A. Physical Abuse
Physical abuse is easier to detect than are the other types of mistreatment. While older adults may be more injury prone, certain types of injuries may be indicative of suspected abuse. Bruises, cuts, scratches, or burns to the thighs, calves, genitals, buttocks, cheeks, or back are more likely a result of abuse than are injuries to bony areas (elbows, knees, hands) which often happen accidentally.

Physical Abuse Indicators:

• Cuts, lacerations, puncture wounds
  
• Bruises, welts, discoloration
  
• Any injury incompatible with history
  
• Any injury that has not been properly cared for (injuries are sometimes hidden on areas of the body normally covered by clothing)
  
• Poor skin condition or poor skin hygiene
  
• Absence of hair and/or malnourished without illness-related cause
  
• Weight loss
  
• Soiled clothing or bed
  
• Signs of over medication or under medication
  
• Burns of any type

B. Emotional Abuse
Emotional abuse is sometimes difficult to determine at first glance but one indicator, which may aid in the detection is behavioral changes in the victim after the alleged incident. These changes may appear as mood changes (laughing or crying excessively), interpersonal changes (refusal to talk or talking incessantly), and changes in sleep, dietary or hygiene routine, as well as more obvious behaviors such as flinching or covering when the alleged abuser or others approach.

Emotional Abuse Indicators:

• Helplessness
  
• Hesitation to talk openly
  
• Implausible stories
  
• Confusion or disorientation
  
• Anger
  
• Fear
  
• Withdrawal
  
• Depression
  
• Denial agitation

C. Sexual Abuse
Sexual abuse of an older person has received little public or professional recognition. Abuse exists when the victim is forced, tricked, threatened, or otherwise coerced into sexual activity without his or her consent or when the individual is incapable of giving consent. Sexual abuse and exploitation can occur in any setting.

Sexual Abuse Indicators:

• Physical injuries to genitals, anus, breast or mouth
  
• Bilateral bruising of the inner thighs
  
• Genital or urinary pain, irritation, itching, infection, bleeding or scarring
  
• Sexually transmitted disease or genital infections
  
• Inappropriate, unusual or aggressive sexual behavior
  
• Torn, stained or bloody underclothing
  
• Difficulty walking or sitting
  
• Frequent, unexplained physical illness
  
• Extremely upset when changed, bathed or examined

Psychosocial or Behavioral Symptoms

• Intense fear reaction to people
  
• Mistrust of others
  
• Sleep disturbances, nightmares
  
• Fear of going to bed
  
• Phobic behaviors
  
• Regressive or aggressive behaviors
  
• Depression
  
• Suicidal thoughts

D. Financial and Material Exploitation
Financial and material exploitation is the illegal or improper use of an older/disabled adult’s resources for another’s profit or advantage. Exploitation relates to misuse of property or financial resources. Exploitation often is discovered only by extensive conversation with the victim or someone outside the victim’s residence that may have information about the victim’s income and/or resources. Allegations of exploitation frequently require extensive investigation.

Financial and Material Exploitation Indicators:

• Missing personal belongings (jewelry, silver, coins, furniture and/or other valuables)
  
• Eviction notice arrives when a person thought he or she owned the house
  
• Property deed no longer in individual’s name
  
• Forced admission to a long term care facility for the purpose of taking possession of his or her property and possessions
  
• Unexplained bank account withdrawals and transfers
  
• Bank statements and canceled checks no longer coming to an individual
  
• Unpaid bills but adequate income
  
• Utilities shut off for nonpayment
  
• Unusually large or frequent gifts or payment for services
  
• Suspicious signatures on checks or other documents
  
• Power of attorney given or Will drawn up that the individual did not understand when signed
  
• Lack of understanding about or proof of financial arrangements
  
• Stolen Social Security checks
  
• Extraordinary interest by family in individual’s assets
  
• "New friends" expressing interests in the individual’s finances, Will, or bank accounts
  
• Questionable explanations given about the individual’s finances
  
• Forced labor

E. Neglect
The absence or omission of essential services to the degree that it harms or threatens harm to the physical or emotional health of an elder. Neglect is often obvious because of the individual’s personal condition or physical surroundings.

Self-Neglect
Occurs when an individual fails to provide adequately for his or her own needs. This usually happens when an older/disabled adult is attempting to maintain an independent lifestyle without the ability to do so. This is the most frequent type of abuse case reported. It is also the problem most often encountered by law enforcement and other agencies.

Indicators of Neglect May Include:
Signs of Neglect in an Individual’s Home

• Absence of necessities including food, water, and/or heat
  
• Lack of shelter, inadequate living environment evidenced by lack of utilities, sufficient space, and/or ventilation
  
• Unsafe housing, e.g., sagging walls, floors or roofing
  
• Faulty wiring, inadequate sanitation
  
• Human or animal waste on floors or furniture
  
• House filled with trash and/or empty liquor bottles
  
• Empty or unmarked medicine bottles or outdated prescriptions
  
• Urine-soaked linens and strong odors
  
• Uncollected mail or newspaper
  
• Animal and/or insect infestations

Signs of Neglect in an individual:

• Lack of clothing appropriate to the temperature and other conditions
  
• Absence of needed eyeglasses, hearing aids, dentures, or other prostheses
  
• Soiled clothing
  
• Lack of needed medical care
  
• Dirty body and/or encrusted fingernails
  
• Untreated bed sores, sores or wounds of any kind
  
• Skin rashes
  
• Dehydration evidenced by low urinary output, dry fragile skin, dry sore mouth, apathy or lack of energy and mental confusion
  
• Untreated medical or mental conditions including infections, soiled bandages, unattended fractures
  
• Lack of needed supervision
  
• Individual left alone or ignored for long periods of time
  
• Unable to communicate
  
• Self mutilation
  
• Threatening harm to others/self

F. Abuse, Neglect or Exploitation in Institutions
Staff, families, outside visitors and other residents/patients can cause abuse in institutional settings, such as nursing homes, adult care homes, and hospitals.

Indicators of Abuse, Neglect or Exploitation in Institutions:

• Failure to provide care and/or treatment
  
• Stealing from the resident, i.e. money, clothing or other belongings
  
• Not having enough staff to care for the residents or patients
  
• Alcohol and/or drug abuse on the part of employees
  
• Yelling at or threatening the resident or patient
  
• Improperly using physical and chemical restraints such as leaving a resident or patient tied or restrained to a bed or chair without a doctor’s order
  
• Pushing, grabbing, shaking, shoving, pinching, slapping or hitting a resident or patient
  
• Leaving a resident in wet clothing or on wet sheets for a long period of time
  
• Leaving residents dressed in soiled or torn clothes for long periods of time
  
• Ignoring or removing a call bell
  
• Retaliating against a resident or patient including threatening to discharge him or her
  
• Misusing patients’ and residents’ fund
  
• Refusing to allow a resident to go to an activity or to go outside or isolating him or her

G. Consumer Fraud
Consumer fraud is another form of exploitation. Older and disabled adults are easy targets for conartists. Seniors own more than half of all financial assets in America and often have saved for retirement. But, at the same time, they are vulnerable because they grew up in an era when business was transacted on a handshake. Research has shown that older adults are quicker to believe promises and slower to take steps to protect their legal rights.

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