Physical neglect is generally defined as the negligent failure of any person having custody of an elder or dependent adult to provide medical care for the person’s physical and mental needs, to keep the person free from health and safety hazards, and to prevent malnutrition or dehydration.
Physical abuse, of course, is defined as the assault or battery of an elder or dependent adult.
We document the following signs and symptoms of physical abuse and neglect:
▪Poor personal hygiene or generally unsanitary conditions of the residents or facility
▪Pressure ulcers (bedsores)
▪Unexplained fractures
▪Sudden and unexplained weight loss
▪Malnutrition or dehydration
▪Repeated falls
▪Improper withholding of medication
▪Over-medication
▪Unexplained change in behavior, confusion or abnormal behavior (pulling out hair, rocking, etc.)
▪Signs of physical abuse such as bruises, cuts, burns or skin discoloration.
Major Types of Abuse of Elderly and Dependent Adults
Abuse of the elderly or those who are considered “dependent adults” is a growing problem. If you know the signs to look for, you can make that important call.There is help available.
Physical abuse when someone suffers physical force that may result in bodily injury, physical pain, or impairment. This may include (but is not limited to) acts such as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. Also, any physical punishment, inappropriate use of drugs, physical restraints and force-feeding, is abuse.
These are some of the signs and symptoms of physical abuse:
•Personal reports
–an elder reports being hit, slapped, kicked, or mistreated
–others notice sudden change in behavior
• Visual things like:
–bruises, black eyes, welts, lacerations, and rope marks;
–bone fractures, broken bones, and skull fractures;
–open wounds, cuts, punctures, untreated injuries in various stages of healing; sprains, dislocations, and internal injuries/bleeding;
–broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained;
• Medical proof:
–laboratory findings of medication overdose or under utilization of prescribed drugs;
IMPORTANT:When the caregiver refuses visitors to see an elder or dependent adult alone, this may be a sign.
Sexual abuse is when non-consensual sexual contact of any kind occurs with an elderly or dependent adult person. If the person is incapable of giving consent to unwanted touching; all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing, this is also considered sexual abuse.
Signs and symptoms of sexual abuse include but are not limited to:
·The affected person reporting being sexually assaulted or raped
·Physical symptoms such as:
–bruises around the breasts or genital area;
–unexplained venereal disease or genital infections, vaginal or anal bleeding;
–torn, stained, or bloody underclothing
Emotional or psychological abuse is when anguish, pain, or distress is inflicted through verbal or nonverbal acts. This invisible abuse includes (but is not limited to) verbal assaults, insults, threats, intimidation, humiliation, and harassment. Also, it occurs when an older or dependent person is treated like an infant; isolated from his/her family, friends, or regular activities (social isolation); and is given the "silent treatment.”
Signs and symptoms of emotional/psychological abuse include but are not limited to:
• an elderly persons or dependent adult reporting being verbally or emotionally mistreated.
• physical signs are:
–emotional upset or agitation;
–extremely withdrawn and non-communicative or non-responsive;
–displays behavior usually attributed to dementia (like sucking, biting, rocking).
Neglect is defined as “the refusal or failure to fulfill any part of a person's obligations or duties to an elder.”This may mean that the person who has fiduciary (finances) responsibilities to provide care (e.g., pay for necessary home care services), or an in-home service provider, fails to provide necessary care.
This failure includes such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials.
Signs and symptoms of neglect include but are not limited to:
• an elder's report of being mistreated
• physical signs are:
–dehydration, malnutrition, untreated bed sores, and poor personal hygiene;
–unattended or untreated health problems
• living condition signs are:
–hazardous or unsafe living condition/arrangements (e.g., no heat, or no running water);
–unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing)
Abandonment is defined as “the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder.”
Signs and symptoms of abandonment include but are not limited to
• an elder's own report of being abandoned
• the desertion of an elder at a hospital or a nursing facility–or at a shopping center or other public location
Financial or material exploitation is defined as the illegal or improper use of an elder's funds, property, or assets.” This couldinclude cashing an elderly person's checks without authorization or permission; forging an older person's signature; misusing or stealing an older person's money or possessions; coercing or deceiving an older person into signing any document (e.g., contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.
Signs and symptoms of financial or material exploitation include but are not limited to:
•an elder's report of financial exploitation
•Banking/financial signs are:
–sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder;
–the inclusion of additional names on an elder's bank signature card;
–unauthorized withdrawal of the elder's funds using the elder's ATM card;
–discovery of an elder's signature being forged for financial transactions or for the titles of his/her possessions;
–the provision of services that are not necessary; and
• Changes in legal / possessions / ownership
–abrupt changes in a will or other financial documents;
–sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions;
–unexplained sudden transfer of assets to a family member or someone outside the family;
–unexplained disappearance of funds or valuable possessions;
–substandard care being provided or bills unpaid despite the availability of adequate financial resources;
Self-neglect is a behavior of an elderly person that threatens his/her own health or safety–generally refusing or failing to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions.
Generally this competent person makes a conscious and voluntary decision to engage in acts that threaten his/her health or safety as a matter of personal choice–even though they understand the consequences.
Physical signs and symptoms of self-neglect include but are not limited to:
–dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene;
–hazardous or unsafe living conditions/arrangements (e.g., improper wiring, no indoor plumbing, no heat, no running water);
–unsanitary or unclean living quarters (e.g., animal/insect infestation, no functioning toilet, fecal/urine smell);
–inappropriate and/or inadequate clothing, lack of the necessary medical aids (e.g., eyeglasses, hearing aids, dentures); and
