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Behind Closed Doors: Understanding, Preventing, and Reporting Elder Abuse

Behind Closed Doors: Understanding, Preventing, and Reporting Elder Abuse

Aging is a reality for every living being on our planet.

Despite this, many of us do not consider how our lives will change over time. In fact, many Americans have unrealistic expectations about the aging process.

One study shows that younger Americans overestimate the amount of time they will spend participating in hobbies, volunteer work, and travel. In this sense, the notion of the care-free “golden years” may prevent us from fully understanding the lives of older Americans.

Understanding the realities of aging populations is especially important as the WHO predicts that “between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double from 12% to 22%.”

Advancements in medicine and other technologies have increased human longevity. As such, by 2030, WHO estimates that 1 in 6 people on Earth will be over the age of 60.

by 2030 1 in 6 people will be over the age of 60

As our older population grows worldwide, we must consider all aspects of their realities, positive and negative. Through this, we can better protect and advocate for our communities and future selves.

FIRST system on stopping elder abuse and neglect

One hidden, yet devastating reality that affects 1 in 6 people over the age of 60 is that of elder abuse. Rates of elder abuse appear to be skyrocketing in the ongoing COVID-19 pandemic.

One 2021 study saw an 83.4% increase in rates of elder abuse compared to pre-pandemic studies of the same group. These figures indicate that elder abuse is an active and pervasive threat to the livelihood of elders worldwide.

In order to prevent and address elder abuse, we must first understand it. The FIRST model provides a guide to understanding, preventing, recognizing, and reporting elder abuse and neglect.

F - Know the facts of elder abuse

The first step to preventing and addressing elder abuse is understanding the scope of the issue. Elder abuse was first defined by medical experts in the 1970s. Today, the National Institute of Aging describes Elder Abuse with the following categories:

  1. Physical abuse (11.7% prevalence) – A form of abuse that may include “hitting, pushing, or slapping” and causes bodily harm. Other forms of physical abuse include confinement and bodily restraint.
  2. Emotional abuse (32.95% prevalence)- This form of abuse includes but is not limited to “hurtful words, yelling, threatening, or ignoring” the victim. This form of abuse may also be referred to as psychological abuse.
  3. Neglect (11.8% prevalence) – This occurs when a designated caregiver does not respond to the needs of the elder. Neglect may include ignoring “physical, emotional, and social needs” or withholding other forms of care.
  4. Abandonment – This form of abuse occurs when an older adult is left alone without a care plan.
  5. Sexual abuse (1.3% prevalence)- A form of abuse that includes but is not limited to forcing an older adult to participate in or watch an unwanted sexual act.
  6. Financial abuse (13.8% prevalence) – This form of abuse occurs when monetary belongings are stolen from an older adult. Financial abuse can take many forms, but common examples include stealing retirement benefits, using one’s credit card information without permission, or changing information on important financial documents.

*statistics are from the WHO and reflect abuse in institutional settings.

Fast Facts about Elder Abuse and Neglect:

64.2% of staff admitted to elder abuse

  • 64.2% of staff in institutional settings admitted to elder abuse (Yon et al.)
  • Up to 5 million American elders are abused each year (NCOA)
  • Annual losses from elder abuse total up to $36.5 billion dollars (NCOA)
  • Victims of elder abuse have a 300% higher risk of death (NCOA)
  • Elder abuse is chronically underreported (NCEA)
  • The financial and community effects of elder abuse are felt by people of all ages (NCEA)

Elder abuse and neglect constitute a wide range of issues. These issues are costly, often underreported, and potentially fatal if left unaddressed.

Abuse can occur anywhere, including both community and institutional settings (nursing homes or assisted living facilities). Fortunately, there are clear signs that when identified can help prevent or stop elder abuse.

I - Intercept Abuse Early

Prevention is more effective than a cure for many issues, including elder abuse. The prevention of elder abuse is a community endeavor, and everyone is able to contribute.

By knowing the signs, creating strong community support networks, and raising awareness about elder abuse, each of us can work to intercept issues of elder abuse and neglect early on.

The following are tips from the CDC and NCEA to help prevent elder abuse:

  1. Learn the signs of elder abuse and neglect. These signs are outlined in the next few sections of this article.
  2. Prevent isolation by communicating regularly with older community members. This could be as simple as sending a letter, making a call, or volunteering at your local nursing home or assisted living facility.
  3. Support caregivers through conversation, providing breaks, or connecting them with local support groups.
  4. Raise awareness about elder abuse and neglect. A few examples may include asking local media to cover World Elder Abuse Awareness Day, joining the Ageless Alliance, or organizing an informational campaign in your own community.

Find more information about preventing elder abuse here.

Through these examples and more, each of us can work to stop elder abuse and neglect before it occurs.

R- Identify the Risks

While elder abuse can happen to anyone, there are factors that may increase the risk of abuse. These factors exist for both caregivers and elders. By knowing these risks, we can better supervise and respond to potentially dangerous situations.

Perpetration Risks

The CDC finds that individuals with high levels of stress, current or past abuse of drugs or alcohol, past experience of disruptive behavior, and/or diagnosed mental illness may be at higher risk for perpetrating elder abuse.

Relationship Risks

The CDC also finds that caregiver-patient relationships with “high financial and emotional dependence,” prior family conflict, or a lack of social support are more prone to abuse.

Individual Risks

As far as risk at the individual level, the WHO finds that persons with “functional dependence/disability, poor physical health, cognitive impairment, poor mental health, and low income” may be at greater risk for elder abuse and neglect.

In understanding the risk factors associated with elder abuse, we can be more proactive in our prevention and responses to abuse.

