Ask experts to define elder abuse and there is no one answer; in fact, there are far too many.
“There’s physical abuse — we know what that means,” said Dr. Teresa Amato, chair of emergency medicine at LIJ Forest Hills and the director of geriatric emergency medicine for Northwell Health. “That’s easy. That’s illegal. It’s against the law.”
But Amato said older adults also are at high risk for other types of abuse, which can include neglect, meaning that they’re not given the things they would need to live a healthy life; or financial abuse from a family member, caregiver or stranger.
“You really have to broaden your definition of it,” Amato said. “You really need to think of all the aspects of seniors’ lives in which they could be taken advantage of whether knowingly or unknowingly.”
Dianne Woodburn is the senior supervising attorney in the Legal Services for Elder Justice program at JASA, a multifaceted senior services agency with service locations throughout the city and Long Island, including Rego Park, Holliswood and the Rockaways.
“You can see the bruising, the lacerations, a black eye,” Woodburn said. “But maybe you see someone with broken glasses, someone who needs a cane and there isn’t a cane there. Those are the ones that are harder, the ones where you have a more difficult time identifying it.”
She said her program, which pairs lawyers with social workers on each abuse case, also has seen emotional, psychological and sexual abuse of their clients.
“With financial abuse, you can have someone who should have enough money to pay their bills, but you see unpaid bills,” she said. “You might see ATM withdrawals from the account of a homebound senior.”
Both experts said cases of elder abuse are greatly underreported. Amato said some studies have placed prevalence between one in 10 to one in five seniors.
Amato said all Northwell emergency rooms are certified for geriatric care, and that some things will immediately send up red flags for ER personnel.
“One, you look at the overall wellness of the patient,” she said. “Do they look like they’re being fed? Do they look like they are clean? Are they well cared for, meaning is their hair brushed? Are their nails clean?”
Amato said being disheveled isn’t necessarily a sign of abuse, but it does trigger staff to be cautious, perhaps even to the point where they would contact the appropriate state agency to do a deeper dive into the patient’s home life.
She added that seniors also can have bruises because they fall or can be on blood thinners.
“It’s also possible that the caregiver is elderly and just can’t take care of things,” she said. But the location of bruises can be a clue. Are there fresh bruises along with older ones that have not yet fully healed?
“You have to take it all into account,” Amato said. As to underreporting, she said there can be a sense of shame or fear.
“They may not even know they are being abused if there is a cognitive deficit or confusion,” she said.
Woodburn said another aspect is that the abuser very often is a family member or someone else in a position of trust.
“It might be an adult child or grandchild,” she said. “You hear about [professional] caregivers, because those get reported.” But she said with a child or grandchild, some times the senior is afraid.
“They think, ‘If they arrest my caregiver, who’s going to feed me?’” Woodburn said. “And sometimes there is love. The senior loves the abuser and the abuser loves the senior. The senior doesn’t want to see the abuser get into trouble. Sometimes the abuser has a mental or cognitive issue. There might be a substance abuse issue.”
Woodburn said JASA’s pairing of social workers with attorneys on abuse cases is designed to address the entire situation.
“There are things victims will tell a social worker that they won’t tell me,” she said. Sometimes the answer includes getting the abuser the help he or she might need, such as substance abuse treatment. Social workers also host group sessions where the victim is with other seniors.
“We take a holistic approach,” she said. “The goal is to have adults being able to age with purpose and dignity in their communities.”