The Role Of Nurses In Detecting Elder Abuse And Neglect

by | Sep 30, 2023 | Health Featured

Going through aging comes with many happy and positive moments. However, some seniors living alone and those in elderly care homes face different challenges that can impact their physical and mental health. Many have to deal with loneliness, anxiety, depression and mood swings.

While all these challenges are common, they often go undiagnosed or unnoticed in some senior care facilities. Nurses have a role in recognizing signs and symptoms of elder abuse and neglect.

In this article, we explore the role of nurses in detecting and reporting elder abuse. We also look at how nurses can work to improve this problem.

What exactly is elder abuse? 

Elder abuse is a repeated, inappropriate action that causes distress or harm to a senior person in any relationship where there’s trust. Some jurisdictions define elder abuse as any intentional or negligent act by a caregiver or any individual who causes a severe risk of injury to a vulnerable adult.

Research by the World Health Organization (WHO) revealed that one in six people over 60 were abused last year. Additionally, the organization noted that elder abuse rates were higher in nursing homes and long-term care facilities.

Types of elder abuse 

Elder abuse can take any form, ranging from financial trickery to neglect. Below, we look at the common types of elder abuse.

Elder neglect

Elder neglect is a common type of abuse, accounting for more than half of abuse-reported cases. It happens when a caregiver fails to perform their duties. Sometimes, neglect can be unintentional or intentional, depending on things such as denial or ignoring that a senior person may need more care than regular people. Other times, it may be due to burnout, lack of awareness or carer stress.

Self-neglect is another form of elder abuse. An older person with physical impairment or cognitive decline often cannot care for themselves. You may notice issues such as being malnourished, declining personal hygiene, and appearing dehydrated in a person suffering from self-neglect.

Financial abuse

Financial abuse occurs when a caregiver mismanages an older person’s resources, property or money. The abuser may use the individual’s bank cards, misuse the power of attorney, or coerce the older person to obtain money.

Sometimes, the abuser may withhold quality care for their financial gain. Another example of financial abuse is when the perpetrator sells or transfers property against the older person’s wishes.

Nurses can identify financial elder abuse by checking for signs such as changes to power of attorney, looking for written checks for caregivers, and evaluating unpaid bills.

Physical abuse

Physical abuse happens when someone close to the older person inflicts injuries on them. This can include shoving, kicking, hitting and punching.

Signs to look out for include sprains, bruises, broken bones, cuts and other unexplainable injuries.

Psychological/emotional abuse

Emotional abuse happens when someone close to the older person behaves in a way that causes emotional or mental distress to them. This can make the older person feel isolated, embarrassed or fearful of what will happen next. Emotional abuse can affect the victim’s self-esteem and confidence.

Signs to look out for include failure to ask about the older person’s wishes, directing verbal threats to them, shouting, or forcing them to agree to something that’s not their decision. Unfortunately, emotional abuse is at the top of the list of the most common types of elder abuse.

Sexual abuse

Sexual abuse can be forced sexual contact or forcing someone to watch sexually explicit things. Abusers can be caregivers, friends or family. This type of abuse can also happen through online activity or mobile phones.

You need to watch for signs such as injuries/bruises around the genitals, sexually transmitted diseases, and mental distress when evaluating sexual abuse.


Elder abandonment happens when the caregiver stops attending to the older person. Abandonment is more common in senior living facilities.

The effort to stop elder abuse begins on the front lines of care. Among the care providers are geriatric nurses, who possess the necessary skills and training to help abused patients. Registered nurses who would like to specialize and work with seniors can enroll in the online geriatric nurse practitioner programs at Wilkes University to gain essential skills and training on how to care for seniors, recognize abuse and help victims.

As a geriatric nurse practitioner, you need to understand the different types of elder abuse, the factors that could contribute to abuse, and the intervention process.

The shocking reality of elder abuse and neglect

Elder abuse is something that’s often overlooked and not talked about enough. However, the alarming reality is that this abuse is common in our societies. It can occur in private homes, healthcare institutions, assisted living facilities and other settings.

Additionally, research shows that three quarters of the abusers are family members. The study indicates that only one out of 23 cases are reported.

Older adults are targeted due to social isolation. The elderly, over time, become isolated and dependent on other people for care. Furthermore, cognitive decline can also make them potential victims of abuse.  Perpetrators use cognitive decline to commit financial abuse, including failing to remit checks, allocating elderly assets to them and more.

What’s more shocking is that the number of elder abuse cases is estimated to increase due to the aging population. According to the WHO, the number will grow to 320 million by 2050. This is because the number of people over 60 years old will increase to two billion.

Unfortunately, elder abuse leads to declining mental and physical health. It can also lead to premature mortality, physical injuries, financial devastation and more.

