Part II of II

It is difficult to take care of a senior with many needs. The demands of care-giving can create situations in which abuse is more likely to occur. Even though many non-professional care-givers consider their role to be satisfying and enriching, the responsibilities can be extremely stressful. This stress can escalate, especially as the elder’s condition deteriorates, and can lead to mental and physical health problems causing caregivers to burn out, become impatient, and unable to restrain their frustration.

Among caregivers, significant risk factors for elder abuse are:

• Inability to cope with stress (lack of resilience)
• Depression, which is common among caregivers
• Lack of support from other potential caregivers
• The caregiver’s perception that taking care of the elder is burdensome and without psychological reward
• Substance abuse

Even caregivers in institutional settings can experience stress at levels that can lead to elder abuse. Nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities, are unsuited for care-giving, or work under poor conditions.

Several factors concerning the elders themselves, while they do not excuse abuse, influence whether they are at greater risk for abuse:

• The intensity of an elder’s illness or dementia
• Social isolation: the elder and caregiver are alone together almost all of the time
• The elder’s role, at an earlier time, as an abusive parent or spouse
• A history of domestic violence in the home
• The elder’s own tendency toward verbal or physical aggression

In many cases, elder abuse, though real, is unintentional. Caregivers may be pushed beyond their capabilities or psychological resources.

You can protect yourself from elder abuse by:

• Make sure your financial and legal affairs are in order. Obtain legal advice concerning arrangements for future disability (e.g. power of attorney).
• Review your will periodically.
• Arrange to have your social security check or pension check deposited directly into your bank account. 
• Avoid becoming isolated. Keep in touch with family and friends. Participate in social and community activities.
• Do not live with someone who has a history of violent behavior or substance abuse.
• Do not sign a document unless someone you trust has reviewed it.
• If you are unhappy with the care you are receiving, at home or in a facility, tell someone you trust.

Caregivers can prevent from becoming elder abusers by following some simple suggestions:

• Request help from friends, relatives, or local respite agencies so you can take a break.
• Find an adult day care program.
• Stay healthy and get medical care for yourself when necessary.
• Do not ignore your limitations and overextend yourself.
• Adopt stress reduction practices.
• Seek counseling for depression.
• Find a support group for caregivers of the elderly.
• If you are having problems with drug or alcohol abuse, get help.
• Do not offer personal home care unless you thoroughly understand the demands and can meet the responsibility and costs involved.

Elder abuse help-lines offer help for caregivers as well. Call a helpline if you think there is a possibility that you might cross the line into elder abuse. (REPORT ELDER ABUSE: PA Dept of Aging 24 Hotline 1-800-490-8505)

If you suspect elder abuse, report it. Look at the elder’s medications to see if the amount left in the bottle is consistent with the dosing schedule and date of the prescription. Watch for possible financial abuse by asking the elder if you may scan financial documents for unauthorized transactions. Call and visit the elderly person as often as you can. Offer to stay with the elder so that the caregiver can have a break.  

Many seniors do not report abuse. Many are ashamed, feel responsible or fear retaliation from the abuser. Others believe that if they turn on their abusers, no one else will take care of them. If you are an elder who is being abused, neglected, or exploited, tell at least one person: your doctor, a friend, or a family member whom you can trust. Every state has at least one toll-free elder abuse hotline or helpline for reporting elder abuse in the home, in the community, or in nursing homes and other long term care facilities. You can also call Eldercare Locator at 1-800-677-1116. For those over the age of 60, help is available through local Area Agencies on Aging (AAA).

Part I of II

One in seven senior citizens nationwide falls victim to some type of elder abuse, usually at the hands of a family member. The abuse can be financial, physical, or psychological and the consequences can be deadly. Statistics suggest that abused and exploited seniors die sooner than other seniors their age. Despite such devastating consequences, most elder abuse goes unreported because of fear or lack of knowledge. If you have been abused, you may be afraid of what might happen if you tell someone. If you suspect that an elderly neighbor or friend is being abused, you may not know where to turn for assistance.

