Signs of Elder Abuse: Prevention and Support

In this episode, we tackle the often-overlooked but critical topic of elder abuse with guest Doni Green, who leads the North Central Texas Area Agency on Aging. With over two decades of experience administering federal programs for older adults and family caregivers, Doni brings invaluable insight into the complexities of abuse, neglect, and exploitation affecting seniors. Host Darleen Mahoney guides a sensitive yet deeply informative conversation, clarifying the many forms elder abuse can take—including physical, emotional, and financial mistreatment—and why it is so frequently underrecognized and underreported.

Listeners will learn to identify the warning signs of abuse, from physical indicators like unexplained bruises to emotional symptoms like withdrawal or intimidation. The discussion also candidly addresses caregiver burnout and the nuanced family dynamics that can sometimes escalate into harmful situations, emphasizing the importance of self-awareness and seeking help before frustrations boil over.

Doni Green explains how services like Adult Protective Services and Area Agencies on Aging can provide crucial support, resources, and interventions for both seniors and caregivers nationwide. She offers guidance on reporting suspected abuse and highlights the availability of respite care, support groups, and counseling—all designed to strengthen family caregiving while ensuring seniors' safety and dignity.

From practical tips for caregivers to a compassionate exploration of the impact of abuse on mental health, this episode is a comprehensive resource for anyone concerned about elder well-being. Tune in for essential information, supportive advice, and actionable resources to protect seniors and maintain healthy caregiving relationships.

SeniorLivingGuide.com Podcast sponsored by LIVDRY & TerraBella Senior Living

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Transcript

Darleen Mahoney [00:00:01]:

And today I am super excited to have Donni Green. She leads the North Central Texas Area Agency on Aging since 1996 and has responsibilities for administrating federal programs for older adults and family caregivers. She has prior work experience at a hospital based geriatric case manager and director of a hospital based senior membership program. She holds a master's degree in geronology. Did I say that correctly?

Donni Green [00:00:32]:

Yes.

Darleen Mahoney [00:00:33]:

Oh, my goodness. I didn't know that there was such a thing.

Donni Green [00:00:36]:

Yes, there is.

Darleen Mahoney [00:00:39]:

Well, that's perfect because I have a feeling that it falls right into what we want to talk about today. As far as some of your expertise, I've been wanting to talk about elder abuse for some time because I think people don't talk about it. And it can happen in many forms. It can happen in a physical way, an emotional way, and it can. I think it's important to know what to look for and to know if it's happening to you or if you're the one doing it. So I appreciate you joining.

Donni Green [00:01:14]:

Well, I appreciate you discussing the topic. It's a hard one. There are a lot of sensitivities and stigmas, but it's a very, very frequent phenomenon. One that, you know, is common but under recognized and underreported. So hats off to you for raising the issue.

Darleen Mahoney [00:01:37]:

Yeah, I think it's really important. I really want our seniors to be safe and secure and not have that. You know, we talk about kids, what happens to kids with child abuse and things like that.

Donni Green [00:01:49]:

And.

Darleen Mahoney [00:01:50]:

And it definitely happens with seniors, especially seniors that may be unable to care for themselves. They're losing some of their abilities to, you know, brush their own hair or the, what we call ADL's every day or ADL.

Donni Green [00:02:05]:

Oh my gosh, activities of daily living.

Darleen Mahoney [00:02:07]:

I'm literally thinking, I'm trying to remember

Donni Green [00:02:09]:

what it stands for.

Darleen Mahoney [00:02:11]:

But when you start losing those and you start becoming dependent on someone else, I think that's where you can maybe kind of fall into that trap.

Donni Green [00:02:18]:

Absolutely.

Darleen Mahoney [00:02:19]:

Yeah. So what have you seen in the work that you've done that are some of the signs that maybe someone that is a senior and is being cared for, some things that they need to be cognizant of so that they recognize it. Because when you're in it, sometimes you don't recognize it because it just becomes life, Especially if it's a slow process.

