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Elder mistreatment means that someone either does something or fails to do something that harms an elderly person or threatens the health and welfare of an elderly person.

Research suggests that 700,000 to 1.2 million elderly people (ie, 4% of all adults older than 65) are subjected to elder mistreatment in the United States and that there are 450,000 new cases annually.

• Elder Mistreatment in the Family, Formal Care Settings, and the Community
• Forms of Elder Mistreatment
• Risk Factors for Elder Mistreatment
• Clues to Possible Elder Mistreatment
• Visible Signs
• Behaviors
• Keeping a Perspective
• What to Expect
• Where to Go for Help

Elder mistreatment can occur in many environments, including within the family, in formal care settings, or in the community or society at large.

Within the family, elder mistreatment is often seen in the context of caregiving. For example, a caregiver may be overwhelmed or may not know what is needed or expected in providing care for the elderly person. Sometimes, a caregiver is reluctant to take on the role. Elder mistreatment can also be seen in the family when someone dependent on the older person reacts inappropriately to the older person’s increasing frailty. An example of this situation might be when an adult child with mental illness reacts with anger or anxiety to a parent’s decreased ability to provide care.

Within formal care settings, when elder mistreatment occurs, it is attributable to those on staff who provide direct patient care (ie, are in close contact with patients), but who have not had adequate training.

Within the community or society at large, the elderly are all too often subject to mistreatment by unscrupulous business people or other criminals.

Elder mistreatment can take a number of different forms, including the following:

• physical abuse
• emotional abuse
• neglect(intentional or unintentional)
• financial exploitation
• abandonment
• a combination of these

Many factors can increase the risk of elder mistreatment. These risk factors include the following:

Frail or debilitated older people may at times be incapable of helping themselves at all. In these situations, they many need more care than the caregiver is able to provide. In particular, mentally disturbed people who may behave in difficult ways (eg, hitting, spitting, or screaming) can greatly add to the stress their caregiver feels, possibly causing the caregiver to respond with some form of elder mistreatment.

Both visible signs and certain behaviors by either the elderly person or the caregiver can raise suspicion of elder mistreatment. Watching and talking to both the older person and their caregiver may provide clues that elder mistreatment may be happening. The behavior of victims of elder mistreatment in the presence of the person who might be abusing them may be significant.

It is important to remember that signs and symptoms that look like inadequate or neglectful caregiving may in fact be because of the dependent person’s physical or emotional disorders. For example, weight loss may be seen in a person with a history of depression. In addition, in chronic progressive conditions, such as Alzheimer’s disease, deterioration is inevitable, even with the best of care.

It is also important to remember that the relationship of the elderly person with the caregiver(s) can be very complex, and the true cause of the problem may not be obvious. In some cases, the elderly person is truly a victim, while in others, the relationship between the elderly person and the caregiver can be mutually abusive. There are even situations when the elderly person knowingly is part of the reason for the mistreatment. Of course, there are many cases in which the older person and his or her caregivers are making the best of a difficult and sometimes tragic situation.

If you think someone you know is a victim of elder mistreatment, you can ask for help and advice from a number of resources:

• Your family doctor or another knowledgeable health professional
• Social workers, psychologists, or psychiatrists in your community
• Your state’s Adult Protective Services (can provide relevant information and often direct assistance)
• The National Center on Elder Abuse ( a good starting point in the search for information and resources)

When you suspect elder mistreatment and visit your doctor or other health care provider, he or she will likely take a number of actions. First, the situation is reported to Adult Protective Services and possibly other public agencies (as required by your state). If the elderly person is in immediate danger, your health care provider will make arrangements for the person’s safety. Possibilities are admitting the person to the hospital (if needed for medical reasons), getting a court protective order, or making sure the person is placed in a safe home. In all cases, the health care provider will make a complete evaluation of the person’s physical, mental, and emotional status as well as the frequency, severity, and intent of the mistreatment.

If the suspicions of maltreatment are determined to be true, your health care provider will coordinate with Adult Protective Services in your state to find the option that least restricts the elderly person’s independence.

If the elderly person is willing to accept voluntary services, he or she can receive several types of including the following:

• education about the tendency for elder mistreatment to happen more often and become more severe over time
• safe home placement, court protective order, hospital admission
• referral to drug or alcohol rehabilitation for the abuser(s) if appropriate
• education, home health, or homemaker services for overburdened families and other caregivers
• referral of the elderly person and family members for social work, counseling services, or legal assistance

If the elderly person is unwilling to accept voluntary services and has the capacity to do make this decision, the health care provider will take the following actions:

• educate the elderly person about the tendency for elder mistreatment to happen more often and become more severe over time
• provide written information on emergency numbers and appropriate referrals
• develop a follow-up plan

If the elderly person is unwilling to accept voluntary services and does not have the capacity to consent, the health care provider and Adult Protective Services will consider the following options:

• financial management assistance
• conservatorship
• guardianship
• committee
• special court proceedings (eg, orders of protection)