(REPORT ELDER ABUSE: PA Dept of Aging 24 Hotline 1-800-490-8505)

Elder abuse is the use of power or control to affect the well-being and status of an older individual. The World Health Organization considers elder abuse as a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. The core feature of this definition focuses on harm which includes mistreatment by people the older person knows or with whom they have a relationship, such as spouse, partner, or family member, a friend or neighbor, or people that the older person relies on for services.

There are several types of elder abuse that are universally recognized:

• Physical: hitting, punching, slapping, burning, pushing, kicking, restraining, false imprisonment, confinement, giving too much or the wrong medication.
• Psychological/Emotional: shouting, swearing, frightening, blaming, ridiculing, constantly criticizing, ignoring, or humiliating a person. A common theme is identifying something that matters to an elder and then using it for coercion.
• Financial: illegal or unauthorized use of a person’s property, money, or other valuables (including changing the person’s will to name the abuser as heir), often fraudulently obtaining power of attorney, followed by deprivation of money or other property, or by eviction from own home.
• Sexual: forcing a person to take part in any sexual activity without consent, including forcing them to unwillingly participate in conversations of a sexual nature.
• Neglect: depriving a person offood, heat, clothing, comfort, or essential medication.
• Rights Abuse: denying the civil and constitutional rights of an elder who was not declared by court to be mentally incapacitated.
• Self-neglect: elderly persons neglecting themselves by not caring about their own health or safety.

Each different type of elder abuse has specific signs. Below are some indicators that you need to be aware of and may recognize when involved personally or professionally with an elderly person:

• Physical: Overt signs of physical trauma: scratches, bruises, cuts, burns, punctures, choke marks; signs of restraint trauma: rope burns, gag marks, welts; repeated, unexplained injuries: sprains, fractures, detached retina, dislocation, paralysis; inconsistent explanations of these injuries; repeated time lag between injury and medical treatment.  
• Psychological/Emotional: Caregiver misbehavior that you witness: threatening, belittling, or controlling; behavior from the elder that mimics dementia: rocking, sucking, mumbling to oneself; other psychological signs: ambivalence, deference, passivity, shame, anxiety, depression, hopelessness, helplessness, suicidal thoughts, confusion, disorientation; behavioral signs: trembling, clinging, cowering, lack of eye contact, evasiveness, agitation, hyper-vigilance.
• Financial: Unusual banking activity: large withdrawals during a brief period of time, switching accounts from one bank to another, ATM activity by a homebound elder, signatures on checks and other documents do not match the signature of the older person, addition of names to senior’s signature card; suspicious changes in financial documents: wills, power of attorney, titles, and policies; items or cash missing from senior’s household: jewelry, art, furs; elders living situation not commensurate with size of elder’s estate: lack of new clothing or amenities, unpaid bills, lack of medical care.
• Sexual: Bruises: breasts, genitals; unexplained diseases or infections: venereal, genital; unexplained bleeding: vaginal, anal; underclothing: torn, stained, or bloody.
• Neglect by caregivers or self-neglect: Signs of malnourishment and dehydration: weight loss, sunken eyes, extreme thirst; untreated physical problems: e.g. bed sores; unsanitary or unsafe  living conditions: dirt, bugs, soiled bedding and clothes, no heat or running water, faulty electrical wiring, other fire hazards; evidence that personal care is lacking or neglected: being left dirty or  not bathed, unsuitable clothing or covering for the weather  
• Rights Abuse: Caregiver withholds or reads elder’s mail; caregiver intentionally obstructs the older person’s religious observances: dietary restrictions, holiday participation, visits by minister, priest, or rabbi; caregiver has removed all doors from the older adult’s rooms.

Read “Health & Exercise Forum” next week to discuss the risk factors and interventions for elder abuse.

Read “Health and Exercise Forum” by Dr. Paul J. Mackarey every Monday in The Scranton Times-Tribune.

Read all of Dr. Mackarey's articles at: https://mackareyphysicaltherapy.com/forum

Dr. Mackarey is a doctor of orthopedic and sports physical therapy with offices in downtown Scranton. He is an associate professor of clinical medicine at GCSOM.