At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.



I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.



I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.


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Emotional Abuse (inflicting mental pain, anguish, or distress on an elder person.)      

Self-neglect (characterized as the failure of a person to perform essential, self-care tasks and that such failure threatens his/her own health or safety.) You may notice:

Additional types of abuse:

Abandonment (desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.)

Exploitation (the illegal taking, misuse, or concealment of funds, property, or assets of a senior for someone else’s benefit.)

Initially you may not recognize or take seriously indications of elder abuse. The elderly patient may present with what may appear to be symptoms of dementia or signs of frailty. Caregivers may explain or dismiss possible signs of abuse in such a manner that may raise alarms and require further investigation. In fact, many of the signs and symptoms of elder bullying or abuse do overlap with symptoms of mental deterioration, but that doe not mean you should dismiss them based upon the perspective of the caregiver alone.

The abused or bullied individual typically has trouble defending him or herself and does nothing to cause the abuse. They are an easy target due to being weak physically and perhaps unable to recall conversations or events. This inability to remember is what the abuser counts on to get by with the abusive behavior because when questioned the inconsistency of the memory can render doubt to the incidents.

It is acceptable to ask probing questions when you suspect possible abuse, but it is important to note that it is not your role to verify that abuse is occurring, only to alert others of your suspicions. There are investigators employed by the state responsible for verification. It is your responsibility, morally and legally, to be alert and vigilant of the possibility. It is the law to report.

Kentucky is a mandatory reporting state. (Reference KRS 209.030).  To report call 1-800-752-6200, calls can be made anonymously. The Office of the Attorney General of Kentucky operates an Elder Abuse Hotline, 1-877 ABUSE TIP (1-877-228-7384). The Child/Adult Abuse Hotline at 1-877-597-2331 or 911 if it is an emergency.


Physicians and other medical professionals are often on the front line due to their accessibility to elderly patients. Sometimes being the only individual to see an elder other than their caregiver, the ability to recognize the signs of abuse is vital.

According to the Administration on Aging in Washington, D.C., each year hundreds of thousands of older persons are abused, neglected, and exploited. Many victims are people who are older, frail, and vulnerable and cannot help themselves and must depend on others to meet their most basic needs. Abusers of older adults are both women and men, and may be family members, friends, or “trusted others” at home or in a senior living community. It is often a private home situation, but abuse can take place anywhere.

In general, elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult. Legislatures in all 50 states have passed some form of elder abuse prevention laws.

As a medical professional you may not be privy to all types of elder abuse, but you will see the signs of most abuse. Whereas, a single sign may not be enough to determine abuse, if you see clusters of signs the possibility of abuse must be considered.

Abuse can be characterized as:


Physical Abuse (inflicting physical pain or injury on a senior)

Sexual Abuse (non-consensual sexual contact of any kind)

Neglect (the failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder)


Dr. Dani Vandiviere is a conflict and bullying specialist and CEO of Summit Conflict Resolutions and Trainings. She is the President of the Bluegrass Continuity of Care Association, a founding member of KY Association of Senior Services, a member Association for Gerontology, and an Elder Care Conflict Trainer and Mediator. She also offers training programs for the workers in the Eldercare industry, medical professional, elder’s families, organizations and businesses.

To learn more contact Dr. Dani at, or 859-305-1900.