Emotional abuse and withdrawal is a common sign of nursing home abuse and neglect. A senior experiencing psychological or mental abuse can show signs of emotional withdrawal and reclusive behaviors, avoidance of social situations and may shut out others.

Emotionally withdrawn seniors are detached, aloof, and reclusive. If a typically engaged and outgoing senior becomes secluded and removed, this is an indication of emotional withdrawal. Emotional withdrawal can manifest in the form of silence around caretakers, especially if the caretakers are the ones causing the elder discomfort.

What Is Elder Emotional Abuse?

According to the Administration for Community Living, part of the U.S. Department of Health and Human Services, emotional abuse is “inflicting mental pain, anguish, or distress on an elderly person through verbal or nonverbal acts.”

Examples of the red flags of emotional abuse include:

  • The humiliation of the elder
  • Intimidation of the elder
  • Threatening behavior towards the elder
  • Isolation of the elder from other residents or activities
  • Ignoring the elder
  • Exploitation of the elder

Emotional withdrawal and silence around caretakers are common signs of emotional abuse.

What Causes Emotional Abuse?

90% of perpetrators of elder psychological abuse are family members.(1) There are many reasons why this could be the case, including:

  • Family members such as a daughter taking on unexpected responsibilities.  Stress felt by caregivers causes them to blame the victim.
  • Caregiver substance abuse such as alcoholism
  • Caregiver workload when the victim is living in the same home
  • Stress when providing care in the home that goes beyond what a family member can provide
  • The degree of elderly health problems. Elderly mental health issue such as dementia such as memory and cognitive impairment. The elderly may repeat questions, have bathroom issues, and other pressures.
  • Domestic violence and verbal abuse of the caregiver that is then taken out on the senior citizen.
Frequently Asked Questions
✅ What is emotional abuse?

Elder emotional abuse (also known as psychological abuse) is defined as "the infliction of anguish, pain or distress through verbal or non-verbal acts. Examples include making threats, harassment, and intimidation.

✅ How many older persons reported experienced abuse or neglect in a year?

A 2003 study found that 565,000 older persons reported experiencing abuse or neglect, with emotional abuse accounting for 15% of all cases. This number is considered to be low since older victims are unable to report their victimization because of cognitive impairments or mistreatment. (3)

✅ How common is emotional abuse in the elderly?

Emotional abuse is the most frequent type of elder maltreatment with estimates of one in twenty older persons being emotionally or psychologically abused each year. (4)

✅ Who commits elder emotional abuse?

In a long-term care setting, the majority of physical and emotional abuse is committed by nurse's assistants. These are also the caretakers that have the most contact with residents.(5)

Signs of Emotional Abuse of the Elderly

The National Center on Elder Abuse lists sudden, unexplained behavioral changes, such as emotional withdrawal and silence around caretakers, as red flags or symptoms of emotional abuse and psychological abuse. Other emotional elder abuse symptoms, vulnerabilities, and warning signs include:

  • Changes in outgoingness and levels of interaction with staff and other residents, reluctance to talk to adults
  • Nervousness in general or around potential abusers
  • Avoidance of eye contact, darting eyes, evasiveness
  • Agitated or fearful behavior in the presence of certain caretakers
  • Change in behavior when the abuser is in the room
  • Anxiety
  • Fear and helplessness, passivity
  • Confusion not related to a medical problem
  • Changes in eating or sleeping routine
  • Avoidance of a bathing routine
  • Aggressive behavior
  • A nursing home that will not let you be alone with the patient
  • A reluctance to answer questions when asked by close friends, other adults, or family
  • Signs that services are being withheld or the needs of the patient are not being met, including deprivation of food or water
  • Indications of outright manipulation of the patient
  • Injury, bruises, scars, or a personal injury that seem unusual or out of place
  • Sudden insistence of providing a caregiver financial support

If you notice several of these behavioral changes in men or women, you should investigate if these changes are the result of emotional abuse by a family member or are a symptom of nursing home abuse.

