Elder Abuse - American Psychological Association - Office on Aging

Elder Abuse - American Psychological Association - Office on Aging

Most elder abuse and neglect takes place at home. The great majority
of older people live on their own or with their spouses, children,
siblings, or other relatives-not in institutional settings. When elder
abuse happens, family, other household members, and paid caregivers
usually are the abusers. Although there are extreme cases of elder
abuse, often the abuse is subtle, and the distinction between normal
interpersonal stress and abuse is not always easy to discern.

There is no single pattern of elder abuse in the home. Sometimes the
abuse is a continuation of long-standing patterns of physical or
emotional abuse within the family. Perhaps, more commonly, the abuse
is related to changes in living situations and relationships brought
about by the older person's growing frailty and dependence on others
for companionship and for meeting basic needs.

It isn't just infirm or mentally impaired elderly people who are
vulnerable to abuse. Elders who are ill, frail, disabled, mentally
impaired, or depressed are at greater risk of abuse, but even those
who do not have these obvious risk factors can find themselves in
abusive situations and relationships.

(Note: The caregiver would often go into mother's bedroom and Elizabeth would be standing over her saying, "I'm the good one, they're the bad ones.")

Elder abuse is the infliction of physical, emotional, or psychological
harm on an older adult. Elder abuse also can take the form of
financial exploitation or intentional or unintentional neglect of an
older adult by the caregiver.

Physical abuse can range from slapping or shoving to severe beatings
and restraining with ropes or chains. When a caregiver or other person
uses enough force to cause unnecessary pain or injury, even if the
reason is to help the older person, the behavior can be regarded as
abusive. Physical abuse can include hitting, beating, pushing,
kicking, pinching, burning, or biting. It can also include such acts
against the older person as over- or under-medicating, depriving the
elder of food, or exposing the person to severe weather-deliberately
or inadvertently.

(Note: Elizabeth would hold mother's hand and forecfully smack her arm while she was talking to her.  It was so bad at one point that the caregiver called the sheriff's office to report Elizabeth's violent behavior and was told, "We were told not to respond to calls from caregivers at this address.")

(Note: Our neighbor heard Daddy screaming "She's trying to kill me!" and came running.  Daddy had long since forgotten how things worked and was on a walker.  Nonetheless, Elizabeth decided that he should mow the yard on the riding mower.  She had put him on it and started it for him.  He had become confused and had driven it up underneath the back deck.  He had gotten stuck and his whole body and mower was jammed so tight that the mower would not move anymore even though he still had his foot on the gas.  Elizabeth was standing near the deck watching when our neighbor arrived and ran up underneath the deck.  One of the caregivers ran out of the house and helped the neighbor get him out from where he was wedged.  Daddy refused to go to the hospital, but shortly afterwards he ended up in the hospital with a staph infection from injuries and eventually was transferred to a nursing home for care.) 

(Note: Daddy's neurologist told Daddy and Elizabeth that under no circumstances should Daddy drive again.  We did not learn this until many months later.  Elizabeth continued to allow Daddy to drive.  Barbara, who was the court appointed guardian/conservator of mother at this time, did not renw the insurance or tag on the car which was in mother's name.  Daddy kept driving.  I purchased a boot and had it put on the steering wheel.  Daddy called the man who did little favors for him in return for 17 acres of free hay (Steve Pennnington) to come over and cut off the boot.  It ended up on my doorstep the next morning.  Barbara then had a state trooper come talk to Daddy about not driving anymore, and he said the wouldn't.  Shortly after that Elizabeth bought a van (her name but mother and daddy's money) and gave Daddy the keys.  Within 24 hours, Daddy had driven the van through the back of the garage, through the back room of the house, and off the deck.  The neighbor heard the commotion and came running.  Daddy was making donuts around the barn.  His foot was stuck on the gas and he could not figure out how to get it off.  The neighbor ran alongside the van, snatched open the door and pulled Daddy to safety.  Elizabeth had the van repaired and brought back.  Daddy still had the keys.)

(Note: Mother was on oxygen 24/7 plus oxygen treatment every 2 hours.  Her lungs would not expel.  Barbara received a frantic phone call from the caregiver at the time.  She said that Elizabeth had ordered her to take mother out to get some fresh air and park her on the porch under the pear tree while Daddy mowed the yard.  Everything was in full bloom, the air was thick with pollen, and mother was having difficulty breathing even in the house.  To have moved her outdoors under the pear tree at this critical juncture could have been lethal for her.   Barbara -the guardian at the time-told the caregiver absolutely not.)

(Note: Mother was past walking and talking.  Elizabeth had come down from Ohio for a visit.  While the caregiver was in the bathtub, Elizabeth attempted to move mother and "accidentally" dropped her.  She left her on the floor without telling the caregiver until the caregiver came into the room sometime later and found mother curled up on the floor.  Elizabeth went back to Ohio and the caregiver did not tell Barbara or me what happened.  Barbara was there a couple of hours later and mother had her eyes closed and was very quiet.  The next morning when Barbara noticed that mother was moaning and crying, she querried the caregiver who told Barbara what  had happened.  Barbara called the ambulance to take her to the hospital.  X-rays revealed no broken bones, but contusions around the hips and pelvic area  -which may or may not have happened as a result of the fall.  As a side note, the 5-day-a-week caregiver was TERRIFIED of Elizabeth and frozen with fear when Elizabeth and Daddy were together.  As mother has said a thousand times, referring to Elizabeth and Daddy, "I can't fight both of them.")

