Abuse in Elder Caregiving

Abuse does not just mean physical abuse. Abuse is physical, emotional, mental, sexual, or neglect. Elder abuse is dark and ugly. It happens in residential centers, at home, in your neighbor’s family, in medical facilities. It can happen anywhere there are older people who have a difficult time advocating for or defending themselves and their rights. Abuse of older people is not limited to dementia patients. It doesn’t only happen to extremely old people, and it is not limited to physical abuse. Denying any individual their personal safety or their rights is abuse. Mishandling someone’s personal finances is abuse. This is different to many scams, seniors are vulnerable to. Neglect is another type of abuse, too.

Thousands of older people are victimized each year. But you may not know first-hand of such problems, or even recognize warning signs. But there are ways you can help. Familiarize yourself with the facts about elder abuse. Write a letter to the editor of your local paper advocating public awareness. Volunteer at a program for frail or elderly people. Visit older neighbors, friends or family members who live alone or may be at risk.

Types of Elder Abuse

“Elder abuse is an umbrella 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.”

  • Physical abuse is inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving them of a basic need.
  • Sexual abuse is the infliction of non-consensual sexual contact of any kind.
  • Emotional or psychological abuse is the infliction of mental or emotional anguish or distress on an elder person through verbal or nonverbal acts.
  • Financial or material exploitation is the illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.
  • Neglect is the refusal or failure by those responsible to provide food, shelter, healthcare, or protection for a vulnerable elder.
  • Self-neglect is characterized as the behavior of an elderly person that threatens his/her own health or safety.
  • Abandonment – The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.
  • Though most victims are women, men can be abused as well, and need help as much as their female counterparts. Keep your eyes and ears open. Often, older people feel they should suffer in silence. Sometimes they even feel they must deserve being treated badly, so they say nothing.

Signs of Elder Abuse

Here are some warning signs, according to the National Center on Elder Abuse:

  • Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
  • Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
  • Bruises around the breasts or genital area can occur from sexual abuse.
  • Sudden changes in financial situations may be the result of exploitation.
  • Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
  • Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.
  • Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs.
  • Evidence of financial exploitation could manifest as sudden changes in bank balances, or a number of withdrawals; new signed documents (that could be forged), the addition of names on bank accounts; sudden changes in a will or ownership or beneficiary status of any financial documents. Coercing an elderly person to sign a document or agree to something is deceit and because of the often deteriorating cognitive status of the elderly person, is often difficult to detect.

Reporting and Preventing Elder Abuse

Reporting elder abuse is the responsibility of everyone and anyone who has contact with an elderly person. According to the NCEA, the most common sources of reporting abuse are family members, social workers, friends, and neighbors. Efforts have been put in place by the NCEA to increase awareness and training to others who tend to have frequent contact with the elderly, such as postal workers, and utility repair persons.

A more accurate means of data collection and measures of reporting, that is uniform at the state and national levels is also suggested by the NCEA as a way to better track and study the incidences of abuse. Information about who is causing the abuse is also necessary and according to the NCEA, critical to prevention, intervention, and advocacy.

Awareness and Education Regarding Elder Abuse

Educating the public and anyone who has contact with the elderly is imperative if we have any hope of decreasing the prevalence of elder abuse in our society. Silence about a suspected case of abuse is not an option. Our parents and loved ones are living longer. Caretakers and others in their lives need to understand their vulnerabilities and work hard to protect them from the abuses they are suffering, in increasing numbers, through education, training, and awareness.

Caregiver Abuse by an Elderly Spouse or Parent

While discussing abuse in elder caregiving, it is also important to discuss abuse on caregiver from the elderly side. Abuse to a caregiver is more common than most families and medical professionals admit. Hitting, punching and kicking the caregiver are behaviors an outsider might chalk up to a debilitating disease or the elderly person having a bad day. To those not living in the home, it seems almost absurd that a frail old person could cause serious harm to an adult child or spouse who sees to the elder’s every need.

To maintain peace within the family, a caregiver may keep silent about an abusive situation that is likely to get worse. Whatever reason a caregiver has for tolerating abuse – guilt, obligation, family honor, loyalty – the situation is serious and demands attention. Avoiding the abuse problem – even verbal assaults – puts both the patient and caregiver at risk for injury.

A Caregiver Who Tolerates Abuse From an Elderly Person

Should a primary home caregiver overlook abuse from an elderly parent or spouse because the elder is old, frail and has a limited time left to live? Should an adult child give in to the elderly parent’s controlling behavior and unreasonable demands because she owes the parent restitution for all the sacrifices the parent made years ago?

The disease is at fault, so why force the elderly loved one into a nursing home when she can’t be held responsible for her actions? And will the rest of the family take sides and argue over the decision to put the elder in a nursing facility? Will the family insist the caregiver wait a little longer in case things get better?

When an elderly loved one becomes violent due to an illness such as Alzheimer’s disease, stroke or mental illness, the caregiver may be reluctant to admit she is in danger. She may even feel too embarrassed to admit anything is wrong. No one should have to endure cursing and insults from verbal abuse; but when an elderly person becomes combative, caregiving becomes a matter of survival.

Signs That a Caregiver May Be Suffering Abuse

An adult child, or a spouse with an ill partner, takes on a huge responsibility when caring for the elderly loved one. When the caregiver’s commitment turns into months or years, the elder’s personality can deteriorate from natural aging or prolonged illness. How can one tell if a family caregiver is being abused?

  • The caregiver is stressed out (more than usual), or is moody and depressed much of the time.
  • There are unexplained bruises on the caregiver’s arms, face, legs, etc.
  • Cuts and human bite marks are covered by bandages.
  • The elderly patient is openly violent, using abusive language toward the caregiver and/or striking the grown child or spouse.
  • The caregiver takes great care not to turn her back on the elderly person, avoids kneeling or stooping in front of the elder, and doesn’t get any closer than necessary.
  • The caregiver lets her appearance go and loses interest in keeping a tidy home.
  • The caregiver refuses to let visitors and friends into the home.
  • The caregiver is anxious, appears helpless or admits to feeling hopeless about the current living situation.
  • The caregiver is extremely tired much of the time because she is afraid to sleep.

What Can Happen When Abuse Toward a Caregiver is Ignored?

The caregiver who lowers her guard can become seriously injured. A single moment of inattention and the caregiver can get punched in the face. Elderly people can show an amazing amount of strength when angered. Sometimes, aggression or abuse happens for no reason at all.

An elderly person can cause serious injury with a cane or other mobility device. Silverware – even plastic utensils – can become weapons and so can dishes (and hot food). Flower vases, alarm clocks, bottles, fireplace pokers, books, clothes hangers, shoes – all these things and many more can cause physical harm in the hands of someone with violent behavior.

Caregivers Face Eldercare Safety Issues

The primary home caregiver is responsible for the elderly person’s safety. Patients with dementia and those with certain types of mental disorders often display bizarre (and sometimes harmful) behaviors. The elderly person may lack the ability to control impulsive aggressive behavior. When a caregiver tries to prevent the elderly loved one from harm, the result can be explosive anger or a physical fight.

A caregiver has no reason to feel guilt or failure when she has to relocate an elderly parent or spouse that has become abusive. Confronting abuse is acting responsibly.

Family and friends who suspect that a caregiver is being abused can offer help and support. Question any signs that may indicate the caregiver is suffering abuse. Discuss the problem with family members. Consult with professionals who can make recommendations and who can assist in making the elder’s transition to a nursing home easier for all concerned. Don’t wait to see if the situation improves, but instead act immediately before a loved one gets hurt.