significant as a role of the nurse to strategically iden-
tify a potentially abused elderly individual and to be
proactive in a myriad of applicable interventions in
the prevention of elder abuse.
Definition of Elder Abuse
Elder abuse includes physical, emotional, sexual,
and/or financial abuse, exploitation, neglect, and
abandonment (Eliopoulos, 2018; National Council
on Aging, n.d.). According to Eliopoulos (2018),
elder abuse is defined as “the infliction of physical
or emotional harm, neglect, financial exploitation,
sexual mistreatment, or abandonment of an older
adult” (p. 500). It is further defined to include abuse
to any individual over age 60 as an intentional act,
or failure to act, in which the victim experiences a
safety breech, a health risk, or an action that results
in actual harm (National Institute of Health, 2016).
The World Health Organization (2016) also added
that elder abuse may be “a single or repeated act that
causes harm or distress to an older person” (para. 1).
Targeted Population
One in ten individuals over age 60 experiences some
type of abuse (Centers for Disease Control and Pre-
vention, 2015). This statistic is believed to be inac-
curate and, in fact, much higher. This may be due to
the individual’s inability to report the abuse or fear
of reporting the perpetrator. The elderly individual
may be unable to report abuse due to inaccessibility
(lack of phone service), geographical isolation, cogni-
tive issues such as memory impairment or dementia,
physical incapacity such as aphasia or frailty, depen-
dency on the perpetrator due to physical limitations
such as effects from a stroke, general fear of retalia-
tion or that the abuser(s) may get in trouble from the
complaint, and other factors.
The profile for the older adult at greatest risk for
abuse is a disabled woman, age 75+, living with a
relative, and physically, socially, or financially depen-
dent on others (Eliopoulos, 2018; Robnett, Brossoie,
& Chop, 2020). The majority of elder abuse occurs to
females. Other victims live alone or may be separated
from their family due to distance. Another separa-
tion factor may be related to family dysfunction such
as a feud or disclaimer of certain family members
Issue 74, 3 2019 Pennsylvania Nurse 6
which thereby eliminates family from visiting on a
regular basis to determine the elder’s welfare.
Elder Abuse: Types, Definitions, and
Manifestations
There are several types of elder abuse that may be
imposed upon the older population. Abuse may occur
in varying degrees and may include more than one
type. Reported studies found that “up to 89% of
abused elders are victims of multiple forms of abuse
which is referred to as polyvictimization” (Ramsey-
Klawsnik, 2017, p. 299). Manifestations may not be
directly evident, or the victim is vague in the descrip-
tion of how the symptoms occurred.
Seven types of elderly abuse are most common: (1)
physical; (2) emotional; (3) sexual; (4) financial; (5)
neglect; (6) abandonment; and (7) healthcare fraud.
Standardization of elder abuse definitions allows
comparisons of the problem across locations (Centers
for Disease Control and Prevention, 2019). Knowl-
edge of definitions and awareness of manifestations
can help identify abuse to further reveal the signifi-
cance of the issue, thereby promoting nurse advo-
cacy for prevention and intervention efforts.
Physical Abuse
Physical abuse is intentional physical force that re-
sults in acute or chronic illness, bodily injury, physi-
cal pain, functional impairment, distress, or death
(Centers for Disease Control and Prevention, 2019).
It may consist of the following direct or indirect
observations: bruises, burns, lacerations, hemato-
mas, loss of hair, scabs, edema, skin discoloration
from healing bruises, pinching, choking, kicking,
bite marks, weight loss, disheveled appearance, poor
hygiene, perineal bruising or orifice discharge, urine
and/or feces odor, spitting, hitting, pushing, broken
eye glasses, and fractures or dislocations on imaging
films.
Emotional Abuse
Emotional abuse is verbal or nonverbal behavior that
results in the infliction of anguish, mental pain, fear,
or distress (Centers for Disease Control and Preven-
tion, 2019). It may consist of the following direct or
indirect observations: shaking, rocking behavior, poor
eye contact, confusion, disorientation, introverted
behavior, anxiety, agitation, violent episodes, disen-