Elder Abuse and Neglect

Linda M. Woolf, Ph.D., Webster University

As the number and percentage of individuals 65 and over has increased in this country, so has the incidence of elder abuse. Unfortunately, the prevalence and nature of this growing problem has generally remained hidden from public view. It is imperative that both professionals and lay persons become more aware of the scope and many issues surrounding this sensitive topic. This web site is designed to address many of the concerns surrounding elder abuse ranging from information concerning the incidence of abuse to a discussion of intervention strategies. It is essential that the incidence of abuse and awareness of the range and breadth of various types of abuse be discussed and understood. However, an awareness of the problem of elder abuse is not enough. Therefore, issues surrounding detection of abuse and strategies for prevention and intervention will also be addressed.

Types of Abuse

Passive and Active Neglect: With passive and active neglect the caregiver fails to meet the physical, social, and/or emotional needs of the older person. The difference between active and passive neglect lies in the intent of the caregiver. With active neglect, the caregiver intentionally fails to meet his/her obligations towards the older person. With passive neglect, the failure is unintentional; often the result of caregiver overload or lack of information concerning appropriate caregiving strategies.

Physical Abuse: Physical abuse consists of an intentional infliction of physical harm of an older person. The abuse can range from slapping an older adult to beatings to excessive forms of physical restraint (e.g. chaining).

Material/Financial Abuse: Material and financial abuse consists of the misuse, misappropriation, and/or exploitation of an older adults material (e.g. possessions, property) and/or monetary assets.

Psychological Abuse: Psychological or emotional abuse consists of the intentional infliction of mental harm and/or psychological distress upon the older adult. The abuse can range for insults and verbal assaults to threats of physical harm or isolation.

Sexual Abuse: Sexual abuse consists of any sexual activity for which the older person does not consent or is incapable of giving consent. The sexual activity can range from exhibitionism to fondling to oral, anal, or vaginal intercourse.

Violations of Basic Rights: Violations of basic rights is often concomitant with psychological abuse and consists of depriving the older person of the basic rights that are protected under state and federal law ranging from the right of privacy to freedom of religion.

Self Neglect: The older person fails to meet their own physical, psychological, and/or social needs.

Potential Indicators of Abuse

Below are some potential indicators for each type of elder abuse. Please be aware that this does not represent a definitive listing.

Passive and active neglect

Physical Abuse

Material or Financial Abuse

Psychological Abuse

Sexual Abuse

Violation of basic rights

Self Neglect - to be discussed in greater depth below.

Additional Indicators of Abuse or Neglect


Elder Abuse Hotline: 1-800-392-0210 (Missouri)
Your local phone book (usually the Blue Pages) or phone operator can provide you a local phone number

Be prepared to give:

Calls are confidential

After a call is received, a trained elder abuse case worker will respond. The most serious/dangerous cases will be responded to within the shortest period of time (within 24 hours).

Adult Protective Services: In many states, Adult Protective Services, the Area Agency on Aging, the Division of Aging, the Department of Aging, or the Department of Social Services is designated to receive and investigate allegations of elder abuse and neglect. Your local phone book (usually the Blue Pages) or phone operator can provide you a local phone number.

Local Law Enforcement: 911 or your local police number. Best place to call if the elder is in immediate danger

Long Term Care Ombudsman Program: Designed to provide assistance in cases of abuse/neglect within a nursing home setting. Your local phone book (usually the Blue Pages), phone operator, or state agency on aging can provide you a local phone number.

Local Area Agency on Aging: Every area agency on aging operates an information and referral service. They can provide individuals with information concerning a broad range of services and programs available to individuals 60 and older. Your local phone book (usually the Blue Pages) or phone operator can provide you a local phone number.

National Center on Elder Abuse: 1-202-682-2470 or 1-202-682-0100.
810 First Street, N.W.
Suite 500
Washington, DC 20002


Self-Neglect is a controversial category in relation to elder abuse. The following questions lie at the heart of the controversy. If an individual is competent but chooses to neglect their personal health or safety, it this abuse? Is intervention, particularly involuntary intervention, appropriate in cases of self-neglect.

