Elder Abuse: Spotting the Signs and Getting Help

Elder abuse. What is it? Where does it happen? Who are the victims? What can we do to protect our loved ones? The questions are simple but the answers are not. Certified Elder Law Attorney Barbara Boone McGinnis shares what you need to know about this growing threat to elderly loved ones. 

What is Elder Abuse and Neglect?

The Tennessee Adult Protection Act defines it this way:

Infliction of physical pain, injury, or mental anguish, or deprivation of services by a caretaker which are necessary to maintain the health and welfare of an adult or a situation in which an adult is unable to provide or obtain the services which are necessary to maintain that person’s health or welfare. 

The National Center on Elder Abuse defines it like this:

“Physical, sexual, or psychological abuse, as well as neglect, abandonment, and financial exploitation of an older person by another person or entity, that occurs in any setting (e.g. home, community, or facility), either in a relationship where there is an expectation of trust and/or when an older person is targeted based on age or disability.”

Types of Elder Abuse

Abuse of elders takes many different forms, some involving intimidation or threats against the elderly, some involving neglect, and others involving financial trickery. The most common are defined below.

Physical elder abuse: The non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. Such abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement.

Emotional elder abuse: In emotional or psychological abuse, people speak to or treat elderly persons in ways that cause emotional pain or distress, including intimidation through yelling or threats, humiliation and ridicule, habitual blaming or scapegoating, ignoring the elderly person, isolating an elder from friends or activities, or terrorizing or menacing the elderly person.

Sexual elder abuse: Contact with an elderly person without the elder's consent. Such contact can involve physical sex acts, but activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse.

Elder neglect or abandonment by caregivers: Elder neglect—failure to fulfill a caretaking obligation—constitutes more than half of all reported cases of elder abuse. It can be intentional or unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as he or she does.

Financial exploitation: This involves unauthorized use of an elderly person's funds or property, either by a caregiver or an outside scam artist. An unscrupulous caregiver might misuse an elder's personal checks, credit cards, or accounts; steal cash, income checks, or household goods; forge the elder's signature, or engage in identity theft. Typical rackets that target elders include announcement of a "prize" that the elderly person has won but must pay money to claim, phony charities, investment fraud, or healthcare fraud and abuse.

Healthcare abuse: Carried out by unethical doctors, nurses, hospital personnel, and other professional care providers, examples of healthcare fraud and abuse regarding elders include not providing healthcare, but charging for it, overcharging or double-billing for medical care or services, getting kickbacks for referrals to other providers or for prescribing certain drugs, overmedicating or undermedicating, recommending fraudulent remedies for illnesses or other medical conditions, or Medicaid fraud.

Where Does Elder Abuse Occur?

According to the Administration on Aging, most abuse occurs where the elder lives, in his or her own home. A relatively small number (1.5 million) and percentage (3.2%) of the 65+ population in 2014 lived in institutional settings. Among those who did, 1.2 million lived in nursing homes. However, the percentage increases dramatically with age, ranging (in 2014) from 1% for persons 65-74 years to 3% for persons 75-84 years and 10% for persons 85+. A growing number of elders are also abused online as humiliating photos or videos are posted on social media accounts. 

How Many Elders are Affected?

It is estimated that one in ten adults over the age of 60 is a victim. We don’t know for certain how many older adults are suffering from abuse. Elder abuse is underreported. It lacks clear legal definition and is complicated by ethical challenges.  Experts suggest that our understanding of elder abuse lies decades behind that of child abuse and domestic violence. 

Who are the Perpetrators?

A study of 4,156 older adults found that family members were the most common perpetrators of financial exploitation of older adults (57.9%), followed by friends and neighbors (16.9%), followed by home care aides (14.9%). In Tennessee, 2011 Adult Protective Services statistics revealed that 71% of identified perpetrators were related to the victim. Ten percent were spouses and 31% were adult children.

What are the Risk Factors?

Several studies have investigated what factors might make someone more at risk of becoming a victim of elder abuse. 

