Family Situations and Elder Abuse
Family situations that can contribute to elder abuse include discord in the family created by the older person’s presence, a history and pattern of violent interactions within the family, social isolation or the stresses on one or more family members who care for the older adult, and lack of knowledge or caregiving skills.
Intergenerational and marital violence can persist into old age and become factors in elder abuse. In some instances, elder abuse is simply a continuation of abuse that has been occurring in the family over many years. If a woman has been abused during a 50-year marriage, she is not likely to report abuse when she is very old and in poor health.
Sometimes, a woman who has been abused for years may turn her rage on her husband when his health fails. If there has been a history of violence in the family, an adult child may take the opportunity to “turn the tables” on the abusing parent by withholding nourishment or by overmedicating the parent. But that doesn’t have to be the case—many adult children who were badly treated by their parents become attentive caregivers.
Family stress is another factor that can trigger elder abuse. When a frail or disabled older parent moves into a family member’s home, the lifestyle adjustments and accommodations can be staggering.
In some instances, the financial burdens of paying for health care for an aging parent or living in overcrowded quarters can lead to stress that can trigger elder abuse. Such a situation can be especially difficult when the adult child has no financial resources other than those of the aging parent.
Sometimes, there may be marital stress between an older couple when they must share a home with their adult children. Or, the new living arrangements could cause tension between an adult child and his or her spouse. When problems and stress mount, the potential for abuse or neglect increases.
Social isolation can provide a clue that a family may be in trouble, and it also can be a risk factor for abuse. Social isolation can be a strategy for keeping abuse secret, or it can be a result of the stresses of caring for a dependent older family member. Isolation is dangerous because it cuts off family members from outside help and support they need to cope with the stresses of caregiving. Isolation also makes it harder for outsiders to see and intervene in a volatile or abusive situation to protect the older person and to offer help to the abuser.
Caregiver Issues and Elder Abuse
Personal problems of the caregiver that can lead to abusing a frail older person include caregiver stress, mental or emotional illness, addiction to alcohol or other drugs, job loss or other personal crises, financial dependency on the older person, a tendency to use violence to solve problems. Sometimes the person being cared for may be physically abusive to the caregiver, especially when the older person has Alzheimer’s or another form of dementia.
Caregiver stress is a significant risk factor for abuse and neglect. When caregivers are thrust into the demands of daily care for an elder without appropriate training and without information about how to balance the needs of the older person with their own needs, they frequently experience intense frustration and anger that can lead to a range of abusive behaviors.
The risk of elder abuse becomes even greater when the caregiver is responsible for an older person who is sick or is physically or mentally impaired. Caregivers in such stressful situations often feel trapped and hopeless and are unaware of available resources and assistance. If they have no skills for managing difficult behaviors, caregivers can find themselves using physical force. Particularly with a lack of resources, neglectful situations can arise.
Sometimes the caregiver’s own self-image as a “dutiful child” may compound the problem by causing them to feel that the older person deserves and wants only their care, and that considering respite or residential care is a betrayal of the older person’s trust.
Dependency is a contributing factor in elder abuse. When the caregiver is dependent financially on an impaired older person, there may be financial exploitation or abuse. When the reverse is true, and the impaired older person is completely dependent on the caregiver, the caregiver may experience resentment that leads to abusive behavior.
James is a financially secure 90-year-old man who has been healthy and active until the last year. He has finally agreed to move in with his oldest daughter, Lorraine, who now believes her father “owes her” more of his money than her brother and two sisters are entitled to. She talks her father into giving her power of attorney for his bank accounts “as a convenience,” then writes herself large checks that she tells herself are for “expenses.” Soon she has come up with excuses to transfer a significant portion of his investment holdings into her name. James has no energy to oversee his finances and is totally trusting that his daughter has his best interests at heart.
Emotional and psychological problems of the caregiver can put the caregiver at risk for abusing an older person in their care. A caregiver who is addicted to drugs or alcohol is more likely to become an abuser than one who does not have these problems. Indeed, caregiving can lead to greater use of alcohol, in an attempt to mange stress. Also, a caregiver with an emotional or personality disorder may be unable to control his or her impulses when feeling angry or resentful of the older person.