These questions go beyond the scope of this web site. Instead, this site will address issues factors involved in self-neglect, and potential intervention strategies.

Self-neglect, if included statistically as a form of elder abuse, represents the highest percentage of cases of elder abuse. In fact, the Public Policy Institute of AARP estimates that self-neglect represents 40 to 50 percent of cases reported to states Adult Protective Services.

Unfortunately, these statistics fail to take into account the fact that self-abusers do not fit a uniform profile. There are many factors which may lead one to self-neglect and the subsequent intervention necessary for each is unique.

Potential Factors Leading to Self-Neglect

Long-Term Chronic Self-Neglect: These individuals have engaged in self-neglecting behaviors periodically or consistently throughout adulthood. Thus, the pattern of self-neglect is not unique to old age. Often times, the individual may have an undiagnosed and/or untreated mental health problem. The problem may escalate when paired with physical impairment, social isolation, malnutrition, substance abuse, cognitive impairment, and/or limited financial recourses. Often times these individuals may be resistant to intervention as prior experiences with intervention (voluntary and/or involuntary) has not been positive and perhaps experienced as harmful. Therefore, interventions must begin small with a high degree of respect for the elder and their decisions. As trust increases, so can the amount of intervention or help provided.

Dementia: The vast majority of older adults are not suffering from any form of dementia. However, those who may be in the early stage of dementia (e.g. Alzheimer's Disease, Multi-Infarct Dementia) may be undiagnosed and susceptible to self-neglect. Clearly, the first step for intervention is diagnosis and appropriate medical treatment.

Illness, Malnutrition, & Overmedication: Many illnesses (e.g. low grade infections, endocrine imbalance) may result in dementia-like symptoms. If left untreated, these symptoms may interfere with the older adult's ability to care for themselves. For a variety of reasons, an older adult may be malnourished (poor nutrition, physiological changes). One of the symptoms of malnutrition, particularly in older adults, is dementia-like symptoms. In addition, overmedication (a common problem in old age due to overprescription of medications and/or age-related changes in the older person's physiology) may also result in dementia-like symptoms and associated self-neglect. Again, diagnosis and appropriate medical treatment is imperative.

Depression: Depression can be an issue for older adults much as it can be for individuals of any age. While there is a broad range of symptomatology for depression (too extensive for discussion here), two symptoms are particularly relevant: difficulty maintaining self-care and dementia-like symptoms. Contrary to common myth, depression is highly treatable in old age. Rapid intervention and treatment is particularly essential as there is a high risk of suicide for older white males in the United States; it is estimated that the rate of suicide for older white males may by as much as 12 times higher than for any other demographic/age group.

Substance Abuse: Substance abuse can also be an issue for older adults. Some older adults suffer from long-term addictions and the concomitant disorders that accompany such additions (e.g. Korsakoff's Syndrome with accompanying dementia). Thus, not only may the older person self-neglect as a direct result of the addiction but they may also self-neglect as a function of the resultant disorder. In addition, some older adults develop substance abuse problems in old age possibly in response to depression, stress, loss, or anxiety. They may also develop a substance abuse problem as a result of overprescription of medicines (e.g. Valium, Xanax) by their physician. Therefore, the substance abuse by itself, the underlying cause of the substance abuse, and/or the often accompanying dementia-like symptoms may result in self-neglecting behavior.

Poverty: Many older adults live on the edge financially. Below are the 1990 census data for median incomes per month based on gender and race for individuals 70 or older.


The figures above represent the median incomes per month. This means that 50 percent of the individuals in each category have less than the median income per month. For example, over half of older African American women had an income of less than 419 per month during the last U.S. census of 1990.

