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October 1, 2009
Eight years since her mother died of Alzheimer’s, B. Lynn Goodwin still remembers the stress of being her caregiver, of driving her mom to doctor appointments, cooking her meals and paying her bills. The task was daunting, and Goodwin found herself increasingly isolated as she poured her energies into caring for her mom.
“Technically, I had nothing I had to do other than go to work and honor my volunteer tutoring and writing commitments,” says Goodwin, now 60, of Danville, Calif. “I could have given all of that up and simply been present for her. I had no husband or kids, and I felt selfish because I craved a life of my own when I had a mother who needed me. I was beyond frustrated. I wanted her to fire me from this unpaid job, but family doesn’t work this way. I was feeling hopeless, immature and miserable.”
All the stress came crashing down on her, and Goodwin found herself yelling at her mother. “I never tried to physically hurt her,” she says. “Never. But I sometimes exploded verbally, irrationally, a bit like an earthquake when the pressure builds until something moves. Sometimes she would look at me with curious eyes, like a child watching something she does not understand.”
Goodwin is thankful that those moments of anger never escalated to anything worse and have since become a distant blur, but she still recalls the shame she felt for getting so angry. She also understands how the rigors of caregiving can lead to elder abuse. Her experience led her to write her book, You Want Me to Do What? Journaling for Caregivers, which helps those caring for others to express their feelings in writing.
Unfortunately, it’s not unusual for caregivers to take out frustrations on their loved ones. Long hours of providing unpaid care to someone with dementia causes undue stress that can exhaust even the hardiest souls.
But unleashing your frustrations can become elder abuse, a crime that is both devastating and morally reprehensible. Elder abuse can take myriad forms:
• Physical abuse may involve hitting, shoving and inflicting pain against the older adult.
• Verbal abuse may include yelling, threatening or ridiculing the elderly person.
• Psychological abuse may involve ignoring the elderly person, isolating her from others or menacing the victim.
• Sexual abuse is engaging the elderly person in inappropriate sexual activities.
• Financial exploitation involves the misuse of the elderly person’s money without his or her consent. It may involve forgery, theft or inappropriate use of the elder’s credits cards and checking accounts.
• Neglect can mean failing to meet the elderly person’s most basic needs, be it food, water or clothing. It may also be withholding medication or isolating him from others.
Experts estimate that there are 1.5 million to 2 million cases of elder abuse a year in the U.S., but that only 5 percent to 10 percent are reported to authorities, says Sy Moskowitz, JD, a professor of law at Valparaiso Law School in Indiana who specializes in elder law and elder abuse and neglect. Though many cases escape the notice of authorities, the number of reported cases is actually growing, Moskowitz says, thanks to a growing awareness of the problem and an increase in the elderly population. According to the National Elder Abuse Incidence Study, reports of elder abuse increased more than 150 percent between 1996 and 2006.
Elder abuse can have dire consequences. “The fact is, elder abuse and neglect is a big risk factor for death,” Moskowitz says. “It can even lead to suicide.”
The Victims and the Perpetrators
Sadly, most cases of elder abuse are committed by a family member, often someone who is caring for the victim. According to the National Elder Abuse Incidence Study, two-thirds of all abusers were adult children or spouses of the elderly victim. “The likelihood of being abused by a family member is much higher than it is by a stranger,” says Allan Hoffman, EdD., author of Elder Abuse (American Public Health Association, 2005) and CEO of Ottawa University of Arizona.
Most cases of abuse occur where the elderly person lives, most often in the home. Older adults with Alzheimer’s and other forms of dementia are especially vulnerable. “They’re less able to prevent these kinds of abusive situations, and they have less access to outsiders,” Moskowitz says.
Many cases of elder abuse never get reported to authorities. Victims are often too intimidated or embarrassed to turn in the abuser, or they don’t want their loved one to get in trouble. “There may also be a lot of fear, as in who is going to take care of me, if I turn them in?” Moskowitz says.
While there is no typical profile of someone who commits elder abuse, certain factors do raise the risk for abuse. According to Hoffman, many people who abuse the elderly are frustrated, stressed caregivers. They tend to come from families with a history of violence and may have been abused as children. Many abusers also suffer from more personal problems such as mental and emotional disorders, alcoholism and drug addiction, and financial troubles. Some researchers have found too, that older adults who are in worse health are more likely to be abused than those in good health.
