Lifelong Health: Elder Abuse Includes Physical, Mental, Fiscal

2009-09-23

Recently, I saw a 78-year-old woman who was brought to the clinic with Alzheimer's disease. She had bruises on both of her arms and would not speak in the presence of her husband. Her husband claimed that she never listened to him and that moving her from one place to another often required force.

Though he refused to believe it, his action toward his wife was certainly considered elder abuse, which is defined as a "knowing, intentional or a negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult."

Sadly, elder abuse is common, as caregivers can easily take advantage of an older patient. Criminal abuse occurs from violence or neglect where the patient is not fed, bathed or given medications. On occasion, abuse can include sexual assault, which is a well-recognized concern for dependent older women.

In addition to physical harm, abuse can take the shape of emotional and even financial harm. In some cases, family members might keep and use a parent's resources for their own purpose, manipulate the will or steal funds from easily accessible bank accounts. In many instances, difficult, fractious and expensive litigation ensues.

There is no stereotypical image of an abusive caregiver. Abuse does not discriminate on the basis of race, sexual orientation, economic status or level of education. Although caregiver stress may contribute to abuse, it is not the only cause. Even in the most loving families, the risk of some form of abuse remains high.

Published in the British Medical Journal, a recent research study indicated that over half of all caregivers of Alzheimer's patients admitted that they had behaved abusively toward their patients. Although physical abuse was rare, 26 percent admitted to screaming or yelling at the patient, insults and swearing occurred in 18 percent, and 4 percent of caregivers threatened to send the patient to a nursing home. All who admitted to some form of abuse felt guilty and remorseful, indicating that stress contributed to the problem. Not uncommonly, the caregivers felt that they were provoked and were responding to acts of aggression by their patients.

Abusive caregivers often point to a patient's unwillingness to cooperate or other difficult situations.

We must do everything possible to prevent elder abuse, and it is imperative that health care providers be aware of the warning signs. Physical abuse is usually fairly obvious. Patients may show bruises, there may be evidence of old fractures, or they may be unkempt and undernourished. Emotional abuse is more difficult to recognize. In many cases, the patient is agitated, very quiet around the caregiver, and may be clinically depressed and withdrawn. An abusive caregiver will often refuse to take the patient to see the doctor, limits family visits, and has no explanations for any physical problems, altered demeanor or any other indicators of a problem.

While there are usually no clear indicators of who is likely to abuse a dependent patient, there are certain characteristics that are more common. In general, abuse is more likely from men, from those who have been abused themselves and who have low self-esteem. The primary caregiver living with the patient is also more likely to abuse. No matter how loving and well-adjusted the caregiver may seem, potential abusive behaviors always exist — it is vitally important that everyone be aware of these characteristics.

Often, abuse occurs when the caregiver reaches an emotional breaking point and has no outlets to address the frustrations. While this certainly does not excuse abusive behavior, it is important to ensure that caregivers are cared for as well. Respite should be encouraged and joining a support group can be helpful.

Abuse is a sad and painful fact of life, but by paying close attention, listening carefully and being aware the problem, abuse can be identified. If there is ever any suspicion, a referral can be made to the state Adult Protective Services agency, usually a unit of a state's Department of Human Services, which can perform an evaluation and can initiate steps to deal with the matter if needed. Vulnerability to abuse always occurs in those who are dependent. And sadly, abuse of our elders occurs as often as the abuse of our children.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.