By Tobi Abramson
Recognizing the signs and symptoms of elder abuse is crucial in getting help for older adult victims. Professionals often initially miss many signs and symptoms that can indicate abuse as they can overlap with other symptoms of deteriorating mental health. Recognizing elder abuse is central to prompt intervention and to reducing the impact of abuse on the older person’s psychological and physical well-being.
Symptoms can be divided into the physical or concrete and the behavioral, although there is often overlap between the two. Professionals and the lay public are most familiar with concrete symptoms. Yet behavioral signs can be extremely important in detecting abuse and neglect, especially in people who have communication challenges and are unable to express what has happened or is happening to them. In many cases, physical signs of abuse may not yet be present or noticed, so behavioral signs are often the first indicators of abuse. Usually people who have been abused exhibit a combination of physical and behavioral changes.
Telltale signs of physical abuse include: bruises, especially in cluster or regular patterns, black eyes, welts, laboratory evidence of overdoses of medication or lack of administration of medication, to name a few. Some older adults may verbally report being physically abused.
From a behavioral standpoint, older adults who are being physically abused may present with anger, fear, anxiety, nervousness or depression. They may avoid eye contact, their eyes may dart or they may even startle easily or cringe. They also may exhibit sudden apathy, or withdrawal behavior. In some cases, the caretaker may refuse visitors or not allow the elder to be alone with visitors.
Psychosomatic complaints are another common indicator of abuse. For men, the most common complaint is stomachaches, whereas women tend to complain of headaches. Other behavioral signs to look for can include changes in the manner in which affection is shown, particularly when this display is unusual or inappropriate, or sudden changes, such as fears of being touched. Sleep patterns can change, too, with an onset of nightmares or difficulty sleeping. These, too, may be telltale signs of physical abuse or neglect.
Emotional abuse by definition means the older adult suffers insults, threats, intimidation, humiliation or harassment, causing distress. Classic symptoms of this type of abuse can be seen when the older adult is emotionally upset or when the elder displays agitated or fearful behavior, especially in the presence of a specific individual. The older adult may withdraw or become apathetic. It is possible that older adults who are experience emotional abuse may regress and engage in unusual behavior like sucking, rocking or even biting. Older adults may experience depression or mood swings when they are victims of emotional abuse. In addition to the behavioral symptoms, some may verbally express suffering this type of abuse or mistreatment.
Financial abuse does not leave physical scars, but can still strip away an older person’s self-esteem and trust. Financial abuse is the financial exploitation or improper use of an older person’s assets, funds or property. Older adults may perceive this type of abuse as shameful. Older adults may seem suspicious of everyone, whereas prior to the abuse they were more trusting. This increased suspiciousness can add to an older adult’s isolation. There is a strong interrelationship between financial abuse and other forms of elder abuse, and as such some of the behavioral symptoms seen may reflect this type of abuse too.
Many behavioral symptoms of elder abuse overlap with symptoms of mental deterioration and can appear to be symptoms of dementia, frailty or other mental health problems. This does not mean they should be dismissed. These signs and symptoms need to be taken seriously. Each victim will respond differently, and professionals need to be sensitive to the presence of certain physical and behavioral indicators. There is no universal response to being a victim of abuse or neglect, so the rule of thumb for recognizing the behavioral signs of abuse, neglect or exploitation is to know what is normal behavior for that older person.
When assessing the person’s behavior, understanding the history of the behavior, obtaining a behavioral baseline if possible, determining whether a clear behavior change has taken place during the time frame in question and considering any changes in the intensity and duration of the behavioral occurrences are all key to identifying abuse and neglect. Proper assessment and diagnosis can mean the difference between neglect and getting help.
Tobi Abramson, Director, Center of Gerontology and Geriatrics, New York Institute of Technology and Member, ASA Board of Directors, Chair, Leadership Coordinating Council, Chair, ASA Awards Committee, Co-Chair, MHAN Editorial Advisory Board.
This article was brought to you by the editorial committee of ASA’s Mental Health and Aging Network (MHAN).