This brochure contains brief references to help identify some forms of mistreatment, abuse, neglect, exploitation, or abandonment of older persons by their caregivers. It suggests preventive actions that individuals, families, or communities can take to avoid problems before they can occur. Although briefly stated, some of these suggestions require complex implementation. But most of them contain practical and realistic information which can help you begin to think about actions you or others can take toward preventing or reducing mistreatment or abuse of older Americans.

More complete information should be sought from state, area or city/county agencies on aging, senior citizen centers or similar community groups, hospital or health care professionals, law enforcement personnel, prosecutors, social and protective services workers, public and mental health agencies, attorneys and other individuals or organizations at the local level.

The information above is extracted from Domestic Mistreatment of the Elderly - Toward Prevention, an AARP publication by Richard L. Douglass, M.P.H., Ph.D. and Lee Pearson, Assistant Manager, AARP Criminal Justice Services, produced with support from the AARP Women's Initiative.

Some Signs and Symptoms of Mistreatment or Abuse

In Caregivers

• New self-neglect
• Conflicting stories
• Mounting resentment
• Excusing failure
• Shifting blame
• Aggressive/defensive behavior
• Substance abuse
• Unusual fatigue
• New affluence
• New health problems
• Preoccupation/depression
• Withholding food/medication

In Older Persons

• Increasing depression
• Anxiety
• Withdrawn/timid
• Hostile
• Unresponsive
• Confused
• Physically injured
• New poverty
• Longing for death
• Vague health complaints
• Anxious to please
• Shopping for physicians

There are other signs and symptoms, and not all of those listed by themselves indicate mistreatment, neglect, or abuse. But if any seem to increase in number or severity in a domestic setting, it may indicate trouble. By watching for some of these signs and symptoms of stress or mistreatment, you may be able to initiate actions to reduce or prevent the situation from deteriorating.

Definitions

Passive Neglect

Unintentional failure to fulfill a caretaking obligation; infliction of distress without conscious or willful intent; etc.

Psychological Abuse

Infliction of mental anguish by demeaning, name-calling, insulting, ignoring, humiliating, frightening, threatening, isolating, etc.

Material Financial Abuse

Illegally or unethically exploiting by using funds, property, or other assets of an older person for personal gain, etc.

Active Neglect

Intentional failure to fulfill caregiving obligations; infliction of physical or emotional stress or injury; abandonment; denial of food, medication, personal hygiene; etc.

Physical Abuse

Infliction of physical pain or injury; physical coercion; confinement; slapping, bruising, sexually molesting, cutting, lacerating, burning, restraining, pushing, shoving; etc.

Towards Prevention ... for Individuals

DOs

• Stay sociable as you age; maintain and increase your network of friends and acquaintances.
• Keep in contact with old friends and neighbors if you move in with a relative or change to a new address.
• Develop a "buddy system" with a friend outside the home. Plan for at least a weekly contact and share openly with this person.
• Ask friends to visit you at home; even a brief visit can allow observations of your well-being.
• Accept new opportunities for activities. They can bring new friends.
• Participate in community activities as long as you are able.
• Volunteer or become a member or officer of an organization. Participate regularly.
• Have your own telephone; post and open your own mail. If your mail is being intercepted, discuss the problem with postal authorities.
• Stay organized. Keep your belongings neat and orderly. Make sure others are aware that you know where everything is kept.
• Take care of your personal needs. Keep regular medical, dental, barber, hairdresser, and other personal appointments.
• Arrange to have your Social Security or pension check deposited directly to a bank account.
• Get legal advice about arrangements you can make now for possible future disability, including powers-of-attorney, guardianships, or conservatorships.
• Keep records, accounts, and property available for examination by someone you trust, as well as by the person you or the court has designated to manage your affairs.
• Review your will periodically.
• Give up control of your property or assets only when you decide you cannot manage them. Ask for help when you need it. Discuss your plans with your attorney, physician, or family members.

DON'Ts

• Don't live with a person who has a background of violent behavior or alcohol or drug abuse.
• Don't leave your home unattended. Notify police if you are going to, be away for a long period. Don't leave messages on the door while you are away.
• Don't leave cash, jewelry, or prized possessions lying about.
• Don't accept personal care in return for transfer or assignments of your property or assets unless a lawyer, advocate, or another trusted person acts as a witness to the transaction.
• Don't sign a document unless someone you trust has reviewed it.
• Don't allow anyone else to keep details of your finances or property management from you.