Donni Green [00:02:43]:

Absolutely, yeah. So it might be helpful to talk about the major categories into which mistreatment can fall. So abuse. You framed it really well. Abuse can include physical Abuse, it can include things like treating someone roughly or hitting or shoving. But physical abuse can also include things like denying someone or medications or perhaps over medicating someone. And that can be a big issue both in the community as well as in long term care facilities. There's been a lot of work over the last couple of decades to discourage facilities from using medications to kind of sedate people instead of, you know, treating the issue. Abuse can also include emotional abuse. So that captures things like name calling or belittling behavior, language, telling someone that she's stupid, discounting their opinion. And then in addition to abuse, there's also neglect, which is a little more subtle. But neglect can include things like denying somebody medical treatment, not getting someone to the doctor, not giving someone her medications, or not ensuring that someone within their care is being housed and clothed and fed and that their hygiene is maintained. It's interesting too that neglect can involve caregiver neglect. It can also involve self neglect. And interestingly enough, that is the majority of reason why people make referrals to adult protective services programs. It accounts for close to half of all referrals that are made. And that can be a person who is wandering, someone who perhaps is living with dementia and is having difficulty maintaining the household. So, you know, it can look very different depending on whether it's abuse, neglect. And then as a gerontologist, I'm also concerned about exploitation, which is using somebody else's money or goods for personal use and not for the benefit of that person.

Darleen Mahoney [00:05:44]:

Yeah, that's a huge array of what would be abusive to a senior. I didn't even think about like the financial side of it. I know that, you know, we've talked about scams and different things, but if you are taking advantage of someone for financial gain, that's abusive for sure.

Donni Green [00:06:06]:

Though, you know, with this topic there are usually many shades of gray. And so if I'm an older person and I have a lot of money and, and my children convince me that they need something, whether it's rent or a new car, and I give them that money. That's not exploitation.

Darleen Mahoney [00:06:33]:

No, no, that's not.

Donni Green [00:06:34]:

If I'm making a gift where it becomes really tricky with abuse, neglect and exploitation is where it's not really clear whether the person has capacity to understand the, that she's making. So I, as a competent adult, I can refuse to go to the doctor, I can refuse to take my medications, and if I understand that, well, my blood sugar may get out of control or my blood pressure may get out of control. I have the right to do that. It just becomes so much more problematic when it's not really clear whether I really do understand the consequences of those decisions. And those are the thorny kinds of issues that adult protective services caseworkers have to sort through.

Darleen Mahoney [00:07:27]:

Sure, sure. So to kind of break it down, starting with the physical abuse, what are some signs that a senior that's listening to the podcast may say, you know what? That's not great, and it's kind of happening to me. Or as a caregiver that might realize that. That maybe they've lost a little bit of control or they're struggling on their end, so they're really taking it out on their mom, their dad, or whoever they're taking care of. So what are some things that can kind of bring them back to getting in the right place on both of those fronts on the actual physical side?

Donni Green [00:08:08]:

Yeah. And physical abuse is probably one of the easiest types of maltreatment to recognize. So the signs and symptoms of physical abuse can include bruises, cuts, sometimes the person who's being abused. You can see it in the demeanor where the person who's being abused may withdraw when in the presence of the abuser or may look away, may feel intimidated. So that body language can sometimes serve as a helpful sign. Somebody who, you know, has lost an awful lot of weight and doesn't really know why. You know, I've worked with families who have denied food as punishment, and, you know, it's not always immediately apparent. And, you know, it's doubly difficult if you're not familiar with the person who may be abused or may not be familiar with the person who, you know, whom you suspect to be an abuser. If you don't know the dynamic between the two.

Darleen Mahoney [00:09:29]:

Right, right. And hearing all that from me, it just, like, it just grips my heart. It's heartbreaking to hear that that's happening, and I know it is. It's happening everywhere. But knowing that seniors, especially those not to discount those that aren't, but those that have cognitive issues because they don't understand what's happening, so they're dealing with so many different things, and that's just layer of stress and anxiety that they really don't need, and in the physical side of it, I totally understand where the food starts getting limited or you start yanking someone around because they're not getting in the shower fast enough or they're not getting out of bed fast enough. And so you find yourself frustrated and you're actually conducting yourself in an abusive manner to someone. And I think that can, that can lead from multiple areas. One is caregiver burnout, I'm sure, is a contributing factor.

