Abuse of the Ederly

By Joel Sender, MD, Division Director, Geriatrics at SBH

“It would certainly shock people to learn that many frail elderly people in our community suffer abuse and mistreatment. Very often, it goes unreported. Estimates are that only 1 in 24 occurrences are reported to authorities. We often don’t talk about it, we don’t look for it, and we fail to take steps to stop it.”

All of us, including health care workers and concerned caregivers, need to be aware of the potential for abuse and take action if we find evidence of abuse. It is also important to determine whether the elderly person lives in an unsafe or threatening environment. One of the reasons that instances of abuse and mistreatment go unreported is that patients suffering in these situations are reluctant to press charges with police or government agencies. It is believed that 1 in 10 older adults are abused in some fashion every year.

Many family members and caregivers are unaware when they “cross the line” and become part of a cycle of elder abuse. Studies have suggested that lack of medical education is often at the root of the problem. Family members and caregivers who do not have a background in healthcare or do not fully understand the illnesses and conditions which trouble the older patient may react in ways which they, themselves, do not see as abusive. Family and caregivers take on so many burdens and sacrifice large parts of their adult lives to care for an aging relative; it can cause people to be angry, to strike out, to be distraught, and even to withhold essential care and concern from those they may love or have loved so deeply.

One way to approach this serious problem is to improve our skills at recognition of situations of abuse. This would also help us decide to intervene sooner.

Here are some observations which might be useful if you are treating elderly patients, or close to or caring for a senior citizen. There are several types of abuse.

NEGLECT – Seniors are, at times, denied attention – in ignorance, anger or frustration by those in their lives. A previously trusted caregiver might fail to provide adequate food or clothing, or assist with medications, as well as personal hygiene including bathing and wearing clean clothing. The home should not be cluttered, or in need of essential repairs, such as for plumbing, heating or cooling, or have clear safety hazards.

PHYSICAL ABUSE – Bruises, especially on the head or upper body, and if shaped like a hand, finger or thumb, might suggest inappropriate use of force or purposeful harm. Unexplained burns, cuts, or sores should also be considered as potential signs of harm. If you find there are missing canes, walkers, hearing aids and glasses making life difficult for the patient this might represent punishments or aggressions by their caregivers. Tying the person to their bed, chair, or wheelchair, or giving the senior unnecessary tranquilizers or sleeping pills should raise considerable attention for abuse.

EMOTIONAL ABUSE – Signs of emotional abuse are sometimes subtle. This may include yelling at the older person, threatening them, humiliating or ridiculing them, or purposely isolating them from activities or people they enjoy for no good reason. More than once I have observed a well-meaning family member, often in frustration, yell and threaten the senior during our office visit when they do not understand that dementia can interfere with the patients’ ability to understand instructions or carry out tasks. You can’t make someone “learn” as well when dementia is present – and threats and yelling just cause fear and confusion. Trying to force a loved one to do things they no longer can runs a risk of going too far – even by those whose intentions are well meaning.

FINANCIAL ABUSE/EXPLOITATION – Concerned family should be sensitive to situations in which spending habits have changed, whether there are withdrawals from savings or checking accounts, a change in the official ownership of assets
– such as a home or insurance policy
– if bills are going unpaid and utilities
are turned off, or if there is a “new best friend” who receives generous “gifts” from the senior.”

SCAMS – In today’s world of advanced technology, such as use of the internet, and robo-calling on the telephone, seniors are prime targets for scam artists. This can take the form of subscriptions not truly wanted, phony requests for money from “grandchildren,” and other pretend friends or family. It can also involve contractors for home repairs that are either unnecessary or highly overpriced. If a senior is still handling their own funds it would pay to arrange for a family meeting to review expenses on a regular basis and make sure caregivers are vigilant. Some of our seniors are victimized by people they otherwise need to depend upon – neighbors in their building, others who do errands, or shop for them but overcharge or keep the change – and may even buy themselves things with the patients’ funds.

SEXUAL ABUSE – This should be considered if there is unexplained vaginal or anal bleeding, torn or bloodied underwear, or bruises around breasts and genitals. The physician should be alerted to investigate for presence of sexually transmitted disease.

The risks for a senior being abused increase if they are disabled, in poor health, have trouble with memory (dementia), have a mental illness, come from a low income background, are isolated and have to depend on strangers, have a history of prior family violence, or are or were substance abusers themselves.

The risks of being an abuser are higher if the perpetrator has prior mental illness, substance abuse, is suffering caregiver stress, had suffered family violence in the past, or has a financial dependence on the older adult.

If we each think back carefully, we all might have experienced or witnessed situations which were similar to what is listed above, but we often feel that there may be little we can do. The most important thing is to realize that we must have the discussion, and each of us can contribute to the safety and security of our older patients. In our Senior Health Center Geriatrics Clinic at St. Barnabas Hospital we are careful to ask whether a patient feels unsafe where they live, or insecure with different people in their lives. We try to engage all the families in discussion about abusive situations, and, where appropriate or necessary, we contact agencies that will help, including the
New York City Adult Protective Services.

It pays to ask questions if you notice evidence of abuse – and get the bad treatment to stop. We hope you feel the same and will keep these thoughts in mind.