Understanding and Preventing Elder Abuse

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa Skinner.

Welcome back, everybody. Today we're going to be diving into a somewhat sensitive topic, but a necessary one to be aware of. It's the topic of elder abuse. And I'm going to cover many aspects of it, including what constitutes elder abuse, how to spot warning signs, how to report mistreatment, and much, much more.

Why?

Because every person, no matter how old, deserves to be safe from harm by those who live with them, care for them, or have daily contact with them. Yet approximately 1 in 10 people age 60 and older who live at home experience abuse, including mistreatment and exploitation. And this is according to the Centers for Disease Control and Prevention. Over time, elder abuse can harm an individual's physical and psychological health. It can destroy social and family ties and cause devastating financial loss. Research also suggests that older people who have been abused tend to die earlier than those who have not been abused, even in the absence of having chronic conditions or life-threatening diseases. And that's according to the JAMA, Network, Article 184342. So what does elder abuse actually look like? Well, there's no single pattern of elder abuse. It's a complex problem that can stem from multiple causes, such as a history of violent interactions within the family, lifestyle adjustments, and tensions that can arise as a result of new living arrangements, or a caregiver's personal problems. For example, caregiver stress, mental or emotional illness, addiction to alcohol or other drugs, job loss, or other personal crises can lead to the abuse of an older person. Then there are certain societal attitudes that may also contribute to violence against older people and make it easier for abuse to continue without detection or intervention. For example, older people are often regarded as being insignificant, leading society to fail to recognize the importance of assuring dignified, supportive, and non-abusive life circumstances for every older person. These factors include the devaluation of and lack of respect for older adults and society's belief that what goes on in the home is a private, quote unquote, family matter. Who is most affected by elder abuse? Like other forms of abuse, elder abuse, again, is a complex problem. And it's easy for people to have misconceptions about it. The truth is that most elder abuse and neglect does take place in the home. The majority of older adults live in the community, either on their own or with their spouses, children, siblings, or other relatives, rather than living in institutional settings. And as a result of these statistics, the home is obviously where most abuse happens. Family members commit elder abuse in nearly 6 out of 10 cases. That's startling. According to the National Council on Aging, anyone can be vulnerable Older individuals who are frail, who are alone or depressed, as well as those with a physical disability or mental illness, are vulnerable to abuse. However, even those who are not affected by these visible risks can find themselves in abusive situations and relationships. Elder abuse affects people across all socioeconomic groups. Cultures, races, and ethnicities. Elder abuse takes many forms in many different ways. Sometimes the signs of abuse are silent or hard to detect, giving the perception that everything is okay. So here are some of the warning signs that a person may be experiencing abuse. There's physical abuse, and it involves including but not limited to inflicting physical pain or injury, or inappropriate use of restraint, unexplained injuries such as bruises, sprains, burns, and/or welts, especially if you're noticing that these things are recurring. Then there's emotional and psychological abuse, and this includes, but not limited to, insults, threats, humiliating the elder, isolating the elder, or intimidating the elder. You'll see sudden or frequent withdrawal from social activities. They're scared or they, um, exhibit anxiety around a specific person, they become more depressed, or you see sudden extreme mood changes or deterioration in their moods or sleep patterns. Also look for changes in appetite, self-blame, or expressions of helplessness. There's neglect, and what falls into this category are failing to provide food, shelter, medicine, hygiene, or medical care. Those are just a few examples. Isolation— that includes limiting the elder from contact with friends and family or monitoring their communications. Then of course there's financial abuse. This can range from theft, misuse of an older adult's funds, exploitation of their assets, forging their signature, sudden changes in a banking institution, bills are— go unpaid yet funds are disappearing, or new unfamiliar accounts. Also, unexplained changes to wills or a power of attorney or a beneficiary signature. You notice large withdrawals, cash advances, or purchases that are not aligned with needs or preferences. Insistence that the elder's finances be managed by the caregiver. And/or missing valuable or inconsistent receipts from shopping or services provided. There's sexual abuse. This includes inappropriate touching, photographing the elder in suggestive poses, forcing the elder to look at pornography, or any unwanted sexualized behavior as well as non-consensual sexual contact or coercion by another person. Self-neglect is also abuse. When an older adult is unable to care for themselves, they can endanger their own health and safety, potentially due to cognitive impairment, depression, or physical disability. Abandonment falls into the abuse category, like deserting— desertion of an older adult by someone responsible for their care. So how do we recognize elder abuse? Well, recognition can be extremely challenging, especially when the abuse is hidden. Or the elder is reluctant to report it. So here are some ideas. Look for a pattern of concerning signs across multiple domains. So here's one classification: social and environmental signs to look for: isolation from friends or other family members, conflicting or implausible explanations about injuries, or their needs. Unsafe living conditions, that includes no heat, unsafe housing, or threats of eviction. Untreated medical or dental needs. Caregiver-elder interactions, this look might look like the caregiver refuses to leave the elder alone. Or the elder is fearful of the caregiver. The elder consistently defers to the caregiver or avoids questions about their care. Apparent caregiver stress and blaming the elder for their problems. Again, self-neglect indicators. You might notice poor hygiene. Propor personal hygiene. They're always in soiled clothing and they're living in dirty living spaces. Their inability to obtain or manage food or their medications or even essential services and severe untreated medical conditions due to intentional neglect. And some of the other indicators would be poor hygiene, malnutrition, and dehydration. Or you notice that all of a sudden their dentures are missing, their eyeglasses have disappeared, their hearing aids cannot be found, or some of their other personal belongings. Now, I just wanna say that some signs may actually have a medical explanation or result from the fact that they live