The U.S. National Center on Elder Abuse estimates that between 1 million and 2 million Americans age 65 or older are victims of abuse each year. Elder abuse can be physical, emotional or psychological. It can also take the form of financial exploitation and intentional or unintentional neglect of an older adult by a caregiver.

Elder abuse usually occurs at a victim’s home, not in institutional settings such as nursing homes. Perpetrators are usually family or other household members or paid caregivers.

Risk factors for elder abuse include discord in the family created by an older person’s presence, a history and pattern of domestic violence and/or substance abuse within the family nucleus, social isolation and lack of knowledge or caregiving skills.

Caregiver stress is another important risk factor. Caregivers can feel trapped and alone while caring for the daily needs of a person, especially if the role is unfamiliar, if they lack training or are also faced with financial stress. In addition, caregivers can also be abused. They frequently experience physical or psychological abuse, especially if the patient has emotional or neurological issues, such as dementia.

Most cases of elder abuse are not reported to authorities. Certain societal attitudes may make it easier for elder abuse to continue without detection or intervention. These factors include a devaluation or lack of respect for elderly people and the conventional belief that matters inside a home are private. Certain cultural factors, such as language barriers, may also make elder abuse or neglect difficult to distinguish.

Signs indicative of elder abuse include:

• Any bruises, grip marks or other injuries indicating physical abuse.
  
  
• Refusal to return to a medical facility for treatment of repeat injuries.
  
  
• Being uncommunicative, showing a lack of interest in social contacts or acting unreasonably fearful or suspicious. This may indicate emotional or psychological abuse.
  
  
• Unexplained vaginal or anal bleeding and sexually transmitted diseases (e.g., herpes). This can suggest sexual abuse.
  
  
• Life circumstances do not match the victim’s lifestyle, including large withdrawals from bank accounts and unusual ATM activity, switching of financial accounts or any other signs of financial abuse or fraud.
  
  
• Sunken eyes, unexplained weight loss, bedsores or dehydration. These can indicate neglect.