Donni Green [00:10:26]:

Absolutely.

Darleen Mahoney [00:10:27]:

And then I also think it could be the relationship you've had with that person. So I know that if you've had a rough relationship growing up, you weren't the best of, you know, mother, daughter, mother, father, or, you know, child, adult, parent. And then you find yourself taking care of your parent because that's the. That may be the only alternative financially that you need to endure on that. You do find that you're losing, you're losing your, your patience and you're. You're doing things you wouldn't do, especially if you don't have that previous relationship.

Donni Green [00:11:04]:

Yeah, yeah, you're absolutely right. And, you know, developing a, an illness, you know, is not something that tends to heal. Family trauma, whatever dysfunction may have been present, is usually intensified, you know, in some cases. And, you know, clearly not all caregivers are abusive. No, I think it's important to recognize that it, you know, that it can be very, very stressful. And it does tend to make a lot of demands on that caregiver. It usually has physical demands. It often has financial demands. It often places a lot of demands on the caregiver's health. And we often see caregivers going without sleep, going without proper nutrition, kind of constricting their social networks. Sometimes they have to cut back on their work hours or resign in order to take on these care responsibilities. And so they're just, you know, several layers of stressors. And. But, you know, a lot of people find it to be very fulfilling. Most caregivers do exceptionally well. But if a caregiver is getting to the point where, you know, it's more than a bad day and that's totally normal, that's a natural stress reaction. Mom was up last night. I didn't get any sleep. I'm exhausted. I've got a deadline I have to meet. That's not particularly a cause for concern. It's when those feelings are persistent and continual and it turns from, gee, this is a really rough situation to, oh, my gosh, I'm so angry at my mother. And again, it's normal and natural to get frustrated with situations, but that's where caregiver stress can lead to caregiver burnout. And if there's not some kind of support that's provided, whether it's a support group or respite care or in home services or financial assistance, that's where there's a risk of it progressing. From burnout to abuse, neglect, to a lesser extent, exploitation. Exploitation is, I think, tied more closely to kind of financial need. But again, one of the things that I've kind of committed my working career to is providing support for both older adults as well as family caregivers, particularly at that point where again, kind of the bad day turns into a bad week, turns into a bad month.

Darleen Mahoney [00:14:36]:

Right. And that can, that can be become resentfulness. That could be triggered by just consistently doing it and not getting that caregiver support that is so available. And I know we're going to provide a couple of resources today for folks as well, which at the end of the day, that's what it's about. It's about listening, talking, having good conversations and then finding solutions when there's. There's problems. And I do think that the. You could start getting perfectly good relationship and then the caregiving, Caregiving, care beginning. If you're not taking care of yourself, you're going to become resentful.

Donni Green [00:15:11]:

Yeah, absolutely.

Darleen Mahoney [00:15:12]:

Yeah. So. And I know we talked a little bit about the emotional side of it as well, about the name calling and things like that. And I feel like I've actually seen some of that, you know, as a child, I kind of saw that a little bit in some different family dynamics. And I remember thinking that I didn't love it at the time, but didn't recognize it as abusive. And that can come a lot of times from resentfulness, just the name calling, that you just start getting frustrated and that's what starts happening. But you can't let it get to that.

