Abuse in Vulnerable Adults—Topic Overview

Adults with physical, mental, or emotional disabilities are more vulnerable than other adults because they are not as independent. They may have a hard time making decisions. Or they may have problems controlling their behavior. Along with older adults, these vulnerable adults have a higher risk of being abused by others.

Types of abuse

These are three types of abuse.

• Domestic abuse. This usually happens in the person's home or in the home of the caregiver. The abuser is often a relative, a close friend, or a paid companion.
• Institutional abuse. This happens in a nursing home, foster home, or assisted-living facility. The abuser's job is to help care for the vulnerable adult.
• Self-neglect. In addition to abuse from others, a vulnerable adult may not take care of himself or herself very well.

Acts of abuse

Abuse in vulnerable adults can include:

• Violent acts. These include hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, choking, and burning. Other examples are misuse of medicines or physical restraints and force-feeding.
• Forced sexual contact. This includes rape, forced nudity, and sexual photos.
• Emotional or psychological abuse. This includes name-calling, insults, threats, intimidation, humiliation, and harassment. Other examples are treating the person like a baby, giving the "silent treatment," and not letting the person see loved ones or do regular activities.
• Neglect. This can include not providing for basic needs. It can also include financial neglect, such as withholding payment for nursing home care or assisted living.
• Misuse of money, property, or assets. This includes forging the person's signature, stealing money, and stealing valuable things. It also includes tricking the person into signing papers to transfer money, property, or assets.

Things that increase the risk of abuse

Abuse of vulnerable adults is a complex problem. Risk factors include:

• A pattern of domestic violence over time.
• Personal problems of caregivers. This can happen if the abuser needs financial or other support from the vulnerable person.
• Social isolation. Caregivers or family members may try to limit contact with others. This can make it easier to keep the abuse a secret.

Signs of abuse

• Along with reports from the vulnerable person about abuse, there are other signs to look out for. They may include:
  • Bruises, black eyes, welts, and rope marks. They can also include cuts, punctures, burns, or injuries that have not been treated.
  • Broken bones, including the skull.
  • Sprains, dislocations, or internal injuries.
  • Broken glasses or dentures.
  • Signs of being restrained.
  • Lab reports of too much or too little medicine.
  • A vulnerable adult's sudden change in behavior.
  • A caregiver that refuses to let visitors see the person alone.
• Signs of possible sexual abuse include:
  • Bruises around the breasts or genitals.
  • A sexually transmitted infection (STI) or other genital infection that can't be explained.
  • Bleeding from the vagina or anus that can't be explained.
  • Underwear that is torn or stained.
• Signs of emotional or psychological abuse include:
  • Seeming upset or nervous.
  • Acting more quiet or paranoid than normal.
  • Behaving strangely. This may include sucking, biting, and rocking.
• Signs of neglect may include:
  • Dehydration (not enough water or fluids).
  • Malnutrition (not enough food).
  • Untreated health problems.
  • Pressure injuries (pressure sores).
  • Unclean clothes, or an unclean body.
  • Living in a place that isn't clean or safe.
• Signs of financial abuse include:
  • Sudden banking changes, such as large withdrawals.
  • Added names on a vulnerable person's bank card.
  • Sudden changes in a will or other legal document.
  • Missing money or valuable things.
  • Unpaid bills or lack of care, even when money isn't a problem.
  • Forging the person's signature.
  • Relatives showing up who weren't involved before.
  • Paying for services that aren't needed.

Help for abuse

If you're worried about possible abuse of a vulnerable adult, talk to his or her doctor. You can also talk to your own doctor if you need help knowing what to do.

To report abuse or to get help, call Adult Protective Services (APS) in your state.