March/April 2009

Aspects of Elder Abuse
By Donald D. Vanarelli, Esq
Aging Well
Vol. 2 No. 2

The statistics are alarming. Reports of elder abuse have increased sharply as the disproportionate rise in America’s elder population continues. Yet experts estimate that elder abuse is vastly underreported for a variety of reasons, making it among the most hidden of contemporary America’s problems.

While the physical abuse of an elder may be more generally recognized, the financial exploitation of older adults also carries with it telltale warning signs. By recognizing the risk factors and warning signs of elder abuse, friends, neighbors, and professionals can provide assistance critically necessary to protect elders from abuse.

Defining the Problem
Elder abuse is broadly defined as the infliction of harm on an older adult. It can occur in a private home or in an institutional setting. Physical or psychological abuses of an older adult, theft of an elder’s money or property, or intentional or unintentional failure to properly care for an older adult are all examples of elder abuse, neglect, and/or exploitation.

Elder abuse is a problem that grows with the increasing older adult population. In the United States between 1986 and 1996, there was a 150% increase in reported incidents of abuse to state adult protective services, according to information presented at the 2002 United Nations Second World Assembly on Ageing. This upward trend is likely to continue. Census data indicate there were 35 million people aged 65 and older in the year 2000; estimates suggest that number will likely double by the year 2030.

Nevertheless, in what has been described as a tip-of-the-iceberg phenomenon, it is estimated that only 14% to 16% of all elder abuse incidents are reported to authorities. U.S. Senate research estimates that between 500,000 and 5 million incidents of elder abuse occur annually.

Types of Elder Abuse
The National Center on Elder Abuse broadly defines seven categories of elder abuse. The first category, physical abuse, is defined as the use of physical force that may result in bodily injury, physical pain, or impairment to the elder. Sexual abuse is defined as nonconsensual sexual contact with the elder.

Another category, emotional abuse, encompasses the infliction of anguish, pain, or distress through verbal or nonverbal acts. The National Center on Elder Abuse defines the category of neglect as “the refusal or failure to fulfill ... duties to an elder.” The category of abandonment is defined as desertion by the person with physical custody of or responsibility for the elder.

Self-neglect is a category of abuse in which the elder engages in behavior that threatens his or her own health or safety. And finally, financial exploitation is the “illegal or improper use of an elder’s ... assets.”

With signs including unexplained physical symptoms or injury or a sudden change in the elder’s behavior, including isolation from friends and family or withdrawal or anxiety in the presence of the elder’s caregiver, the first six categories of abuse may be more easily recognizable. But there are also symptoms and warning signs of financial exploitation and recognizing these signs and symptoms can result in successful intervention.

Financial Exploitation
It has been estimated that people aged 50 and older hold approximately 70% of the nation’s wealth. In the year 2000, cases of financial exploitation accounted for 10.5% of the total number of reports investigated and substantiated by Adult Protective Services.

Disturbingly, the perpetrators of financial abuse are most often the victims’ adult children, accounting for more than 60% of such abuse. The victims’ grandchildren account for 9.2% of the abuse, other relatives account for 9.7%, and friends and neighbors account for 8.7%.

Victim Profiles and Risk Factors
The likelihood of becoming a victim of financial abuse increases with age. According to one study, nearly one half of the victims are aged 80 and older, and nearly 30% are between the ages of 75 and 79. Women are reportedly more vulnerable to financial exploitation than men.

Interestingly, the likelihood of becoming a victim of financial abuse does not increase with increased income levels. An estimated 46% of victims identified in one study had incomes between $5,000 and $9,999; nearly 30% had incomes between $10,000 and $14,999; and 22% had incomes of $15,000 or more.

The likelihood of becoming a victim of financial exploitation increases with the following risk factors:

• isolation or loneliness;

• disability (physical or mental);

• recent personal loss (e.g., death of a spouse);

• lack of financial sophistication; and

• unemployment or substance abuse problems in the family.

The Problem of Underreporting
The problem of underreported elder abuse is not limited to cases involving physical abuse. Elder victims of financial abuse are frequently unwilling or unable to report that they have been or are being exploited. This may occur for a variety of reasons. For example, a disability may preclude the victim from reporting, or even being aware, that the exploitation has occurred.

The abuse victim may also be ashamed. An elder may fear that he or she will not be believed or that he or she will be labeled a victim. The victim may rely on the perpetrator for love, companionship, care, or shelter and may fear retaliation or abandonment. The individual may be reluctant to report the abuse because he or she does not want to get a family member in trouble. Finally, the victim may fear that reporting the exploitation will lead to the loss of independence (e.g., through the appointment of a guardian or placement in a long-term care facility).

Warning Signs of Financial Abuse
Third parties may be able to recognize indicators that financial exploitation is occurring or has occurred. For example, there may be inappropriate or new persons conducting financial transactions for the elder. The elder may be opening new joint bank accounts or adding names on bank signature cards. Perhaps the elder’s mail is being forwarded to a different address. There may be bank activity that is inconsistent with the elder’s abilities (such as the use of an ATM by a bedridden elder). Another indicator may be large, unexplained bank withdrawals, transfers, or checks made payable to cash. Suspicious signatures may appear on estate documents or financial papers. There may be unpaid rent, utilities, or other bills or changes to the elder’s estate plan or financial arrangements, such as a will or power of attorney, that the elder cannot explain.

Other indicators of financial abuse may be sudden isolation or estrangement of the older adult from his or her family and friends. The elder may exhibit signs of hoarding, such as carrying belongings in bags. There may be sudden changes in the elder’s attorney, stockbroker, physician, or other professional or the appearance of new best friends or previously uninvolved relatives.

The elder may appear reluctant to discuss matters alone or may have a third party speak for him or her. The perpetrator may display hostility toward the elder’s visitors. It may also become apparent that the elder is receiving an inappropriate level of care given the size of the elder’s estate. Finally, the elder’s caregiver or other third party may display an unusual interest in the elder’s financial arrangements.

Reporting Suspected Elder Abuse
If you suspect that an elder may be the victim of abuse, you can report your concerns to a number of agencies, including the local police or prosecutor’s office, Area Agencies on Aging, or the state attorney general’s office. The National Center on Elder Abuse Web site includes a geographic listing of agencies and resources to assist in cases of suspected abuse.