S - Know the Signs of elderly abuse

Just as preventing elder abuse is a community endeavor, recognizing signs of abuse is up to each of us. Each type of abuse has its own distinct markers. Some markers are outlined in the following information from NCEANIH, and DFI.

Financial Signs

  • Forged documents and fake signatures
  • Quick, “unusual changes in bank account or money management”
  • Unpaid bills, eviction notices, or other signs of financial mismanagement
  • New and unexpected powers of attorney

Physical Signs

  • “Poor living conditions”
  • “Broken bones, bruises, and welts”
  • Missing aids (this could include glasses, walkers, or medications)
  • “Torn, stained or bloody underclothing”
  • “Dirtiness, poor nutrition, and dehydration”
  • Quick weight loss
  • Bed sores or other preventable injuries

Emotional and Behavioral Signs

  • Fear, anxiety, and depression
  • Quick changes in behavior, sleep, or mood
  • Withdrawal from activities one previously enjoyed

How to Respond to Suspected Elder Abuse

After identifying signs of elder abuse in your own community, there are a few steps you can take to address the situation.

First, you may consider having a conversation with the victim. Through an initial conversation, you may gain more context about the abuse, comfort the victim, and create a plan of action for their safety. The most important part of this conversation is to have an open dialogue, listen to their concerns, and understand their wishes moving forward.

Creating a Safety Plan

After identifying abuse, a safety plan may be needed to help the victim transition to a better situation. The CNPEA suggests that local shelters, victim services, and police can help create a safety plan. Components of a plan may include scheduling regular visits, putting emergency funds aside, or packing an emergency overnight bag.

After identifying the sign of elder abuse and opening a dialogue with the victim, reporting elder abuse can provide further protection for the elder.

T - Timely Reporting

Depending on the situation, different types of reporting may be needed. The Department of Justice offers several suggestions and support resources for elder abuse and neglect situations.

For immediate and life threatening emergencies, 911 should be contacted. For non-life threatening emergencies, other resources are available:


National Elder Fraud Hotline
(or 833–372–8311)
10AM – 6PM Eastern Time
Monday – Friday

Eldercare Locator helpline

National Domestic Violence Hotline

800-799-7233 (toll-free, 24/7)

800-787-3224 (TTY/toll-free)


Consumer Financial Protection Bureau

Office for Older Americans

855-411-2372 (toll-free)

[email protected]


Reporting Abuse

Abuse can be reported to the Adult Protective Services Association.

Victims of elder abuse may also be entitled to financial compensation. Contact an elder abuse attorney at the Peck Law Group at (866) 999.9085 for further information.

Elder abuse is a pervasive and destructive global issue. Each of us has a role to play in the prevention, identification, and reporting of elder abuse. The FIRST model provides a guide to understanding and addressing concerns of elder abuse and neglect. By increasing awareness and understanding of elder abuse, we can work to put a stop to its deadly reality.


Centers of Disease Control and Prevention, ‘Fast Facts’, Violence Prevention, 2021 <https://www.cdc.gov/violenceprevention/elderabuse/fastfact.html> [accessed 22 December 2021]

———, ‘Violence Prevention: Risk and Protective Factors’, 2021 <https://www.cdc.gov/violenceprevention/elderabuse/riskprotectivefactors.html> [accessed 23 December 2021]

Chang, E-Shien, and Becca R. Levy, ‘High Prevalence of Elder Abuse During the COVID-19 Pandemic: Risk and Resilience Factors’, The American Journal of Geriatric Psychiatry, 29.11 (2021), 1152–59 <https://doi.org/10.1016/j.jagp.2021.01.007>

National Council on Aging, ‘Get the Facts on Elder Abuse’, 2021 <https://ncoa.org/article/get-the-facts-on-elder-abuse> [accessed 22 December 2021]

National Institute on Aging, ‘Elder Abuse’, 2020 <https://www.nia.nih.gov/health/elder-abuse> [accessed 22 December 2021]

The Canadian Network for the Prevention of Elder Abuse, ‘Responding to Abuse’ <https://cnpea.ca/en/what-is-elder-abuse/responding-to-abuse> [accessed 23 December 2021]

The National Center on Elder Abuse, ‘5 Things Everyone Can Do to Prevent Elder Abuse’ (The National Center on Elder Abuse, 2017)

The National Center on Elder Abuse and Keck School of Medicine, ‘12 Things Everyone Can Do to Prevent Elder Abuse’ (The National Center on Elder Abuse, 2017)

———, ‘Signs of Elder Abuse’ (The National Center on Elder Abuse, 2018)

The Pew Research Center, Growing Old in America: Expectations vs. Reality, 29 June 2009 <https://www.pewresearch.org/social-trends/2009/06/29/growing-old-in-america-expectations-vs-reality/> [accessed 22 December 2021]

The United States Department of Justice, ‘Find Help or Report Abuse’, 2016 <https://www.justice.gov/elderjustice/find-support-elder-abuse> [accessed 23 December 2021]

Washington State Department of Financial Institutions, ‘Warning Signs of Elder Financial Abuse’, Washington State Department of Financial Institutions <https://dfi.wa.gov/financial-education/information/warning-signs-elder-financial-abuse> [accessed 23 December 2021]

World Health Organization, ‘Ageing and Health’, 2021 <https://www.who.int/news-room/fact-sheets/detail/ageing-and-health> [accessed 22 December 2021]

———, ‘Elder Abuse’, 2021 <https://www.who.int/news-room/fact-sheets/detail/elder-abuse> [accessed 22 December 2021]

About the Author

Shania Montufar is the winner of our 2021 elder abuse and neglect scholarship.

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