Are older people safe at home from mistreatment?
It’s a simple question that social workers, nurses, doctors, paramedics and indeed all health care providers need to ask their older patients every time they see them. That simple question can be a crucial first step toward identifying potential elder mistreatment.
Most elder mistreatment is never discovered. An Institute of Medicine report noted one in 10 older Americans, “experience physical, psychological or sexual abuse, neglect, or financial exploitation.” But for every elder mistreatment case that is brought to the attention of authorities, more than a dozen go unreported.
Elder Mistreatment in Australia
Elder mistreatment in Australia has a similar incidence. From Australian studies, it has generally been estimated that around 3 per cent of people aged 65 years and over have suffered some type of abuse. A recent study at Hornsby Ku-ring-gai Hospital, however, raises this figure to 4.6 per cent, while the NSW Task Force on Abuse of Older People revealed that as many as 5 per cent of the over 65 age group become victims of abuse. A further 8 per cent of adults know an older person who has been abused.
Approximately 90% of abusers are family members and friends, most often adult children, spouses, partners and others, many of them suffering from drug or alcohol abuse or mental illness, or collapsing under the stresses of caregiving. Older people in poor health are three to four times more likely to be abused than those in good health, and maltreatment cuts across economic, social, religious and educational lines. The high risk groups for elder mistreatment are: female, very old, dependent, drinkers, in poor relationships, self-blaming, excessively loyal, stoic and isolated. Conditions characterising abuse highlight the pathological nature of the carer, the stress of caring for an often impaired older person, the very close relationship between the carer and the elderly person when the dependency of one may be the trigger for the other, and the inter-generational transmission of violence.
Dependency appears to be the common denominator. There are two common scenarios when it comes to identifying abuse. The first is that the greater dependency of older persons leads to stress on the carer/relatives, which may manifest in mistreatment. The second hypothesis focuses on the stressed carer. The dependency of the abusive relative upon the elderly person is the crucial factor in maltreatment. Perpetrators, because of their own dependency, react to the stress caused by the dependent person’s impaired social functioning, caused, for example, by emotional problems, Alzheimer’s disease, or brain damage.
Abuse is therefore more likely to occur, first, as the relations between the older person and the carer become more intimate and, secondly, as the older person’s daily needs begin to significantly distort a carer’s time schedule and personal space requirements. Stress levels, already pushed to the limit, can be severely tested when an extra variable is introduced into the family unit. About 95 per cent of older Australians live in private homes, rather than in aged care facilities. Some individuals either live alone or with a spouse; some share with siblings or other relatives; some share with friends of their own generation; and some live with single or married offspring who themselves may have children or grandchildren.
How Health Care Workers Can Help Prevent Elder Mistreatment
Although many professionals may be well-positioned to detect any maltreatment of older people, they lack the specific training which would allow them to follow through with such cases. This is where standardised procedures for the identification and referral of individual circumstances would facilitate cooperation and coordination between agencies such as community care workers, geriatric and rehabilitation services, hospitals, medical practitioners, solicitors and chamber magistrates. Through such a variety of agencies, it becomes possible to detect the more subtle forms of abuse (emotional, psychological and economic) as well as the more obvious cases of physical abuse.
The effectiveness of any intervention strategy is ultimately dependent upon the ability to recognise cases of elder maltreatment. However, the detection of such cases is not easily accomplished. Victims of elder abuse and neglect are often incapable, either physically or psychologically, of stopping the abuse. Fear of further punishment or abandonment keeps others quiet, as does the shame and guilt associated with the fact that the abuser is often a close family member. Moreover, the person in the caregiver’s role, who normally would be most likely to identify and seek assistance for physical or emotional problems, has a strong vested interest in keeping such problems hidden.
Because people who suffer elder mistreatment are often isolated, any contact represents a critical opportunity to intervene. Health care professionals and allied health workers are often the first, perhaps the only, line of defense for a vulnerable older person. The emergency department likewise offers an important opportunity. Frequent visits to the ED may constitute a warning sign for mistreatment, and all emergency personnel should be aware of the need to flag injuries possibly caused by abuse, document any suspicions, and take action if necessary.
It’s important to recognise that situations change day to day. An older person who was safe at the last visit may not be at future appointments. Vigilance is extremely important.
Prevention rather than treatment is obviously the preferable option. As such, the emphasis changes from examining specific cases in which mistreatment is known or suspected to have occurred, to a concern with older people and their caregivers.
While recognising that the role of caregiver is an extremely valuable resource, it cannot be assumed that all family members are equally suited to provide care for an older person. By the same token, many people do not want to look after their older relatives. Indeed, there is strong empirical evidence to suggest that the abuse and neglect of older people may result from the fact that the caregiver is not economically, physically or psychologically prepared to take on the responsibilities that such a commitment implies. This would indicate that those individuals and families who are thinking about taking on the caregiving role need to be assessed with respect to their relevant capabilities before such a responsibility is considered. If the decision to become a caregiver is made, respite programs could alleviate some of the emotional and physical burden associated with the long term provision of care.
Problems associated with the high incidence of social isolation among older people also need to be addressed. Increased social integration has the ability to empower the older person and to increase awareness of options regarding his or her circumstances. More active involvement in the community may increase self-confidence and reduce feelings of dependency. It also enhances the visibility of the older person and the caregiver.
We always encourage any family thinking about the care needs of an aging family member to document the process and the agreement with the entire family.
For the sake of there being no misunderstanding among the family as to the motivation of a family member in caring for an older person and indeed for the older person in choosing to live in one household as apposed to another, it is our experience, that it is best for there to be open discussion. We can facilitate that open discussion. Secondly, it is our experience, that it is best to document care arrangements.
Further, sometimes it is necessary for older people to go into aged care facilities. The operators of aged care facilities present a whole range of documentation, which they suggest is standard and should simply be signed. Sometimes the suggestion is that the bond is derived by some act of science and it should just simply be paid with no questions asked. It is our position, that questions should always be asked and that everything is subject to negotiation. We are able to assist people in advising on care agreements with aged care facilities and with also the calculation of bonds.
As older people age, it is important to examine how best to live a comfortable and healthy life. Contact us today for your free, 10-minute phone consultation.