Elder or Dependent Adult Neglect
When a caregiver fails to meet the needs of an elderly person who cannot care for themselves, neglect can result. Sometimes the caregiver may withhold nourishment, medications, or even hygiene, leaving the elderly person in serious danger. According to the federal Centers for Disease Control and Prevention, hundreds of thousands of seniors are intentionally neglected by family members and caregivers each year. Many victims are people who cannot help themselves and depend on others to meet their most basic needs.
Neglect occurs when a caregiver does not provide for an elder's safety or for their physical and/or psychological needs. Physical neglect can mean failing to provide an elder with adequate and necessary medication or physical therapy, not taking care of their personal hygiene needs, or forcing them to live in unsanitary or potentially harmful conditions. Psychological neglect can mean leaving an older person alone for long periods of time or failing to provide the social contact, activities, and information necessary for an elder to thrive.
Self-neglect is one of the most common forms of elder abuse and neglect. Self-neglect occurs when an elderly person engages in behavior that threatens their own safety, such as failing to provide themselves with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions.
While states define abuse differently, each one has passed some form of elder abuse prevention laws and established a reporting system. Generally, Adult Protective Services (APS) agencies receive and investigate reports of suspected elder abuse or neglect.
According to the National Council on Aging, one in 10 elderly persons has experienced some form of elder abuse. However, many possible cases are not reported, because the elderly person is unwilling or unable to tell family, friends, or authorities about their experiences.
Additional research reveals the following disturbing findings:
- 551,011 persons age 60 and older experienced abuse, neglect, and/or self-neglect in a one-year period.
- Conservative estimates put the number of elders who have been injured, exploited, or otherwise mistreated at about 1 to 2 million; however, studies suggest that only 1 in 14 domestic elder abuse incidents comes to the attention of authorities. Almost four times as many new incidents of abuse, neglect, and/or self-neglect are unreported than are reported to and substantiated by Adult Protective Services agencies.
- The one-year prevalence of various kinds of abuse is:
- Persons age 80 years and older suffer abuse and neglect at a rate two to three times greater than their proportion of the older population.
- The great majority of abusers are family members, most often an adult child or spouse. A family member is the perpetrator of abuse or neglect in 90 percent of reported cases. Two-thirds of the perpetrators are adult children or spouses.
- Abuse can also occur at a long-term care facility, such as a nursing home or assisted-living residence. Employees and temporary staff who have direct contact with residents are the most frequent perpetrators. Other offenders may include other family and old friends, newly developed "friends" who intentionally prey on older adults, and service providers in positions of trust.
Possible signs of elder abuse or neglect include:
- Absence of necessities including food, water, and heat
- Untreated or unexplained worsening of medical or mental conditions
- Inadequate living environment evidenced by a lack of utilities, sufficient space, and ventilation
- Animal or insect infestations
- Signs of medication mismanagement, including empty or unmarked bottles or outdated prescriptions
- Unsafe housing as a result of disrepair, faulty wiring, inadequate sanitation, substandard cleanliness, or architectural barriers
- Unexplained injuries or unlikely explanations for injuries
- Dehydration or malnutrition, often evidenced by loss of weight or extreme thirst, low urinary output, dry, fragile skin, dry, sore mouth, apathy, lack of energy, and mental confusion
- Poor personal hygiene
- Untreated bedsores
- Being unclothed, or improperly clothed, for the weather
- Extreme withdrawal or agitation
- Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces, or commodes
- Nightmares or difficulty sleeping
- Regressive or self-destructive behavior
- Exhibiting emotional distress
- Ambivalent feelings toward caregivers or family members
Many older people don’t report neglect or abuse because they are embarrassed, afraid, or physically or mentally unable to do so. Some may not even realize they are being neglected. Additional fears include retaliation, the threat of being moved or placed in a nursing home, and not believing that help is available.
Elder neglect is the failure to provide an older person with important needs such as adequate food, water, medicine, or safety. Elder abuse, by contrast, is the infliction of physical or psychological pain or the deliberate deprivation of resources to sustain the older adult’s physical and mental health. The distinction involves intention and action—neglect generally represents a lack of caretaking while abuse involves actively harming the person.
Older people who live alone sometimes fall into decline and stop caring for themselves. Self-neglect is failing to adequately care for one’s health and hygiene; the person may be malnourished, dehydrated, or live in an environment that is very dirty or dangerous, such as in a home without heat or electricity. People who self-neglect sometimes struggle with dementia, mental illness, or social isolation.
Caregiver stress is a factor that can trigger elder neglect. Caregiving is widely recognized to be a highly stressful activity. Sources of caregiver stress can include lack of support from other potential caregivers, and the perception that caregiving is burdensome or without psychological reward. Adult children who have no financial resources for providing health care other than those belonging to their aging parent are especially vulnerable to stress.
Caregivers and family members who are solely responsible for the bulk of a senior's care may become isolated from other relatives and friends, leaving them cut off from the support they need to cope with caregiving. Isolation also makes it harder for other people to intervene when a senior is being abused or neglected.
Cognitive impairment increases the likelihood of being victimized. Beginning in the early stages of dementia, seniors are particularly vulnerable to financial abuse while family members, including spouses, may be more likely to engage in physical intimidation or neglect if they feel overwhelmed by the responsibility of caring for someone with dementia.
Substance abuse is a key risk factor for elder abuse and neglect. Substance use could on the part of the victim, leading to increased vulnerability or self-neglect, or on the part of the perpetrator, who may be driven to financially exploit the victim to continue their use or fail to carry out their responsibilities due to their use.
Elder self-neglect is often driven by dementia, depression, grief, substance use, and other mental health conditions. Some may refuse to reach out for help because they feel embarrassed, fear the consequences such as being forced to move, or lack adequate social support to comfortably ask for assistance.
An observer who suspects that a senior is being neglected by a caretaker should contact their county's Adult Protective Services unit or a medical professional. All calls to APS agencies are kept confidential. If the APS unit suspects that elder abuse laws are being violated, the agency will assign a caseworker to carry out an investigation.
Alleviating caregiver stress is, in many cases, the first step toward preventing elder neglect. If a caregiver feels overwhelmed, they can seek therapy or help from other family members, or consider other care options for the elderly person. Many state and nonprofit agencies also offer respite services to provide family members with temporary relief from the stress of caring for a senior. There are many support groups for caregivers of the elderly; they can provide a forum to discuss the issues around caregiving.