Experts say elder abuse is happening in all settings

Leif Adachi

WAIKAPU — The older veteran whose son pushed him down the stairs, the man who kept an elderly woman alive to get her Social Security checks, the overworked caregiver who took the stress out on a patient — all are examples of elder abuse, and often they go unnoticed, experts on aging and abuse said Thursday.

“There are still people who think elder abuse only occurs in nursing homes,” said Kathy Greenlee, vice president of aging and health policy with the Center for Practical Bioethics. “Most abuse occurs, by the raw numbers, in the community, and it’s appropriate that we deal with it in all settings.”

Greenlee was the keynote speaker at the daylong Elder Abuse Awareness Conference attended by nearly 200 people at the Kahili Golf Course on Thursday, which was designated World Elder Abuse Awareness Day.

Elder abuse often goes unnoticed because many people aren’t aware that it happens, and victims are ashamed to report it, Greenlee said. In Hawaii, where it’s common for many generations to live together, the risk for neglect or abuse persists.

“Caregivers mostly don’t intend to start out and harm their loved ones,” said Deborah Stone-Walls, executive on aging for the Maui County Office of Aging. “Most of the time the abuse happens because of the mounting stress. . . . It’s very cultural here in Hawaii for us to care for our families. We don’t even view ourselves as caregivers. I’m just helping my mom. That’s my job.”

Dr. Adam Coles

That’s why it’s important to be alert for signs of abuse and take steps to prevent it, speakers at the conference said.

Researchers estimate that one out of every 10 people age 60 and older who live at home suffer abuse, neglect or exploitation, Greenlee said. Two-thirds are women, and victims are disproportionately African-American, Latino, poor or isolated. Abuse also can increase mortality rate among elderly victims by almost 300 percent.
“Not from the abuse itself but the ongoing trauma,” Greenlee said. “It’s a serious public health crisis . . . in terms of what it does to people.”

Part of the problem is that many people are reluctant to admit when it happens. Often abusers can be a family member or caregiver and, in addition to feelings of shame and guilt, many elderly greatly fear losing their independence.

Others simply don’t realize it’s an issue. For example, it can be hard for someone to believe that an elderly person is a victim of sexual abuse, because “the general public doesn’t see older people as sexual people,” Greenlee said.

Kathy Greenlee

Elder abuse comes in many forms: physical, emotional, psychological, sexual, medical and financial. It includes neglect — failing to provide proper food, clothing, medical, hygiene or supervision.

But how do family members or friends distinguish the normal signs of aging from signs of declining health due to abuse? Often, it comes down to looking for things that seem off, explained Dr. Adam Coles, a psychiatrist and clinical director at the Maui Family Guidance Center. It could be new or recurring injuries, especially those where the explanation for the injury or the accounts of the caregiver and the elderly patient don’t match up. It could be sudden weight loss or the onset of depression, or any unusual change in behavior.

“There’s going to be some obvious signs,” Stone-Walls said. “Broken bones, bruises, some overt things like an unkempt home . . . and poor hygiene. But there may also be other more subtle signs, such as withdrawal or a noticeable change in activities. . . . Usually with seniors when there’s a drastic change in their ability to spend money to care for themselves, that could be an indication that they are being financially abused.”

The elderly are frequent targets of financial scams, said Leif Adachi, a detective with the Maui Police Department who investigates financial crimes.

“Why are kupunas targeted? The number one reason should actually be money,” Adachi said. “Grandma who’s retired and worked all her life has a savings.”

Deborah Stone-Walls

Criminals have concocted a wide array of tricks, from claiming to be computer techs to posing as a grandchild calling from prison and needing money for bail. And, it’s not just distant crooks doing the swindling. It’s also people who misuse their elderly family members’ money. Adachi advised people to stay up to date on the latest scams, validate people’s information before doing business with them and reporting any suspicious activity to police.

But the most common source of elder abuse is at the hands of caregivers. While providing long-term care is “a burden of love,” it’s also a risk, Greenlee said.

“I think it’s too easy to dismiss all caregiver abuse as stress, but I think it’s a great correlation,” she said. “There are mean caregivers. But there are also caregivers who are under tremendous stress, and we need to pay particular attention to them and give them interventions and support.”

Stone-Walls encouraged people to call their local aging office “before they feel stressed.”

“Even if they don’t feel like they need anything today, we can help them know what could be available in the future,” Stone-Walls said. “Caregivers need to be sure to not put themselves last. 
When they put themselves last, it can have devastating effects.”

Coles said one of the many ways people can prevent potential abuse is by “maximizing the independent living skills of the elderly,” which takes a burden off caregivers and gives the elderly a greater sense of freedom.

Avoiding the TV, getting some exercise and providing them with human or animal companionship also can help combat loneliness and feelings of neglect. It’s also important to make sure their medical and mental needs are meant.

Sometimes, people just need to “be brave enough to ask,” Stone-Walls said.

“Even for professionals, sometimes I hear, ‘I think someone might be being abused and I don’t know how to ask,'” Stone-Walls said. “Sometimes people just need you to say, ‘Are you OK? How can we help you?'”

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Experts say  elder abuse is happening in all settings