The recent arrest and indictment of a Chapel Hill nurse on murder and other abuse charges resulting from her alleged mistreatment of nursing home patients brings to light a vexing and too often hidden problem: elder abuse.

Fittingly, June 15 marked the fifth observance of World Elder Abuse Awareness Day – an event that's intended to increase public awareness and understanding of a serious problem that affects many seniors in North Carolina, throughout the United States and the world.

Let's hope that it's even more successful than previous efforts in expanding awareness and saving and improving lives because, as events have again confirmed, the problem remains distressingly widespread.

Researchers believe that more than a half-million seniors are abused in their homes in this country each year and that anywhere from two percent to as many as one-in-ten is abused in some way.

Of course in some respects, this is not surprising. As a person ages, his or her ability to care for himself or herself diminishes. Diminished capacity in elders creates a vulnerability to exploitation and abuse – whether it's in the form of consumer and financial scams perpetrated by outside predators or, in cases like the one in Chapel Hill, caregivers themselves. Indeed, during the current economic downturn, there have been several instances in which children forced to return to their parents' home have wrongfully taken control of assets and income, and even physically abused the parent when they were confronted.

Elder abuse occurs in a variety of forms, but experts generally refer to seven: physical abuse, emotional or psychological abuse, sexual abuse, financial exploitation, neglect, abandonment and self-neglect.

Interestingly, the most commonly occurring form is self-neglect. These cases occasionally draw public attention when local authorities must enter an elderly person's home because of complaints, only to discover such things as hoarding of various materials, neglected animals and/or other serious health problems.

Generally, however, the public pays more attention when there is some kind of high-profile case of financial exploitation, as occurred this year with wealthy socialite and philanthropist, Brooke Astor. Astor's son was convicted of taking millions of dollars while his mother relied upon him to manage her assets.

Though the dollar figures in this case were extraordinary, the Astor story is, in many respects, sadly typical. Not only was the abuser a family member, but many of his misdeeds were perpetrated out of the public eye in such a way that made it difficult for the already reluctant community to recognize or report the abuse. Only a small percentage of elder abuse cases are ever reported. In North Carolina the number may be as low as 10%.

Another insidious form of abuse involves the misuse of a power of attorney. Though many elders have been rightfully encouraged to create these legal forms to allow assistance when needed, they can be and are abused – to transfer money from bank accounts or to sell property. On occasion, strangers ingratiate themselves, convince the elder to sign a power of attorney, and then take everything that the senior possesses.

Improved awareness is the first and most important step in addressing elder abuse. By demystifying the phenomenon, we can improve the ability of community members to recognize abuse, empower and encourage them to report it more frequently, and thereby reduce the number of incidents.

Risk factors to be on the lookout for include: isolation from the community, loss of independence, misplaced sense of family duty and devotion, a reduced ability to protect him or herself, and dependence upon unreliable caregivers. There are also factors to be recognized among potential abusers and in various settings and locations, including residential care facilities.

And abuse itself sends a variety of signals. Some are obvious, such as injuries, bruises or scars, but some are more subtle. These can include unsuitable clothing, unsanitary or unsafe living conditions, or weight loss. Financial exploitation has its own set of signals, most related to financial activity or missing assets.

If you suspect elder abuse is occurring, the first step is to report it so that investigators and law enforcement officers can investigate and intervene. In fact, North Carolina law actually requires you to do so if there is a reasonable cause to believe that a disabled adult is being abused and in need of protective services. Reports can be anonymous.

To make a report, you should contact your local law enforcement office or the Adult Protective Services Division in your local Department of Social Services. You can find this contact information online by visiting http://www.ncdhhs.gov/dss/local and clicking on your county.

Thankfully, truly horrific cases like the one alleged in Chapel Hill are quite rare. With greater public awareness, there's reason to believe we can make them even rarer.

Richard Trottier is an attorney who specializes in elder law at Legal Aid of North Carolina.