Donni Green [00:15:49]:

Yeah. And you know what, what really matters is the impact the behavior is having. And in some families, you know, there's just a lot of kidding and name calling. You know, in my household, our nicknames are stinky and Loser. You know, you know, that's just, that's just our way of interacting. But, but with abuse, neglect, what's really important is, is there harm created to the older person? Is, you know, is the person withdrawing because of the way she's being treated? Is she being denied opportunities to, you know, to have visitors because, you know, the family restricts access because, you know, they're embarrassed that she may say something or do something that's inappropriate? You know, that's where it kind of crosses over from kind of reasonable concern and safeguards into harm. And that's the point at which some kind of intervention is necessary. And in terms of abuse, neglect and exploitation, it's pretty staggering to look at the incidents. So it's estimated that about 1 in 10 older adults, people age 65 and over, will experience abuse, neglect or exploitation during a year's time. And if you look at the number of Americans age 65 and over, we're looking at about 60 million people. Well, if you do the math, one in 10. Oh, my goodness, that's, you know, that's around six, six and a half million people per year. And in those cases, only about somewhere between 3 and 5% of all incidents are reported to adult protective services. To me, that's what's most concerning is that, you know, a lot of people don't see it, or they may notice that something is a little bit off, but they don't want to get involved. They don't want to get in trouble. They don't want to be responsible for the person having to go to a nursing home. And the nation's system of adult protective services is structured so that all reports are kept confidential. So a caseworker is not going to come out and say, you know, your neighbor Donnie, you know, told me she was concerned about you. They'll do their investigation. And, you know, their approach is always to try to get people the supports they need to support them in the least restrictive setting. They don't have the power to remove people from their homes. In some situations, if it's, you know, an imminent threat to somebody's health or safety, they can go through the court, but that happens so infrequently. So, you know, our message is, you know, if you have any reasonable suspicion, just report what you know. You don't have to make a determination of whether there's abuse, neglect, or exploitation going on, but, you know, you just need to share any reasonable suspicions so that the experts can do their investigations and can, you know, determine if there is a threat to health or safety, determine, you know, if the person has capacity to make the decisions that he or she is making. So, again, I just really applaud you for dealing with this issue. Yeah.

Darleen Mahoney [00:20:03]:

Because I do feel like when there is any form of elder abuse, that elder person will experience mental health issues and different things. That I think it's starting to get recognized in seniors because I think a lot of people think, oh, they're older, they're just going to be depressed. That's just the way that they are. It's just part of getting old. And that's not necessarily true. Just because you're older doesn't mean there should be an expectation that you're going to have a decline in depression and mental health. And not address it. And I do think that you definitely would have some of those issues with people that are experiencing any form of elder abuse.

Donni Green [00:20:42]:

Yeah, absolutely.

Darleen Mahoney [00:20:45]:

Yeah. And that's concerning to me. I think that, you know, we get one life and in the grand scheme of things, it's very life very short, I should say. And you should be able to live your best life for as long as you're here and you're healthy and you're able to do it or even if you're not healthy, still, there's still joys and expectations of a daily living that should be provided to everyone.

Donni Green [00:21:07]:

Absolutely.

Darleen Mahoney [00:21:08]:

Yeah, for sure. So you kind of mentioned adult protective services. So if you were, if you think that maybe your neighbors being being abused or maybe your sister is not taking very good care of your mother, but she's not going to allow you to get involved in anything or whatever the case may be. I'm just throwing out some general scenarios. Do you just go online and Google adult protective services?

Donni Green [00:21:33]:

You sure can. And each state has its own adult protective services agency. So you would need to Google it to find the agency for your state. The other option would be to contact the Elder care locator, which is a program of the federal government. It doesn't operate the adult protective services system for the states, but it can provide that information and it also connects people with their area agencies on aging. In some states, the area agencies on aging do perform investigations. In most states they're separate. But the area Agencies on aging are wonderful resources in terms of providing that education and support and connecting both older adults who need some in home help as well as caregivers with support services. So the elder care locator is at 800-677-1116 again, 800-677-1116. So if you're not a Googler, you can call.

Darleen Mahoney [00:22:53]:

Exactly.

Donni Green [00:22:53]:

Contact information that way as well.

Darleen Mahoney [00:22:56]:

And, and I do have the link that you did provide me, so I do appreciate that. And we're going to include that in the description as well. So that could be an easy click. And then I know that you provided one for the, the area on agency for your area, which is nctgoc.org backslash aging/or-services backslash. And I will include that in the description as well because that was a mouthful.