The unique positioning of nurses in addressing elder abuse

Nurses are uniquely positioned in the healthcare system to address elder abuse. They provide care, empathy and comfort. This makes them able to recognize signs of senior abuse and neglect.

Below, we look at the multifaceted role of nurses in addressing elder abuse.

Nurses go through training to conduct early detection and assessment

Nurses go through training to identify different forms of abuse. One of those skills is interviewing skills. As a nurse, you’ll start with open-ended questions to determine why injuries are sustained. You’ll also speak to the caregiver to determine if abuse exists.

Nursing professionals also need to understand the risk factors for elder abuse to determine if some people are more susceptible to abuse. Common risk factors include being over 80 years old, being female, having a disability, being socially isolated, and being dependent on a caregiver.

Empowering the seniors to speak about their experience fosters confidence in nurses, and they can share their ordeal without fear.

Besides interviewing skills, nurses also conduct skin assessments to determine if there is abuse. This includes looking for grip marks, bruises, lacerations, fractures and other injuries. You also need to identify signs of sexual abuse, such as genital bleeding, genital injuries, newly acquired STDs, or difficulty ambulating.

Nursing professionals must also watch for other signs of abuse, such as worsening medical conditions, malnutrition, dehydration, poor hygiene and inappropriate clothing.

All these signs often go unnoticed by others, but as a nurse, you must be able to identify all these red flags. Looking out for these signs is essential in stopping elder abuse. You also need to recognize certain risk factors that contribute to the maltreatment. Things such as declining mental/physical health, substance abuse, shared living conditions and socioeconomic factors make older people susceptible to abuse. With these factors in mind, you can determine the next steps to stop elder abuse.

Nurses have the role of documenting all the reports after gathering information from older people. Having proper documentation allows the court to take action against the perpetrator. It’s also advisable to prioritize any seniors who have been abused. You’ll need to call for emergency services if the case is severe and requires immediate handling.

Acting as educational advocates

Nurses educate older people, their families and the entire community. As a nurse, you’ll need to ensure that seniors understand what abuse looks like and some of the signs to identify. You’ll also have to inform them of the available resources they can access if they’re suffering from abuse. Adult protective services, community agencies and law enforcement are significant intervention and prevention resources. Offering therapy services makes it easier for the victims to cope with abuse and can help break the cycle.

Apart from educating patients and their families, nurses need to work with community organizations to create educational programs and policy development processes that raise elder abuse awareness. The community has a significant role to play in terms of promoting the wellness and safety of seniors. This can only be done by creating suitable structures that center on the needs of the elderly. Interdisciplinary collaboration ensures that the seniors receive ample support and care.

Nurses should also empower other healthcare providers to learn how to intervene and prevent further abuse.

Through advocacy, nurses spread knowledge, further empowering the community to take a proactive approach against elder abuse.

Creating a safe environment for victims

Although a significant part of nursing involves clinical skills, the profession also calls for empathetic and compassionate communication skills. Much of your career involves talking to patients, their families and other healthcare stakeholders.

Nurses should avoid using judgmental language as it can traumatize and harm the victim. This can leave the person feeling invalidated and ashamed. You should be friendly and use informal language.

Creating a safe, non-judgmental space where abuse victims can feel comfortable to express their feelings and share their concerns should be your top priority. By empathizing with them and showing emotions, you can help to identify signs of abuse and neglect that victims may hesitate to share with others.

Reporting responsibility

Nurses have a responsibility to create a safe environment for older people. Part of this involves reporting any elder abuse you come across. You need to follow your health facility’s protocol when reporting suspected abuse. Sometimes, you may need to call Adult Protective Services and follow up with a report.

Some institutions allow you to contact law enforcement. For example, victims with cognitive impairments may require legal intervention that calls for a court-appointed guardian.

Remember that you need to have evidence of the abuse when reporting. Review the patient’s statements, listing any signs noted and their account of their ordeal. This documentation is crucial as it may be presented in court as evidence against the perpetrator.

Start by familiarizing yourself with how reporting elder abuse works in your state and follow your institution’s policies when presenting the cases. Some institutions can take disciplinary actions against nurses, which includes them losing their nursing license.

Nurses can also offer to connect abuse victims to counseling services. Therapy provides an escape for victims who find it hard to break the cycle of abuse. They can express their concerns when speaking to a therapist, which can help to break the cycle.

Addressing elder abuse through nursing interventions

Elder abuse is more common than you may think. It happens in healthcare facilities, aged care facilities, homes, and any place when elders interact with caregivers. Although there’s a high rate of elder abuse, most of these cases go unnoticed and unreported.

Fortunately, nurses are uniquely positioned to identify, assess and report elder abuse. By familiarizing themselves with the common risk factors and speaking out when it occurs, nurses can help to reduce the high rate of senior abuse.

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