ABUSE, ELDERLY

Elderly abuse has become increasingly common in the last 20 years. In the United States alone, about 4% of individuals older than 65 years (approximately 1 million individuals) experience abuse or neglect. There are four types of mistreatment of the elderly: physical abuse, physical neglect, psychological abuse, and material abuse. Physical abuse consists of assaults, rough handling, burns, sexual abuse, and unreasonable confinement. Physical neglect often includes dehydration, malnutrition, poor hygiene, allowing the wearing of inappropriate or soiled clothing, improper giving of medication, and failure to obtain medical care for the elderly individual. Psychologic abuse involves verbal or emotional abuse, threats, and isolation/confinement. Finally, the elderly may experience material abuse, such as the withholding of finances, misuse of their funds or outright theft, and withholding the means of daily living. Elderly victims of abuse are usually (1) older than 75 years, (2) women, (3) white, and (4) widowed. In addition there are other characteristics of elderly individuals who are abused. They have behavioral problems, are incontinent, display shouting (especially nighttime shouting), exhibit paranoia, have many physical complaints, and are fairly socially isolated so that abuse is less likely to be discovered. Those elderly individuals with emotional and/or physical problems, and those who are totally dependent on a caregiver are more likely to be abused. The abusers of the elderly are usually (more than 60% of the time) married to them. In about a quarter of cases, the abuser is an adult child living in the home, who is dependent on the older individual. Elderly abuse occurs in all races and economic classes. The assessment of elderly abuse should first involve a suspicion that it is happening. Elderly abuse should be suspected in those individuals who have frequent falls and orthopedic injuries, who seem to have a lot of problems with their medication, and who seem to be losing weight without explanation but who gain weight while hospitalized. Unexplained incontinence and body odor may be signs of elderly neglect. The treatment of elderly victims of abuse involve treating whatever medical problems may be the result of the abuse. It is often necessary to contact a reporting agency such as Adult Protective Services. Depending on the nature of the abuse, immediate hospitalization for urgent medical care may be indicated. Treatment should also involve providing support for the abuser and reducing the level of stress in the environment. In some cases, the filing of legal charges and the removal of the elderly individual from the home may be needed. Like children, the elderly are susceptible to abuse because they are often more vulnerable and dependent. Prevention of abuse of the elderly requires a heightened sense of awareness that it exists, sharing the responsibilities for caring for an elderly parent among different family members, so no one individual is overwhelmed, promptly treating any medical or psychiatric problems in the elderly, and increasing social outlets for elderly patients. It is essential that all of us check on the elderly in our neighborhoods, families, and churches, to prevent mistreatment of our older citizens.