Table of Contents

About This Course

1. Introduction to Elder Abuse
2. The Basics of Elder Abuse
3. Substance Use and Other Risk Factors
4. Screening and Assessment
5. Intervention and Treatment
6. Preventing Elder Abuse

Supplements
Case Studies
References
Resources

Out of the Shadows
Uncovering Substance Use and Elder Abuse

Module 4 Pages 1 - Objectives2 - What Is Screening and Assessment?3 - Who Can Screen For Elder Abuse?4 - What Are the Indicators of Elder Abuse?5 - Behavioral Signs in the Suspected Victim of Abuse6 - Indicators of Nursing Home Abuse and Neglect7 - How to Assess Abuse8 - Screening Caregivers for Elder Abuse9 - Screening for Intimate Partner Violence10 - Screening for Alcohol Abuse11 - Screening for Depression12 - Barriers to Identifying Elder Abuse13 - Victim Barriers14 - Summary15 - Case Study16 - Quiz

What Are the Indicators of Elder Abuse?

Indicators are signs or clues that abuse may have occurred. In most States, suspicion of elder abuse is sufficient cause to generate a report to Adult Protective Services. The challenge for health and social service providers is that other conditions may cause the same signs and symptoms. For example, an accidental fall can cause an injury, and some medications can cause inappropriate or unusual behavior. No single sign or clue can be conclusive of abuse. Only a pattern of physical, behavioral, and environmental indicators points to a need to question.ref

Indicators of abuse may vary based on the type of abuse or the behaviors exhibited as a result of abuse.

• Signs of Physical Abuse
• Signs of Sexual Abuse
• Signs of Financial Abuse
• Signs of Neglect
• Signs of Medication Misuse
• Signs of Violation of Personal Rights
• Environmental Indicators

Signs of Physical Abuse

Signs of physical abuse include:

• Sprains, dislocations, fractures, or broken bones
• Burns from cigarettes, appliances, or hot water
• Abrasions on arms, legs, or torso that resemble rope or strap marks
• Internal injuries characterized by pain, difficulty with normal functioning of organs, and bleeding from body orifices
• History of similar injuries and/or numerous suspicious hospitalizations
• Injuries in various stages of healing (indicating they occurred over time)

The following types of bruises are rarely accidental: ref

• Bilateral bruising to the arms (indicating the person has been shaken, grabbed, or restrained)
• Bilateral bruising of the inner thighs (indicating sexual abuse)
• "Wrap-around" bruises on an older person's arms, legs, or torso (indicating physical restraint)
• Multicolored bruises (indicating they were acquired over time)
• Untreated previous injuries
• Signs of traumatic hair and tooth loss

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Signs of Sexual Abuse

Signs of specifically sexual physical abuse include:ref

• Genital or anal pain, irritation, or bleeding
• Bruises on external genitalia or inner thighs
• Difficulty walking or sitting
• Torn, stained, or bloody underclothing
• Sexually transmitted diseases

Signs of Psychological Abuse

Indications of psychological or emotional abuse include:ref

• Significant weight loss or gain not attributed to other causes
• Stress-related conditions, including elevated blood pressure
• Problems sleeping
• Depression or confusion

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Signs of Financial Abuse

Financial abuse may be evidenced by:ref

• Unpaid bills, eviction notices, or notices to discontinue utilities
• Withdrawals from bank accounts or transfers between accounts the older adult cannot explain
• Bank statements and canceled checks no longer delivered to the older person's home
• New "best friends"
• Legal documents, such as powers of attorney, the older person did not understand when signing
• Unusual activity in the older person's bank accounts, including large, unexplained withdrawals, frequent transfers, or ATM withdrawals
• A caregiver's excessive interest in the amount of money spent on the older adult
• Missing belongings or property
• Suspicious signatures on checks or other documents
• Absence of documentation about financial arrangements
• Implausible explanations by the older adult or caregiver about the his/her finances
• Ignorance or lack of understanding regarding financial arrangements made on his or her behalf

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Signs of Neglect

The following warning signs may indicate neglect:ref

• Poor personal hygiene including soiled clothing, dirty nails and skin, matted or lice-infested hair, odors, and the presence of feces or urine
• Unclothed or improperly clothed
• Bedsores
• Skin rashes
• Dehydration, evidenced by low urinary output, dry/fragile skin, dry/sore mouth, apathy, lack of energy, and mental confusion
• Untreated medical or mental conditions, including infections, soiled bandages, and unattended fractures
• Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces, or commodes
• Exacerbation of chronic diseases despite a care plan
• Worsening dementia

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Signs of Medication Misuse

Signs of medication abuse/misuse include: ref

• Drowsiness
• Incoherence
• Abnormal laboratory or clinical findings

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Signs of Violation of Personal Rights

Indications that a person's rights may have been violated include:ref

• Forcible eviction or placement in a nursing home
• Loss of decisionmaking power, power of attorney, or guardianship
• Loss of privacy

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Environmental Indicators

Other signs that an older person may not be receiving proper care include:ref

• Absence of necessities, including food, water, and heat
• 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
• Unsafe housing as a result of disrepair, faulty wiring, inadequate sanitation, substandard cleanliness, or architectural barriers

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