Due to internal and external stressors the elderly are being injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection. It is estimated that for every one case of elder abuse, neglect, exploitation, or self-neglect reported to authorities, about five more go unreported. (National Elder Abuse Incidence Study 1998) Caring for a non-well older adult suffering from a mental or physical impairment is highly stressful. Individuals who do not have the requisite skills, information, resources, etc. and who are otherwise ill-prepared for the caregiving role may experience extreme stress and frustration. This may lead to elder abuse and/or neglect. Individuals who are being abused and neglected will need the ABC model of crisis intervention to help them gain some control back over their life.
John is concerned about his neighbor Mr. Jones. He reports that he no longer sees Mr. Jones out in his yard. He knows that there is the son who comes in daily to check on Mr. Jones but for some reason John feels something is not right. John admits that due to his concern he has tried to visit with Mr. Jones when the son is not there but is no longer asked to come into the house. This is very strange behavior according to John because he and Mr. Jones used to meet in the morning for coffee at a little restaurant in the neighborhood. Mr. Jones has not been at the restaurant for over two months. The last time John did see Mr. Jones he thought he saw a bruise on his face. John is here today in hopes that a Crisis Worker will make a home visit to see what is going on.
Like other forms of abuse, elder abuse is a complex problem, and it is easy for people to have misconceptions about it. Many people who hear “elder abuse and neglect” think about older people living in nursing homes or about elderly relatives who live all alone and never have visitors. But elder abuse is not just a problem of older people living on the margins of our everyday life. It is right in our midst. Arriving at Mr. Jones house I need to caution and be aware of my surroundings. If he is being abuse by his son this may be a hostile situation and I need to have someone else there to help out in case something goes wrong. When I enter their home I would need to speak privately with Mr. Jones to build rapport. I need be patient and understanding towards Mr. Jones situation. He needs to know that he can trust me so he will be able to talk to me openly. If I sense that Mr. Jones is in fear of his son I will have him taken to APS. From the reports Mr. Jones no longer ventures out into his yard. He no longer meets his neighbor for coffee and doesn’t let his neighbor come to visit and I need to find out why. When I am confident that Mr. Jones is at ease I then need to begin asking him a series of questions to find out why his routine has changed. There is also the report of him having a bruise on his face so in order for Mr. Jones to tell me how he received it it’s best that I take him some place safe.
Once I have established a rapport with Mr. Jones and he is comfortable with talking to me I would then need to identify the precipitating event. I will need to ask opened and closed ended questions about his son to find out why he is hurting his father. There are many different factors that may be the cause of his son’s behavior. His son may be going through a number of things like: Caregiver stress: Caring for a non-well older adult suffering from a mental or physical impairment is highly stressful. Individuals who do not have the requisite skills, information, resources, etc. and who are otherwise ill-prepared for the caregiving role may experience extreme stress and frustration. This may lead to elder abuse and/or neglect.
External Stress: External stress such as financial problems, job stress, and additional family stressors have been hypothesized to also increase the risk for abuse. This correlation has been clearly demonstrated in studies examining spousal or child abuse.
Social Isolation: Abuse, whether spousal abuse, child abuse, or elder abuse occurs most often in families characterized by social isolation. Of course, this may be both an indicator of potential abuse as well as a potential contributing cause of abuse.
Dementia: The vast majority of older adults are not suffering from any form of dementia. However, those who may be in the early stage of dementia (e.g. Alzheimer’s disease, Multi-Infarct Dementia) may be undiagnosed and susceptible to self-neglect. Clearly, the first step for intervention is diagnosis and appropriate medical treatment.
Depression: Depression can be an issue for older adults much as it can be for individuals of any age. While there is a broad range of symptomatology for depression (too extensive for discussion here), two symptoms are particularly relevant: difficulty maintaining self-care and dementia-like symptoms. Contrary to common myth, depression is highly treatable in old age. Rapid intervention and treatment is particularly essential as there is a high risk of suicide for older white males in the United States; it is estimated that the rate of suicide for older white males may by as much as 12 times higher than for any other demographic/age group.
Dependency or impairment of the older person: It has been argued that as an older adult1s dependency increases so does the resentment and stress of the caregiver. Studies have found that individuals in poor health are more likely to be abused that individuals who are in relatively good health. In addition, caregivers who are dependent on the elder financially is also more likely to perpetrate abuse. This is hypothesized to counteract the feelings of powerlessness that may be experienced by the caregiver.
Intergenerational transmission of violence: Individuals who are abused as children are hypothesized to become part of a cycle of violence. Violence is learned as a form of acceptable behavior in childhood as a response to conflict, anger, or tension. Thus, when these feelings arise during caregiving, the caregiver is at risk for becoming a perpetrator of elder abuse or neglect. Some have also hypothesized a “what goes around comes around” theory of elder abuse. If the older person receiving the care previously abused their child, that child now in the role of caregiver simply is returning the abuse they suffered.
Substance Abuse: Substance abuse can also be an issue for older adults. Some older adults suffer from long-term addictions and the concomitant disorders that accompany such additions (e.g. Korsakoff’s syndrome with accompanying dementia). Thus, not only may the older person self-neglect as a direct result of the addiction but they may also self-neglect as a function of the resultant disorder. In addition, some older adults develop substance abuse problems in old age possibly in response to depression, stress, loss, or anxiety. They may also develop a substance abuse problem as a result of over prescription of medicines (e.g. Valium, Xanax) by their physician. Therefore, the substance abuse by itself, the underlying cause of the substance abuse, and/or the often accompanying dementia-like symptoms may result in self-neglecting behavior.
Isolation: There is a clear cut correlation between social support and life satisfaction. As life satisfaction decreases, the risk for self-neglect increases; Isolation is a risk factor for all forms of elder abuse. Intervention entails the creation of trust, increased involvement of the older adult in the community, and the creation of social supports. This, of course, may be problematic for those individuals who have had little social support throughout their life-span.
After identifying the precipitating event I then need to help Mr. Jones find ways to cope. Before I decide to place Mr. Jones in a nursing home I need to find out if his son wishes to have him back home and if so if he is will to seek help for his behavior. Once we all have come to an agreement I need to assess Mr. Jones to see how much damage psychologically and physically has his son caused. If there is minimal damage I would recommend family therapy for them both. I would as recommend private therapy for his son so that he may be able to work out his issues. I would as recommend that Mr. Jones visit the local senior home every day so he will have some interaction with people his own age and his son will be able to have time for himself. If there is major damage I would recommend sending Mr. Jones to an assistant living facility and continue with therapy.
Every person-no matter how young or how old-deserves to be safe from harm by those who live with them, care for them, or come in day-to-day contact with them. Elder abuse, like other forms of violence, is never an acceptable response to any problem or situation, however stressful. Effective interventions can prevent or stop elder abuse.