Risk factors among caregivers

Many nonprofessional caregivers — spouses, adult children, other relatives and friends — find taking care of an elder to be satisfying and enriching. But the responsibilities and demands of elder caregiving, which escalate as the elder’s condition deteriorates, can also be extremely stressful. The stress of elder care can lead to mental and physical health problems that make caregivers burned out, impatient, and unable to keep from lashing out against elders in their care.
Among caregivers, significant risk factors for elder abuse are
• inability to cope with stress (lack of resilience)
• depression, which is common among caregivers
• lack of support from other potential caregivers
• the caregiver’s perception that taking care of the elder is burdensome and without psychological reward
• substance abuse
Even caregivers in institutional settings can experience stress at levels that lead to elder abuse. Nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities, are unsuited to caregiving, or work under poor conditions.
The elder’s condition and history
Several factors concerning elders themselves, while they don’t excuse abuse, influence whether they are at greater risk for abuse:
• The intensity of an elderly person’s illness or dementia
• Social isolation; i.e., the elder and caregiver are alone together almost all the time
• The elder’s role, at an earlier time, as an abusive parent or spouse
• A history of domestic violence in the home
• The elder’s own tendency toward verbal or physical aggression
In many cases, elder abuse, though real, is unintentional. Caregivers pushed beyond their capabilities or psychological resources may not mean to yell at, strike, or ignore the needs of the elders in their care.
Reporting elder abuse
If you are an elder who is being abused, neglected, or exploited, tell at least one person. Tell your doctor, a friend, or a family member whom you trust. Other people care and can help you.
You can also call Eldercare Locator at 1-800-677-1116.
The person who answers the phone will refer you to a local agency that can help. The Eldercare Locator answers the phone Monday through Friday, 9 am to 8 pm, Eastern Time.
How do I report suspected elder abuse?
The 500,000 to 1,000,000 reports of elder abuse recorded by authorities every year (the vast majority of which are proven to be true) are only the tip of the iceberg; according to data from different states, for every case of elder abuse reported, another 12 or 13 are not. Accordingly there’s a great need for people to report suspected abuse.
In every state, physical, sexual, and financial abuses targeting elders that violate laws against assault, rape, theft, and other offenses are punishable as crimes. With some variation among states, certain types of emotional elder abuse and elder neglect are subject to criminal prosecution, depending on the perpetrators' conduct and intent and the consequences for the victim.
States differ on who is required to report suspected elder abuse (there’s no federal standard), though the categories of mandatory reporters are expanding. Typically, medical personnel, nursing home workers, peace officers, emergency personnel, public officials, social workers, counselors, and clergy are listed as mandatory reporters, and that responsibility is spreading to financial institutions and other entities that work with seniors.
While it’s important for elders to seek refuge from abuse, either by calling a local agency or telling a doctor or trusted friend, many seniors don't report the abuse they face even if they’re able. Many fear retaliation from the abuser, while others believe that if they turn in their abusers, no one else will take care of them. When the caregivers are their children, they may be ashamed that their children are behaving abusively or blame themselves: “If I’d been a better parent when they were younger, this wouldn’t be happening.” Or they just may not want children they love to get into trouble with the law.
The first agency to respond to a report of elderly abuse, in most states, is Adult Protective Services (APS). Its role is to investigate abuse cases, intervene, and offer services and advice. Again, the power and scope of APS varies from state to state. However, every state has at least one toll-free elder abuse hotline or helpline for reporting elder abuse in the home, in the community, or in nursing homes and other longterm care facilities. In addition, information and referral are also available from the national Eldercare Locator: 1-800-677-1116
Preventing elder abuse and neglect
We can help reduce the incidence of elder abuse, but it’ll take more effort than we’re making now. Preventing elder abuse means doing three things:
• Listening to seniors and their caregivers
• Intervening when you suspect elder abuse
• Educating others about how to recognize and report elder abuse
What you can do as a caregiver to prevent elder abuse
If you’re overwhelmed by the demands of caring for an elder, do the following:
• Request help, from friends, relatives, or local respite care agencies, so you can take a break, if only for a couple of hours.
• Find an adult day care program.
• Stay healthy and get medical care for yourself when necessary.
• Adopt stress reduction practices.
• Seek counseling for depression, which can lead to elder abuse.
• Find a support group for caregivers of the elderly.
• If you’re having problems with drug or alcohol abuse, get help.
And remember, elder abuse helplines offer help for caregivers as well. Call a helpline if you think there’s a possibility you might cross the line into elder abuse.
What you can do as a concerned friend or family member
• Watch for warning signs that might indicate elder abuse. If you suspect abuse, report it.
• Take a look at the elder’s medications. Does the amount in the vial jive with the date of the prescription?
• Watch for possible financial abuse. Ask the elder if you may scan bank accounts and credit card statements for unauthorized transactions.
• Call and visit as often as you can. Help the elder consider you a trusted confidante.
• Offer to stay with the elder so the caregiver can have a break — on a regular basis, if you can.
How you can protect yourself, as an elder, against elder abuse
• Make sure your financial and legal affairs are in order. If they aren’t, enlist professional help to get them in order, with the assistance of a trusted friend or relative if necessary.
• Keep in touch with family and friends and avoid becoming isolated, which increases your vulnerability to elder abuse.
• If you are unhappy with the care you’re receiving, whether it’s in your own home or in a care facility, speak up. Tell someone you trust and ask that person to report the abuse, neglect, or substandard care to your state’s elder abuse helpline or long term care ombudsman, or make the call yourself.
Finally, if you aren’t in a position to help an elder personally, you can volunteer or donate money to the cause of educating people about elder abuse, and you can lobby to strengthen state laws and policing so that elder abuse can be investigated and prosecuted more readily. The life you save down the line may be your own.