In general, an elder may exhibit some signs that could signal any type of maltreatment may be occurring. Consider changes in the behavior and affect of the patient, including:26
sudden change in behavior;
withdrawn or passive behavior;
depression, agitation or anxiety; or
a self-report of being abused, confined or isolated, or having someone inappropriately controlling their finances.
Note that these changes can also be associated with other medical issues as well, so it is essential to take and have good comprehensive medical history. As a dental clinician, we must be able to discern normal aging processes from signs of elder abuse as well.
Physical maltreatment – inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving the elder of a basic need. Signs may include:
bruises; lip trauma; bone fractures; broken eyeglasses or frames; fractured, loose, or unexplained missing teeth; unexplained bruises, pressure marks, bruising of eye(s), welts, lacerations, cuts, or burns.
Sexual maltreatment – inflicting non-consensual sexual contact of any kind.
Emotional or psychological maltreatment – inflicting mental or emotional anguish or distress on an elder person through verbal or nonverbal acts. Signs may include:
caregiver’s refusal to allow visitors to see the elder alone,
consistent degrading comments or threats (including the threat of moving the elder to a nursing home or other facility), or
depriving the elder from going into the community.
Financial or material exploitation – illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder. Signs may include:
report of unexpected withdrawals from financial accounts; abrupt changes in the elder’s financial documents such as power of attorney forms, healthcare directives, trusts, or a will; and unpaid dental bills (especially if finances are controlled by a fiduciary such as a power of attorney or conservator).
Neglect – refusal or failure by those responsible to provide food, shelter, health care, or protection to a vulnerable elder. Signs may include:
ill-fitting dentures, lack of dental care, and poor dental or personal hygiene; signs of being restrained; report of confinement or isolation; failure to appear at scheduled appointments; and delays in seeking care.
Self-neglect – the behavior of an elderly person that threatens his/her own health or safety. Self-neglect is different from other types of neglect (i.e. caretaker neglect) because it is not attributable to another person.
Abandonment – the desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.