(Note: Remy called Barbara and told her that Elizabeth had defiantly taken mother to WalMart (without Barbar's permission).  This resulted in a major medical setback for Mother.  She ended up on antibiotics for 18 days.)  She also took her to get ice cream (windows down in the car, air blowing in mother's face).  They were gone for 3 hours.  Mother ended up coughing and congested,  which rolled right into a diagnosis of congestive heart failure.  She never recovered from that setback and began a slow decline in health from that point until her death.)

Emotional or psychological abuse can range from name-calling or giving
the "silent treatment" to intimidating and threatening the individual.
When a family member, a caregiver, or other person behaves in a way
that causes fear, mental anguish, and emotional pain or distress, the
behavior can be regarded as abusive. Emotional and psychological abuse
can include insults and threats. It can also include treating the
older person like a child and isolating the person from family,
friends, and regular activities-either by force or threats or through

(Note: Elizabeth had the sheriff' department throw mother's only living relative, her sister, off the property when she went over to visit.  Charlsie was an RN and she and mother have always had a close, personal relationship, partly because the two of them depended on each other as children when their father was killed and their mother sent them to an orphanage, and partly because they both ended up in relationships with abusive spouses.  Charlsie had divorced her husband but mother had never had the courage to do so because of what others might think of her.  Still, she occasionally talked about her lack of having done so to those closest to her.)
(Note: Mother's sister, Charlsie, being an RN, had made a wall of pictures in mother's bedroom of those people and events in mother's life that had brought her joy...pictures of people and snapshots of events.  Elizabeth removed all of the pictures from all of the walls and shelves in the house which were not of her or her family (pictures which were never seen again), repainted the wall in mother's bedroom, and placed large pictures of her and her family on the wall, on mother's dresser, and on all of the shelves in the entire house.  She took away (also never to be seen again) all of the little gifts that her loved ones had given her, such as a special pillow Barbara had given her that she loved and called her "Chocolate Pillow".  She visually erased mother's life.) 

(Note: Elizabeth removed all of mother and daddy's personal papers from the house -they always kept them in a briefcase in the closet- and took everything in the safe deposit box and closed it out.  The papers, which included notes on what their wishes were as well as their will, disappeared.  Mother saw her take the papers and could do nothing.)

(Note:  Elizabeth went through mother's closed in front of her in the bedroom and sorted through her clothes, taking everything that was nice.  She left only a few of the old gowns.  All of the new gowns, dresses, etc. that Barbara and Charlsie had purchased for her disappeared.)

(Note: Elizabeth perfected what Barbara and I called "The Quilt Walk."  Anything large that could not be sneaked out of the house without someone seeing it would begin "The Walk."  It would start in the room where the article was found.  Suddenly and unexplicably, the article would appear out in the room on a chair, bed, or table.  There it would sit for 2-3 days.  Then it would mysteriously appear in the next room closer to the garage, usually the living room which was rarely used.  Lastly, it could be found poised on the shelf above the washer/dryer.  There it would sit for 2-3 days until one day, it was just missing.  By them Elizabeth would have moved her car into the garage "to pack it".  The garage door is 3 steps from the washer/dryer.  Most of the valuables would disappear this way: quilts, afgans, clothes, pillows, pictures.)

(Note: The house phone was in the bedroom and living room.  As mother became more bedridden, Daddy started to answer the phone and say that mother wasn't available to talk.  This behavior started after the long listen phone calls started from Elizabeth.  It continued to get worse and Daddy wouldn't let mother talk at all on the phone.  To resolve the problem, Barbara and I had a separate line put in mother's bedroom next to her bed.  Elizabeth told the guardian ad litem that the phone in the bedroom needed to come out because it created a fire hazard.  When that didn't work, she tried unsuccessfully through the court to have it taken out. )

Financial exploitation can range from misuse of an elder's funds to
embezzlement. Financial exploitation includes fraud, taking money
under false pretenses, forgery, forced property transfers, purchasing
expensive items with the older person's money without the older
person's knowledge or permission, or denying the older person access
to his or her own funds or home. It includes the improper use of legal
guardianship arrangements, powers of attorney, or conservatorships

Financial or material exploitation is defined as the illegal or
improper use of an elder's funds, property, or assets. Examples
include, but are not limited to, cashing an elderly person's checks
without authorization or permission; forging an older person's
signature; misusing or stealing an older person's money or
possessions; coercing or deceiving an older person into signing any
document (e.g., contracts or will); and the improper use of
conservatorship, guardianship, or power of attorney.

Cues That Cannot Be Explained Medically May Signal Elder Abuse

Many of the symptoms listed below can occur as a result of disease
conditions or medications. The appearance of these symptoms should
prompt further investigation to determine and remedy the cause.
  •     Emotional/Psychological Abuse
  •      Uncommunicative and unresponsive
  •      Unreasonably fearful or suspicious
  •      Lack of interest in social contacts
  •      Chronic physical or psychiatric health problems
  •      Evasiveness 
  •      Financial Abuse or Exploitation
  •      Life circumstances don't match with the size of the estate
  •      Large withdrawals from bank accounts, switching accounts, unusual  ATM activity 

    Family Situations and Elder Abuse
    Family situations that can contribute to elder abuse include discord
    in the family created by the older person's presence, a history and
    pattern of violent interactions within the family, social isolation or
    the stresses on one or more family members who care for the older
    adult, and lack of knowledge or caregiving skills.

    Intergenerational and marital violence can persist into old age and
    become factors in elder abuse. In some instances, elder abuse is
    simply a continuation of abuse that has been occurring in the family
    over many years. If a woman has been abused during a 50-year marriage,
    she is not likely to report abuse when she is very old and in poor