Adult Abuse Prevention Kit

Section Three: Issues Facing Vulnerable Adults

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What is Self-neglect?

Self-neglect occurs when individuals fail to provide themselves with whatever is necessary to prevent physical or emotional harm or pain. The reasons that vulnerable adults neglect their own needs are often complicated, and frequently people are unaware of the severity of their situation.

What are the signs? Some common signs that may indicate self-neglect include:

  • obvious malnutrition
  • being physically unclean and unkempt;
  • excessive fatigue and listlessness;
  • dirty, ragged clothing;
  • unmet medical or dental needs;
  • refusing to take medications or disregarding medical restrictions;
  • home in a state of filth or dangerous disrepair;
  • unpaid utility bills; and
  • lack of food or medications.

What are the causes? Depression can cloud a person's view of the world and their circumstances, leading to self-neglecting behavior. Often, elderly people lose their motivation to live because they are lonely and isolated. Other reasons that elders neglect themselves can include unexpressed rage, frustration, or grief; alcoholism or drug addiction; and sacrificing for children, grandchildren, or others at the expense of their own unmet needs. Finally, mental or physical illness can quickly result in the deterioration of an elder's ability to adequately provide for his/her own needs.

What can be done to help? As much as possible, respectfully involve the elder in an effort to determine the cause of their particular case of self-neglect. Acknowledge and discuss the situation with the elder. If appropriate, ask the question, "What would make life meaningful for you again?" Allow them to express their feelings; this could reveal both the cause of the problem and its solution.

Depending on the circumstances, other helpful actions could include: medical or dental treatment; anti-depressant medications; help them get involved in a favorite hobby or provide transportation to a social group; get them a pet; confront them with their self-neglect; or get family members involved. When drug or alcohol addiction is the issue, hospital-based treatment is frequently the best solution. Sometimes the cause of self-neglect is directly related to the influence of someone else in their life. Perhaps the elderly individual is sacrificing his/her needs in order to care for grandchildren or an ill spouse. Intervening in such situations often requires extreme caution, as the elder may be resistant to any change that threatens the relationship. Use your judgment to weigh the options, and involve professionals if it seems appropriate.

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Medication/Substance Abuse

Using medications wisely and substance abuse are concerns that apply to all age groups. But due to several factors, the elderly and people with disabilities are at a greater risk for having trouble with both areas.

Using Medications Wisely. Medicine helps people live longer and more productively every day. But because medications are powerful substances, the consequences of using them can be dangerous, even deadly. Drugs can affect people in different ways. The elderly are at risk of misusing medications because they generally have several prescriptions and because reactions to medications change as the body ages.

People who are elderly or have disabilities need to find out about the drugs they are taking and possible drug interactions. They should inform doctors, pharmacists, and health professionals about their current medications.

Taking several medications can get confusing. In fact, many people forget whether they have taken a medication. One way to ease confusion is to create a chart that contains the name of each medication, its side effects, and when it needs to be taken. The chart should also include a column to be checked-off once a medication has been taken.

If several medications are taken at different times of the day, people may use a container system. A container can be as simple as a cup or egg carton or as fancy as daily multiple pill containers available at drug stores. Caution: People who live in homes with children should be wary of any container system since it requires leaving medications out in the open.

Substance Abuse. Coping with a disability or aging can be difficult. Some people who are elderly or have disabilities may turn to alcohol and drugs. Vulnerable adults must be aware that even small amounts can seriously hurt them. Alcohol can produce a dangerous reaction with acetaminophen, antibiotics, antidepressants, muscle relaxants, or sleep medication.

Alcohol, marijuana, and other drugs affect memory, ability to solve problems, and reaction time. Prolonged use of alcohol, tobacco, and other substances may have serious long-term health effects.

For more information about the risks of substance abuse, consult with health professionals, Alcoholics Anonymous, or Narcotics Anonymous. If people who suffer from chronic pain fear they are abusing pain medication, they should consult with their doctor to learn about other pain-reduction methods such as special exercises and biofeedback.