Cultural Issues and Elder Abuse
Certain societal attitudes make it easier for abuse to continue without detection or intervention. These factors include the devaluation and lack of respect for older adults and society’s belief that what goes on in the home is a private, “family matter.” Certain cultural factors, such as language barriers, make some situations more difficult to distinguish from abuse or neglect, and it is important not to ignore abuse by attributing the cause to cultural differences. However, before reporting abuse, anyone working with older people should be sensitive to cultural differences and not mistake these for abuse or neglect. Definitions of what is considered “abuse” varies across diverse cultural and ethnic communities.
Lack of respect for the elderly may contribute to violence against older people. When older people are regarded as disposable, society fails to recognize the importance of assuring dignified, supportive, and nonabusive life circumstances for every older person.
The idea that what happens at home is “private” can be a major factor in keeping an older person locked in an abusive situation. Those outside the family who observe or suspect abuse or neglect may fail to intervene because they believe “it’s a family problem and none of my business” or because they are afraid they are misinterpreting a private quarrel. Shame and embarrassment often make it difficult for older persons to reveal abuse. They don’t want others to know that such events occur in their families.
Religious or ethical belief systems sometimes allow for mistreatment of family members, especially women. Those who participate in these behaviors do not consider them abusive. In some cultures, women’s basic rights are not honored, and older women in these cultures may not realize they are being abused. They probably could not call for help outside the family and may not even know that help is available.
How Can We Prevent Elder Abuse?
The first and most important step toward preventing elder abuse is to recognize that no one—of whatever age—should be subjected to violent, abusive, humiliating, or neglectful behavior. In addition to promoting this social attitude, positive steps include educating people about elder abuse, increasing the availability of respite care, promoting increased social contact and support for families with dependent older adults, and encouraging counseling and treatment to cope with personal and family problems that contribute to abuse. Violence, abuse, and neglect toward elders are signs that the people involved need help—immediately.
Education is the cornerstone of preventing elder abuse. Media coverage of abuse in nursing homes has made the public knowledgeable about—and outraged against—abusive treatment in those settings. Because most abuse occurs in the home by family members or caregivers, there needs to be a concerted effort to educate the public about the special needs and problems of the elderly and about the risk factors for abuse.
Respite care—having someone else care for the elder, even for a few hours each week—is essential in reducing caregiver stress, a major contributing factor in elder abuse. Every caregiver needs time alone, free from the worry and responsibility of looking after someone else’s needs. Respite care is especially important for caregivers of people suffering from Alzheimer’s or other forms of dementia or of elders who are severely disabled.
Social contact and support can be a boon to the elderly and to the family members and caregivers as well. When other people are part of the social circle, tensions are less likely to reach unmanageable levels. Having other people to talk to is an important part of relieving tensions. Many times, families in similar circumstances can band together to share solutions and provide informal respite for each other. In addition, when there is a larger social circle, abuse is less likely to go unnoticed. Isolation of elders increases the probability of abuse, and it may even be a sign that abuse is occurring. Sometimes abusers will threaten to keep people away from the older person.
Counseling for behavioral or personal problems in the family can play a significant role in helping people change lifelong patterns of behavior or find solutions to problems emerging from current stresses. If there is a substance abuse problem in the family, treatment is the first step in preventing violence against the older family member. In some instances, it may be in the best interest of the older person to move him or her to a different, safer setting. In some cases, a nursing home might be preferable to living with children who are not equipped emotionally or physically to handle the responsibility. Even in situations where it is difficult to tell whether abuse has really occurred, counseling can be helpful in alleviating stress.
What You Can Do About Elder Abuse
If you suspect that an older person is being abused or neglected…
Don’t let your fear of meddling in someone else’s business stop you from reporting your suspicions. You could be saving someone’s life. The reporting agencies in each state are different, but every state has a service designated to receive and investigate allegations of elder abuse and neglect. Even if these agencies determine that there is only potential for abuse, they will make referrals for counseling. (Call the Eldercare locator at 1-800-677-1116.)
