Lesson 4: Response and Services

Psychological abuse

Inflicts emotional distress through verbal and non-verbal behaviors, this can be just as damaging as verbal abuse causing anguish, fear, and distress.

sexual abuse

involves any non-consensual sexual contact of any kind with an older adult or disabled person. this is a violation of their personal boundaries or dignity.

neglect

occurs when a caregiver fails to provide for basic needs, leading to harm or risk of harm. this can also include abandonment, the dissection by a responsible caregiver.

financial abuse and exploitation

involves the legal or improper use of a person money, benefits, property, or assets for someone else’s gain. this is a common form of abuse perpetrated by family members or caretakers for elderly or disabled persons.

Elder abuse

any intentional or negligent act by a caregiver or other person that causes harm or a serious risk of harm to an older adult (age 60 or older)

Physical Elder Abuse

is injury, impairment, and/or pain inflicted through physical assault, force-feeding, and drug administration

 Physical Elder Abuse Examples: 

• Hitting, slapping, pushing, or kicking 

• Shoving or grabbing 

• Restraining (physically or chemically i.e through medications) 

• Inappropriate use of medications 

• Force-feeding 

• Burning 

Psychological Elder Abuse 

involves inflicting emotional distress via verbal assault, harassment, and humiliation. This can include verbal or nonverbal behaviors that inflict anguish, fear, or distress on an older adult. 

Psychological Elder Abuse examples:

• Verbal assaults, insults, and name-calling 

• Threats of harm or abandonment 

• Humiliation, intimidation, and bullying 

• Isolation from friends and family 

• Ignoring or infantilizing the older adult 

Sexual Elder Abuse 

can involve unwanted sexual activity or viewing of pornography. This involves any non-consensual sexual contact of any kind with an older adult.

Sexual Elder Abuse examples:

• Unwanted touching or fondling 

• Forced sexual intercourse 

• Sexual harassment 

• Showing pornography 

Neglect

This is the failure of a caregiver to provide for an older adult's basic needs, leading to harm or risk of harm.

neglect examples:

These needs include: 

• Food and water 

• Shelter 

• Clothing 

• Hygiene 

• Medical care 

• Protection from health and safety hazards 

Abandonment

the desertion of an older adult by a caregiver who is responsible for their care. 

self-neglect

can occur in elderly persons. This happens when an older adult fails to provide themselves with adequate care, putting their own health and safety at risk. This can be due to physical or mental limitations or because of depression. 

Financial Abuse and Exploitation

This a common form of victimization by family members and caretakers, is the illegal and improper use of a senior’s property and assets. This involves the illegal or improper use of an older adult's money, benefits, property, or assets for someone else's gain.

This often happens when money or belongings are misused or stolen from an older adult. It can include forging checks, taking someone else’s retirement or Social Security benefits, withholding access to money or financial information, or using a person’s credit cards and bank accounts without their permission. It also includes changing names on a will, bank account, life insurance policy, or title to a house without permission. 

Financial Abuse and Exploitation examples:

• Theft of money or possessions 

• Coercing or deceiving an older adult into signing over assets 

• Misusing power of attorney 

• Scams and fraud targeting seniors 

Signs of Physical Abuse

Unexplained injuries: Bruises, welts, cuts, burns, fractures, sprains, or dislocations. These injuries may be in various stages of healing

Signs of restraint: Rope marks, broken eyeglasses, or physical signs of being tied down or confined

Medication mismanagement: Over-sedation, under-medication, or unexplained changes in medication and/or the amount of the medication that is present 

• Caregiver's refusal to allow the older adult to be seen alone 

• Stories that are unbelievable/implausible related how-to injuries occurred 

Signs of Emotional or Psychological Abuse 

Sudden changes in behavior or personality: Withdrawal, fearfulness, anxiety, depression, or agitation and alertness 

• Hesitancy to talk openly or a fear of speaking in front of the caregiver

• Frequent yelling, name-calling, insults, threats, or humiliation as well as being ignored 

• Strained or tense relationship and/or communication with the caregiver 

• Unusual behaviors such as sucking, biting, or rocking 

Signs of Financial Abuse or Exploitation

Sudden changes in financial situation: Large or frequent unexplained withdrawals, new credit cards, or changes in banking practices, as well as unexplained disappearance of funds or valuable possessions