Clearly, many of these individuals are forced to choose between food, housing, and medication. From the outside looking in, it may appear that the individual is choosing to self-neglect (e.g. he/she neglects take their heart medication or are undernourished) when in fact, they simply can not afford to adequately care for themselves. Therefore, intervention must take the form of increased social services/supports (e.g. rental subsidies, food stamps, low cost health care). Note that currently most older adults are not eligible for many of these services/subsidies as their income is above the Federal Poverty Line for individuals 65 and over (in 1990, the poverty line for seniors was 437.91 per month).

Isolation: There is a clear cut correlation between social support and life satisfaction. As life satisfaction decreases, the risk for self-neglect increases. Isolation is a risk factor for all forms of elder abuse. Intervention entails the creation of trust, increased involvement of the older adult in the community, and the creation of social supports. This, of course, may be problematic for those individuals who have had little social support throughout their life-span.

Possible Causes of Elder Abuse

Elder abuse is an extremely complex problem. Below is simply a listing of some of the possible contributory factors related to elder abuse. It is important to also remember that these factors usually do not operate in isolation but rather interact in unique ways depending on the victim and perpetrators' situation.

Caregiver stress: Caring for a non-well older adult suffering from a mental or physical impairment is highly stressful. Individuals who do not have the requisite skills, information, resources, etc. and who are otherwise ill-prepared for the caregiving role may experience extreme stress and frustration. This may lead to elder abuse and/or neglect.

Dependency or impairment of the older person: It has been argued that as an older adult1s dependency increases so does the resentment and stress of the caregiver. Studies have found that individuals in poor health are more likely to be abused that individuals who are in relatively good health. In addition, caregivers who are dependent on the elder financially is also more likely to perpetrate abuse. This is hypothesized to counteract the feelings of powerlessness that may be experienced by the caregiver.

External Stress: External stress such as financial problems, job stress, and additional family stressors have been hypothesized to also increase the risk for abuse. This correlation has been clearly demonstrated in studies examining spousal or child abuse.

Social Isolation: Abuse, whether spousal abuse, child abuse, or elder abuse occurs most often in families characterized by social isolation. Of course, this may be both an indicator of potential abuse as well as a potential contributing cause of abuse.

Intergenerational transmission of violence: Individuals who are abused as children are hypothesized to become part of a cycle of violence. Violence is learned as a form of acceptable behavior in childhood as a response to conflict, anger, or tension. Thus, when these feelings arise during caregiving, the caregiver is at risk for becoming a perpetrator of elder abuse or neglect. Some have also hypothesized a "what goes around, comes around" theory of elder abuse. If the older person receiving the care previously abused their child, that child now in the role of caregiver simply is returning the abuse they suffered.

Intra-individual dynamics or personal problems of the abuser: Some caregivers may be at risk for abusing elders as a function of their own difficulties. For example, a caregiver who suffers from such problems as alcoholism, drug addiction, and/or an emotional disorder (e.g. a personality disorder) is more likely to become an abuser than an individual who do not suffer from such problems.


AARP has put together a comprehensive list of do1s and don1ts related to prevention of elder abuse. Consult AARP to request a copy of Domestic Mistreatment of the Elderly: Towards Prevention

or consult your local AARP chapter. Some of AARP's subjections are provided below: Towards Prevention for the Individual

Toward Prevention for Families

Toward Prevention for Communities

In addition, the following suggestions (perhaps a wish list) are presented in relation to prevention of elder abuse.

  1. Sufficient income, health care, and social services for all older adults.

  2. Public awareness and professional training in relation to elder abuse and other older adult issues.

  3. Coalition building

  4. Mental health services and family counseling available to all in need of such services

  5. Alcohol and substance abuse treatment programs available to all in need of such services

  6. Assertiveness training, promotion of elder rights, and self-advocacy training for all older adults.

  7. Adequate caregiver training and services.

  8. Adequate and available financial management and planning services

  9. Violence reduction, conflict resolution, and mediation programs and services available to all in need of such services/programs.

  10. Awareness and facilitation of positive and productive aging.

Recommended Readings


Copyright 1998 Linda M. Woolf, Ph.D.

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