The Other Side Of Elder Abuse. Here’s What Older Caregivers Face

by Sophie Okolo, MPH

In his 2018 song “Hurt The Ones We Love The Most,” singer-songwriter-producer Evan Blum writes, “So, tell me why we hurt the ones we love the most. Because we think they'll never go. Of everyone we've come to know. We hurt the ones we love the most.” When we ponder these lyrics, one cannot help but wonder about its uncanny similarity to the current state of caregiving in the U.S. It can be hard and exhausting, and it often affects relationships. But what happens when things go wrong?

There are shocking stories about older people being treated poorly by friends, family members, and nursing home employees. Elder abuse is more common than one might think; approximately one in 10 Americans aged 60+ have experienced some form of abuse. It is a critical public health issue that results in poor health outcomes and increased mortality among older adults of all races, cultures, sexual orientations, social classes, and geographic areas. But older caregivers, those providing care to a younger loved one or otherwise, also experience a unique type of treatment. While studies show that elder abuse occurs in various forms, from physical to financial, psychological, and social, what plagues older caregivers is relational trauma. This type of trauma refers to trauma within a close relationship, usually with a caregiver.

According to a new study published in the Journal of Internal Medicine, older adults are increasingly serving as caregivers to others, which may increase their risk of adverse interpersonal experiences. The study analyzed caregiving (assisting another adult with day-to-day activities) and experience of elder mistreatment of caregivers across three domains: emotional, physical, and financial, adjusting for age, race, ethnicity, gender, education, marital status, concomitant care-receiving status, overall physical and mental health, and cognitive function. The study also examined the link between being the primary caregiver (rather than a secondary carer) and each domain of mistreatment among older caregivers. Interestingly, older caregivers were associated with experiencing emotional and financial mistreatment after age 60, and those who served as primary rather than secondary caregivers for other adults had over two-fold increased odds of emotional mistreatment. As the study implied, this is due to potential problems in interpersonal relationships.

A Snapshot Of Abuse And Older Caregiving

Each year, it is estimated that a shocking 500,000 older adults are abused in the United States, with family members most often the abusers. One common form is verbal abuse, which can instill terror and power in a relationship and lead to more types of abuse. Angela (not her real name) is a 66-year-old Cameroonian immigrant who takes care of her mother, but the relationship is strained due to past family trauma: “My mother feels I could have lived a better life… No matter what I do, she always brings this up while lashing at me. It has continued to affect our strained relationship, and living with her has become unbearable.” While Angela would like more harmony in the home, she feels trapped. “I feel like I have no say in my own home,” she says. It is critical for families to have open lines of communication, healthy boundaries, and plan for extra help and support like respite care, counseling, etc. If a parent and child have clear and similar expectations, then risk of abuse and mistreatment can be reduced.

With an aging population, there is a high likelihood of increase in older adults serving as caregivers, but the percentage of such caregivers being abused may also rise. Hence, as the findings suggest, efforts to prevent or mitigate elder mistreatment should put more emphasis on vulnerable older caregivers since the consequences of abuse can be especially serious and take a longer time to recover. It will take a holistic perspective to understand and tackle this problem. If not, it will continue with devastating societal implications for older adults and those working as caregivers. Raising awareness of this issue through education, empowerment, and advocacy is one step in helping reduce elder abuse, but developing a shift in mindset is the first step toward culture change.

Older Domestic Workers Matter

When the 2018 drama film Roma burst onto the scene, it made waves all around the globe because of the incredible story about an indigenous domestic worker living in Mexico. There are parallels between caregiving and domestic work, particularly with those employed as nannies, home care workers, house cleaners, and family caregivers. There are 70 million domestic workers worldwide without worker rights, which has laid the ground for abuse. Older domestic workers face a unique challenge because some do not have sufficient funds for retirement or a family to care for them in old age. Moreover, they feel undervalued and underappreciated, a sobering fact that another human being would deem another human being less than them. Research has shown that abuse against older women remains a serious problem. Most domestic workers are women, some are undocumented, and others lack social support. It is imperative that we need a multifaceted approach to ensure the protection of these workers, particularly those who are older women.

Prioritize Elder Justice

What society needs to address elder abuse is the collaboration of both primary care and social service sectors, which can enhance the comprehensiveness of future programs, policies, and legislation. As research has shown, elder abuse can happen in families and institutions of care, places where it should not happen. It also continues to be a global problem and can seriously diminish the quality of life of older caregivers. Victims become more confused, frail, and unhappy with their circumstances as they are abused and exploited. If not checked, elder abuse can persist despite policy recommendations, health interventions, etc. The significance of this problem as a public health and human rights issue has been acknowledged by the United Nations International Plan of Action, but it should not stop there. Elder justice must become a priority, and whether young or old, everyone deserves dignity, love, and respect. When this happens, we make good strides to overcome ageism and toward a world free from the threat of abuse, neglect, and exploitation.

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The Other Side Of Elder Abuse. Here’s What Older Caregivers Face