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Fraud and Exploitation and How to Avoid Them

Fraud by friends and family-new "best friends," thieving caregivers," religious con artists, financial abuse by family members—these are examples of exploitation and should be reported to Adult Protective Services at 1-800-252-5400.

Report instances of fraud as described below to the Consumer Protection Division of the Attorney General's office at 1-800-621-0508.

Home Equity Fraud.Homeowners may be tricked into signing over the deeds to their homes. Often a person pretending to be a repairman or someone offering another service does this scam. The elderly person signs a contract believing it to be for roof repair, for example, and does not read it carefully enough to realize that it is a deed to their own home.

How to Avoid Home Equity Fraud. Some examples of how to avoid home equity fraud are:

  • make sure the contractors you hire are licensed, bonded, and insured;
  • hire only attorneys with malpractice insurance;
  • keep current with property tax bills;
  • sign a grant deed with an attorney present;
  • have a reputable attorney or trusted person examine documents before you sign them;
  • don't use your home as collateral;
  • get several estimates from contractors and check their references;
  • contact the Better Business Bureau;
  • read the fine print; and
  • check with your city or bank for home repair financing programs.

Telemarketing Fraud. Some examples of telemarketing schemes which target elders are:

  • the “You Are A Winner! " pitch, which misleads victims with a nonexistent prize in order to get them to buy something;
  • offers to "get your stolen money back for you";
  • great loans or "fixing" bad credit;
  • fantastic low prices on merchandise; or
  • any caller requesting your bank account or credit card number.

How to Avoid Telemarketing Fraud. If you hear the following tip-offs just say NO and hang up.

  • Act now or the offer will expire.
  • You've won a "free" gift, vacation, or prize, but you must pay for "postage and handling" or some other charge.
  • You must send money, give a credit or bank card number, or have your check picked up by courier before you can think it over.
  • You can't afford to miss this high-profit, no-risk offer; we can get your money back.
  • Make a decision based on trust.

Mail Fraud. If it sounds too good to be true, it probably is. Watch out for:

  • fake contests;
  • prize;
  • lotteries;
  • chain letters;
  • insurance deals;
  • land and advance-fee selling swindles;
  • franchise and charity schemes;
  • work-at-home and fraudulent diploma schemes; and
  • promotions for fake health cures, beauty devices, or diets.

How to Avoid Mail Fraud. Don't believe you have won a contest until you receive the check, and if you have to pay money or buy something to get the check, it is a scam. For more information contact Postal Service Mail Fraud Complaint Center at 1-800-372-8347 or National Fraud Information Center 1-800-876-7060.

Health Fraud. Some health fraud scams to watch for are:

  • advertisements for fake "cures";
  • fraudulent medical and health services marketed via the television or telephone (victims send in their money and never receive the ordered item or receive a copy rather than an authentic product);
  • "free" hearing tests and hearing aids;
  • health care fraud where phony or real physicians take advantage of patients as a means of getting money from the victim's insurance company; and
  • bogus insurance companies.

How to Avoid Health Fraud

  • Beware of "free hearing tests" and never agree to a hearing test in your home.
  • Shop around before buying; question any "free" medical service or quick or painless cure.
  • Avoid special, secret, ancient, or foreign formulas that are only available by mail or from only one supplier.

Money-related Fraud

  • Theft of stocks and bonds that are stored at home.
  • Mismanagement of assets by caregivers.
  • Real estate rip-offs.
  • ATM "repairman" thefts of cash, ATM cards, or account passwords.
  • Check forgery.
  • Nonrefundable fees for services not delivered.

How to Avoid Money-related Fraud

  • Avoid or hang up on strangers who want to take your money or know about your finances.
  • Say "No!" to anyone who presses you to make an immediate decision.
  • Never give anyone a blank check.
  • Count your change and check your receipts.
  • Don't give your credit card number over the phone unless it's a reputable company.
  • Be cautious if you don't have experience in handling money.

Contact the Women's Financial Information Program of the American Association of Retired Persons for more information at 1-512-480-9797.

Report instances of telephone fraud as described below to the Public Utility Commission at 1-888-782-8477.

Slamming. Your telephone long distance carrier service is changed without your permission. It is illegal.

