The number of American Indian and Alaska Native elders 65 and over is expected to increase from 13 percent in 2012 to 20 percent by 2030, according to the U.S. Census Bureau. As the population of elders grows, so does the abuse of those who require care.
Traditionally, American Indian elders have held a place of honor for their wisdom, experience and cultural knowledge. Unfortunately, this is changing in some tribal communities. The abuse and neglect of American Indian and Alaska Native elders occurs with alarming frequency in tribal communities. Tribal leaders from across the country have identified three major challenges in addressing elder abuse and neglect issues on reservations. There is a need to increase training about elder abuse and neglect, a lack of codes addressing elder abuse issues and a lack of policies and procedures for tribal agencies handling elder abuse and neglect issues.
Every year an estimated 5 million (or 1 in 10) older Americans are victims of elder abuse, neglect or exploitation. And that’s only part of the picture: Experts believe that for every case of elder abuse or neglect reported, more than 79 percent of cases go unreported. Many tribes don’t have their own specialized elder protective service so there may not be anyone to report abuse to, or insufficient resources for a response even if a report was made. Additionally, many elders have experienced the impacts of past U.S. federal government policies and may fear further institutional abuse through contact with government agencies and authorities.
Elder abuse is a global social issue which affects the health and human rights of millions of older persons around the world. Around 4 to 6 percent of older adults have experienced some form of maltreatment at home. In many parts of the world elder abuse occurs with little recognition or response.
In the past, this serious social problem was hidden from the public view and considered mostly a private matter. Even today, elder abuse continues to be taboo, mostly underestimated and ignored by societies across the world. However, evidence is accumulating to indicate that elder abuse is an important public health and societal problem. Sadly, as awareness of elder abuse increases nationwide, its presence is also on the rise in Indian Country.
Elder abuse can be defined as a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. Elder abuse can take various forms such as physical, sexual, financial, psychological or emotional. It can take the form of hitting, shoving, sexual abuse, threats, intimidation and inappropriate use of drugs, restraints or confinement. It can also be the result of intentional or unintentional neglect or abandonment.
Nationally, neglect is the most frequent form of elder abuse. But emotional and psychological abuse, physical abuse, financial and material exploitation, and abandonment are also common. Native American elders may also experience spiritual abuse, such as being denied access to ceremonies or traditional healing. Many forms of abuse are interrelated and may be experienced simultaneously.
Tribal social service providers estimate that nearly 80 percent of those abusing American Indian and Alaska Native elders are immediate family members and 10 percent are extended family members. Adult children are the most likely perpetrators. Spouses, other relatives, grandchildren and caregivers are also likely.
Rates of abuse of American Indian and Alaska Native elders are highest in families where income levels are extremely low for the elder and for the abuser/caregiver. Caregiver unemployment also appears to be a risk factor for abuse in American Indian and Alaska Native communities. Abuse rates are also higher when the elder lives in the same home as the primary caregiver.
In 88 percent of cases where the gender of the abuser was known, the victim was female and the perpetrator was male. Communities must explore the connection between domestic violence, sexual assault, stalking, and elder abuse. Creating comprehensive, victim-centered services can help prevent interpersonal violence in future generations. Adult Protective Services and tribal law enforcement should be notified immediately in cases where elder abuse is suspected.
Elder abuse must be reported. If you live on tribal land, report abuse to your local police department or social services. Call 911 immediately if you or someone you know is in immediate, life-threatening danger. If the danger is not immediate, call the Eldercare Locator at 1-800-677-1116. Specially trained operators will refer you to a local agency for help. The Eldercare Locator is open Monday through Friday, 9 a.m. to 8 p.m. EST.
Warning Signs & Symptoms of Abuse
While one sign does not necessarily indicate abuse, the following are some telltale signs that there could be a problem:
- Bruises, pressure marks, broken bones, abrasions and burns may be an indication of physical abuse, neglect, or mistreatment.
- Unexplained withdrawal from normal activities, a sudden change in alertness and depression may be indicators of emotional abuse.
- Bruises around the breast or genital area can occur from sexual abuse.
- Sudden changes in financial situations may be the result of exploitation.
- Bedsores, unattended medical needs, poor hygiene and unusual weight loss are indicators of possible neglect.
- Behavior such as belittling, threats and other uses of power and control are indicators of verbal or emotional abuse.
- Strained or tense relationships and frequent arguments between the caregiver and elder are also signs.
- Hoarding, failure to take essential medications or seek medical treatment, poor hygiene or housekeeping, dehydration, and not wearing suitable clothing for weather can be signs of self-neglect.
The Role of Culture
The answers to these questions can provide guidance to professionals working with members of diverse ethnic and cultural communities:
- What role do elders play in the family? In the community?
- Who, within the family, is expected to provide care to frail members? What happens when they fail to do so?
- Who makes decisions about how family resources are spent? About other aspects of family life?
- Who, within the family, do members turn to in times of conflict or strife?
- What conduct is considered abusive? Is it considered abusive to use an elder’s resources for the benefit of other family members? To ignore a family member?
- What spiritual beliefs, past experiences, attitudes about social service agencies or law enforcement, or social stigmas may affect community members’ decisions to accept or refuse help from outsiders?
- Under what circumstances will families seek help from outsiders?
- To whom will they turn for help (e.g. members of the extended family, respected members of the community, religious leaders, physicians)?
- What/who are the trusted sources of information in the community?
- How do persons with limited English speaking or reading skills get their information about resources?
How can health professionals get involved?
- Screen for abuse and be aware of the various types: financial exploitation, neglect and self-neglect, emotional or psychological abuse, physical abuse, sexual abuse, verbal abuse, institutional abuse, spiritual abuse
- Participate in interdisciplinary geriatric teams
- Encourage adoption of abuse protocols and screening
- Prompt medical associations to get involved
- Learn more about elder abuse
Questions to consider when creating or modifying an existing screening tool:
- Is the elder in imminent danger?
- Is the elder able to talk openly about their care? (Caregiver or companion may need to leave the room for assessment to take place.)
- Is the elder in need of emergency services to prevent injury or loss?
- What is the nature and extent of the abuse?
- Is abuse likely to occur again?
- What is the level of risk?
- Is the elder able to make decisions about their care?
- What measures are needed to prevent future abuse and ensure the wellbeing of the elder?