Types of Nursing Home Abuse Injuries & Symptoms
As individuals age, their bodies become more susceptible to both accidental and intentional injury. Not all physical injuries are cause for immediate concern, but it is the responsibility of caregivers to ensure injuries and abuse are prevented. Recurring or excessive physical injuries in any form must be taken seriously.
Physical abuse is the result of direct physical force, either from someone intentionally causing harm or being careless in their actions.
Examples of physical abuse injuries include:
- Bruises: Bruises, including black eyes, are one of the most common indicators of abuse. Newer bruises will appear as dark blue or purple marks on the skin, changing to yellow over time. Unlike in younger individuals, it can take several weeks for the bruise on an elder to turn yellow, making it difficult to determine the exact time and cause of some bruises.
- Burns: Skin burns can be a symptom of active abuse or neglect. Burns are characterized by damaged tissue as the direct result of extreme heat, like cooking burns or friction, such as rope burns.
- Welts: Appearing on the skin as red, raised bumps, there are many different causes of welts. Some of which can be indicative of elder abuse.
- Bedsores/Pressure Sores/Ulcers: Although commonly associated with neglect, bedsores can be a sign of physical abuse if a caregiver knowingly allows them to occur and does not take adequate steps to prevent or heal these sores. A bed sore is essentially an open wound on the body, often occurring in bony areas such as the elder’s back, ankles, hips or buttocks.
- Cuts & Lacerations: These injuries can be identified by cuts or scars and can appear anywhere on the body.
- Skin Tears: As people age, their skin becomes more susceptible to tearing. Skin tears look like rips, flaps or tissue loss and can vary in severity. Skin tears can be an indicator of handling that is too rough, intentional or not.
- Broken Bones & Fractures: The bones of elderly individuals are more porous, making fractures or breaks a more common occurrence. While some broken bones and fractures can result from accident, it is also possible to see these symptoms in physical abuse victims.
- Dental Injuries: Sudden damage to the teeth or surrounding bones can be an indicator of trauma.
- Head Injuries: Injuries to the head resulting in mild traumatic brain injury (TBI) or worse can be a sign of physical abuse, although there may be other causes as well.
- Malnutrition & Dehydration: A lack of proper nutrition and hydration can occur when elders are not being properly cared for or when they lose appetite due to trauma.
- Insomnia & Sleep Issues: An inability or unwillingness to sleep can indicate physical abuse, particularly if pain is causing the disturbances or if the victim fears their abuser will return at night.
- Chronic Pain: Ongoing or recurrent pain in any form can be a symptom of physical abuse.
- Gangrene: Gangrene is dead and decomposing flesh on a living person. Without proper bathing and care, nursing home residents can develop skin infections or gangrene. In 2017, an 84-year-old nursing home resident in Florida died after gangrene caused his genitals to rot. The infection set in because nursing home residents did not wash him properly, according to a report from Naples Daily News.
- New Illnesses: Physical and mental strain on the body can also cause physical abuse victims to catch new diseases or illnesses. Unfortunately, it can be very challenging to directly link a new illness to physical abuse.
- Worsened Existing Conditions: In addition to new injuries or illnesses, physical trauma can also worsen pre-existing health issues. This is because physical trauma prevents the body from properly taking care of itself.
Nursing Home Neglect
The difference between physical abuse and neglect is usually intent, although both can have equally devastating impacts. Many symptoms of neglect overlap with the physical abuse symptoms outlined above.
In addition to physical abuse symptoms, signs of elder neglect include:
- Inadequate Hygiene: An elder who does not receive adequate hygiene may appear dirty or have a bad smell. They may also experience teeth decay, persistent infection or other indicators of lacking hygiene. This can be a common issue in understaffed nursing homes where bath quotas may be overlooked.
- Malnutrition, Dehydration & Weight Loss: Inadequate nutrition and hydration can be indicators that an elder is not eating properly. In many cases, these are symptoms of self-neglect and may need direct interference from loved ones.
