Domestic violence can affect anyone, regardless of gender, ethnicity, socio-economic status, or age. Certain populations, however, face unique forms of abuse and barriers to support. One such population is older adults, one of the fastest growing demographics in the United States. While the elder population has been steadily increasing for decades, it spiked dramatically in the 2010s as baby boomers began to turn 65. As of 2020 there were 55.8 million adults, 16.8% of the population, aged 65 and over in the United States. (US Census) By 2040, that number is expected to climb to 80 million, comprising nearly 21% of the total population. In 2034, it is anticipated that older Americans will outnumber children for the first time. (NCEA) The World Health Organization (WHO) estimates that the global population of people aged 60 years and older will increase exponentially in the next few decades, from 900 million in 2015 to about 2 billion in 2050. With such a growing number of older adults, elder abuse is likely to become even more of an issue in the future. June is Elder Abuse Awareness Month, an opportune time to learn more about this problem and what can be done about it.

Infographic with a smartphone and the words, "A survey of callers to the National Domestic Violence Hotline found that 85% reported that a partner or ex-partner had called them crazy, 73% said that a partner or ex-partner had deliberately done things to make them feel they were going crazy or losing their mind, 50% reported that a partner or ex-partner had threatened to report to the aurthorities that they were crazy as a way to keep them from getting certain important goals such as custody of the children, medication, or protective orders

Elder Abuse Definition & Prevalence

Elder abuse is generally defined as the intentional or negligent mistreatment of an older adult, a deliberate act or failure to act that causes or creates a risk of harm to an adult over the age of 60. While some count people as young as 55 as “older adults” and others don’t consider anyone under age 70 to fall into this category, 60 is the most frequent age cited. Elder abuse is most commonly perpetrated in the victim’s home by someone they know, typically a caregiver. The National Center on Elder Abuse (NCEA) reports that 90 percent of the abuse of elders occurs by family members, most often spouses, partners, or adult children (DomesticShelters). Data on elder abuse in institutions such as hospitals, nursing homes, and long-term care facilities is scarce, but in a 2018 study, 2 out of 3 staff members at these institutions reported perpetrating some form of abuse in the prior year.

Infographic with a smartphone and the words, "A survey of callers to the National Domestic Violence Hotline found that 85% reported that a partner or ex-partner had called them crazy, 73% said that a partner or ex-partner had deliberately done things to make them feel they were going crazy or losing their mind, 50% reported that a partner or ex-partner had threatened to report to the aurthorities that they were crazy as a way to keep them from getting certain important goals such as custody of the children, medication, or protective orders

The CDC estimates that 1 in 10 Americans aged 60 and older experience abuse. Worldwide, this figure jumps to 1 in 6 (WHO). Studies estimate that roughly only 1 in every 14 to 24 cases of elder abuse is reported to police, however, so it is likely to be much more common than statistics show. Older women are more likely to be abused than older men, according to the National Institute on Aging. Though the CDC reports that physical abuse among senior men is on the rise, having increased 75% between 2002 and 2016 as compared with a 35% increase for senior women. Adults over 80 years old, people of color, and those with low income are also more likely to be abused (Healthline). Older adults who are dependent on a caregiver for daily living activities (dressing, bathing, eating, medication, bill paying, etc.), live in a long-term care facility, who have a physical disability or dementia/memory problems, and/or lack support from loved ones are at higher risk of abuse as well (DomesticShelters).

Unique Aspects of Elder Abuse

As with all domestic violence, there are different types of elder abuse. Many of these are the same types that victims of any age may face, such as physical, emotional/psychological, sexual, and financial abuse. There are aspects of these types of abuse, however, that are distinct to older adults, and there are some types of abuse that are specific to older adults. As people age, they are more likely to have physical and mental health issues and, thus, to need assistance with everyday tasks. Like with child abuse, this frequently puts victims in a position of dependence on their abuser, automatically giving the abuser power and control over the victim and providing them with unique opportunities to take advantage of or reinforce that dynamic.

