Monday, April 4

Elder Abuse in Dementia: Signs, Effects, What to Do

Many people with dementia are victims of elder abuse, sometimes called elder mistreatment. Abuse can happen in many places, including the person's home, a family member's house, an assisted living facility, or a nursing home. Learn the signs. Find out what you can do to help.

Gerald, 73, had a stroke. Vascular dementia developed. Unable to care for himself, he moved in with his son's family. His son, David, tried to help, but wasn't home much during the work week. So, it was Gerald's daughter-in-law, Frances, who cooked special meals and helped him bathe and dress. Frances was already busy taking care of two teenage boys and teaching third grade.

At first, everyone was glad to have Gerald living with the family. But after a few months, Frances was feeling overwhelmed and began yelling at Gerald. Often, no one helped him get dressed until late in the day. Gerald was upset, but he didn't know what to do.

Abuse can happen to anyone—no matter the person's age, sex, race, religion, or ethnic or cultural background. Many people with dementia are victims of elder abuse, sometimes called elder mistreatment.

Abuse can happen in many places, including the older person's home, a family member's house, an assisted living facility, or a nursing home.

Types of Abuse

There are many types of abuse:
  • Physical abuse happens when someone causes bodily harm by hitting, pushing, or slapping.
  • Emotional abuse, sometimes called psychological abuse, can include a caregiver saying hurtful words, yelling, threatening, or repeatedly ignoring the older person. Keeping that person from seeing close friends and relatives is another form of emotional abuse.
  • Neglect occurs when the caregiver does not try to respond to the older person's needs.
  • Abandonment is leaving a senior alone without planning for his or her care.
  • Sexual abuse involves a caregiver forcing an older adult to watch or be part of sexual acts.

Money Matters: Financial Abuse and Healthcare Fraud

After Victor's mother died, he started looking after his elderly grandparents. His grandfather had been diagnosed with mild cognitive impairment. His grandmother refused any cognitive tests, though she seemed to be exhibiting signs of early dementia. Victor had them add his name to their bank account so he could pay their bills. For the past 6 months, Victor has been taking money from their account for his own use. He feels guilty, but tells himself that the money will soon be his anyway.

Financial abuse happens when money or belongings are stolen. It can include forging checks, taking someone else's retirement and Social Security benefits, or using another person's credit cards and bank accounts. It also includes changing names on a will, bank account, life insurance policy, or title to a house without permission from the older person. Financial abuse is becoming a widespread and hard-to-detect issue. Even someone you've never met can steal your financial information using the Internet or email. Be careful about sharing any financial information online—you don't know who sees it.

Healthcare fraud can be committed by doctors, hospital staff, and other healthcare workers. It includes overcharging, billing twice for the same service, falsifying Medicaid or Medicare claims, or charging for care that wasn't provided. Older adults and caregivers should keep an eye out for this type of fraud.

Who Is Being Abused?

Most victims of abuse are women, but some are men. Likely targets are older people who have no family or friends nearby and people with disabilities, memory problems, or dementia.

Abuse can happen to any older person, but often affects those who depend on others for help with activities of everyday life—including bathing, dressing, and taking medicine. People who are frail may appear to be easy victims.

What Are Signs of Abuse?

Two years ago, the doctor diagnosed Eduardo's mother with mid-stage Alzheimer's disease. When she needed more help, he moved her into a nearby nursing home. For the past few months, she's been depressed and withdrawn. Eduardo doesn't like the way a nurse talks to his mother.

You may see signs of abuse or neglect when you visit an older person at home or in an eldercare facility. You may notice the person:
  • Has trouble sleeping
  • Seems depressed or confused
  • Loses weight for no reason
  • Displays signs of trauma, like rocking back and forth
  • Acts agitated or violent
  • Becomes withdrawn
  • Stops taking part in activities he or she enjoys
  • Has unexplained bruises, burns, or scars
  • Looks messy, with unwashed hair or dirty clothes
  • Develops bed sores or other preventable conditions
If you see signs of abuse, try talking with the older person to find out what's going on. For instance, the abuse may be from another resident and not from someone who works at the nursing home or assisted living facility. Most importantly, get help.

Who Can Help?

Elder abuse will not stop on its own. Someone else needs to step in and help. Many people with dementia are unable to communicate mistreatment. Older people are too ashamed to report it. Or, they're afraid if they make a report it will get back to the abuser and make the situation worse.

If you think someone you know is being abused—physically, emotionally, or financially—talk with him or her when the two of you are alone. You could say you think something is wrong and you're worried. Offer to take him or her to get help, for instance, at a local adult protective services agency.

Many local, state, and national social service agencies can help with emotional, legal, and financial problems.

The Administration for Community Living has a National Center on Elder Abuse where you can learn about how to report abuse, where to get help, and state laws that deal with abuse and neglect. Go for more information. Or, call the Eldercare Locator weekdays at 1-800-677-1116.

Most states require that doctors and lawyers report elder mistreatment. Family and friends can also report it. Do not wait. Help is available.

If you think someone is in urgent danger, call 911 or your local police to get help right away.

What Is the Long-Term Effect of Abuse?

Most physical wounds heal in time. But any type of mistreatment can leave the abused person feeling fearful and depressed. Sometimes, the victim thinks the abuse is his or her fault. Protective services agencies can suggest support groups and counseling that can help the abused person heal the emotional wounds.

Caregiver Stress—You're Not Alone

Caring for a person with dementia can be rewarding. It's also demanding, difficult, and often stressful work. The caregiver may need to be available around the clock to fix meals, provide nursing care, take care of laundry and cleaning, drive to doctors' appointments, and pay bills. Often, family caregivers need to give up paying jobs so that they have time for these new responsibilities.

It may be hard to keep a positive outlook when there's little hope of the older person's physical and mental condition improving. Over time, the demands and stress of caregiving can take their toll. A caregiver might not even know he or she is being neglectful or abusive.

If you are a caregiver, make sure you have time to rest and take care of your needs. You can ask a family member or friend to help out for a weekend, or even for a few hours, so that you can take some time for yourself. Or, some community service organizations provide caregivers a break, called respite care. You might also consider joining a caregiving support group if you are feeling overwhelmed. Exercise could even help with stress.

For More Information About Elder Abuse and Where to Get Help

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Eldercare Locator

Family Caregiver Alliance
1-800-445-8106 (toll-free) (email)

National Adult Protective Services Association

National Center on Elder Abuse
1-855-500-3537 (toll-free) (email)

National Committee for the Prevention of Elder Abuse
1-202-464-9481 (email)

National Domestic Violence Hotline
1-800-799-7233 (toll-free, 24/7)
1-800-787-3224 (TTY/toll-free)

National Family Caregiver Support Program
Administration on Aging
1-202-619-0724 (email) Caregiver

National Library of Medicine MedlinePlus: Elder Abuse

National Long-Term Care Ombudsman Resource Center
1-202-332-2275 (email)

Stop Medicare Fraud: Prevent Fraud

U.S. Department of Justice
1-202-514-2000 (email)

WellSpouse® Association
1-800-838-0879 (toll-free) (email)

For information on health and aging, including resources on caregiving and Alzheimer's disease, contact:

National Institute on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (toll-free/TTY) (email)

National Institute on Aging
National Institutes of Health
U.S. Department of Health & Human Services

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