Five Elder Abuse Signs

Elder-AbuseHard to imagine and way under-reported

Nurses, physical therapists, counselors etc, who provide care in the community are on the front lines identifying potential elder mistreatment. Abuse and neglect of the elderly is a serious and prevalent problem that was estimated to affect more than a million individuals. And that number may be conservative.


Terry Fulmer, PhD,  Advanced Practice RN, reported in her article in The Hartford Institute for Geriatric Nursing, only one in ten cases of elder abuse are actually reported and there is even serious under-reporting by clinical professionals.  Ms.Fulmer attributes this professional under-reporting to, most likely, lack of appropriate screening instruments. Elder mistreatment is defined by abuse (physical, verbal and even sexual), mistreatment, neglect, exploitation, and abandonment.

We use a screening tool called the Elder Assessment Instrument (EAI) which has been present in literature since the 1980’s. This tool or some variation of it, may be used in all clinical settings by people who treat the elderly population. The tool takes about 15 minutes to use and includes assessment of five indicators.

These indicators include:

  • A general assessment
  • Possible abuse
  • Possible neglect
  • Possible exploitation
  • Abandonment

What to look for:

General assessment includes appearance of clothing/hygiene/ skin/nutrition and any additional findings of care and environment.

Abuse and neglect indicators include injuries, bruising, various stages of fractures, sexual abuse, and clinical signs like bed sores, depression, diarrhea, poor hygiene, and failure to respond to warning of obvious disease and repetitive hospital admissions due to probable failure of health monitoring.

Exploitation indicators include misuse of money and finances with reports of demands for goods in exchange for services and inability to account for money and/or property.

Abandonment may include withdrawn care without alternative arrangements, or evidence a senior citizen has been left alone in an unsafe environment without adequate support.

Each of these indicators also may be reported by the elder in question as well. Although there is not a formal scoring system in this tool, clinicians AND care-givers can be more aware of the signs of elder mistreatment by using the tool as a starting point and guide.

As we provide care to our ever-increasing elderly population, responsibility lies not only with clinicians but well-meaning family and friends. If there is ANY question an Elder is being mistreated, a social service referral should be generated.

How to report or inquire about elder abuse:

The National Center on Elder Abuse (NCEA) serves as a resource center dedicated to the prevention of elder mistreatment. It was first established by the U.S. Administration on Aging (AoA) in 1988 as a national elder abuse resource center. I have included the link above so you may review this site for more details and contact information for reporting potential elder abuse and local support in your geography.

All of us have the responsibility to participate in the full circle of properly caring for our wise, valued, and vulnerable seniors.

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