... for Families

DOs

• Maintain close ties with aging relatives and friends. Keep abreast of changes in their health and ability to live independently.
• Discuss an older relative's wishes regarding health care, terminal medical care alternatives, home care in the case of incapacitation and disposition of his/her personal assets.
• Find sources of help and use them. Chore services, housekeeping, home-delivered meals, senior recreation, day care, respite care, and transportation assistance are available in many communities.
• With the older person's consent, become familiar with his/her financial records, bank accounts, will, safe deposit boxes, insurance, debts, and sources of income before he/she becomes incapacitated. Talk and plan together now about how these affairs should be handled.
• Anticipate potential incapacitation by planning as a family who will take responsibility such as power-of-attorney or in-home caregiving if an aging relative becomes incapacitated.
• Closely examine your family's ability to provide long-term, in-home care for a frail and increasingly dependent relative. Consider the family's physical limits.
• Plan how your own needs will be met when your responsibility for the dependent older relative increases.
• Explore alternative sources of care, including nursing homes or other relatives' homes, in case your situation changes.
• Discuss your plans with friends, neighbors, and other sources of support before your responsibilities become a burden. Ask for their understanding and emotional support - you may need them.
• Familiarize family members with emergency response agencies and services available in case of sudden need.

DON'Ts

• Don't offer personal home care unless you thoroughly understand and can meet the responsibilities and costs involved.
• Don't wait until a frail older person has moved in with you to examine his/her needs. You'll need to consider access, safety, containment, and special needs. (Do you need a first-floor bathroom, bedroom, or entry ramp? Will carpets or stairs become barriers? Do you need a fenced yard to prevent the loved one from wandering away? Does your kitchen allow you to prepare special diets or store medications properly? Can you move the person safely in case of fire?)
• Don't assume that poor interpersonal relationships between you, or other members of the household, and the older person involved will disappear.
• Don't expect irritating habits or problems such as alcohol abuse to stop or be controlled once the dependent moves into your home.
• Don't ignore your limitations and over-extend yourself. Passive neglect could result.
• Don't hamper the older person's independence or intrude unnecessarily upon his/her privacy. Provide a private telephone if you can and make other changes if possible.
• Don't label your efforts a failure if home care is not possible and you must seek an alternative.

DOs

• Develop new ways to provide direct assistance to caregiving families. Improve crisis response to help families that face the difficult decision to discontinue home care.
• Through public awareness programs, advocate the cause of caregiving families and the needs of victims of mistreatment.
• Ask other community groups to become more involved in aging service programs, including those at nursing homes or senior citizen housing projects. Their involvement can lead to improved facilities and services.
• Encourage both public and private employers to help caregiving families, especially those with caregivers nearing or beyond retirement age, with fixed incomes and increasing health problems.
• Publicize available support services and professionals available to caregivers, such as senior day-care centers, chore services, companions and housekeeping services. Caregivers may not know about them.
• Give public agency employees basic training in responses and case management. They can be trained to recognize some of the causes of neglect or abuse of older persons and can help in support roles.
• Provide training for community "gatekeepers " and service workers - primary care physicians, public health and social workers, law enforcement officers, transportation and utility workers, postal employees and others - to help them recognize at-risk situations and take appropriate action.
• Expand Neighborhood Watch programs and similar community groups to include training on home care of frail elderly, identification of the signs of mistreatment, and how to provide assistance or initiate preventive actions to reduce such victimization.
• Open your eyes and ears to the possibility that mistreatment is occurring. Become aware of individuals who are at risk. Develop procedures for investigation, public education, and public support of assistance to troubled families.
• Recognize that many forms of mistreatment or abuse are crimes. Volunteers can help victims file formal complaints, seek compensation for losses, seek prosecution of guilty parties, and give the victim assistance subsequent to prosecution. Prosecution can result in sentencing, diversion, training, counseling or other types of family assistance services as alternatives to criminal sanctions.
• Urge public support of agencies to provide the necessary services.

DON'TS

• Don't ignore family caregivers of dependent elderly. They are significant parts of the community. Community services can try to involve isolated people in appropriate services or self-help programs. Those at risk, living in isolation, may simply lack knowledge or information and may welcome community outreach.
• Don't assume that gerontology is a study confined to universities and hospitals. Begin to educate the entire community about aging. (This should be as common in public education as information about childcare.)
• Don't sensationalize stories of abuse of older persons. Instead, try to arouse public interest in techniques and strategies to prevent abuse.
• Don't start a major intervention just because an older person is alone or is said to be eccentric. The goal is to seek the least intrusive alternative.