: National Council on Elder Abuse, 1-800-677-1116, www.ncea.aoa.gov National Adult Protective Services Resource Center, www.apsnetwork.org Texas Department of Family and Protective Services, 1-800-252-5400, www.txabusehotline.org or www.dfps.state.tx.us