The thought of intentionally inflicting harm on an elderly person is anathema to most people. Yet thousands of older Americans are abused each year by their caregivers, reports the National Center on Elder Abuse (NCEA), an agency of the U.S. Administration on Aging.

Exact figures are difficult to determine because many abuse victims have dementia or decline to report the abuse, out of fear or because they don't want to get the abuser in trouble. However, the most recent major studies on incidence found 7.6 to 10 percent of study participants experienced some type of abuse in the prior year.

Elder abuse is defined as intentional actions that cause harm or create a serious risk of harm, whether or not harm is intended, to a vulnerable elder by a caregiver or other trusted. It includes:

• Physical abuse: inflicting or threatening to inflict physical pain or injury on a vulnerable elder or depriving them of a basic need such as food, care, or medication.
• Emotional abuse: inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts.
• Sexual abuse: nonconsensual sexual contact of any kind.
• Exploitation: illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.
• Neglect: refusal or failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder.
• Abandonment: the desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.

Elder abuse can occur in any environment. In the home, an abuser might be a spouse, a family caregiver, or someone hired to assist the elder person. In a nursing home, an assisted-living facility, or a group home, abuse might occur at the hands of staff or others. According to the NCEA, most cases of abuse are perpetrated by someone known and trusted by the victim.

Some signs of elder abuse are obvious, others less so. Common indicators include:

• bruises, abrasions, pressure marks, broken bones, or other signs of physical abuse, neglect, or mistreatment;
• unexplained withdrawal from normal activities or unusual depression (potential signs of emotional mistreatment);
• bruises around the breasts or genital area, which may indicate sexual abuse;
• bedsores, unattended medical needs, poor hygiene, or unusual weight loss (strong signs of caregiver neglect);
• agitation at the mention of a particular caregiver's name or in the caregiver's presence by an elder with dementia, which might suggest abuse by that caregiver. Because people with advanced dementia cannot communicate verbally, it is sometimes difficult to determine whether they have been abused. However, unexplained changes in behavior are a possible indicator; and/or
• a gradual or sudden depletion of funds, missing checks, or unauthorized “gifts” to caregivers. This might indicate financial exploitation.

If you or someone you know is a victim of elder abuse or you suspect a vulnerable senior is being abused by a caregiver, report your concerns to the protective services agency in your community. If physical abuse is indicated, the police also should be notified so they can investigate. Elder veterans receiving care at VA medical centers are encouraged to tell their primary care providers as well as their local protective services agency of any abuse.

You can help prevent elder abuse by talking to the elders in your family or circle of friends to make sure they are aware of the signs of elder abuse and know who to contact should they experience mistreatment or know someone who has. Silence allows abusers to continue their mistreatment.