Although a goal of zero tolerance is the ideal, elder abuse—or abuse of vulnerable persons of any age—may never be completely prevented. However, we may reduce the incidence of abuse if we identify the abusers and address the causes of abuse.
Who are abusers of elderly persons? By what means do they abuse, and why? Under what circumstances does abuse happen?
Elder abuse, essentially, is a crime of means, motive and opportunity.
Means of Elder Abuse
The Canada Safety Council identifies four primary means of elder abuse:
Physical elder abuse: “non-accidental use of force against an elderly person that injures or causes physical pain”—e.g. striking, pushing, shaking, burning, inappropriate physical restraints or harm created by over or under medicating.
Psychological elder abuse: “actions that decrease a person’s sense of self-worth and dignity” including "insults, threats, intimidation, humiliation, harassment...ignoring...isolating elders from family, friends, or regular activities."
Financial abuse: “unauthorized use of an elderly person’s funds or property”—e.g. misuse of an elderly person’s property or money; forging an elderly person’s signature, excessive pressuring on elders to make or change a will or to sign legal documents that they do not fully understand, or sharing an older person’s home without paying a fair share of the expenses when requested.
Elder neglect: “intentional or unintentional (ignorance or denial)." Neglect may include a caregiver or family member not providing appropriate nourishment, shelter, clothing, medication or medical attention, and assistance with the basic necessities of life.
Motive for Elder Abuse: Stress at Home
Veronica Burns suggests that “in most cases, abuse is by a family member or spouse or significant other. Additionally, the abuser is often dependent on the elder for accommodation or money.” Burns points to stress as a contributing factor, noting in the same article that abuse is often the result of caring for an aging relative, and notes, too, that “this is especially true if the elder person is infirm or experiencing diminishing mental capacity” (for example, Alzheimer's disease).
Certainly being a caregiver is stressful. With respite care options few and costly, with long waiting lists for both respite placement and permanent placement in long-term care facilities, family caregivers are often pushed to the limit. Sleepless nights, brutal financial burdens, exhausting physical care, and emotional strain take a toll on caregivers who are just as much victimized by dementia as is the dementia patient. Add to that the demands of other family members and/or outside jobs, and the stage is set for caregivers to lash out, albeit unintentionally, at the perceived reason for their fatigue and money worries: the vulnerable person in their care.
Some older people and their caregivers in community settings are isolated, with infrequent external contacts (friends, neighbours, casual visitors, health care representatives), and are too fearful of being abandoned completely, or lack the capacity to indicate a need for help, let alone access the help that is available to them. Abuse in such circumstances is almost impossible to detect and remedy.
Motive for Elder Abuse: Stress in Long-Term Care
Elder abuse is not only a private, family-based matter. Most long-term care (LTC) facilities have professionally trained staff (nurses, personal support workers, and administrators) familiar with the sometimes challenging behaviours and needs of residents under their care. Although most facilities take seriously their responsibility to provide a safe and caring environment, abuse has nevertheless been documented in some LTC facilities.
“Elder Abuse,” a Canadian Mental Health Association study involving 31 nursing homes, reported that 36% of nursing home staff had witnessed the physical abuse of an older adult and 81% had witnessed some form of psychological abuse. This study also noted caregiver stress—i.e. caregivers within the LTC setting—as a key factor in abuse.
Jessica Luh and Sherry Dupuis also suggest in a 2004 MAREP study that “low job satisfaction, high staff burnout, low levels of education and job experience, a history of violence and stress in personal lives, and high case loads” amongst professional caregivers in long-term care facilities may contribute to elder abuse.
Opportunity for Elder Abuse
Abuse may occur anywhere, at any time, in the home, in public, and in community care settings. Where circumstances make it possible for one individual or group to have power over another, more vulnerable individual or group, the potential for abuse exists.
Some Canadian provinces (Ontario, for example) allow an individual to grant both Power of Attorney for Personal Care (authority to determine where, when, to what extent care is provided) and Continuing Power of Attorney for Property (authority to use or dispose of property) to another person or persons. This is usually given to a trusted family member or friend.
