The Scourge of Elder Abuse

Dr. David Lipschitz

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 refused to speak in the presence of her husband.

He said she just didn't listen and to move her from one place to another required force on his part.

He refused to believe that what he was doing was elder abuse that 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.” The abuse may be verbal, physical, sexual, neglect or financial.

Sadly, caregivers can take advantage of an older parent. Often one family member reports that sibling is taking advantage of their parent and stealing them blind.

Not infrequently, family keep and use a parent's resources for their own purpose, manipulate the will or frankly steal funds from their parent.

Difficult and fractious litigation is often needed to resolve the problem and often the concerned family cannot afford or don't feel the effort is worth it. This form of abuse that is clearly motivated by greed.

Criminal abuse occurs from neglect where the patient is not fed, bathed or given medications, from violence and on occasion sexual assault that, just like child abuse by a parent, is a well-recognized concern amongst dependent older women.

The stereotypic view of an abusive caregiver is incorrect. 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's not the only cause. Even in the most loving families, the risk of some form of abuse remains high.

A recent research study published in the British Medical Journal indicated that over half of all caregivers of Alzheimer’s patients admitted that they had behaved abusively toward the patient.

Although physical abuse was rare, 26 percent admitted to screaming or yelling at the patient, insults and swearing occurred in 18 percent and in 4 percent, the caregiver threatened to send the patient to a nursing home.

All admitted guilt and wished it didn't happen and admit that stress contributed to the problem.

Not uncommonly, the caregiver will state that he or she was provoked and were responding to an act of aggression by the patient or another difficult situation, such as an unwillingness on the part of the patient to cooperate.

While we must do what we can to prevent elder abuse, it's imperative that healthcare providers be aware of the warning signs of abuse.

The patient may show obvious bruises, there may be evidence of old fractures or he may be unkempt and undernourished. Emotional abuse is more difficult to recognize.

The patient is usually agitated, very quiet around the caregiver and may be clinically depressed and withdrawn.

An abusive caregiver will often refuse to bring the patient to see the doctor, refuses to allow the family to visit and has no explanations for the patient's physical findings and demeanor.

We must also be aware of the characteristics of caregivers most likely to abuse. No matter how loving and well adjusted the caregiver, potential that abusive behaviors always exist.

However, there are certain characteristics that are common in caregivers who are more likely to abuse. Abuse is more common in males, in those who have themselves be abused, have low self-esteem and are usually the primary caregiver who lives with the patient.

Often abuse occurs because the caregiver reaches a breaking point and has nowhere to turn.

It's important therefore that close attention is paid to the caregiver, making sure his or her needs are met, encourage respite and joining a support group.

But if there is a high level of suspicion the health care provider is required to ask for an evaluation by "Adult Protective Services."

Abuse is a fact of life, by paying close attention, listening hard and being aware the problem abuse can be identified or if the risk is high steps can be initiated to avoid the problem.

Vulnerability to abuse occurs in those who are dependent at the extremes of life and sadly abuse of our elders is as common as abuse in children.

Dr. David Lipschitz is the medical director for the Mruk Family Education Center on Aging and the Fairlamb Senior Health Clinic. Contact him at askdrdavid@gmail.com.

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The Scourge of Elder Abuse