Sunday, August 17, 2014

The Guide To Elder Abuse


In 2012, 8,616 individual cases of elder abuse and self-neglect were reported to the Los Angeles County Adult Protective Services program.1 However, research shows that for every abusive incident reported, 13 incidents go unreported.2 By these estimates, as many as 120,624 older adults in Los Angeles – or 1 in 10 adults aged 65+ – may be victims of abuse or self-neglect.3

Elder abuse is more than just physical assault and battery. It can include isolating an elder from family and friends, withholding or mismanaging medications, refusing to seek appropriate medical care, leaving an elder in soiled clothing or sheets, , abandoning a dependent elder, stealing checks or money, enticing vulnerable elders to give away large amounts of money or property, or knowingly encourage an elder with cognitive impairments sign legal documents. Self-neglect occurs when an older adult is unable to care for their physical, emotional or psychological needs. This can include using poor judgment to make decisions that may lead to harm, refusing to comply with medical treatment, living in deplorable or hoarded conditions, and being unable to provide for one’s food, clothing and shelter.”

Social workers, police officers, doctors, nurses, psychologists, and gerontologists work to investigate and intervene in cases of abuse, but everyone has a role to play. Most abuse victims live in the community, and many continue to drive, shop for their own groceries, and do their own banking. Family members, friends, neighbors, professionals, and everyday service providers are uniquely positioned to monitor older adults and report suspicions of elder abuse to professionals to resolve cases of mistreatment.

The Guide for Elder Abuse Response (GEAR) application was developed for use by community members and elder abuse professionals in Los Angeles. The app provides practical information on abuse, tools, resources, and ways to report abuse.

This app is provided as a resource by the University of Southern California Davis School of Gerontology, a leader in aging research and gerontological education, and the Los Angeles County Elder Abuse Forensic Center, a multidisciplinary team of elder abuse professionals dedicated to the investigation, intervention, and resolution of abusive situations.

1 California Department of Social Services – SOC 242 Monthly Statistical Reports January – December 2012. Retrieved online from on 10/28/2013.2 Sources: Bonnie, R. J. & Wallace, R. W. (2003). Elder mistreatment: Abuse, neglect and exploitation in an aging America. Washington, D.C.: The National Academies Press & the National Center on Elder Abuse, “Statistics & Data” (

3 U.S. Census Bureau. Retrieved online from


Signs & Symptoms

Physical Abuse

Physical actions perpetrated against an elder with the intent to cause harm or injury. Physical abuse can include:

  • Assaultive actions – Hitting, punching, kicking, choking, pinching, slapping, grabbing, and twisting
  • Burns – Forcing an individual to touch hot surfaces, immersing him or her in overheated baths, placement of body or limbs on overheated heating pads, cigarette or acid burns
  • Physical restraint – Unauthorized use of bed restraints, chains, or other materials to restrict an individual’s ability to move
  • Chemical restraint –  Forcing an individual to take drugs or medication, including psychotropic medication or sedatives, even if it has been prescribed by their doctor

Things you may see that may suggest a person is being physical abused:

  • Unexplained bruises – anywhere on the body, but especially if bruises are present on the face, wrists, or head, or in a specific shape/pattern (ie. hand print)
  • Lacerations or abrasions – cuts or scratches anywhere on the body
  • Fractures – any fracture, but especially if it is a torsion fracture (occurs by twisting a limb) or if the fracture occurs to the skull
  • Burns – any burns, but especially if it is an immersion burn or if the burn is in a specific pattern (ie. stove coil or iron)
  • Joint dislocations
  • Changes in orientation, mental status or personality


The failure, inability, or refusal to provide for an elder’s safety, physical, or emotional needs by an individual in a caregiving role.

Things you see that may suggest an elder is being neglected:

  • Unclean clothing, poor hygiene, overgrown hair and nails, unusual weight loss, need for medical or dental care, untreated bedsores
  • Withdrawal from normal activities, unexplained change in alertness, or other uncharacteristic behavior
  • Caregiver appears to be indifferent, apathetic or hostile to elder
  • Pressure ulcers, malnutrition, dehydration


Financial Abuse

The taking or appropriation of an elder’s money or property, for any wrongful use, or with the intent to defraud.