The Incidence of Psychological Abuse

Studies have shown that psychological abuse has a reported incidence rate of 54.1%(1) despite the difficulty of having no clear evidence or concrete assessment criteria. A study in 2012 by the Bureau of Justice Statistics and the National Center on Elder Abuse reports that elder neglect was the most common form of elder abuse.(2)

A study found that approximately 15% of older persons reporting abuse or neglect have suffered from emotional abuse.(3)

Reasons to Report Elderly Emotional Abuse Cases

There are two types of abuse symptoms:

  1. physical/concrete
  2. behavioral

Unlike the effects of physical abuse and the risks to patient safety, the effects of emotional abuse are almost entirely behavioral. Emotional abuse cases often go unreported because of the lack of visible physical symptoms.

However, emotional abuse can result in:

  • Personality changes and the development of personality disorders (ex. schizophrenia)
  • Beginning or worsening of cognitive decline
  • Depression
  • Post-traumatic stress disorder
  • Anxiety disorders

Laws Relating to Emotional Abuse of the Elderly

There are several laws that describe specific legal interventions and patient rights related to emotional abuse. These include:

  • APS (adult protective services statutes) – emotional abuse is prohibited in the statutes of 42 states. Some states require that cases are reported to the police.
  • Protective order statutes
  • State nursing home laws
  • Medicaid and Medicare laws
  • Long term care ombudsmen laws
  • Criminal law (violence, assault)
  • Mandated reporting laws
  • Penalty enhancement laws

How to Report Emotional Abuse Cases

Follow these steps if you suspect and need to report emotional abuse:

  1. Report the behaviors of caretakers and their effects on the patient to the manager of the nursing home. Be prepared to take further action if the facility manager does not take steps to remediate the situation and care for the needs of the patient.
  2. Alert state authorities. If the nursing home is in New Jersey, visit the New Jersey Long Term Care Ombudsman Website to learn more about filing a complaint about the care quality or staff. If the agency determines that the behavior violates elder abuse laws, it will initiate an investigation.
  3. If you believe that emotional distress is the result of negligence or abuse, we suggest speaking with one of our Howard Law attorneys at (201) 488-4644.

Some aspects of emotional abuse, such as threatening harm, destroying personal property, are criminal and warrant legal action. If a patient reports any of these behaviors, keep a record of these accounts. Document any behavioral changes.

Concerned About Nursing Home or Long Term Care Abuse and Neglect?

The first step after discovering that a loved one suffered from any form of abuse is to speak with a member of our legal team. Call (201) 488-4644 or fill out the form below. There is never a charge to consult with a member of our team regarding suspected abuse.


    (1) Devious Damage: Elder Psychological Abuse By Margie Eckroth-Bucher, PhD, RN, PMHCNS-BC
    Aging Well Vol. 1 No. 4 P. 24

    (2) National Center on Elder Abuse

    (3) Teaster, Pamela B., Tyler A. Dugar, Marta S. Mendiondo, Erin L. Abner, Kara A. Cecil, and Joanne M. Otto. 2006. The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 years of Age and Older. Washington, D.C.: National Center on Elder Abuse.

    (4) Acierno, Ron, Melba A. Hernandez, Ananda B. Amstadter, Heidi S. Resnick, Kenneth, Steve, Wendy Muzzy, and Dean G. Kilpatrick. 2010. “Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study.” American Journal of Public Health 100(2): 292–297.

    (5) Payne, Brian K. 2011. Crime and Elder Abuse: An Integrated Perspective. 3rd ed. Springfield,  Illinois: Charles C. Thomas. ; Payne, Brian K., and Randy R. Gainey. 2006. “The Criminal Justice Response to Elder

    (6) Bureau of Justice Statistics

    (7) Administration for Community Living, U.S. Department of Health and Human Services

    (8) American Society on Aging

    (9) Family Caregivers Online

    (10) New Jersey Department of Health