HEALTH MATTERS
By: Dr. Rick Meyer
Elder abuse is an act or a mission that results in harm or threatened harm to the health or welfare of an elderly person.
Elderly Americans are falling victim to various forms of abuse in astonishing numbers ranging from 500,000 to 2 million cases per year. In 2000, a congressional commission formed to review patterns of abuse across the country found that only 6 percent of elder care facilities to be in compliance with federal quality standards. In addition, in 40 percent of these facilities, there was a report of an event that was either actively or hypothetically harmful to the elderly population the facilities serve.
Of course, abuse does not happen just in nursing homes. It happens when a neighbor repeatedly loses her temper with her elderly parent or a co-worker forgets to check in regularly on his father who lives alone.
In 1987, the American Medical Association (AMA) formed a Council on Scientific Affairs to review elder abuse, recognizing these six categories: physical abuse, sexual abuse, neglect, psychological abuse, financial and material exploitation, and violation of rights. Of these, by far the most pervasive is neglect, which the AMA notes is "characterized by failure of the caregiver to provide the goods and services that are necessary for optimal functioning to avoid harm."
It is important to note that many of these instances involve elder self-neglect. Every person has different cultural expectations and some value independence and autonomy over safety. This is where quality of life issues come into play. The elderly who choose to live alone may suffer from depression or be in early stages of dementia, yet their social skills are intact. This means that if family members call from afar, they may be told that everything is just fine. The reality may be quite different.
On average, the abused are 85 years old and older. They more often are women than men, and come from all economic strata. Abuse appears to be more common in those who suffer chronic, progressive and disabling illnesses, such as depression and dementia, perhaps because it is not unusual for these people to manifest aggressive behavior, often without realizing it.
The best way to combat the problem is through education and training for both family members and all levels of caregivers. Family members who take over caring for an elderly relative may experience rapid burnout, as they are forced to juggle the demands of family and work. Likewise, nursing home aides who are on the front lines of caring for the elderly often have little training and minimal education, and they receive little pay. When caregivers experience stress, it can cloud their judgment and result in abuse.
If you suspect that an elderly person is suffering from neglect, you have several options.
Every state has an agency that is set up to provide safety and services to older members of the population. In New Jersey, you can call the Adult Protective Services (APS) agency if you suspect neglect, would like a situation assessed, or need help finding a solution to care giving. Neglect results in shortened survival. There are several signs and symptoms to look for, including listlessness, poor hygiene, malnourishment, inappropriate dress, pressure sores, urine burns, lack of supervision in a dangerous situation, and inability to get needed medications.
Also, elders who have a history of substance abuse, live in an institution, have no family or friends, or have supporters who are exhibiting caregiver burn-out are at high risk.
It is not uncommon for families to be unaware of the threat of danger to an elderly loved one. In instances of dementia such as Alzheimer’s disease, social skills are preserved until the later stages of the disease. When a loved one loses the ability to perform basic activities (dressing, bathing, grooming) and instrumental activities (cooking, cleaning, managing finances), it is time to arrange for supervised help.
If you are unable to provide this in your home, you will need to find a nursing care facility that is right for you and your loved one.
Focus on facilities with resources that hire educated, experienced, well-trained people. Tour the facility and speak with staff members to get a sense of how the place is run. Have workers established a rapport with residents? Are residents’ needs being met? Is the facility clean? Inquire about safety measures and daily routines.
In many cultures, the elderly are the revered members of society, valued for their great knowledge and experience. As America’s population ages, it is important to consider how we view our elderly, what respect we reserve for them, and what services we provide for them.
For more information, look in the blue pages of the local telephone directory under Health and Senior Services. There you will find contacts for the Adult Protective Services (609-588-3464) and NJ Ease Senior Services toll-free hotline (1-877-222-3737).
Dr. Rick Meyer is a board-certified internist specializing in geriatric medicine. He is on staff at The Medical Center at Princeton. This article was prepared in collaboration with Lorraine Seabrook.

