Elder or Dependent Adult Neglect

When a caregiver fails to meet the needs of an elderly person, neglect can result. Sometimes the caregiver may withhold nourishment, medications, or even hygiene leaving the elderly person in serious harm.

Definition

Each year hundreds of thousands of seniors are neglected by family members and caretakers. Many victims are people who cannot help themselves and depend on others to meet their most basic needs.

Neglect is when a caregiver does not provide for an elder's safety, or for his or her physical and/or psychological needs. Physical neglect can mean failing to provide an elder with adequate and necessary medication or physical therapy, not taking care of an elder's personal hygiene needs, or forcing an elder to live in unsanitary or potentially harmful conditions. Psychological neglect can mean leaving an older person alone for long periods of time or failing to provide social contact, activities, or information.

According to Nursing magazine, nearly 50 percent of elder abuse cases are the result of neglect. While states define abuse differently, each one has passed some form of elder abuse prevention laws and established a reporting system. Generally, Adult Protective Services (APS) agencies receive and investigate reports of suspected elder abuse or neglect.

Research suggests that 700,000 to 1.2 million elderly people (i.e., 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.

In 1996, Congress ordered the National Elder Abuse Incidence Study; its findings suggested that 500,000 elderly Americans are abused, neglected and exploited by family members each year. Reports to APS agencies of domestic elder abuse also increased 150 percent between 1986 and 1996. This increase dramatically exceeded the 10 percent increase in the older population over the same period.

Recent research has found the following:

  • 551,011 persons age 60 and older experienced abuse, neglect, and/or self-neglect (when a dependent adult does not obtain needed care) in a one-year period.
  • Conservative estimates put the number of elders who have been injured, exploited, or otherwise mistreated at about 1 to 2 million. That may only be the "tip of the iceberg." Recent research suggests only 1 in 14 domestic elder abuse incidents comes to the attention of authorities.Almost four times as many new incidents of abuse, neglect, and/or self-neglect were unreported as those that were reported to and substantiated by Adult Protective Services agencies.
  • Persons age 80 years and older suffered abuse and neglect at a rate two to three times greater than their proportion of the older population.
  • Hard as it is to believe, the great majority of abusers are family members, most often an adult child or spouse.
  • Abuse can also occur at a long-term care facility, such as a nursing home or assisted-living residence. Employees and temporary staff who have direct contact with residents are the most frequent perpetrators. Other offenders may include other family and old friends, newly developed "friends" who intentionally prey on older adults, and service providers in positions of trust. A family member was the perpetrator of abuse or neglect in 90 percent of reported cases. Two-thirds of the perpetrators were adult children or spouses.

Symptoms

Older people do not always report abuse because they may be embarrassed, afraid or unable to do so. Some may not even realize they are being neglected.

Here are some signs:

  • Absence of necessities including food, water, heat
  • Untreated or unexplained worsening of medical or mental conditions
  • Inadequate living environment evidenced by lack of utilities, sufficient space, and ventilation
  • Animal or insect infestations
  • Signs of medication mismanagement, including empty or unmarked bottles or outdated prescriptions
  • Housing is unsafe as a result of disrepair, faulty wiring, inadequate sanitation, substandard cleanliness, or architectural barriers
  • Unexplained injuries or unlikely explanations for injuries
  • Dehydration or malnutrition (often evidenced by loss of weight, or extreme thirst, low urinary output, dry fragile skin, dry sore mouth, apathy, lack of energy, and mental confusion)
  • Poor personal hygiene
  • Untreated bedsores
  • Unclothed, or improperly clothed for weather
  • Extreme withdrawal or agitation
  • Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces, or commodes
  • Confusion
  • Depression
  • Has nightmares or difficulty sleeping
  • Exhibits regressive or self-destructive behavior
  • Exhibits emotional distress
  • Ambivalent feelings toward caregivers or family members

Causes

Caretaker stress is a factor that can trigger elder neglect. Some sources of caregiver stress include depression, lack of support from other potential caregivers, and perception that caregiving is burdensome or without psychological reward. Adult children who have no financial resources for providing health care other than those of their aging parent are especially vulnerable to stress. Caretakers and family members who are solely responsible for the bulk of a senior's care may become isolated from relatives and friends. This can be dangerous because it cuts them off from the support they need to cope with caregiving. Isolation also makes it harder for other people to intervene when a senior is being abused or neglected.

Treatments

If you suspect that a senior is being neglected by his or her caretaker, contact your county's Adult Protective Service's unit or a medical professional. All calls to APS agencies are kept confidential. If the APS unit suspects that elder abuse laws are being violated, the agency will assign a caseworker to carry out an investigation.

If you are a caretaker and feel overwhelmed, seek therapy, help from other family members, or consider other care options for the elderly person. Many state and nonprofit agencies also offer respite services to provide family members with temporary relief from the stress of caring for a senior. Stay healthy and get medical care for yourself when necessary. Find a support group for caregivers of the elderly which can provide a forum to discuss the issues around caregiving. Alleviating caretaker stress is, in many cases, the first step toward preventing elder neglect.

Sources

  • National Center on Elder Abuse
  • American Geriatric Society
  • National Elder Abuse Incidence Study
Last reviewed 11/24/2014