How to Avoid Slamming. Check your telephone bill carefully every month.

Cramming. Charges are made to your credit card or phone bill which you did not authorize. You don't have to pay for fraudulent charges.

How to Avoid Cramming

  • Carefully review your telephone bill and credit card bills each month.
  • If you fill out a form to enter a contest or sweepstakes, read the fine print to be sure you are not authorizing changes or charges to your telephone.

E-mail and Internet fraud. More and more seniors and people with disabilities use the Internet on a regular basis. Like everyone else, these users may be tricked into entering contests or some other activity over the Internet involving money. They may also receive bogus e-mail messages that give the appearance of being from a legitimate organization such as banks, credit unions, credit cards, etc. Often such e-mails include web site graphics and logos that give the look and feel of a trusted source. Such e-mails are an attempt to entice recipients to provide personal financial details, such as account information, credit card, and Social Security numbers.

How to Avoid Email and Internet fraud. As a precaution, never respond to an unsolicited e-mail that asks for personal financial or identification information. If you believe you have provided sensitive information about yourself through such a scam, immediately notify the financial institution or credit card company to inform them that you may be the victim of a scam.

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Preventing Exploitation Through Money Management

An estimated 500,000 older people in the United States need help with their financial affairs. As a result, a new field called daily money managers is evolving to provide money management services.

Daily money managers organize and keep track of financial and medical insurance records; establish a budget; help with check writing and checkbook balancing; and administer the benefits of people who can't manage their own financial affairs.

Daily money managers typically charge $25 to $100 an hour. While it is difficult to generalize the total cost, many clients require only a few hours of services each month. Some local governments and community organizations also offer reduced-fee or free services for low-income clients.

Do You Know An Elder Who Needs a Daily Money Manager? With the elder's help or permission, review his or her checkbook, bank statements, and canceled checks. Look for things such as payments for medical bills that already have been paid; numerous payments to credit card companies, home shopping networks, sweepstakes or other contests; unusually large charitable donations; failure to track deposits or expenditures; lost checkbooks or bank statements; numerous transfers from savings to checking accounts; or consistent or unusual payments to a questionable recipient.

Review bills and correspondence and watch out for letters from creditors for past due notices. The review may indicate that a daily money manager is needed. If your review gives you reason to believe that a caregiver, family member, or friend is improperly using the elder's resources for their own benefit, report the situation to Adult Protective Services at 1-800-252-5400.

If you and the vulnerable adult decide that a daily money manager would be a helpful resource, interview several candidates. Get references and talk with their clients. Ask money managers for their company's financial statement. Contact the Better Business Bureau, Chamber of Commerce, local consumer protection agency, or area agency on aging. Ask if they have any complaints on file, but be aware that a lack of complaints does not mean that problems did not exist.

For More Information. The Eldercare Locator - a nationwide, toll-free assistance directory sponsored by the National Association of Area Agencies on Aging - will refer you to the area agency on aging nearest to your parent or other older adult. The phone number is 1-800-677-1116.

American Association of Daily Money Managers
P.O. Box 755
Silver Spring, MD 20918
(814) 238-2401

The association can provide names of daily money managers in an older person's community or nearby.

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Isolation and self-neglect are common among people who are elderly or have disabilities. Isolation is defined as the lack of participation in activities that require contact with people. This problem applies to people regardless of their education, income, ethnicity, geographic location, or social lifestyle. People who are most at-risk of isolation are frail or chronically ill, widowed or divorced, usually female, living alone, have reduced resources, and are members of a minority group.

Isolation may lead to loss in personal integrity, estrangement from family and friends, inability to care for one's self, and deterioration of the ability to think and make decisions. Isolation can result in self-neglect, which is a form of elder abuse when living conditions are potentially life threatening. Isolation may lead people to be self-neglecting to the point that they deny any physical or mental problems and refuse help from family and friends.

Isolation means that people usually have less support and interaction from others (often due to the death of a significant other); experience reduced coping skills; are less able to make decisions; are at greater risk of depression, substance abuse, mental impairment, or mental illness; have lost self-esteem; and may be unable or refuse to accept changes or acknowledge a need for help.