In the province of Ontario, the Ministry of the Attorney General provides print or downloadable copies of Powers of Attorney kits. These may be completed without the intervention of lawyers or third party assessors of any kind, and there is no requirement that these documents be registered anywhere or with anyone.
In theory, no one can be forced to grant POA to anyone else, but who can say that coercion or deceit has or has not been applied in order to obtain a signature? What protection is there for someone no longer capable of communicating his or her wishes, or no longer capable of resisting a caregiver who is less than well-intentioned?
Prevention of Elder Abuse
For as long as there are those in our society who are vulnerable, and those in our society who have means, motive and opportunity, the potential for abuse will always be with us. The best we can do—and what we as a society have a responsibility to do—is first, recognize abuse when we see it, second, act upon what we see to ensure that vulnerable persons are protected, and third, work toward removing the motive, means and opportunity for any future occurrences of abuse.
Know It When You See It
In their 2010 National Senior Safety Week campaign, The Canada Safety Council notes that the following may be symptoms of mental deterioration, but we should not dismiss these warning signs in case they are symptoms not only of mental deterioration, but also of abuse:
... changes in personality or behaviour in the elderly; fear, anxiety, depression or passiveness in relation to a family member, friend or care provider; unexplained physical injuries such as bruises, sprains or broken bones...dehydration, poor nutrition or poor hygiene; improper use of medication; confusion about new legal documents such as a new will or new mortgage; sudden changes in elder’s finances, such as significant withdrawals; reluctance to speak about the situation.
Luh and Dupuis include in their MAREP article a list of some indications of abuse in LTC settings:
- injuries around the mouth, face and eyes
- bedsores or bruises in unexplainable places or for unexplainable reasons
- signs of malnourishment
- lack of clean bedding or clothing
- broken or missing glasses, dentures or hearing aids
- resident’s behaviour changes when LTC staff member enters or leaves the room
- cheques are signed by another person without legal authority and/or the resident does not remember writing large cheques for anything
- prescribed medications are not available
Act Upon What You See
If you suspect abuse, either in a long-term care setting or in a private setting, stay in touch with the vulnerable person on a regular basis, investigate and report your suspicions to authorities. Reassure the person at risk that he or she is not alone: help, safety and support are available.
No Substitute for A Nosy Neighbour
Provided that one has access to and is able to use a telephone, fax or the Internet, one can report abuse, obtain information, or ask for help.
If one is being abused, physically, psychologically, financially, or through neglect, but unable to communicate this, or if one is a stressed-out caregiver needing immediate relief to prevent stress resulting in abuse of the vulnerable person in care, help might as well be on the moon.
“I need help and I need it right now!” echoes hollowly down an empty tunnel.
For as long as there are vulnerable individuals in society—individuals whose functional language is not English, for example, or those lacking the ability to communicate—and for as long as there are individuals inclined and/or desperate enough to take advantage of the vulnerable amongst us, there will be abuse. With all the information available, all the websites and programs and telephone numbers, the person being abused, and the abuser, still remain dependent upon the abuser to stop or be stopped. Toward identification and prevention of elder abuse, toward zero tolerance of elder abuse, there is perhaps no substitute for a nosy and caring neighbour.
Sources
Burns V. Elder Abuse in Canada. Nishnawbe-Aski Legal Services Corporation.
Canada Safety Council: Preventing Elder Abuse: National Senior Safety Week November 6-12, 2010.
Elder Abuse. Canadian Mental Health Association.
Luh J. and Dupuis S., Recognizing and Preventing Elder Abuse in Long-Term Care Settings: Recommendations for Families. Innovations: Enhancing Ability in Dementia Care. A Publication of MAREP: the Kenneth G. Murray Alzheimer Research and Education Program. Vol. 3, Issue 3, Fall 2004.
Powers of Attorney, The Office of the Public Guardian and Trustee, Ministry of the Attorney General.
The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact a doctor for advice.
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