All people, regardless of age or infirmity, deserve to be treated with dignity and respect. Being safe from physical, emotional and financial harm is a basic human right. Each year millions of seniors in the United States fall victim to people who abuse their trust and need. Abuse in public forums, such as nursing homes, is widely recognized, but alarmingly, elder abuse primarily occurs in the most private of settings, the elder’s home, where abuse is least likely to be recognized by outsiders who could intervene and provide help.

The overwhelming majority of elder abuse occurs at the hands of family members, other household members and paid caregivers. These people have the closest contact with their victims, which puts them in an ideal position to inflict abuse, neglect or exploitation. Unfortunately, the very situation that requires elderly people to rely on others - their dependence upon another - is often the single most contributing factor to the abuse. The physical presence of someone so dependent within a family’s home changes the dynamics of that home, as lifestyles must be adjusted. This causes additional stress within a unit that already has its own internal stresses, which is especially enhanced when there has been a history of abuse in a family. Often, abusive parents are abused by their children if they become dependent upon them, but clearly this is not always the case.

Abuse comes in many different forms. Physical abuse occurs when the abuser uses enough force to cause pain or injury, including acts of violence such as striking, hitting, biting, burning, pinching, restraining and inappropriate use of drugs. Most people would recognize obvious external signs, such as broken bones, bruises, wounds and untreated injuries in various stages of healing, but there are more subtle signs that can signal trouble. Broken eyeglasses, depression, lethargy or a caregiver’s refusal to allow the elder to receive unsupervised visitors could all be signs that abuse is occurring at home.

Emotional abuse occurs when the abuser acts in a manner that causes fear, anguish or emotional distress. Abusers may use verbal threats, insults or intimidation as tactics, as well as humiliation or harassment. Subtler means of emotional abuse include treatment that makes an elder feel like a child, imposing the “silent treatment,” or isolating the elder from others.

Neglect occurs when the caregiver fails to meet the physical, social or emotional needs of the elder, whether or not intentionally. Intentional neglect occurs when the caregiver does not provide adequate food, water, clothing, medication or personal assistance with daily activities, including maintaining proper hygiene. Unintentional neglect occurs when the elder is not properly supervised, for example when the elder is allowed to wander out of his or her home and is lost or harmed as a result, or when he or she causes a fire through unsupervised and improper use of the stove.

Exploitation occurs when the financial resources of the elder are misused. This can be especially prevalent in situations where caregivers rely on their elderly charges for their own financial welfare. Often, elderly people simply do not understand the implications of granting their caregivers carte blanche access to bank accounts and other assets. Sometimes abusers use coercion and forgery as the means to exploit the financial resources of the elderly. In any case, outsiders must keep their eye out for many telltale signs of potential abuse. Unusual banking activity, such as large withdrawals or unusual ATM transactions, could signal problems. Signatures on financial documents that do not match past signatures or documents being drawn up on the elder’s behalf should be red flags. In addition, an elder suddenly living in a style or condition that is contrary to what resources suggest, such as unpaid bills, lack of new clothing, or other amenities, could be a signal that a problem is occurring at home.

Isolation contributes to elder abuse. When outsiders or other family members are kept away, it can be difficult to spot the signs of abuse. Occasionally, the elder hides the abuse that is inflicted upon them. Oftentimes, they feel indebted to their caregiver or believe they have nowhere else to go. Sometimes, they have an acute fear that abuse will worsen if they complain about their situation. In some cases, the abused is an elderly caregiver, caring for an ailing spouse who is exhibiting abusive tendencies. An example of this would be an Alzheimer’s patient who acts out in a rage against the caregiver. Regardless of the situation, there is often reluctance on the part of the abused elderly person to report the abuse to someone who could remedy the situation. This contributes to deeper feelings of depression, isolation and worthlessness.

Elder abuse prevention includes regular respite care. When caregivers have relief even for a few hours per week, they are better able to manage the stress that comes along with the responsibility of caring for an elderly charge. Social contact is also very important for both caregivers and dependents. When caregivers have the opportunity to vent their concerns and frustrations in a forum that provides sympathy and understanding, tensions are relieved and solutions to problems can be found. It is very important that caregivers reach out for help themselves.

Those legally obligated to report elder abuse include healthcare professionals, law enforcement, social services representatives, and anyone responsible for a dependent’s care. Concerned outsiders are also always under a moral obligation to intervene when abuse is suspected. Social pressure to not meddle in another’s family business allows the harsh treatment of elders to continue when it could have been stopped had it been reported. In Massachusetts, elder abuse may be reported by calling your local elder protective service.