Do not put the older person in a more vulnerable position by confronting the abuser yourself unless you have the victim’s permission and are in a position to help the victim immediately by moving him or her to a safe place.
If you feel you are being abused or neglected…
Your personal safety is most important. If you can safely talk to someone about the abuse (such as your doctor, a trusted friend, or member of the clergy) who can remove you from the situation or find help for the abuser, do so at once. If your abuser is threatening you with greater abuse if you tell anyone, and if the abuser refuses to leave you alone in a room with others who could help, you are probably afraid to let anyone know what is happening to you. A good strategy is to let your physician know about the abuse. The physician has a legal obligation to report the abuser and to help you find safety.
If you are able to make phone calls, you can call protective services or a trusted friend who can help you find safety and also find help for the person who is abusing you.
If you feel you have been abusive or are in danger of abusing an older person in your care…
There is help available if you have been abusive to an older person or if you feel you want to hurt someone you are caring for. The solution may be to find ways of giving yourself a break and relieving the tension of having total responsibility for an older person who is completely dependent on you. There are many local respite or adult day care programs to help you.
If you recognize that abuse, neglect, or violence is a way you often solve problems, you will need expert help to break old patterns. There is help and hope for you, but you must take the first step as soon as possible. You can learn new ways of relating that are not abusive. You can change. Talk with someone who can help—a trusted friend or family member, a counselor, your pastor, priest, or rabbi. If alcohol or drugs are a problem, consider contacting Alcoholics Anonymous or some other self-help group.
Therapists specialize in helping people change destructive behaviors; to find a competent therapist, ask your physician or your health plan for a recommendation. If you cannot afford private therapy, call your city or state mental health services department to find out what your options are.
The most important thing for you is to be honest—with yourself and with those who want to help you—about your history of violent behavior and about your abusive relationship with the older person. Someone’s life—and your own—may depend on it.
Administration on Aging
Where To Go for Help
National Center on Elder Abuse – NCEA is a resource for public and private agencies, professionals, service providers, and individuals interested in elder abuse prevention information, training, technical assistance, and research.
1225 Eye Street, NW, Suite 725
Washington, DC 20005
Fax: (202) 898-2583
Eldercare Locator is sponsored by the Administration on Aging (AoA). If you know the address and ZIP code of the older person being abused, Eldercare Locator can refer you to the appropriate agency in the area to report the suspected abuse.
Area Agency on Aging
Most states have an information and referral line that can be helpful in locating services for victims or potential perpetrators of elder abuse and neglect. Check your local telephone directory.
Medicaid Fraud Control Units (MFCU)
Each state attorney general’s office is required by federal law to have an MFCU that investigates and prosecutes Medicaid provider fraud and patient abuse and neglect in health care programs and home health services that participate in Medicaid.
Adult Protective Services
In many states, Adult Protective Services is designated to receive and investigate allegations of elder abuse and neglect. Every state has some agency that holds that responsibility. It may be the Area Agency on Aging, the Division of Aging, the Department of Aging, or the Department of Social Services.
National Domestic Violence Hotline
The hotline provides support counseling for victims of domestic violence and provides links to 2,500 local support services for abused women. The hotline operates 24 hours a day, every day of the year.
The National Elder Abuse Incidence Study. (1998). U.S. Department of Health and Human Services, Administration on Aging (www.aoa.dhhs.gov/abuse/report/default.htm).
Diagnostic and Treatment Guidelines on Elder Abuse and Neglect. American Medical Association.
A Profile of Older Americans. (1998). American Association of Retired Persons (AARP) and the Administration on Aging, (www.aoa.gov/aoa/stats/profile/default.htm).
Understanding and Combating Elder Abuse in Minority Communities. (1998). Archstone Foundation and the National Center on Elder Abuse.
Domestic Mistreatment of the Elderly: Toward Prevention. AARP.