Some cases of elder abuse can be easily detected, but in many cases elder abuse can be subtle. Some of the signs and symptoms of elder abuse are easy to see. But others can only be noticed by someone who knows the victim very well and because of that an abusive situation may continue for many years before someone notices.

Unfortunately, as mentioned earlier, a large number of these cases go unreported. There are many reasons why this happens. Many elderly people who are abused are, for various reasons, completely dependent on the people who are abusing them. Along with that dependence comes fear – fear that if the abuse is reported that much worse will happen and that the abuse will continue. Elderly people who are abused may also feel shame that the abuse is happening to them. They may be unaware of their rights or be made to somehow feel that they”deserve” such treatment. The abused elder person may be forcibly prevented from contacting anyone who could help. It is also possible that there are cultural and language barriers that prevent the abuse from being recognized and /or reported. And finally, in these difficult economic times, social service agencies that could help may simply not have the money or personnel to devote to potential cases of elder abuse in their communities.

As a CNA, it is important that you understand how to recognize when an elderly person is being abused.

• Unexplained injuries: Does the person you are caring for have burns, bruises, scars, or welts that can’t be explained? Do they have injuries that are obviously very old but are just being recently reported? Do they have an injury and the explanation for its cause – the explanation given to you by the victim, the caretaker, or a family member – just does not make sense? Does the explanation for an injury given to you by the victim contradict the explanation given to you by the person who cares for them? Finally, if an elderly person with an injury does not want to talk about how the injury happened or seems evasive when you question him or her that can be an indication that abuse is happening.

• Sexual injuries: Does the elderly person have a sexually transmitted disease? Older adults can certainly be sexually active, but if this person has no partner or has been living alone the presence of a sexually transmitted disease would be a strong indication of sexual abuse. Other signs of sexual abuse would be injuries to the genital areas or torn or bloodstained underclothing.

• Emotional trauma: Is the elderly person fearful or withdrawn? Is the person depressed, do they avoid eye contact? Have they been cheerful and outgoing and now they don’t seem to be as friendly or talkative? These could all be signs of emotional abuse. This could be especially true if these emotional issues are new for that person.

Learning Break: There are many reasons why someone could be depressed or withdrawn; these emotions in an older person don’t necessarily mean that she/he is being abused. But if these changes happen to an elderly person who is dependent on someone else and you notice that the elderly adult seems frightened or subdued when the caretaker/relative is present, you should start to suspect the possibility of abuse.

• Physical neglect: Elderly people may have multiple medical problems that affect their health and their ability to care for themselves. However, even if they are dependent on someone for their basic needs there is no reason why, if they are given proper care and attention, they should not be healthy, clean, well groomed, well dressed, adequately dressed, and well nourished. If a dependent elderly person is dehydrated, dirty, poorly or inadequately dressed, living in unclean or unsafe conditions, or is obviously malnourished, they may be victims of elder abuse. The elderly person who is being physically abused may also show evidence that they are being overmedicated or not receiving the medications she/he needs. Was a prescription for this person recently filled but the bottle is empty? Was the prescription filled a long time ago, but there is a lot of medication left?

• Financial abuse/exploitation: It would be difficult for someone who is not legally responsible for the financial affairs of an elderly person to know if this type of abuse is taking place. Evidence that this is occurring would be drastic and sudden changes in someone’s financial status, an unexpected and unexplained inability to pay bills or buy the necessities of life, valuable items that go missing, or purchases of items the elderly person would be unlikely to buy, want, or need. If the elderly person is not well nourished or has not been taking his/her medications and she/he says that buying food and medications is simply too expensive, it might be wise to consider the possibility of elder abuse.

• Sudden changes in health: A sudden change in health is not uncommon in an elderly person. But if this change is accompanied by emotional distress, injuries, or the change is unexpected for that person, then elder abuse may be happening.

Change in relationships: Do you notice tension between an elderly person and her/his relatives? Do the relatives or close friends of an elderly person refuse to allow you to be alone with that person? Is the elderly person fearful or withdrawn when a relative or caretaker is present, but seems more comfortable when that person is absent? These are signs that elder abuse may be happening.