• Abrupt changes in a will or other financial documents 

• Lack of knowledge or information about their financial situations

• Signatures on financial documents that do not resemble the individuals 

• New "friends" or caregivers showing excessive interest in the older adult's finances 

• Unpaid bills/late notices even though there are enough finances to pay for items

• Elderly individual living in substandard conditions despite having adequate financial resources 

• Excessive gifts or making payments to a caregiver for unclear reasons 

Signs of Neglect

• Dehydration, malnutrition, weight loss, poor hygiene, untreated medical conditions, bedsores, or inappropriate clothing for the weather 

• Unsafe living conditions such as lack of heat, running water, electricity, or unsanitary environment 

• Lack of necessary medical aids: Missing eyeglasses, dentures, hearing aids, or medications 

• Failure to provide necessary care or seek medical attention for individual when needed 

Signs of Sexual Abuse 

• Bruises or injuries around the breasts or genital area

• Unexplained sexually transmitted infections (STIs) or genital infections 

• Unexplained vaginal or anal bleeding

• Torn, stained, or bloody underclothing 

• Changes in the older adult's demeanor such as fear or withdrawal around a specific person 

Risk Factors for Elder Abuse Victimization

1. Increased Dependence & declining physical health

2. Cognitive Impairment & Mental Health Issues

3. Social Isolation

4. History of Trauma or Abuse

Increased Dependence & declining physical health

Older adults who may suffer from physical disabilities, chronic illnesses, or cognitive impairments that make them more vulnerable and reliant on others. They may need daily care or help with essential activities. This can make them more vulnerable to abuse.

The greater the dependence that an elder individual has, the higher the risk can be. Reduced physical health and limited mobility can limit an elderly person’s ability to resist different forms of abuse, seek help, and/or escape a dangerous situation. 

Cognitive Impairment & Mental Health Issues

Elder individuals who suffer from dementia may not understand what is happening, remember instances of abuse, or be able to communicate when abuse happens. They may also exhibit behaviors that frustrate caregivers, increasing the risk of abuse.

Elder persons who suffer from depression, anxiety, or other mental health conditions are more vulnerable and make it harder for them to advocate for themselves. 

Social Isolation

Elderly adults may be isolated, or separated from family, friends, and community support networks and as a result are at a higher risk for abuse. If a victim is isolated, that can hide the abuse and make it harder for the victim to obtain help or services.

Abusers may intentionally isolate their victims as a result. Sharing a living situation with a potential abuser increases the opportunities for abuse to occur and continue. 

History of Trauma or Abuse

Individuals who have experienced trauma or abuse earlier in life may be at higher risk of revictimization as an elderly person. 

Risk Factors for Perpetration of Abuse

1. Substance Abuse

2. Mental Health Issues

3. Caregiver Stress and Burnout

4. Lack of Caregiving Skills and Knowledge

5. History of Violence

6. Financial or Emotional Dependence on the Older Adult

7. Negative Attitudes Towards Aging and Older Adults

8. Poor Impulse Control

Substance Abuse (Risk Factor for Perpetration of Abuse)

Alcohol or drug abuse can be a risk factor for individuals to perpetrate elder abuse

Mental Health Issues (Risk Factor for Perpetration of Abuse)

Perpetrators with mental illness, such as depression, anxiety, or personality disorders, or others may be more likely to abuse 

Caregiver Stress and Burnout (Risk Factor for Perpetration of Abuse)

Caregiving can be very stressful on people, especially caring for someone with constant and significant needs. Caregiving can lead to stress, frustration, and burnout, increasing the risk of abuse 

Lack of Caregiving Skills and Knowledge (Risk Factor for Perpetration of Abuse)

Individuals who are unprepared to be a caregiver and/or lack the skills to provide appropriate care may become frustrated and overwhelmed, increasing the risk for abuse 

History of Violence (Risk Factor for Perpetration of Abuse)

Individuals with a history of violence or aggressive behavior are at higher risk for perpetrating abuse 

Financial or Emotional Dependence on the Older Adult (Risk Factor for Perpetration of Abuse)

Perpetrators who are financially or emotionally dependent on the older person may feel resentment or entitlement, leading to abuse 

Negative Attitudes Towards Aging and Older Adults (Risk Factor for Perpetration of Abuse)

Holding negative stereotypes or devaluing older people can contribute to abusive behavior 

