Older people today are more visible, more active, and more independent than ever before. They are living longer and in better health. But as the population of older Americans grows, so does the hidden problem of elder abuse, exploitation, and neglect. Recent research suggests that elders who have been abused tend to die earlier than those who are not abused, even in the absence of chronic conditions or life threatening disease. Like other forms of abuse, elder abuse is a complex problem, and it is easy for people to have misconceptions about it. Many people who hear "elder abuse and neglect" think about older people living in nursing homes or about elderly relatives who live all alone and never have visitors. But elder abuse is not just a problem of older people living on the margins of our everyday life. It is right in our midst: Most incidents of elder abuse don’t happen in a nursing home. Occasionally, there are shocking reports of nursing home residents who are mistreated by the staff. Such abuse does occur, but it is not the most common type of elder abuse. At any one time, only about 4 percent of older adults live in nursing homes, and the vast majority of nursing home residents have their physical needs met without experiencing abuse or neglect. Most elder abuse and neglect takes place at home. The great majority of older people live on their own or with their spouses, children, siblings, or other relatives; not in institutional settings. When elder abuse happens, family, other household members, and paid caregivers usually are the abusers. Although there are extreme cases of elder abuse, often the abuse is subtle, and the distinction between normal interpersonal stress and abuse is not always easy to discern.
There is no single pattern of elder abuse in the home. Sometimes the abuse is a continuation of long-standing patterns of physical or emotional abuse within the family. Perhaps, more commonly, the abuse is related to changes in living situations and relationships brought about by the older person’s growing frailty and dependence on others for companionship and for meeting basic needs. It isn’t just infirm or mentally impaired elderly people who are vulnerable to abuse. Elders who are ill, frail, disabled, mentally impaired, or depressed are at greater risk of abuse, but even those who do not have these obvious risk factors can find themselves in abusive situations and relationships. Elder abuse, like other forms of violence, is never an acceptable response to any problem or situation, however stressful. Effective interventions can prevent or stop elder abuse. By increasing awareness among physicians, mental health professionals, home health care workers, and others who provide services to the elderly and family members, patterns of abuse or neglect can be broken, and both the abused person and the abuser can receive needed help.
Sometimes older adults harm themselves through self-neglect (e.g., not eating, not going to the doctor for needed care) or because of alcohol or drug abuse. However, one of the most difficult problems family members face is achieving a balance between respecting an older adult’s autonomy and intervening before self-neglect becomes dangerous. Older adults who show signs of dementia may become abusive as part of the disease process, and the object of the abuse may be another older adult, for example, a spouse who is caring for the impaired elder. The abuse may take the form of hitting or gripping the caregiver to the extent of causing bruises, or creating hazards such as setting furniture on fire. Although the behavior can be explained by the impairment, it is still unacceptable. Importantly, while abuse comes in many guises, the net effect is the same. Abuse creates potentially dangerous situations and feelings of worthlessness, and it isolates the older person from people who can help.
Depression seems to be another issue that older American face today. When we get very old and lose close friends and family, depression sets in deep and hard. At age 80, it is hard to make new friends and to be involved in social events. I have watched some of these people break down and have to wait an hour to get themselves together to examine their eyes. An estimated 20% of older adults in the community and as many as 50% in nursing homes suffer from depression. Older Americans have the highest suicide rate of any age group, and depression is its foremost risk factor. Although older adults comprise only 13% of the population, they account for 20% of the suicide deaths in our country. Depression in older adults not only causes distress and suffering but also leads to impairments in physical, mental, and social functioning. Because depression tends to be a recurrent disorder, many older adults will have experienced previous bouts of depression and will be at increased risk. Risk factors for late-onset depression include: widowhood, physical problems, educational attainment less than high school, impaired functional status, and heavy alcohol consumption. Depressed older adults tend to utilize health services at high rates, engage in poorer health behaviors, and evidence what is known as "excess disability."
The older Americans are facing some hard times. Some say it is as hard or harder than fighting in some of the wars many of them fought. The most important issue that is facing them today is abuse. In our group, we all agreed this was the worst. It is sometimes hard to detect abuse. Most older folks who are abused are afraid to say anything for feat of the abuser.
