gagement in activities, depressed appearance, fearful,
being threatened, isolation from others, yelling at
and/or humiliating the victim, ignoring, or control-
ling the victim.
Sexual Abuse
Sexual abuse is forced or unwanted sexual interac-
tion (touching and non-touching acts) of any kind
with an older or older incompetent adult (Centers for
Disease Control and Prevention, 2019). It may con-
sist of the following direct or indirect observations:
bruises, burns, bite marks, perineal bruising or orifice
discharge, forcing the victim to participate in sexual
acts, or making the victim view sexually explicit
photos or movies.
Financial Abuse
Financial abuse is the illegal, unauthorized, or
improper use of an older individual’s resources by a
caregiver or other person in a trusting relationship,
for the benefit of someone other than the older indi-
vidual (Centers for Disease Control and Prevention,
2019). It may consist of the following direct or indi-
rect observations: unauthorized withdrawals from
the victim’s bank accounts, transferring or coercing
property without consent, or unauthorized use of
finances from the victim for personal use such as cash
or credit cards.
Neglect
Neglect is failure by a caregiver or other responsible
person to protect an elder from harm, or the failure
to meet basic needs which results in a serious risk of
compromised health and safety (Centers for Disease
Control and Prevention, 2019). It may consist of
the following direct or indirect observations: lack
of medication or medical care, failure to respond to
the victim’s needs, living in an unsafe or unsanitary
environment, evidence of pressure ulcers, or desert-
ing the elder.
Abandonment
Abandonment is purposeful desertion of an older
individual where the person is left in private or public
locations (Thomson Reuters, 2019). It may consist of
the following direct observations: leaving the victim
alone in private or public for long periods of time and
not caring for needs during this time.
According to the National Institute on Aging (2017),
seven million Americans are long-distance caregivers.
This means that the caregiver lives more than one
hour away, but assists the individual who needs some
type of care. Care may include financial manage-
ment, coordination of in-home care, or other health-
related services. The long-distance caregiver may
be a family member, friend, or a person associated
with an agency, and could be implicated in cases of
neglect or abandonment.
Healthcare Fraud
Healthcare fraud is improperly charging the el-
derly individual or providing inadequate healthcare
services (Robinson, Saisan, & Segal, 2019). This is
a fairly new category added to the traditional list
of abuse. It may consist of the following direct or
indirect observations: healthcare providers charging
the victim for services not rendered or over-charging,
fraudulently billing insurance companies, over or un-
der medicating, or suggesting fraudulent treatments.
The Abuser
Frequently, the abuser is trusted and well-known
to the victim such as a family member, neighbor, or
caregiver. The abuser may also be a non-acquain-
tance such as a professional employee at a health care
facility, a roommate in a long-term care institution,
or a boarder in the elder’s home.
The abuser may display the following characteristics:
controlling behavior, mental health issues such as
mania/depression/personality disorders, nervousness,
frustration, low self-esteem, physical or emotional
aggression, refuse to allow the victim to be alone
with healthcare or agency personnel, lack of sup-
port for the victim, statements that the victim is
a burden, suspected or confirmed use of substance
abuse, criminal record especially related to abuse or
history of family violence complaints, or history of
being abused or neglected as a child. In addition, em-
ployees who abuse the elderly may lack training, be
overworked or working in poor conditions, or experi-
ence anger management issues with violent behavior.
See Table 1.
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