Each year, thousands of older adults are abused, neglected, and exploited. Elder abuse can happen to anyone, even those who are mentally competent and those who do not require constant care. According to the World Health Organization’s (WHO) “Toronto Declaration on the Global Prevention of Elder Abuse,” elder abuse is “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. It can be of various forms: physical, psychological, emotional, sexual, financial, or simply reflect intentional of unintentional neglect” (2002, p. 3). Worldwide, the number of adults 60 years and older is steadily increasing, so the WHO—in conjunction with other groups—established World Elder Abuse Day on June 15, 2011. (See the International Network for the Prevention of Elder Abuse website [www.inpea.net] and the United States Department of Justice website [www.ovw.usdoj.gov/director-june2010msg.htm] for more information.)

The WHO’s international declaration aimed at preventing elder abuse was a result of the following factors:

• Elder abuse is a universal problem in both developed and developing countries. In addition, abusers tend to be well known to the abused individual because abuse often occurs in the context of the family or care unit.
• In any society, some population subgroups are particularly susceptible to elder abuse, such as the very old, those with limited mental or physical functioning, women, and the poor.
• When elder abuse is identified, often there are not proper legal frameworks or resources to respond to and effectively deal with these situations.
• Preventing elder abuse requires the strong involvement of multiple sectors of society (e.g., social services, police, legislators, healthcare systems or professionals, concerned citizens).
• Primary healthcare providers frequently play a pivotal role in identifying and dealing with cases of elder abuse and need to be properly educated about this problem.
• Disseminating information and education (professional and public) is central to combating elder abuse because it helps removed the stigma of elder abuse and helps eradicate stereotypes associated with older adults.

As rehabilitation nurses, we often serve at-risk populations and we must remain particularly vigilant regarding the various types of elder abuse, its signs and symptoms, and the preventative actions and steps we should take when abuse is suspected. According to the National Center on Elder Abuse (NCEA; 2010), some of the more common signs of elder abuse include

• physical abuse—unexplained bruises, slap marks, burns, and blisters
• emotional/psychological abuse—unexplained changes in alertness, withdrawal from normal activities, other unusual behavior changes
• sexual abuse—unexplained sexually transmitted diseases, bruises around the breasts or genital areas
• financial abuse/exploitation—altered wills and trusts, unusual bank withdrawals, checks written as either loans or gifts, loss of property, changes in finances or accounts
• neglect—filth, pressure ulcers, malnutrition, or dehydration.

What actions need to be taken when elder abuse is suspected and what are some preventative measures that can be taken? The following are some recommendations suggested by the NCEA (2005).

• Be aware of the possibility of abuse. Does the older adult appear withdrawn, nervous, anxious, and sad, especially around certain people?
• Report suspected mistreatment to your local protective services agency or law enforcement. Make sure that you have specific information and also dates and times that evidence of mistreatment occurred. Document signs of abuse such as bruises or changes in behavior in your healthcare record as appropriate.
• Keep in contact with and provide resources to your patients. Schedule follow-up appointments with your older patients. When interacting with the patient and family/significant others determine if additional resources are needed such as a home health nurse or aide, physical therapy, Meals on Wheels, etc.
• Contact the local Area Agency on Aging office. They can be a great resource for services, information, and education for patients, their families, and significant others.
• Volunteer. Get involved with assistance programs that offer support to older adults.
• Participate in World Elder Abuse Day activities in your community on June 15, 2011.
• Learn more about elder abuse. Visit the NCEA website (www.ncea.aoa.gov) or WHO website (www.who.int/ageing/publications/elder_abuse/en/index.html) for more information.

Although older adults are at risk for elder abuse, much can be done by rehabilitation nurses to help reverse this trend and take a more proactive role. Because of the prominent role rehabilitation nurses have in inpatient, outpatient, home care, and long-term care settings, it is important that we are aware of the potential for elder abuse; we can improve the quality of life of our patients.

References

National Center on Elder Abuse. (2005). 15 questions and answers about elder abuse. Retrieved December 27, 2010, from www.ncea.aoa.gov/ncearoot/Main_Site/pdf/publication/FINAL%206-06-05%203-18-0512-10-04qa.pdf.

National Center on Elder Abuse. (2010). Why should I care about elder abuse? Retrieved December 27, 2010, from www.ncea.aoa.gov/ncearoot/Main_Site/pdf/publication/NCEA_WhatIsAbuse-2010.pdf.

World Health Organization. (2002). The Toronto declaration on the global prevention of elder abuse. Retrieved December 27, 2010, from www.who.int/ageing/projects/elder_abuse/alc_toronto_declaration_en.pdf.