Second in a three-part series

by Shari Keller RN, CRRN for the Salisbury Post

As World Elder Abuse Awareness Day on June 15 illuminated the problem, research indicates neglect, violence, and exploitation is one of the biggest issues facing seniors. How do you identify elder abuse? Studies show that nearly half of those with dementia experience abuse or neglect and have a 300 percent higher risk of death compared to an elder not abused.

Families of nursing home residents need to be watchful. Abuse and neglect may not always be obvious.

For example, the resident may seem detached or cognitively confused, show signs of dehydration or weight loss, which may be confused with typical signs of aging. In cases lacking a concrete history of dementia, families should look for reasons causing the confusion, including overmedication or excessive use of sedatives.

• Physical abuse may be noted with bruising, especially in clusters or regular patterns, pressure marks, broken bones, abrasions, burns, black eyes, welts, evidenced overdoses or lack of administration of medication.

Some residents may report physical abuse, display anger, fear, anxiety, nervousness or depression. They may avoid eye contact, startle easily or exhibit withdrawal behavior. Neglect can be an attributing factor in bedsores, unattended medical needs, poor hygiene and unusual weight loss.

• Emotional abuse means the resident suffers insults, threats, intimidation, humiliation or harassment, causing distress, and is the hardest to recognize by those untrained in elder abuse. Being emotionally upset, displaying agitation or fearful behavior, especially in the presence of a specific individual, are classic signs of elder abuse. The resident may withdraw from normal activities; have significant weight loss, a sudden change in alertness, unusual depression, mood swings and strained or tense relationships. Arguments, lashing out, displays of anger and fear are common symptoms. Some residents regress and engage in unusual behavior like sucking, rocking or biting.

• Financial abuse is the financial exploitation or improper use of an older person’s assets, funds or property. The senior may appear suspicious of everyone, whereas prior to the abuse they were more trusting. This increased suspiciousness can add to an older adult’s isolation. It is important to be aware of a sudden change in financial situations. There is a strong interrelationship between financial abuse and other forms of elder abuse.

Many behavioral symptoms of elder abuse overlap with those of mental deterioration and can appear to be symptoms of dementia, frailty or other mental health problems. Each victim will respond differently, and professionals need to be sensitive to the presence of certain physical and behavioral indicators.

The rule of thumb for recognizing the behavioral signs of abuse, neglect or exploitation, is to know what normal behavior is for that older person. Determining whether a clear behavior change has taken place during the period in question, and considering any changes in the intensity and duration of the behavioral occurrences are key to identifying abuse and neglect. Having proper assessment and diagnosis can mean the difference between overlooking abuse or identifying it and getting help.

Professionals often initially miss many signs and symptoms that indicate abuse, due to the overlap with other symptoms of deteriorating mental health.

A study by the US General Accountability Office in 2008 indicated that state surveys do not reflect the total problem occurring in licensed nursing facilities, citing seventy percent will miss a nursing home deficiency and 15 percent of surveys miss incidences of immediate jeopardy or harm to a resident.

Even at the highest levels of investigation, education regarding signs of elder abuse is severely lacking. Compared to identifying child abuse and domestic violence, statistics indicate we are 40 years behind in educating health care professionals, social workers, law enforcement and the public on the escalating problem of elder abuse in our communities.

Information for this article was also provided by the National Council on Aging, Nursing Home Abuse Center, National Elder Abuse Incident Study, American Society on Aging – Tobi Abramson, U.S General Accountability Office, The Clinical and Medical Forensics of Elder Abuse and Neglect Carmel Dyer, et al.

Coming next: Part III: The Silent Condition – What Can We Do?

Shari Keller has been a registered nurse for more than 35 years and is a Certified Rehabilitation RN. She lives in Salisbury with her husband. Contact her at slkeller930@yahoo.com