Often Overlooked: Elder Abuse

June 15th is World Elder Abuse Awareness Day (WEAAD). Sharon Merriman-Nai discusses this often invisible form of trauma, where to find help, and how we can work together to prevent it.

When we think about trauma, we often think of child abuse, domestic violence, people who survive gun violence, war, hurricanes and other natural disasters. But older individuals who have been abused, neglected, or exploited do not come to mind as quickly. Elder abuse is one of the most invisible forms of interpersonal violence even as it impacts millions of people worldwide. How big is the issue? It remains difficult to measure because most cases never come to light and as a result many who are victimized suffer in silence. In the US, it is estimated that more than one in ten older individuals living in the community experience this form of violence (Acierno et al., 2010).

I am embarrassed to admit that even as a community mental health counselor who had worked with more than a few older clients, elder abuse had not been on my radar. It wasn’t until I started working on a federally-funded project at the University of Delaware with Dr. Karen Stein, one of the first researchers to examine the issue, that I became aware of the magnitude of the problem. The consequences are dire; physical, psychological, and financial impacts can be devastating. Early research suggests that older individuals who are mistreated are at increased risk for premature death (Lachs et al., 1998; Dong et al., 2009). In addition to the personal trauma suffered, because our population is aging, elder abuse is an increasing public health threat.

When we do recognize elder abuse, it is often mistakenly believed to be a problem mainly occurring in nursing homes. While people who are institutionalized can and do experience mistreatment, most older individuals live at home, alone or with family members, and the vast majority of cases occur in the community. Perpetrators are usually people that they know and trust, including adult children, spouses, and others. Why are cases underreported? Like many forms of interpersonal violence, elder abuse commonly takes place behind closed doors. People who are mistreated may not be aware of where or how to report it or may not be capable of reporting due to cognitive or other limitations. They may be embarrassed, afraid, or even feel guilty or responsible for the mistreatment. They may also fear retaliation or worry that the perpetrator, who they may depend on for social connection or other support, will abandon them. Or, like many people who have been abused, they may be in denial about what is happening.

On June 15th, we will observe World Elder Abuse Awareness Day (WEAAD). It was conceived of by Dr. Elizabeth Podnieks, the esteemed Canadian elder justice advocate and researcher, and launched by the International Network for the Prevention of Elder Abuse. It was first observed in 2006 in support of the United Nations International Plan of Action on Ageing. Since then, communities have recognized WEAAD throughout the US and around the globe as a day of unity to illuminate the issue and to honor those who have been affected. Senior centers, community groups, government agencies, and others conduct public events and trainings to educate people on the risk for and signs of mistreatment. People are urged to wear purple as a sign of solidarity.

WEAAD is a very important day, but the work of elder abuse prevention is ongoing year-round. Here are just a few steps we can all take to reduce the risk for mistreatment:

• • Learn to recognize the potential signs of abuse, neglect, and exploitation. In addition to bruises, injuries, or other signs of physical mistreatment, they may include anxiety, depression, or other emotional reactions. Financial irregularities may indicate exploitation.
  • Stay active and socially connected as you grow older, and visit or call older neighbors and loved ones and encourage them to remain socially engaged. This reduces isolation and may also allow problems to be identified as they come to light.
  • Foster healthy aging by supporting policies that reduce barriers to health and social services. Volunteer for programs to support healthy aging, such as Meals-on-Wheels.
  • Work to recognize and reduce ageism and promote intergenerational environments.
  • Designate a trusted person as your financial power of attorney and appoint a trusted contact for financial institutions. Consider subscribing to a financial monitoring program such as EverSafe to detect financial irregularities and to help prevent or recover from fraudulent activity.
  • Encourage older people who have been mistreated to seek counseling and other support to reduce trauma-related to abuse, and help to connect them to services. Family and couples counseling can also decrease escalating conflicts, and allow a safe space for planning adequate caregiving and living arrangements.
  • Report suspected elder abuse. In Delaware, everyone has a duty to report. For suspected abuse, neglect, and exploitation occurring in the community, contact Adult Protective Services at 1-800-223-9074. To report a concern about suspected mistreatment taking place in a nursing home or assisted living facility, contact the Division of Health Care Quality at 1-877-453-0012. If someone is in immediate danger, call 911 or the local police.

Together, we can prevent elder abuse. But first, we need to see it.

Sharon Merriman-Nai
Trauma Matters Delaware, Board Secretary and member of the Primary, Secondary, Vicarious Trauma & Resilience Workgroup
Journal of Elder Abuse and Neglect, Associate Editor

For more information on elder abuse, visit the Delaware Adult Protective Services web page. The Guide to Services for Older Delawareans and Persons with Disabilities is an online resource guide produced by the Delaware Division of Services for Aging and Adults with Physical Disabilities. You can also visit the Aging and Disability Resource Center online or call 1-800-223-9074 for information related to services.

References
Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The National Elder Mistreatment Study. American journal of public health, 100(2), 292-297.

Dong, X., Simon, M., Mendes de Leon, C., Fulmer, T., Beck, T., Hebert, L., Dyer, C., Paveza, G., & Evans, D. (2009). Elder self-neglect and abuse and mortality risk in a community-dwelling population. JAMA, 302(5), 517–526. https://doi.org/10.1001/jama.2009.1109

Lachs MS, Williams CS, O’Brien S, Pillemer KA, Charlson ME. (1998). The Mortality of Elder Mistreatment. JAMA. 280(5), 428–432. doi:10.1001/jama.280.5.428