Indicators of Elder Abuse and Neglect

The following indicators do not signify abuse or neglect per se. They can be clues however, and thus helpful in assessing the older person’s situation. The physical assessment of abuse should be done by a physician or trained health practitioner.

Physical Indicators

• Injury that has not been cared for properly.
• Any injury incompatible with person’s explanation.
• Pain on touching.
• Cuts, lacerations, puncture wounds.
• Bruises, welt, discoloration:
  • On both upper arms.
  • Clustered on trunk, but may be found over any area of the body.
  • Injury looks like an object.
  • Presence of old and new bruises at the same time.
• Dehydration and/or malnourishment without illness-related cause; loss of weight.
• Pallor.
• Sunken eyes, cheeks.
• Evidence of inadequate care (i.e., gross decubitus without adequate medical care).
• Evidence of inadequate or inappropriate use of medication.
• Absence of hair and/or hemorrhaging below scalp.
• Soiled clothing or bed.
• Burns – may be caused by cigarettes, caustics, acids, friction from ropes or chains; from confinement.
• Signs of confinement (tied to furniture, bathroom fixtures, locked in a room).
• Lack of bandages on injuries or stitches when indicated, or evidence of unset bones.

Injuries are sometimes hidden under the breasts or on other areas of the body covered by clothing. Repeated skin or other bodily injuries should be noted and careful attention paid to their location and treatment. Frequent use of the emergency room and/or hospital or health care “shopping” may also indicate physical abuse. The lack of necessary aids such as walkers, canes, bedside commodes; lack of necessities such as heat, food, water, and unsafe conditions in the home (no railings on stairs, etc.) may indicate abuse or neglect.

Behavioral Indicators

These behaviors in themselves, of course, do not indicate abuse or neglect. However, they may be clues to ask more questions and look beyond the obvious.

• Fear
• Withdrawal
• Depression
• Helplessness
• Resignation
• Implausible stories
• Confusion or disorientation
• Ambivalence/contradictory statements not due to mental dysfunction
• Anger
• Denial
• Non responsiveness
• Agitation, anxiety

Indicators from the Family/Caregiver

• The older person may not be given the opportunity to speak for him or herself or to see others without the presence of the caregiver (suspected abuser).
• Obvious absence of assistance attitudes of indifference or anger toward the dependent person.
• Family member or caregiver “blames” the older person (i.e., accusation that incontinence is a deliberate act).
• Aggressive behavior (threats, insults, harassment).
• Previous history of abuse to others.
• Problems with alcohol or drugs.
• Flirtations, coyness, etc. as indicators of possible inappropriate sexual relationship.
• Social isolation of family or isolation or restriction of activity of the older adult within the family unit.
• Conflicting accounts of incidents by the family, supporters, victim.
• Unwillingness or reluctance to comply with service providers in planning for care and implementation.
• Withholding of security and affection.

Possible Indicators of Financial Abuse

This list is not intended to be exhaustive. Likewise, the reader is cautioned to fully evaluate a situation before coming to the conclusion that there is financial abuse. This list is intended to convey POSSIBLE abuse. Great care must be taken before making any accusations.

• Unusual activity in bank accounts.
• Activity in bank accounts that is inappropriate to the older adult, i.e., withdrawals from automated banking machines when the person cannot walk or get to the bank.
• Unusual interest in the amount of money being expended for the care of the older person, concern that too much is being spent.
• Refusal to spend money on the care of the older person. Numerous unpaid bills, overdue rent, when someone is supposed to be paying the bills.
• Recent acquaintances expressing gushy, undying affection for a wealthy old person.
• Placement not commensurate with alleged size of the estate.
• Lack of amenities, i.e., TV, personal grooming items, appropriate clothing when the estate can well afford it.
• Personal belongings such as art, silverware, jewelry missing.
• Housekeeper tries to isolate older adult from friends and family, tells older person no one wants to see him/her, and older person then becomes isolated and alienated from those who are for her/him; comes to rely on housekeeper alone who then has total control.
• Promises of life-long care in exchange for willing or deeding of all property/bank accounts to caretaker.
• Signatures on checks, etc. that do not resemble older person’s signature.
• Checks and other documents signed when older person cannot write.

Texas Adult Protective Services
Elder Abuse Hotline
1.800.252.5400 or

1.512.834.3784