Physical

Physical abuse is when the abuser causes or threatens physical violence or bodily harm, including hitting, kicking, pushing, shaking, and burning, among others. For older adults, who may have physical challenges and/or mental impairments, physical abuse can also involve things like excessive and unnecessary use of force or restraints, force-feeding, and over or under-medicating. It may also include actively preventing victims from leaving the house or calling for help.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively
Emotional/Psychological

Emotional or psychological abuse is inflicting mental anguish through verbal or nonverbal acts, such as insults, threats, intimidation, and harassment. Older adults may be particularly vulnerable to humiliation and isolation if their abuser has control over aspects of their lives such as hygiene and transportation. Those with memory or cognitive issues may also be more susceptible to gaslighting and other manipulations.

Sexual

Sexual abuse is any non-consensual sexual activity, including unwanted touching, sexual assault, and sexual harassment. Since assisting with changing clothes and hygiene needs requires touching older adults and seeing them in various states of undress, it is all too easy for abusive caregivers to exploit the situation and cross the line into sexual abuse. Elders with mental impairments, such as dementia, may also lack the capacity to give consent.

Financial

Financial abuse is the illegal, unauthorized, or improper use, misuse, or concealment of a victim’s funds, property, assets, or benefits for the abuser’s gain or to deprive the victim of their rightful access. This is particularly common with older adults who may not understand new technologies and systems used in the financial world or may not have the ability to properly take care of their own finances any longer due to mental or physical impairment. Financial abusers often take advantage of their access to older adults’ homes and legal circumstances such as conservatorship, guardianship, or power of attorney to steal or misuse victims’ money or possessions. Abusers may coerce or deceive older adults into signing a financial document benefiting them, such as a contract or will. Financial abuse of elders can also include financial neglect, where the perpetrator ignores the victim’s economic responsibilities that they should be taking care of, such as paying rent, bills, and taxes.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Financial swindles and schemes (credit card scams, Nigerian princes emailing for assistance, phone calls saying their social security has expired/been cancelled or that they’re in trouble with law enforcement, etc.) perpetrated by a stranger on an older adult, while having many similar aspects, are usually considered fraud and not elder abuse, as there is no domestic, familial, or caregiving relationship between the victim and the perpetrator. Health care fraud taking advantage of older adults, on the other hand, often is considered elder financial abuse because, while not always occurring in a domestic setting, a caregiving relationship does exist. Typically, this type of abuse takes the form of health care providers/workers or hospital staff duping older adult patients out of money by doing things like intentionally overcharging, billing twice for the same service, charging for care that wasn’t provided, or falsifying Medicaid/Medicare claims.

Neglect

Neglect is the failure to provide basic necessities, such as food, water, clothing, shelter, and medication. As people age, daily tasks related to these essential needs can become more difficult, and older adults often require assistance accomplishing them. Despite agreeing to assist someone who cannot perform these tasks themselves, neglectful caregivers fail to provide or intentionally withhold necessities from victims who depend on them. Neglect can also include failing to provide adequate supervision of the victim such that they engage in unsafe behaviors, like wandering off into dangerous areas and attempting tasks too difficult for them (using stairs, lifting heavy objects, cooking with sharp knives or hot stoves, etc.).

Abandonment

Abandonment is the desertion of a person by someone who has responsibility for providing care to them. For older adults, it often involves a caregiver leaving the victim at a hospital, nursing home, or other public place, such as a shopping center, and not returning for them. Leaving the victim alone in their home without providing for their care can also be considered abandonment. Some states classify abandonment as a type of neglect and others categorize it as a separate form of elder abuse (NCEA).