Donni Green [00:23:25]:

Yes, it is.

Darleen Mahoney [00:23:26]:

Yes. But I do appreciate the fact that, you know, Central Texas is, is, is working in this arena and they have the area on agency that's able to help folks in that area.

Donni Green [00:23:39]:

Yeah, it's not unique to our area we are part of a national network of services that was created by the Older Americans Act. So with your national audience, anybody in the United States or its territories would have an area agency on aging that serves that area.

Darleen Mahoney [00:23:58]:

That's good to know. So no matter where you are in the US There is an area in aging that's actively able to provide the services, information, resources, and that. Caregiver support.

Donni Green [00:24:09]:

And caregiver support, yeah. Yes. Since 2001, our federal legislation has provided funding to provide various supports to caregivers. So the area agencies on aging can provide information and referral, can provide respite care to caregivers. Some of them will pay for counseling programs, education, support groups, you name it. And all of those services are provided at no charge to older adults and family caregivers who qualify.

Darleen Mahoney [00:24:40]:

I think those are definitely the keys to reduce the elder abuse that goes on is to continue to provide those, you know, that support. But you have to look for it. You can't just not look for it. So if you're listening and you feel like you're frustrated, you're taking care of mom, dad, their ADL's, the daily living, they're declining, and you're getting frustrated or resilient, resentful, you got to start looking for support. You've got to start looking for resources. You can't just continue down that path because it's not fair to the person you're taking care of. And it's definitely not fair to yourself as well.

Donni Green [00:25:15]:

Absolutely. Yep.

Darleen Mahoney [00:25:17]:

Yeah, I know. There's even Facebook caregiving groups. My girlfriend was telling me about that. I thought that was really cool. And it's the area that you live so you can get together with, you know, people that are your same age or same interest or whatever that are going through a lot of the similar things you might be going through with an aging parent. So that's amazing. So is there anything else that we didn't touch on? I know that we didn't do the financial crimes too much, or not financial crimes, but financial abuse, where maybe you're just taking advantage of mom, maybe writing checks out of her checkbook for things that she didn't tell you you could. Things like that, that's not okay either. And I think that's something that. If that's happening, if you see a family member or something like that doing that, that it's. It has to be addressed as well.

Donni Green [00:26:07]:

Absolutely.

Darleen Mahoney [00:26:09]:

Yeah.

Donni Green [00:26:09]:

Yeah.

Darleen Mahoney [00:26:10]:

And that sometimes can be really easy to do to. To. To take things that maybe weren't authorized when you're Caring for someone that's older and then also clearly the cognitive issues as well. So.

Donni Green [00:26:22]:

Yeah, yeah, yeah. One of the red flags we see with exploitation is someone being coerced into signing a power of attorney for business affairs and then that agent just kind of going wild saying, well, I'm the agent and you know, I'm going to buy a new car, new house, and.

Darleen Mahoney [00:26:42]:

Yeah.

Donni Green [00:26:43]:

And you know, mom's going to continue living in the house with the leaky

Darleen Mahoney [00:26:48]:

roof, the van down by the river. So.

Donni Green [00:26:50]:

That's right.

Darleen Mahoney [00:26:52]:

So I will tell you, if someone has cognitive issues, that attorney should not be entertaining the idea of taking them on as a client because of those cognitive issues, because they don't have the ability to make those decisions. They just don't.

Donni Green [00:27:08]:

Yeah. I mean, one of the requirements for executing a power of attorney is having the capacity to understand the decision. Now, you know, people can have early dementia and still make reasoned decisions.

Darleen Mahoney [00:27:23]:

That is true.

Donni Green [00:27:24]:

It's not a cut and dry thing. And you know, that's, that's a challenge for adult protective services. It's a challenge for the attorney as well. But yeah, if somebody, you know, no longer understands the consequences of financial decisions, that ship has sailed. That person should not sign a power of attorney. And at that point, you know, really the, the only alternative would be to look at a guard.