with cognitive impairment or dementia. So keep that in mind before maybe jumping to a rushed decision about what's going on. Who is at the highest risk? So the list of elders who are at the highest risk of abuse include older adults with cognitive impairment and/or dementia, dependence on others for daily needs, physically or financially, living with a caregiver who is under stress, has a history of abuse, or They lack training, social isolation or lack of supportive networks, a previous history of abuse within their own family, and financial dependence on their caregiver. What are the barriers to reporting and disclosing abuse? Well, The most obvious one would be fear of retaliation or losing essential caregiver support, losing their independence. Having cognitive impairment or communication difficulties could hinder their memory and ability to communicate with others. Feeling shame, guilt, embarrassment, Or a believing that abuse is a normal part of living, or it's a cultural belief. Dependency on the abuser for care. And you always have to factor in family dynamics or fear of institutionalization. What do you do if you suspect elder abuse? Step 1: The first thing you want to do, make sure the elder is safe. If there is any immediate danger or acute harm, you want to contact emergency services. In the U.S., dial 911. Elsewhere, use the local emergency numbers. Number 2, document what you are observing. Record dates, times, and descriptions of your concerns. Note physical signs, statements from the elder, or changes that you've noticed in their behavior, and preserve any physical evidence. So in other words, don't wash or move injured belongings unless necessary to to prevent harm. Step 3: Try talking with the elder if safe and appropriate. Choose a private, calm setting. Use respectful, non-judgmental language. Express concern for them and ask open-ended questions. For example, I'm worried about your safety. Can you tell me what's been happening? Avoid pressuring or arguing with them and respect their autonomy and decisions. And then of course, report it, what you discover, to the right authorities. Reports are often confidential and protected by law. In the US, you can report to Adult Protective Services in your state, your local police or sheriff department, a long-term care ombudsman if abuse occurs in a facility, a state agency overseeing elder care or social services. And then in other countries, you can contact a social services or department of aging and elder affairs, police for criminal abuse, National helplines or elder abuse hotlines. If you're uncertain, start with Adult Protective Services or local social services, and they can guide you. Seeking additional support: medical evaluation for injuries or healthcare concerns by a medical provider, or social services are available for counseling, respite care, and/or caregiver support. Legal advice is available. Elder care attorneys on guardianship, powers of attorney, and/or protective orders. And then financial protection resources that include credit monitoring and fraud protection. And then finally, create a safety plan. Identify trusted individuals who can help with daily oversight. Arrange for safer housing, access to transportation, and regular check-ins. And then consider temporary or permanent changes in caregiving arrangements if you feel that is necessary. Now I'm gonna talk a little bit about how different settings affect reporting and resources because that varies. So if the abuse is occurring and we— it's in a home-based environment, this often requires coordination with Adult Protective Services, social workers, and primary care providers. If the abuse is occurring in a nursing home, assisted living, memory care facility, or long-term care facility, you want to file complaints with state regulatory agencies, the facility's ombuds person, long-term care regulators, and notice patterns of neglect or abuse. If the abuse is occurring in a hospital setting, the medical teams can document injuries, coordinate with social work involvement, and report concerns to Adult Protective Services if abuse is suspected. So here are some prevention strategies for you to be aware of. Regular open communication with older adults and caregivers. Provide caregiver support. That includes respite services, training in caregiving techniques, and in stress management. Safeguard their finances, monitor their accounts, set up alert notifications. And use trusted financial professionals. Do some proactive legal planning by creating advanced directives or a durable power of attorney, guardianship arrangements, and living wills and trusts. Ensure safe living environment by monitoring home safety assessments and assistive devices to prevent falls. Then there are community connections, social groups, senior centers, and routine check-ins. Welfare checks is one of them. And of course, always stay on top of educating yourself. Recognize signs of abuse. How to report, and how to access the resources available in your area or community. Legal and ethical considerations to be aware of: elder abuse is a crime in many jurisdictions. The legal definitions, however, and penalties do vary. There are mandated reporters. Many professionals— your doctors, your nurses, your social workers, teachers, law enforcement— these people are legally required to report suspected abuse. It's mandatory. Now, privacy versus safety, balancing elder autonomy with protective interventions. Adult Protective Services focus on the elder's safety while respecting their rights. Capacity and consent. Determine their decision-making capacity. Are they confused? Are they being coerced? Because all these things can definitely and obviously complicate them giving consent to anything. So I want to finish by debunking some common myths to elder abuse. So the myth— this is one myth— that elder abuse is only about physical harm. The reality: it comes in a lot of different shapes and forms, including emotional, financial, neglect, self-neglect, among others. Another myth: Well, the elder will just tell someone if something's wrong. The reality of that is that many elders, again, their number one fear is retaliation. They feel ashamed sometimes or depend on the abuser for care, making disclosures rare. That's the sad truth of this. Another myth: if there are injuries, it must be due to an accident. But the reality to that myth is inconsistent injuries, repeated incidents, or injuries not matching the elder's activity level can certainly indicate abuse. One more myth: Reporting abuse will ruin the family. Reality: Protective services prioritize safety and can provide supportive services. Reporting can prevent further harm. So hopefully you will benefit from being aware of everything that I've shared with you today, and This recording, of course, is available for you to access when it airs and then anytime in the future. So that concludes today's episode of the Truth, Lies Alzheimer's Show. And once again, I'm Lisa Skinner, your host, and I certainly appreciate you taking the time to spend part of your day with us here. And I look forward to bringing you another brand new episode next week. Have a great rest of your week. And please try to stay happy and healthy. Bye for now.

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