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Caregiver Abusers

The vast majority of elder abuse is perpetrated by caregivers. This makes sense from the perspective that these are the people who interact most frequently with older adults, often in vulnerable circumstances. Caregivers are typically family members, friends, or paid professionals, who are thought to have a vested interest in assisting the victim. Some caregiver abusers are simply not concerned about their victims and are interested only in how they can exploit the situation to their benefit and to gain power and control over their victim. Others may have mental health problems or substance abuse habits that contribute to abusive choices. Caregivers are also more likely to be abusive if they are untrained, are caring for someone with a mental illness, are unprepared for the burden and responsibility of caring for an older adult, lack coping skills, and have limited resources, support, and, perhaps most worryingly, respite. Caregiver stress and burnout can certainly be an unfortunate factor in elder abuse. These are not excuses for abusive behavior but do indicate opportunities for intervention to help prevent it. (DomesticShelters & Healthline)

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Signs of Elder Abuse

Elder abuse isn’t always easy to identify, but there are signs to watch out for. While these signs are often indicators of abuse, they don’t always definitively mean abuse is occurring. Unexplained bruises, broken bones, marks, and abrasions, especially in various states of healing, and broken eyeglasses or other assistance devices could be signs of physical abuse or neglect. Other signs of physical neglect include malnutrition and dehydration, unusual weight loss, bedsores, poor hygiene, inappropriate clothing, and mismanagement of medications. Neglect can also show itself in home safety issues, lack of proper utilities, unsanitary living conditions, hoarding, wandering, and risky behaviors such as unsafe driving and unsafe smoking. Unpaid bills and eviction or foreclosure notices could indicate neglect or financial abuse. Compulsive spending, large unexplained withdrawals, changes in bank accounts or practices (including names on financial accounts), sudden transfers of assets, missing valuable possessions, and abrupt changes to a will or financial document are additional signs of financial abuse.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Frequent arguments with a caregiver, belittling or threats by a caregiver, and refusal of a caregiver to allow visitors to see or to be alone with the older adult may be signs of emotional or psychological abuse. An older adult’s withdrawal from normal activities, sudden changes in alertness, unusual depression, and strained or tense relationships could be indicators of emotional/psychological abuse and possibly sexual abuse. Other signs of sexual abuse include bruising around breast or genital areas, trouble sitting or walking, unexplained venereal disease or genital infections, unexplained vaginal or anal bleeding, blood/stains on sheets, linens, or clothing, and evidence of pornographic material being shown to an older adult who has diminished capacity. (USDOJ)

Effects of Elder Abuse

Elder abuse can have multiple devastating effects on victims. Any form of abuse can create and/or exacerbate physical health problems, especially physical abuse, sexual abuse, and neglect. Older bodies may not heal as fast or as well as younger ones. Chronic stress can compromise the immune system, leaving victims more vulnerable to illnesses, which may hit harder and linger longer in older adults. The result is all too often premature death. In fact, older adults who have been abused have a whopping 300% higher risk of death than those who have not (NCO).

Mental health is also a huge concern for older adults experiencing abuse. Trauma and undermined confidence and self-esteem can be extremely challenging to deal with, especially in a population more likely to be isolated, leading to issues such as depression, anxiety, and cognitive decline. Additionally, abuse may compound other physical and mental impairments and may also cause victims to be wary of others and have problems with trust, which effects both relationships and the ability to seek outside support, potentially further compounding physical and mental impairments.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Financial abuse of older adults can also have massive impacts on their health and quality of life. Losing a home, life savings, and precious possessions can have emotional consequences and result in the inability to pay for a suitable place to live and/or the care they require. Elder financial abuse and fraud costs Americans an estimated $2.6 billion to $36.5 billion annually, which is likely under-reported (NCO).

Barriers to Support

While there are many reasons why it is not always safe or right for any victim to leave an abuser, there are some specific considerations that often particularly effect older adult victims. Older victims grew up with different cultural norms surrounding domestic violence. They may believe it is something to be tolerated and kept private. They may not even consider things like leaving an abuser or obtaining a restraining order to be options. Some older adult victims have been living with the abuse for so long that it seems normal. They have been worn down and are resigned to the situation, or they may feel ashamed or guilty that they let it continue for so long and embarrassed to tell anyone about it.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

According to DomesticShelters.org, cases where the abuser of an older victim is their adult child or grandchild are more common than cases where the abuser is an intimate partner. Parents naturally love and want to protect their children and feel responsible for them. As with abusive partners, shame and guilt are significant factors in how abused parents react. This adds up to them being less likely to report abuse or cut contact with their abusive child.

