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How to Detect and Respond to Elder Abuse

Some signs are subtle — and abusers may try to hide their behavior

By Emily Gurnon

The man and his wife had been married for decades. She was now in failing health, dependent on him for nearly everything. One day, he lashed out and struck her. Social workers responding to the report years ago believed the man was experiencing caregiver stress and needed services.

“She’s the most important person in my life,” the man told them. “But she can’t take care of herself, the house or me.” He said the physical violence had only happened once, and would never happen again.

That scenario is a composite based on what Bonnie Brandl has seen over many years of experience in the field of elder abuse. Brandl is the founder and director of the National Clearinghouse on Abuse in Later Life (NCALL), a project of the Wisconsin Coalition Against Domestic Violence. Such statements by a man accused of hurting his partner are “classic batterers’ language,” she said during a presentation I attended at the American Society on Aging’s annual Aging in America conference in Chicago recently.

Brandl explained that those who work with older adults, and anyone who has an older adult in their life, should pay attention to signs of domestic violence and sexual abuse. Studies have consistently shown that most older adult victims of abuse are women, with spouses as the perpetrators, she said.

Batterers often will try to stay in the same room or have subtle signals that if you say anything, there will be negative consequences.

Is It Caregiver Stress, or a Desire for Control?

Brandl said that early research on elder abuse, in the late 80s and early 90s, concluded that it stemmed largely from caregiver stress. Those studies focused on the perpetrators; in some, the victims were not even interviewed.

Of course, caring for an ailing loved one is difficult, Brandl said. But the issue is more complicated. Some abusers blame stress, perhaps subconsciously, to avoid taking responsibility for their actions.

Instead of working to address the needs of the abuse victims, Adult Protective Services workers who were trained to work on the caregiver stress theory, focused their efforts on providing resources to the perpetrators, Brandl said.

"A lot of the survivors we were dealing with in Wisconsin said, 'No, it really didn’t have anything to do with (caregiver) stress at all,'" Brandl said. Instead, it is often about power, control, greed (in the case of financial abuse) and a sense of entitlement.

Take the man in the example above, saying his wife is "the most important person" in his life. Those words may indicate that he is fixated on her in an effort to control her. By "she can’t take care of herself, the house or me," he may be implying that housework and cooking were her designated responsibilities, and that she was shirking them, Brandl said.

Identifying Signs of Elder Abuse

Elder abuse can take many forms. Some violence leaves obvious marks, such as a black eye or broken bones, but those may be blamed falsely on a fall or other type of accident. The abuser may be verbally aggressive, critical or demeaning.

Older adults who are neglected may have poor hygiene, lack sufficient food in the house, lack proper supervision or develop bedsores (pressure ulcers). Sexual abuse may result in a sexually transmitted disease.

Victims of financial abuse may "voluntarily" and uncharacteristically give large cash gifts to caregivers. They may sign legal documents giving control of finances to another, but be unable to explain what the documents mean, according to the National Center on Elder Abuse.

The Story of Pat — 50 Years of Abuse

An 83-year-old California woman identified as "Pat" was interviewed as part of a film on elder abuse called In Their Own Words, created by the National Clearinghouse on Abuse in Later Life. Her last name is not disclosed. Brandl presented the clip during her conference session.

"It started out, he was very, very controlling," Pat says of her husband, Stan. "I mean, he didn't want me to go here or there without him. And he didn't approve of me going out with my friends or anything like that."


Pat's niece says that Stan never worked much because his anger would get him fired from jobs. "Every situation was always somebody else's fault," she says.

The couple's son, Rick, tells of one particularly horrific night. The family was eating dinner when Stan grabbed Rick's fork off his plate, swung around to where Pat was walking past and "he buried that fork in her thigh." Stan then jumped on top of Pat and began punching her. Rick says he thought he was about to witness a murder. (Watch the video below to learn how their story ended.)

Watch for These Clues

Some abuse may show itself only in subtle ways, Brandl said. Examples, according to Brandl and the National Center on Elder Abuse, might include a victim:

  • Withdrawing from normal activities
  • Making veiled statements like, "My son has a temper"  or "My husband doesn’t like me going out places
  • Being isolated, having to return home right after work (because the partner or spouse demands it) or not being able to maintain other relationships
  • Being unable to talk on the phone
  • Being "unavailable" or "asleep" when authorities or loved ones come to check on his or her welfare
  • Rarely having an opportunity to meet with outsiders in the home without his or her partner being present

"Batterers often will try to stay in the same room or have subtle signals that if you say anything, there will be negative consequences," Brandl said. Such a signal might be a certain look, fingers drumming on a table or use of a code word designed to intimidate the victim.

She told Next Avenue that one abuser would use the word "vacation" to refer to an incident in which he hurt his wife so badly that she ended up in the hospital for a week.

How to Respond

Brandl said elder abuse victims may be reluctant to talk about the abuse for fear of retaliation. But even if he or she is not ready to confront the issue at a particular time, "seeds get planted" when a concerned person is kind and asks gentle questions, she said.

"I think compassion and kindness and listening and paying attention really make a difference," she said.

Emily Gurnon
Emily Gurnon is the former Senior Content Editor covering health and caregiving for Next Avenue. Her stories include a series of articles on guardianship abuse that was funded by the Journalists in Aging Fellows Program. She previously spent 20 years as an award-winning newspaper reporter in the San Francisco Bay Area and St. Paul. Reach her through her website. Read More
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