  • Low social support has been found to significantly increase the risk of virtually all forms of mistreatment.
  • Dementia is also a risk factor. A 2009 study revealed that close to 50% of people with dementia experience some kind of abuse.
  • Experience of previous traumatic events—including interpersonal and domestic violence—has been found to increase the risk for emotional, sexual, and financial mistreatment.
  • Functional impairment and poor physical health are associated with greater risk of abuse among older persons.
  • Women appear to be more likely to be abused than men.
  • Younger age may be associated with greater risk of abuse. Adults in their late 50s and 60s are more likely to report verbal mistreatment or financial mistreatment than older adults. Young-old respondents (aged < 70 years) were more likely than respondents in the old-old group to fall victim to emotional, physical, and financial mistreatment by strangers. However, this difference may be attributable to the absence of institutionalized older adults or their representatives in their sample.
  • Living with a large number of household members other than a spouse is associated with an increased risk of abuse, especially financial abuse.
  • Lower income or poverty has been found to be associated with elder abuse. Low economic resources have been conceptualized as a contextual or situational stressor contributing to elder abuse.

What are the Warning Signs?

How can you tell that an elder is being abused? The following signs may point to a problem:

  • Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
  • Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
  • Bruises around the breasts or genital area can occur from sexual abuse.
  • Sudden changes in financial situations may be the result of exploitation.
  • Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
  • Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.
  • Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs.

Be alert. The suffering is often in silence. If you notice changes in a senior’s personality or behavior, you should start to question what is going on.

Remember, it is not your role to verify that abuse is occurring, only to alert others of your suspicions. Please visit the webpage What If I Suspect Abuse, Neglect, or Exploitation? to learn what you should do if you are concerned that someone you know is being abused. If an elder is isolated, depressed, avoids eye contact, speaks in monotone, has memory issues, is suffering from dementia, seems overly fearful, or is not allowed to speak, those could be red flags indicating unmet psychological needs.

What Should You Do if You Suspect Elder Abuse?

If you’re concerned that someone you care about is a victim of elder abuse, report what you know to the proper authorities. And don't think that it's up to you to prove abuse. Let the authorities investigate. By law in Tennessee, everyone is a mandatory reporter, meaning that if you suspect that an older adult is being abused, neglected, or exploited, you are required to tell someone. 

If the abuse is a life-threatening emergency, call 911. Otherwise, call your local police department. 

If the abuse involves neglect, either self-neglect or neglect by caregivers, call the Adult Protective Services hotline at 888-277-8366 or report online at https://reportadultabuse.dhs.tn.gov. 

If you want to report adult abuse that has occurred outside the State of Tennessee and you do not know how to contact the state where it occurred, go to http://www.napsa-now.org/ to find contact information for each state. 

If the abuse involves mail fraud, theft, lottery scams, mass media scams, or wire fraud, call the US Postal Service at 877-876-2455.

If the abuse is occurring in a long-term care facility, call the Long-Term Care Ombudsman at 877-236-0013. You can also call the Tennessee Department of Health if the abuse is taking place in a nursing home, residential home for the aged, hospital, residential hospice, or assisted living facility, or if the abuse involves employees of a home care organization such as home health, home hospice or home medical equipment. 

For more information on how and where to report, visit the Tennessee Commission on Aging & Disability at https://tn.gov/aging/topic/elder-abuse and 

Can Elders Recover Damages?

Here’s something most perpetrators don’t consider. Tennessee law says that an elderly person or disabled adult, in their own right or by conservator or next friend, has the right to recover compensatory damages in a civil action for abuse, neglect, sexual abuse or exploitation. In addition, they may recover for theft of property accomplished by fraud, deceit, or coercion.

If the elder or disabled adult dies, the right to bring a lawsuit passes to the spouse or next of kin, unless the alleged wrongdoer is a family member.  If the alleged abuser or thief is a family member, the right to bring suit and recover damages passes to a personal representative appointed by a court.

Damages can include money to compensate for abuse, neglect, sexual abuse or exploitation and money to compensate for any property taken by financial exploitation. Damages can also include punitive damages, court costs, and attorneys’ fees.

As part of a claim for elder abuse, a court can declare a marriage void and unenforceable. The court must find that the marriage was part of a scheme to commit abuse or theft.  


Willful abuse, neglect or exploitation of an elder or disabled adult is also acrime—it’s a Class A misdemeanor.  Willful physical abuse or gross neglect that causes serious mental or physical harm is punishable as an aggravated assault. 

Preventing Elder Abuse is Everyone’s Responsibility

It’s up to all of us to learn about elder abuse so we can help stop it. Knowing what to look for—and what to do if you see red flags—is the most important first step.~

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