But don’t be deceived by appearances, says Marion Somers, PhD, author of Elder Care Made Easier (Addicus Books, 2006). “It’s not necessarily somebody who talks loud,” she says. “It can be the sweetest, meekest person in the world. And they might be hurting someone without knowing it.”
A Quiet Crime
Like most forms of domestic violence, it isn’t always easy to spot an elderly victim of abuse, especially if you don’t see that person on a regular basis. But there are clues that sometimes may cause concern. Victims who are being physically hurt, for instance, may have unexplained bruises, broken bones or other inexplicable injuries. Those who are being neglected may lose weight, become increasingly isolated and disappear from activities that they once cherished.
The most telling signs may occur in the presence of the person committing the abuse. “You have to watch (the elderly person’s) body language around the abuser,” Somers says. “The victim may pull toward you, or their voice may go down. They may also avert making contact with the person.”
Financial abuse is tougher to spot, especially if you don’t have access to the victim’s accounts. But if you do, you may notice large, unexplained withdrawals of cash from bank accounts, changes in her financial situation, unpaid bills, and suspicious changes in documents such as wills, power of attorney and insurance policies.
Even so, many cases of elder abuse are so subtle as to go unseen. For instance, an unemployed child may simply “borrow” funds from an elderly parent with the intention of paying it back someday, or an exhausted caregiver may grab the elderly person’s arm when she refuses to cooperate.
And in the current economic climate, experts say the incidence of financial abuse has gone up. Of particular concern is a caregiver with power of attorney over an elderly parent’s assets and finances, especially when there is evidence of financial mismanagement.
Moskowitz estimates that most cases of abuse are deliberate, but there are also those in which caregivers become abusive as a result of all the stress. “Caregivers are often overwhelmed and just can’t take it anymore,” he says. “They’re acting out of frustration or anger.” For caregivers, the best thing they can do to stop themselves from becoming abusers is to be aware of the fragility of their situation and to look out for their own well-being. “They have to take physical and emotional care of themselves,” Hoffman says. “They need a break from taking care of the individual.” Here’s what experts advise caregivers to do to avoid slipping into an abusive situation:
• Join a support group. Local organizations such as the Alzheimer’s Association often provide weekly support groups for caregivers to gather and talk about the challenges of caregiving. Being among others in your situation can be a tremendous source of comfort and relief. “The best thing for anybody is to become part of a support group,” Somers says. “You can connect with others in your same situation, and you can vent some of your frustrations.”
• Take advantage of community services. These same organizations— which may be social service agencies, churches or local non-profits—are also often able to help you with practical care for your elderly relative. Some may provide adult day care and respite services, which will give you the breaks you desperately need.
• Stay socially connected. It’s easy to abandon friends and social activities when you’re in the throes of caregiving. But maintaining connections can help you endure the difficulties.
• Do what’s necessary to stay healthy. Exercise, a good night’s sleep and healthy meals aren’t luxuries—they’re necessities for your well-being. Maintaining your own health will make you a better caregiver and give you the stamina you need for the long haul.
• Be smart with your time. Somers says caregivers should know their limitations, learn to make lists of what needs to be done and do what they can to make the best of their time. Even shopping for groceries according to the layout of the store can save time and make a caregiver less fretful.
• Learn to ask for help. Resist the urge to do it all by yourself. Instead, delegate responsibilities to siblings, your children, your spouse and others. If no one wants to help, ask for contributions of money instead. Use the money to hire someone to look after mom for a couple days while you take a break.
• Talk to a professional. If you think you’re on the brink of becoming abusive, seek professional help from a therapist or social worker. Airing your concerns can relieve stress and help you regain your footing while avoiding an abusive situation.
Do You Suspect Abuse?
Putting a stop to elder abuse takes effort, both on the part of the individual and the community. Whether it’s the vigilant neighbor who notices that her elderly neighbor is no longer out and about, or the watchful bank teller who spots unusual withdrawals from a customer’s savings account, it’s important that everyone be on the lookout for elderly people who are targets of abuse. Here’s what you can do if you think someone is being victimized:
• If you think an elderly person is being abused, contact your state’s Adult Protective Services agency or the police. You can also locate help on the National Center on Elder Abuse Web site at www.ncea.aoa.gov.
• If you don’t live near the victim, you can contact the national Eldercare Locator number to find services and agencies in the community where the older person lives. That number is 1-800-677-1116.
• And if you’re the victim of elder abuse, consider reporting it to the police, talking to your physician, a clergy member or a close friend. They may be able to report the problem and get you the help you need. Remember, elder abuse is a crime.