TAKING ADVANTAGE - Seniors With Dementia More Vulnerable to Abuse

by Women's Brain Health Initiative:Many of the common effects of growing older, such as decreased mobility and strength, and diminished sight and hearing, leave seniors vulnerable to being abused, and this is especially true for elders with dementia. It is unknown exactly how many older adults are abused worldwide since it is a difficult subject to research. There are varied ways to define and measure elder abuse, and many of the abused are either reluctant or unable to disclose what they are experiencing, or may not even recognize it as abuse. A recent Canadian study, “Into the Light: National Survey on the Mistreatment of Older Canadians, 2015” found that 8.2 percent of older adults had experienced some form of mistreatment in the past year.Research indicates that people with dementia have an increased risk of experiencing abuse, and the level of risk increases as dementia progresses. According to the US Department of Health & Human Services’ National Center on Elder Abuse website, “Prevalence rates for abuse and neglect in people with dementia vary from study to study, ranging from 27.5% to 55%.” With such incredibly high prevalence rates being found (rates that may underestimate the problem given the research challenges), elder abuse among dementia patients is clearly a massive public health and societal concern.Elder abuse is any action that causes harm or distress to an older person. It can involve just a single incident or be a repeated pattern of behaviour. There are many forms of elder abuse: physical, psychological, financial and sexual abuse, as well as neglect.Most types of physical abuse are easy to recognize such as hitting, pushing and restraining, but physical abuse can also include the inappropriate use of anti-psychotic drugs.Psychological abuse includes any behaviour that decreases a senior’s sense of self worth and dignity, such as insults, threats, treating the senior like a child or socially isolating them.Financial abuse includes improper use of the senior’s money through coercion, theft or forgery. According to the Government of Canada’s website for seniors, it can also include “unduly pressuring seniors to make or change a will,” or “sharing an older person’s home without paying a fair share of the expenses when requested.”Any type of sexual contact against someone’s will is considered sexual abuse. This can include rape and inappropriate touching (over or underneath clothing).When a caregiver does not provide the senior with the basic needs for survival, it is considered neglect. This includes not providing adequate nutrition, access to healthcare, or correct medication. For seniors with dementia, though, neglect can include simply leaving the person home alone since that can be dangerous.Despite much media coverage of abuse at senior care facilities, the reality is that elder abuse is much more common at home, and perpetrated more often by family members rather than by professional caregivers.When seniors are abused by their loved ones, they are often reluctant to report the abuse because they feel shame or guilt, are afraid of being punished by their loved one or not being believed, are worried they will be put in a nursing home, or are apprehensive about involving the police or going through the court system. Sometimes they are not aware of their rights or of support systems that are available to help them. Most shocking, though, is that some seniors don’t even realize that they are being abused; rather, they rationalize the behaviour in some way.Dr. Lynn McDonald, a professor in the Faculty of Social Work at University of Toronto and principal investigator for the “Into the Light” survey, knows first-hand how often seniors will rationalize abuse. As part of a research project, older adults completed a measurement tool to assess whether they were being abused, checking off applicable experiences such as being hit or yelled at. Then participants were interviewed about their experiences, and it was surprising to discover the disconnect between what people reported on the measurement tool and what they would say. The tool would clearly indicate someone had experienced abuse but they would blow it off as if it wasn’t abuse when asked about it. Dr. McDonald shared two examples of this disconnect:1. “Someone checked off ‘broken bones’ on the abuse measurement tool but when asked verbally if they thought they were being physically abused, the person said, ‘Oh no, I wasn’t abused.’ Further discussion revealed this person’s rationale for what happened, ‘Well, my daughter’s always in a hurry and she’s got to get me dressed before she goes to work. And you know, my bones are really thin, and she just snapped my wrist by mistake.’”2. “One of the biggest areas of disconnect was also between what people checked off on the measurement tool and what they said involved psychological abuse. For example, someone would check off yelled at, intimidated, etc. but when asked if they felt they were being treated disrespectfully and abused, they would say, ‘Oh, no. My son always yells at me. He’s always scary, always saying he’s going to put me in a nursing home if I don’t do this or that.’ These people didn’t even realize they were experiencing abuse!”Dr. McDonald continued, “It is outrageous that sometimes older people come to see themselves as so unimportant that it doesn’t matter how much we hurt them. It tells us how much we need to >> educate, not just for younger people but for older people as well.”Spotting the Signs of Potential Elder AbuseElder abuse can be hard to detect but watch for the following signs that may point to an elder being victimized or neglected:

• mysterious physical injuries
• unexplained credit card expenses or a sudden decrease in cash flow or financial assets
• unexplained new legal documents, e.g. will
• frequent arguments between the senior and a caregiver
• a caregiver refusing to allow anyone else to be alone with the senior
• weight loss or dehydration
• poor hygiene
• noticeable behavioural or personality changes,e.g. fear, anxiety, depression, passiveness
• under or overdose of medication

Some of these warning signs can be the natural result of increasing frailty with age, and some overlap with the symptoms of dementia, making it challenging to confirm cases of abuse. It is especially challenging to confirm abuse of older adults with dementia since they may be unable to communicate what is happening to them, may forget the details or may be experiencing hallucinations that something is happening but isn’t (e.g. delusions of sexual abuse can be one of the behavioural and psychological symptoms of dementia).Taking action if you suspect elder abuseIf you notice any signs of potential elder abuse, it is important to take action. Speak directly to the elder, asking questions about what you have observed. Research support services for abuse in your community and offer to connect the elder with those services. In some cases the older adult may insist nothing is wrong; that may be true, but remember that it is common for elders not to report abuse out of fear or shame.If you feel strongly that something is amiss and the elder refuses to seek help or if the elder is incapable of seeking help on her or his own, you can contact abuse support services to report your observations and they can investigate the matter further.The Elder Abuse Ontario website reminds us that “everyone has a role to play to assist someone they suspect is being abused.” Don’t assume that someone else will have already spoken to the elder about it or reported possible abuse. Don’t be reluctant to get involved; the older adult with dementia may be in desperate need of your help.Where to Find HelpDifferent communities will have different kinds of services available to help address elder abuse. The “What You Can Do to Keep Yourself Safe from Abuse” brochure that is part of the It’s Not Right! campaign to address elder abuse in Canada (http://itsnotright.ca/) describes the types of services to look for, including:

• Provincial/territorial telephone numbers
• General information lines about community services
• Senior abuse or family violence helplines. An example of a senior abuse helpline exists in Ontario, Canada. The Seniors Safety Line (1-866-299-1011) is a toll-free, confidential resource that provides information, referrals and support 24 hours a day, seven days a week
• Legal services lines
• Domestic violence shelters/elder abuse safe accommodation programs
• Victim services
• Health care providers
• Mental health programs

Of course, in an emergency, you need to call 911 or the local police.It’s Not Right! was developed by The University of Western Ontario’s Centre for Research & Education on Violence Against Women and Children.Source: MIND OVER MATTER