Things you see that may suggest an elder is being financially abused:

  • Elder does not know the location of personal checks, cash, ATM and credit cards, or name of bank where accounts are held
  • Elder spends money in a manner inconsistent with past spending habits
  • Unpaid bills (e.g., utilities, nursing home care, mortgage), when sufficient funds should be available
  • Elder made financial choices (e.g., investments, purchases) that were not in his or her best interests
  • Family members are fighting over the elder’s money and/or property
  • The person responsible for managing the elder’s finances did not provide an adequate accounting of spending
  • Suspicious checks made out to cash or to others without evidence of goods or services being provided
  • Unauthorized withdrawals from elder’s accounts
  • Others are residing with the elder but not paying rent or providing adequate care
  • Unexplained changes made to an elder’s accounts or will/trust (e.g., new names added to bank accounts)
  • Recent transfers of the elder’s funds or property
  • Recent change in the elder’s power of attorney
  • Elder pressured to sign documents without understanding them
  • Another person is dependent on the elder for housing and/or financial support
  • Elder was convinced to buy something that he or she does not need or that was drastically overpriced
  • Someone the elder trusts took elder’s money or possessions without permission



Inability or refusal of an elder to reasonably care for his or her personal physical, mental, or emotional well-being. Self-neglect can include:

  • Inability or refusal to obtain food, clothing or shelter
  • Inability or refusal to make reasonable medical decisions
  • Inability or refusal to advocate for their best interests

Things you may see that suggest an elder is self-neglecting:

  • Poor hygiene – Body odor/need to shower, Bad breath/need to brush teeth, smells of urine, long finger or toe nails, unkempt appearance, dirty clothing
  • Lack of food and/or water in the home
  • Lack of electricity, running water (hot & cold), and/or natural gas (utilities) in the home
  • Missed doctor’s appointments, treatments, advice or medications. Does not follow doctors’ advice or treatment plan. Failure to fill medication prescriptions
  • Hoarding – unreasonable accumulation of items within the individual’s home or personal space, especially if it becomes a danger to the individual’s health or safety. Hoarded areas are characterized by having little open floor or sitting space and walkways or trails around items that the individual uses to move around the space.
  • Poor judgment – Making decisions that are unreasonable or not in the individual’s best self-interest. This includes personal beliefs or decisions made by the individual that allow others to take advantage or cause personal harm (i.e. signing away title to the home or car, signing inappropriate POA/DPOA, obtaining a new exploitative significant other or best friend, allowing strangers to live in the home, knowingly engaging in scams, etc.)
  • Wandering, getting lost, and/or being unable to find their way home
  • Foreclosure or eviction from home even though the individual has the means to pay their mortgage or rent and stay in the home
  • Stacks of unopened mail in the home
  • Unpaid or outstanding bills or taxes, especially if the individual is able to pay them
  • Empty prescription bottles and/or unfilled prescriptions

Sexual Abuse

Sexual interaction with an elder without elder’s consent.

Things you may see that could suggest an elder is a victim of sexual abuse:

  • Bruises around breasts, thighs, or genitals
  • Unexplained venereal disease or genital infections
  • Unexplained vaginal or anal bleeding
  • Torn, stained, or bloody underclothing
  • Elder withdraws when touched or wishes to be alone
  • Elder is fearful about removing clothes for assistance bathing
  • Uncharacteristically scared or timid behavior


Emotional Abuse

Treatment of and elder in a way that causes the elder emotional distress. Emotional abuse can include:

  • Blaming
  • Isolation
  • Intimidation through yelling or threats
  • Humiliation and ridicule
  • Verbal attacks, threats, rejection

Things you see that may suggest an elder is being emotionally abused:

  • Anxiety
  • Depression
  • Withdrawal from normal activities, unexplained change in alertness, or other unusual behavior



Forced social isolation of an elder by another.

Things you may see that could suggest and elder is a victim of isolation:

  • An individual denying the elder visits from family members or friends
  • An individual only allowing supervised interaction between the elder and others
  • Not allowing a telephone or a cell phone in the home

















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