- Improper Medication: Neglected individuals may not take their medications or may be given improper doses. They also may be given medications for the wrong reasons. A 2017 study conducted by the Washington Post estimated that nearly 180,000 nursing home patients are unnecessarily given antipsychotics each week. The Post noted that the drugs are given to sedate patients rather than to treat actual issues.
Emotional & Psychological Injuries
Emotional or psychological abuse is any form of abuse that impacts the emotional well-being of an individual. Emotional abuse can be particularly hard to diagnose due to a lack of evidence or physical symptoms. However, there are a few common indicators of psychological trauma.
Signs of psychological trauma include:
- Anxiety/Fear: Elders who have been emotionally abused may become anxious or fearful, possibly to the extent of hypervigilance.
- Aggression: Unexpected or unexplained aggression can also be an indicator of abuse used by the elder as a defense mechanism. This can be particularly apparent if elders are aggressive only towards one or two individuals.
- Depression: Symptoms of depression, like withdrawal from social scenarios, oversleeping and lack of interest in activities, can all be signs of emotional abuse.
- Learned Helplessness: Elders who have been emotionally abused may become helpless, expecting others to do tasks that are within their abilities.
- Low Self-Esteem: A noticeable decline in self-esteem or self-worth can be an indicator of prior or ongoing emotional abuse. Elders may suddenly feel undesirable, stupid or helpless.
- PTSD: Individuals who have been abused may show other signs of post-traumatic stress disorder (PTSD), including panic attacks.
- Substance Abuse: Ongoing elder abuse can lead to substance abuse as a coping or escape mechanism.
- Suicidal Thoughts/Attempts: Long-term emotional abuse can cause elders to contemplate or attempt suicide.
The above list is by no means all-inclusive. Emotional abuse tends to impact the personality and mental health of an individual and can, therefore, manifest itself in unexpected ways. If you suspect emotional abuse may be occurring, take immediate action.
Sexual Abuse Symptoms
Sexual abuse can be one of the most devastating forms of elder abuse. Yet, it is one of the hardest to identify and least reported. Sexual abuse occurs when an individual participates in any form of sexual activity without their explicit consent or without the ability to consent.
The symptoms of sexual abuse can mimic physical and emotional abuse, as these types of abuse often overlap.
The following are additional indicators of sexual abuse:
- Genital Injury: Unexplained bruising, swelling or physical injury to the vagina, penis or anus can be indicative of sexual abuse.
- Breast Injury: Bruising or injury to the breasts or chest are a common symptom of sexual abuse.
- Mouth Injuries: Bruising on the top of the mouth or to the uvula that dangles in the back of the throat can be symptoms of forced oral sex.
- Urinary Tract Infections (UTIs): Recurrent UTIs can indicate sexual abuse, as sexual activity can cause these infections.
- New STIs: A new sexually transmitted infection is a strong indicator that an individual is involved in sexual activity and can be a symptom of sexual abuse.
- Increased Interest In Sex: A sudden interest or obsession with sex or sexual content can occur when individuals are sexually abused. They may suddenly say sexually suggestive things or want to access more sexual content. They may also become sexually aggressive towards other individuals.
- Inappropriate Relationships: A change in relationship or behavior between a caregiver and elder may be a sign of sexual abuse. This change could be perceived as negative, such as a sudden fear, or it could appear to be “positive,” like a new infatuation.
It is important to take any of these symptoms seriously when observed. If you suspect sexual abuse is occurring to you or your loved one, report it immediately.
Financial abuse is a very common form of abuse that elders can easily fall victim to, particularly as technologies advance while elders simultaneously become more reliant on the advice and care of others. There are numerous forms of financial abuse, including scams, fraud and theft, although many are subtle.
Some signs of financial elder abuse include:
- Unexplained transactions or withdrawals
- Sudden change in financial circumstance
- Overdue bills that were thought to be paid
- Inability to access money
- Loss of control over financial decisions
- Pressure to donate, share or lend money (or assets)
Unlike other forms of elder abuse, financial abuse often preys on individuals without other impairments. The most common profile for financial abuse victims are widows or widowers in their 70s or 80s who still live independently within a community.