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June 15 marks World Elder Abuse Awareness Day. Every day elder abuse takes place in some form in this country and across the world. It is estimated that 1 in 10 aging adults suffer from some form of abuse. These estimates are likely low because as in most abuse situations the victim is often afraid to tell anyone and in many situations, unable to report abuse.

Abuse is defined by the World Health Organization as "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm to an older person." Under Maryland law, abuse is defined as "the sustaining of any physical injury by a vulnerable adult as a result of cruel or inhumane treatment or as a result of a malicious act by any person."

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The six types of reported abuse are: Physical abuse, sexual abuse, emotional abuse, neglect, abandonment and financial abuse. You can add to this list self neglect, which is a growing problem among the aging.

The National Institute on Aging defines the various types of abuse as:

• Physical: abuse by a caregiver causing bodily harm by hitting, pushing or slapping.

• Emotional: abuse by another by yelling, saying hurtful words, threatening or repeatedly ignoring the older person. Keeping an older person from seeing close friends and relatives is another form of emotional abuse.

• Sexual: abuse by another forcing an older adult to watch or be a part of sexual acts.

• Neglect: abuse that occurs when the caregiver is not responsive to the aging person's needs.

• Abandonment: abuse in the form of leaving the older person alone without planning for his or her care.

Most often abuse takes place in the home setting but also happens in care settings such as assisted living, day care, and long-term care or nursing homes. Financial exploitation is the most frequently reported form of abuse. Most often family, friends or neighbors are the source of financial abuse but formal or paid caregivers are reported for financial abuse as well as scam artists and, sadly, even charitable organizations that target the aging population.

Who is at risk for exploitation and abuse? A vulnerable adult who is defined as "a person aged 18 or older who lacks the physical or mental capacity to provide for his or her daily needs. We refer to those needs as activities of daily living such as the ability to ambulate, transfer out of chair, bed, etc.; bathe, dress, toilet oneself, eat, and the instrumental activities such as driving, shopping, cooking, cleaning, managing medications, and using the telephone." Dependency on another for assistance often creates a situation where the abused adult feels helpless to change the situation out of fear that they will not be cared for or in institutional settings that they will suffer from retaliation.

What are some signs of abuse? Physical abuse may manifest in unexplained bruises, injuries, burns or evidence of tying or restraining to name a few. Psychological abuse often manifests as the older adult being isolated from others. The aging adult may express fear of "rocking the boat" and may capitulate to "keep the peace" to avoid the "silent treatment" or conversely being yelled at.

Sexual abuse often takes place in cases where the victim cannot express themselves and may manifest in behaviors of fear when caregivers enter the room or acting out behaviors. Neglect can be in the form of withholding medical care, dehydration, malnutrition, weight loss, and bedsores from being unattended to.

Financial exploitation comes in many forms from charitable organizations accepting large donations and repeatedly sending more mail, targeted because of age, to family members or caregivers writing check to themselves without the aging adult's awareness or understanding. Caregivers accepting large gifts and compensation in addition to the agreed compensation for care is a red flag.

What can you do if you suspect abuse or are yourself a victim of abuse? If the aging adult lives at home you can contact the local Adult Protective Services at 410-386-3434. If you or the aging adult whom you are concerned about lives in an institutional setting contact the local Ombudsman program at 410-386-3800.

It is really up to each of us to protect the rights of those who can't or are afraid to speak for themselves. If you are concerned about the abuse of a vulnerable adult it is a responsibility that should be taken very seriously.

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As U.N. Secretary-General Ban Ki-moon said, "All human beings are born with equal and inalienable rights, and have the right to age with dignity, respected by their families and communities, free of neglect, abuse and violence."

Jill Rosner is a registered nurse, certified geriatric care manager and owner of Rosner Healthcare Navigation. She provides patient advocacy and care management services to clients with health and aging issues. Contact her at JillRosnerRN@aol.com.

Resource

dhmh.maryland.gov/psych/pdf/dutytoreportabuse.pdf

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