Poor Impulse Control

Individuals with poor impulse control may be more likely to react 

Social and Environmental Risk Factors

Social Isolation of the Elder: As mentioned earlier, this lack of external oversight increases the likelihood of abuse going undetected 

Lack of Support for the Caregiver: Caregivers who lack support from family, friends, or community resources are more likely to experience stress and burnout. A lack of support services can increase caregiver stress 

Cultural Norms that Devalue Elders: In societies where older adults are not respected or valued, abuse may be more likely to occur and be tolerated 

Institutional Settings: Factors within nursing homes and residential facilities, such as understaffing, inadequate training, staff burnout, and poor administrative oversight, can increase the risk of abuse 

Acceptance of Aggressive Behavior: In environments where aggressive behavior is tolerated or normalized, abuse is more likely to occur 

Elder abuse is significantly underreported due to ___

fear of retaliation, shame, or cognitive impairment. 

A physical disability challenges …

a person’s ability to physically function, hindering such actions as walking, lifting, or basic hygiene functions.

Developmental disabilities…

affect a person’s cognitive abilities. Examples of developmental disabilities include autism, cerebral palsy, and intellectual disability.

Persons with Disabilities & Family Violence

Increased Vulnerability: Individuals with disabilities are at higher risk for experiencing family violence as they have increased vulnerability due to their physical or developmental limitations 

Higher Rates of Abuse: Research consistently shows that people with disabilities experience violence at rates significantly higher than those without disabilities. This is often a result of increased reliance on caregivers, social isolation, physical limitations and/or difficulties in communication. 

Unique Forms of Abuse: Individuals with disabilities can experience unique forms of abuse such as a caregiver withholding necessary medications or assistive devices. A caregiver can exploit a disabled person’s dependence and commit acts of abuse related to personal care, such as inappropriate touching or denial of hygiene. They can also commit different acts of abuse on individuals and depending on the type of disabilities the person has. The victim may not be able to convey that they are being abused. A caregiver can also abuse a service animal. 

Barriers to Seeking Help: Individuals with disabilities may face barriers to seeking help. They may not be ablet o access support services. They also may fear loss of essential care or their caregivers if they report the abuse. They may not be able to communicate their abuse. 

Hate Crimes

This occurs when a crime is motivated by prejudice, hate or bigotry towards a person's disability. This can include verbal abuse, physical violence, sexual abuse, property damage, and online harassment, as well as financial exploitation.

Hate crimes against individuals are rooted in ableism and a lack of respect for people with disabilities. People who perpetrate hate crimes are motivated by the bias they have against a person with a disability.

Hate Crime Types Towards Disabled individuals

Physical violence - Physical assault

Verbal Abuse - Insults and harassment

Property Damage - Vandalism of disability equipment such as wheelchairs, canes, hearing aids)

Online Abuse -Cyberbullying and hate speech targeting a person's disability

Access Denial - Blocking necessary accommodations such as ramps,elevators, etc.

Institutional Abuse - Abuse in care facilities

Hate crimes against people with disabilities can have devastating physical, emotional, and psychological effects on victims. Victims experience feelings of fear, isolation, and a decreased sense of safety.

Hate crimes against disabled persons are significantly underreported. This is often due to some disabled person’s communication difficulties, a fear of not being believed, dependence on abusers who are caregivers, and/or a general lack of awareness that they have been a victim of a hate crime

Mate (friend) Crimes

This is a form of hate crime that occurs when individuals who are disabled are victimized by people who they believed to be their friend (mate).

This is a form of disability hate crime where a person intentionally befriends a disabled person deliberately to take advantage of them.

Disabled individuals are targeted for this type of crime because of their vulnerability and often because the perpetrator may harbor malicious feelings regarding disabled individuals generally. 

Within mate crime, these so-called "friends" will often exploit the victim financially, taking their money, pressuring them to buy them things or pay their expenses. They also may abuse them physically or emotionally. A perpetrator may intentionally target a disabled person to sexually abuse or exploit them. They pretend to be their friend for the sole purpose of harming them. A disabled person who experiences this type of victimization may not recognize that they are being abused because they believe the perpetrator is a genuine friend. The perpetrator also may lie and coerce the individual to control them and obtain what it is that they want. Depending on their person and their disability, the victimization may be harder to detect.