Isolation and self-neglect require individual or community intervention. The communication and attention other persons provide can improve the self-esteem and lifestyle of an isolated elder. They can act as confidantes, assist with errands, housekeeping, and meet transportation needs.

People who are isolated can benefit from support groups for people living alone. Support groups are effective because they provide the opportunity for sharing experiences, mutual support, and problem solving.

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Everyone feels sad or blue sometimes. But when sadness persists and interferes with everyday life, it may be depression. Very treatable, depression affects about 15 out of every 100 adults older than age 65.

How to Recognize Depression. Recognizing depression in the elderly and people with disabilities is not always easy. Vulnerable adults with depression may not know how to explain how they feel. They also may fear that they will be labeled as "crazy" or as having character weakness. Vulnerable adults and their families may dismiss depression as a passing mood.

Common Symptoms. Symptoms may include persistent sadness, feeling slowed down, excessive worries about finances or health, frequent tearfulness, weight changes, pacing and fidgeting, difficulty sleeping, difficulty concentrating, and physical symptoms such as pain or gastrointestinal problems.

Causes. Since depression is commonly due to biological changes in the brain, it is likely to occur for no apparent reason. Biological changes to the brain and body, medical illnesses, or genetics may put groups like elderly people at greater risk of depression. A specific event like retirement or the loss of a partner or loved one may lead to depression. It is normal to grieve over such events, but if the grief persists, it may be a sign of depression. Illnesses such as cancer, Parkinson's disease, heart disease, stroke, or Alzheimer's disease may cause late-life depression. These diseases may also hide symptoms of depression.

Suicide and Depression. Suicide is more common in older people than in any other age group. The population of people older than age 65 accounts for 25 percent of the nation's suicides. Suicidal attempts or severe thoughts should be taken seriously.

Treatment. Most people can improve dramatically with treatment, which may include psychotherapy, antidepressant medications, and other procedures. Psychotherapy can play an important role with or without medications. There are many forms of short-term therapy (10 to 20 weeks) that have proven to be effective. Antidepressants help restore the balance and supply of neurotransmitters in the brain. Mixing doses, taking the wrong amount, or suddenly stopping antidepressants may result in negative effects.

Caring for a Person with Depression. The first step is to make sure the person gets a complete physical checkup because depression may be a side effect of another medical condition. If the person is confused or withdrawn, accompany the person to the doctor. The doctor may refer the person to a psychiatrist. If the person is reluctant to see a psychiatrist, try to assure the person that an evaluation is necessary to determine what treatment is needed.

Common Indicators of Depression

  • Dejection and sadness without any apparent cause
  • Lack of interest in once enjoyable activities
  • Change in appetite or weight
  • Insomnia and waking early in the morning
  • Fatigue and lethargy
  • Lack of concentration; indecisiveness
  • Talk of suicide or death
  • Feelings of hopelessness
  • Excessive feelings of guilt and worthlessness
  • Irritability or hostility
  • Vague complaints of chronic aches and pains with physical basis
  • Poor grooming and personal hygiene
  • Weeping or tearfulness
  • Change in bowel habits, especially constipation
  • Increased use of alcohol, drugs, or tobacco
  • Memory loss

Adapted with permission from “How to Care for Aging Parents,” Virginia Morris, Workman Publishing Company, New York, 1996, page 107.

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Danger from Summer Heat is Everyone’s Business

According to the Centers for Disease Control, hundreds of people across the United States die and millions are at risk of getting sick every year from heat-related illnesses. Most of these occurrences are preventable if only people understood more about the dangers of heat and dehydration, especially in vulnerable populations. [download tip card]

Protecting adults who are elderly or have disabilities from summer heat is everybody’s business. If you know a vulnerable adult who is in danger due to the heat, contact the Texas Abuse Hotline at 1-800-252-5400 or report the incident online at If you believe it is a life-threatening emergency, dial 911.

Heat Related Illness. Heat related medical conditions include heat stroke, heat exhaustion, heat cramps, sunburn, and heat rash.

