When Seniors Are Mistreated

By Richard Trubo
WebMD Feature

Reviewed By Brunilda Nazario

When Helen Love testified before Congress, describing how she was severely beaten in a horrifying case of elder abuse, her words were so riveting that the legislators and spectators in the hearing room remained still and stunned from beginning to end. As she spoke, slowly and deliberately, Helen's head was held steady by a metal "halo" pinned to her skull.

At age 75 and weighing just 95 pounds, Helen had been living in a Sacramento, Calif. nursing home. One evening, she was attacked by a certified nurse's assistant who became enraged when she soiled her diaper. "He choked me and went and broke my neck ... and broke my wrist," Helen said. "I was so close to death and somehow survived that attack."

But Helen didn't survive for long. Her testimony before the U.S. Senate Special Committee on Aging in March 2002 was particularly poignant because it was delivered on videotape, part of a deposition she had given about the assault. It turned out to be deathbed testimony. Two days after the tape was made, Helen died of her abuse-related injuries.

A National Nightmare

For too many aging Americans, their "golden years" have turned out to be anything but. Elder abuse, whether it takes place in a nursing facility or the victim's own home, is a disturbing trend, and certainly not rare.

Although accurate statistics are difficult to pin down, more than 470,000 cases of elder abuse were reported to authorities in the U.S. in 2001, according to Sen. Larry Craig, a member of the Committee on Aging.

But that statistic represents only the tip of the iceberg. Researchers with the National Elder Abuse Incidence Study have estimated that only 16% of all cases of elder abuse are ever reported. For too many victims, they're either incapable of complaining (because of dementia, for example) or too embarrassed to do so.

"Elders are hidden," says Sara Aravanis, director of the National Center on Elder Abuse. "In many cases, they are isolated in their communities, isolated in their homes or apartments, they don't have routine exposure to the rest of the world, and people don't see them. A big issue is the hidden nature of this problem."

Some senior citizens intentionally conceal their victimization because of fear of retaliation from the perpetrator, or because of anxiety over being placed in an nursing facility if they complain, says Daniel L. Swagerty, Jr., MD, MPH, associate director of the Center on Aging at the University of Kansas Medical Center. "Some older adults may be more fearful of being placed in a nursing home than of remaining in the current situation in their home," explains Swagerty. "From their vantage point, the abuse or neglect may be bad, but even worse is the thought of being moved to a nursing home."

Donna Benton, PhD, assistant research professor of gerontology at the University of Southern California Andrus Gerontology Center, agrees. "Many people will do anything, including accepting abusive behavior, to stay out of a nursing home," she says. "The abuse may also go unreported because there's a lot of shame associated with it, and sometimes guilt. The older person may feel that, in some way, he or she deserves the abuse."

Anatomy of the Problem

Elder abuse can take many forms. It may be physical, involving slapping, beating, shaking, shoving, restraining or burning. Psychological or emotional abuse can include verbal threats, insults, and humiliation, and may lead to anxiety, depression, and resignation in the victim. Neglect is another type of elder abuse, occurring when the caregiver provides inadequate food, water, clothing, medicine, and other necessary items.

"The more frail and more dependent an elderly person is, the greater his or her risk is of being abused or neglected," says Swagerty.

Most cases of abuse take place in the home, and the perpetrators tend to be family members. The National Elder Abuse Incidence Study found that 47% of abusers are children of the elderly victims, followed by spouses (19%) and grandchildren (9%). Friends, siblings, other relatives, and paid caregivers fill out the ranks of other abusers.

"A lot of cases of abuse are not malicious in nature, but arise from a lack of coping skills on the part of the caregiver," says Benton. Tough economic times and other family stresses can contribute to the likelihood of elder abuse, she says.

"People cope in different ways," adds Benton. "But as stress goes up, there's a higher risk and a higher incidence of abuse. About 57% of caregivers are under age 65 and are employed outside the home, so they're juggling work and caregiving responsibilities. These people can become very stressed."

Reporting & Preventing Abuse

If you're a victim of elder abuse, or know of a family member or friend who is being mistreated or neglected, contact the family's physician or the adult protective services agency (or the department of social services) in your community. In most states, doctors are required by law to report suspected elder mistreatment to the appropriate government agencies.

The local protective services agency will typically assign a social worker to investigate reports of abuse or neglect. It may also make arrangements for services to help protect the elderly victim.

If you're a caregiver on the brink of burnout, adult day care programs for the elderly person under your care may be available in your community. Support groups can also help stressed-out caregivers, and teach them coping skills.

Here are some other abuse-prevention suggestions:

Caregivers should arrange for regular breaks from the demands upon them. Even two to three hours at a time can make a difference in their psychological well-being. Check on the availability and cost of home-health aides. Under a recently approved federal law, says Benton, funds may be available through area aging agencies for respite care or for education classes on frustration management.
Elderly people should avoid living with relatives or other people who have a background of violent behavior or drug or alcohol abuse. Senior citizens should keep in touch with friends and form a buddy system with them.
"If you're in need of caregiving assistance in the home, evaluate the people you might hire as carefully as possible," says Aravanis. Check references and conduct criminal background checks.

Published Oct. 14, 2002

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