A sense of duty may tie older adults to an abusive partner or child, and so, too, a financial or medical dependence. It is difficult to start over later in life and may seem impossible for those who can’t work and have no means of financial support besides their abuser. Even without financial considerations, they may be afraid to live alone or in a care facility if they require assistance. Medical complications go both ways. Victims may be dependent on their abusers to be their caregiver and be unable to do without their day-to-day support. Mental impairments may also mean victims are unable to express or even recognize that they are being abused. Conversely, victims may be the caregiver to their abuser and feel they can’t leave them without the support they need or feel the abuse is a result of a medical issue (such as Alzheimer’s or dementia) and not the abuser’s fault. While there is a difference between aggression and violence due to frustration, fear, and confusion stemming from memory loss and the exacerbation of abusive tendencies due to these factors, it can be difficult to discern the difference and easy to excuse abuse as illness.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Older adults may be more isolated and lack information on assistance options. They may not be as familiar with online resources or lack tech skills or internet connection to access them. Biases can also sometimes work against them when it comes to medical and law enforcement professionals who are trained to look for signs of abuse. Those who could potentially offer assistance may not consider, for example, that older adults could be victims of sexual assault, or they account for injuries and illnesses with age factors rather than considering abuse as a possible explanation.

How to Help

Education on elder abuse, recognizing it, and understanding options for assistance can help prevent elder abuse and increase victims’ safety. Checking in with older adults in one’s life helps mitigate isolation, keeps shifting circumstances on one’s radar, and can help one recognize signs of abuse sooner. Offering support and respite to caregivers can also help prevent burnout, a potential catalyst of abusive behavior. Talking to an older adult one suspects might be experiencing elder abuse can be a lifeline and prompt their reaching out for assistance. Just listening and believing without judgment can make a huge difference in breaking through feelings of shame and guilt. Offering resources and assistance can be helpful, but letting victims with clear mental capacity make their own choices is vital.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

Resources

There are a lot of assistance options and resources available, both to help domestic violence victims in general and specifically geared toward older adults. If victims are in immediate danger of harm, calling 911 is likely the best way to get rapid support and first responder assistance. Otherwise, reporting elder abuse to Adult Protective Services will trigger an investigation, assistance with safety planning and health issues, and referrals to social services. For those considering legal options, the Elder Abuse Guide for Law Enforcement (EAGLE) is a great tool to understand the specific statues and laws in each state. Trained Advocates are available to offer support from many organizations, including the National Domestic Violence Hotline, the National Center on Elder Abuse (NCEA), and DVSN.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

The Eldercare Locator is a resource from the US Administration on Aging to connect people with services for older adults, searchable by zip code online and also accessible by phone. Additionally, the US Department of Justice has an Elder Justice Resources Page, searchable by state for all types of elder services. Area Agencies on Aging coordinate and offer services to adults in their homes, which may help lessen a victim’s dependence on an abuser. In Massachusetts, Minuteman Senior Services and the MA Councils on Aging offer assistance with information, support, and services.

Emergency shelters may be an option for victims who need a place to go. Unfortunately, some shelters may not be equipped to deal with all of the needs and caregiving certain older adult victims may require. There are, however, shelters specifically designed to care for survivors of elder abuse. DomesticShelters.org has a filter on their shelter search page (filters available after inputting a zip code) to specify an elder demographic criteria, and Spring Alliance is a network of shelters that cater to elder adults and their particular needs.

upset young woman sits in a chair crying while her boyfriend stands over her yelling aggressively

For victims in long-term care facilities, reports of abuse can be made to the state’s licensing agency. Long-Term Care Ombudsmen are advocates trained specifically to assist those living in these facilities with resolving complaints, protecting rights, improving quality of life, and investigating abuse. Learn more about Ombudsmen and search by state for the local program at The National Consumer Voice for Long-Term Care website.

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