Heat exhaustion occurs when a body has lost a lot of its fluids through sweating, and, as a result, the body overheats. Signs include heavy sweating, pale complexion, muscle cramps, tiredness, weakness, dizziness, headache, nausea, vomiting, fainting, skin may be cool and moist, fast and weak pulse, fast and shallow breathing.

If untreated, heat exhaustion may progress to heat stroke, which is a life threatening medical condition that can result in damage to the brain and other organs.

Of all people who die of heat stroke, about 80 percent are age 50 or older. Deaths attributed to diabetes, lung disease, and hypertension increase more than 50 percent during heat waves. Heat stroke occurs 12 to 13 times more frequently in people age 65 and older than in younger persons.

Elderly people are more susceptible to heat exhaustion and heat stroke because they:

  • begin to sweat at higher body temperatures and less effectively than younger people – their sweat glands do not function as well;
  • are more likely to have medical conditions that upset normal body responses to heat. These include any thyroid diseases, high blood pressure, heart/circulatory problems, and chronic illnesses such as lupus;
  • are more likely to take medications that cause mouth dryness, increase sensitivity to the sun, change ability to reason, or impair the body’s ability to regulate temperature or perspire. These include diuretics, antibiotics, antidepressants, anti-psychotics, nonsteroidal anti-inflammatory drugs, sedatives, and antihistamines;
  • and are more susceptible to other risk factors such as mental illness, alcoholism, impaired self-care ability, and unavailability of air conditioning.

What You Can Do If You Are An Adult Who Is Elderly Or Has Disabilities

  • If possible, stay in an air-conditioned area, either at home or in a public place such as a mall, library, or recreation center. If air conditioning is not available, pull shades over the windows and use cross-ventilation and fans to cool rooms.
  • Drink plenty of fluids, but avoid drinks with alcohol, caffeine, or a lot of sugar. Don't wait until you are thirsty.
  • Start drinking fluids at least 30 minutes before going out.
  • Plan strenuous outdoor activity for early morning or evening when the temperature is lower.
  • Take frequent breaks when working outside.
  • Wear sunscreen SPF 15 or higher, wide-brimmed hats, and light-colored, loose-fitting clothes.
  • Eat more frequently, but be sure meals are well balanced, cool, and light.

What You Can Do to Help Protect Adults Who Are Elderly or Have Disabilities

  • Visit them at least twice a day and watch them for signs of heat exhaustion or heat stroke.
  • Take them to air-conditioned locations if they have transportation problems.
  • Make sure they have access to an electric fan whenever possible.
  • Many APS offices have organized resource rooms to distribute items to the elderly such as donated fans. To find out how you can help, contact the DFPS Volunteer Services Coordinator nearest you – a list is available at

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Getting Involved

Ways You Can Help

  • Form a Home Improvement Alliance within your organization or congregation to repair homes of the elderly and disabled adults. Services could include yard work; minor electrical, plumbing and carpentry repairs; building ramps; house painting and roof repair.
  • Assist elders with pet care by taking pets to the vet, exercising dogs, helping with grooming and medications, etc.
  • Deliver Meals on Wheels.
  • Provide transportation.
  • Call your local Area Agency on Aging to inquire about specific volunteer needs, which could include money management, guardianship, and ombudsman volunteer opportunities.
  • Organize a "Caregivers" group through your church.
  • Relieve a caregiver by sitting with their ill loved one; this helps the elder as well as the caregiver who may desperately need a break.
  • Get to know your elderly neighbor, become personally involved and include them in your family activities.
  • Join groups such as Gray Panthers or American Association of Retired Persons (AARP).
  • Collect holiday and birthday gifts for the elderly and disabled adults in your community.
  • Recruit organizations and businesses to donate their resources to help the elderly and disabled who are in need of assistance.
  • Develop local Adult Protective Services Multidisciplinary Teams or participate in an existing project in your community that supports the elderly and adults with disabilities.
  • Donate blankets, non-perishable food items, pet food, and household items to your local APS Resource Room.
  • Help create a Resource Room or food pantry if one is not available in your area.
  • Call your local DFPS office and request information on the programs that benefit vulnerable adults in your area.

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