Elder Abuse and Alzheimer's Disease

Types of Elder Abuse

There are several different kinds of abuse that may affect older adults. This abuse can take place at care facilities such as nursing homes and assisted livings, as well as in the person’s own home. Being aware of these possibilities can, in some cases, prevent you or your loved ones from experiencing them.

• Physical:
  Physical abuse includes hitting, kicking, pushing, slapping, biting and other physical violence. Domestic violence is a kind of physical abuse where there is a pattern of violence by a spouse or domestic partner used to control a person.


• Emotional / Psychological:
  Emotional abuse includes using intimidation or threats to control another person, as well as yelling, name-calling and verbal insults.


• Sexual:
  Sexual abuse consists of a wide spectrum of behaviors including sexually inappropriate comments and non-consensual sexual contact of any kind.
  
  With people who have dementia, this type of abuse can turn into a dilemma due to the difficulty of determining if a person who is confused may still be classified as a consenting adult.


• Financial / Property:
  This type of abuse is also sometimes referred to as misappropriation of property and involves taking or misusing someone’s money or his belongings without the individual’s permission. It can also include coercion of the person so that he agrees to give someone money but only because he is placed under pressure to do so by someone.


• Involuntary Seclusion:
  This kind of abuse involves restricting the individual’s freedom to interact with others for extended periods of time against her will.
  
  Occasionally, this can be used therapeutically, and then it is not considered abuse. For example, if an individual is extremely combative (i.e., hitting or kicking at you) while you’re trying to provide care to her, she may benefit from a few minutes alone in her room to calm as well as prevent others from being hurt.


• Neglect:
  Neglecting someone also can constitute abuse. Neglect can be intentional or unintentional. If someone requires care for a medical condition and her caregiver is not addressing that need, neglect could be present.
  
  If someone can no longer bathe herself, doesn’t eat enough food because she regularly forgets that it’s time for a meal, and is unable to take her medications, her case could be reported to the Protective Services department in your area for investigation of neglect because she may not be competent to make appropriate decisions.


• Abandonment
  Some organizations add the additional category of abandonment. Abandonment is a type of neglect where a caregiver deserts (abandons) an older adult for whom they are they caregiver. Sadly, they may leave the elder at a store or a facility, similar to cases when babies have been abandoned.

Elder Abuse Statistics

• According to the National Committee for the Prevention of Elder Abuse, 84% of abuse is not reported to the authorities.
• Abuse costs tens of billions of dollars each year due to lost wages, health care, social services and legal costs.
• The National Center on Elder Abuse reports that approximately 2/3 of abuse perpetrators are related to the victim, and often are a spouse or adult child.
• The most recent data from 2005 suggests that there may be 5 million cases of abuse each year.

How Do Alzheimer’s and Other Dementias Increase the Risk for Abuse?

Alzheimer’s disease and other types of dementia place someone at a higher risk of abuse due to memory impairment, poor judgment, an inability to be independent and fear of repercussion. These people can be in a vulnerable position of needing help and may easily trust someone they shouldn’t. Their social interaction is often limited, which increases the opportunity for abuse to occur.

Know the Signs: Indicators of Abuse

• Frequent bruising: Matching bruises on arms may indicate rough grabbing of the person, for example. Be aware that an older person’s skin is often very fragile and bruise easily, so a bruise doesn’t always mean abuse is present. Certain medications like blood thinners or steroids can also cause a person to bruise easily.
• Unexplained injuries: The individual can’t or won’t explain what happened, or family members have different explanations that don’t seem to fit with the scenario.
• Pain or bleeding: If there is no explanation for vaginal or anal pain or bleeding, it should be investigated.
• Pain when sitting down: The individual shows unusual or new pain when sitting down.
• Frequent caregiver expressions of anger: If the caregiver often expresses her anger with the older adult, this is a concern since her frustration may be directed toward the person she’s caring for.
• Unpaid bills: The person begins to receive notices of overdue bills or checks are returned because there are insufficient funds.
• A new close friend: Someone may move in with the older adult and begin to ask for gifts or offer to help with his or her banking.
• Inappropriate questions from a caregiver: If, for example, the in-home aide begins to ask more questions about someone’s finances, this can indicate a red flag.
• Absence of food or medication: The person is lacking adequate nutrition and is not taking his medications regularly.
• Lack of appropriate treatment:If the older adult has decubitis ulcers (bedsores) that are not being treated, this is a sign of neglect.
• New power of attorney document: The older person has suddenly changed their financial power of attorney and you question her ability to understand the document.
• Isolation: The caregiver may isolate the older adult in order to hide signs of abuse or to control him.
• Withdrawal:The older person may withdraw emotionally and appear depressed, or withdraw physically in response to touch or proximity of another person.
• Emotional distress: The person may begin to frequently cry or appears anxious or worried.
• Verbalization: The older victim may choose to confide in you about her experience of abuse. Take it seriously and report it to your local adult protective services department. You can find this contact information by looking up your local government agencies and searching for adult protective services.

How Can You Help Prevent Abuse?

• Ask questions
• Be aware
• Ensure financial checks and balances
• Check references of in-home helpers
• Consider monitoring the checkbook
• Be involved in your loved one’s life
• Understand that family, unfortunately, can be the abuser
• Prevent caregiver overload and burnout
• Know how to cope with challenging behaviors in Alzheimer’s and other dementias

Who to Call for Help

If the older person lives in his own home, you should contact your local Adult Protective Services department. You can also consult with social workers, medical personnel or the local police department.

If the older person lives in a facility such as a nursing home or assisted living, you should report your concerns to the administrator of that facility. You can also report abuse to your state agency that oversees nursing homes here.

_Sources:

_{Alzheimer’s Association. Monitoring Abuse. Accessed January 20, 2012. http://www.alz.org/living_with_alzheimers_monitoring_abuse.asp}

_{National Center on Elder Abuse. Fact Sheet. Accessed January 20, 2012. http://www.ncea.aoa.gov/ncearoot/Main_Site/pdf/publication/FinalStatistics050331.pdf}

_{National Center on Elder Abuse. Types of Abuse. Accessed January 20, 2012. http://www.ncea.aoa.gov/ncearoot/Main_Site/pdf/basics/fact1.pdf}

_{National Center on Elder Abuse. Who are the abusers? Accessed January 20, 2012. http://www.ncea.aoa.gov/ncearoot/Main_Site/FAQ/Basics/Abusers.aspx}

_{National Committee for the Prevention of Elder Abuse. Accessed January 20, 2012. http://preventelderabuse.org/}