Risk Factors/Screening

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Risk Factors for Elder Abuse

Elder abuse can happen to anyone and occur at any place, including the person’s home, an assisted living facility, a nursing facility or in a hospital. It can affect elderly persons of all socioeconomic groups, races, and cultures. Surprisingly, most of the mistreatment of the elderly comes from family members in the patient’s own home.

Those at the greatest risk for elder abuse are home-bound elders, women, individuals older than 80, and those who live in isolated conditions.

Typical risk factors that make an elder more susceptible to abuse are

  • An isolated or withdrawn elderly person

  • The elderly person is in poor health

  • The elderly person has a mental health issue, a substance abuse issue or suffers from dementia

  • The caretaker has substance abuse or mental health issues

There are several risk factors, which increase the likelihood that an elderly person will become a victim of elder abuse. Such risk factors for elder abuse include an elderly person who:

  • Has memory problems (such as dementia)

  • Has physical disabilities

  • Has depression, loneliness, or lack of social support

  • Abuses alcohol or other substances

  • Is verbally or physically combative with the caregiver

  • Has a shared-living situation

There are also several risk factors, which increase the likelihood that a caregiver will participate in elder abuse. Such risk factors for elder abuse include a caregiver who:

  • Feels overwhelmed or resentful

  • Has a history of substance abuse or abusing others

  • Is dependent on the older person for housing, finances, or other needs

  • Has mental health problems

  • Is unemployed

  • Has a criminal history

  • Has a shared-living situation

Risk factors can also be categorized into individual, relationship, community and socio-cultural levels. At individual level, elders who have poor physical and mental health are at higher risk. At relationship level, a shared-living situation is a huge risk factors for the elderly. Living in the same area with the abuser is more likely to cause an abuse. Third, at community level, social isolation is caused by the caregivers. In addition, some socio-cultural risk factors that can contribute to elder abuse is a representation of an older person as weak and dependent, lack of funds to pay for care, children leaving elderly parents alone and destruction of bonds between the generation of a family.

These are the things you need to look for in caregivers who abuse the elderly:

  • Having a history of mental illness, substance abuse, family violence or criminal behavior

  • Failing to show affection toward the older person

  • Keeping the elderly person from talking to visitors alone

  • Being indifferent, angry or aggressive toward the elderly person

  • Being flirtatious, coy or inappropriate

  • Speaking about the elder as if they were a burden

  • Withholding affection from the elderly person

  • Having conflicting explanations of physical incidents

If you suspect abuse, you need to report it. You can protect seniors by bringing up the issue of abuse with a trusted authority member.

Why Screen?

  • Elder/dependent adult abuse is one of the most under reported crimes in the country, with approximately 1 in 20 elders being abused, as well as an unknown but larger number of dependent adults.

  • Elder/dependent adult abuse is a repetitive crime that often involves multiple types of ongoing abuse.

  • After controlling for age, comorbidity, and socioeconomic factors, abused elders are 3x more likely to die than non-abused.

  • Neglect can wrongly be attributed to depression or dementia.

  • Once pressure ulcers appear, they are much more likely to recur in the same place with minimal trauma, and therefore become a chronic problem.

  • Elderly women may be too ashamed to report sexual abuse.

  • Some studies report over 50% of female dependent adults are sexually abused, often repeatedly.

  • Self-neglect is one of the largest categories of abuse, and is reportable.

  • Screening the caregiver can help identify caregiver frustration and burnout, which can then be addressed to help prevent abuse.

A healthcare setting provides a vitally important opportunity to screen for elder/dependent adult abuse. Office or ED visits may be the only time the patient can have safe, confidential contact with someone other than the abuser. If the patient can understand questions and respond to them, interview in a quiet, private location with a professional interpreter as needed. Always see the patient alone for at least part of the visit.

Interviewing can be difficult if the patient is mentally challenged, or if you suspect the caregiver is the abuser. This is best handled by someone with expertise in geriatrics, and/or a social worker or other mental health professional.

Asking indirectly:

  • Do you feel safe where you live?

  • Who prepares your food?

  • Does someone help you with your medication?

  • Who takes care of your checkbook?

Asking directly:

  • Does anyone at home hurt you?

  • Do they scold or threaten you?

  • Touch you without your consent?

  • Make you do things you don’t want to do?

  • Take anything that’s yours without asking?

  • Had you sign documents that you did not understand?

  • Are you afraid of anyone at home?

  • Are you alone a lot?

  • Has anyone ever failed to help you take care of yourself when you needed help?

Follow-up questions:

  • Explore mistreatment – what, how, when, how often?

  • Who is the perpetrator?

  • How does the patient cope?

  • Assess safety

  • What are alternative living options; who are alternative caregivers?

  • What can be done to prevent future abuse?

If you need help

Visit One Place Family Justice Center at 530 S. Lawrence Street, Montgomery, Alabama or call 334.262.7378 or if you are in immediate danger Call 911.

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