ELDER ABUSE: Compounded When Caregivers Not Trained In Dementia

Author Elder Rage www.ElderRage.com
Host Coping With Caregiving Radio Show www.wsRadio.com/CopingWithCaregiving

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ELDER ABUSE is becoming an expanding serious problem affecting hundreds of thousands of elderly people in the United States. Unfortunately, the issue remains largely hidden by the families--causing gross under-reporting of the growing crisis. Compounding the problem is the fact that one out of every ten persons by the age of 65 gets some form of dementia (Alzheimer's being one type), and nearly one out of every two by the age of 85 is afflicted, which adds an enormous burden on families who are already ill-prepared for the strain of caring for aging loved ones. And, since the fastest growing segment of our population is the 85+ group, the problem will undoubtedly get worse before it gets better.

STATISTICS VARY
Various studies have attempted to estimate the size of the elder abuse problem, but the true figure remains unknown. Ten years ago, the National Center on Elder Abuse (NCEA) estimated there were 1.01 million victims of elder abuse (2.16 million including self-neglecting elders). The median age of victims was 77.9 years of age: 66.4% white, 18.7% black, 10% Hispanic, and less than 1% each Native Americans, Asian Americans/Pacific Islanders. The report indicated that the victims were most often female (68.3%).

A 2000 Survey of State Adult Protective Services Agencies indicated there were 473,000 reports of abuse nationally, but only 169,946 were ever substantiated. This corroborates the fact that the problem remains protected in a shroud of secrecy by the families. The perpetuators of the abuse are more often male relatives: 30% spouse or intimate partners, and 17% adult child.

It is frightening that 303,054 cases couldn't be substantiated, and we will never know how many hundreds of thousands were never even reported to Adult Protective Services. It is still estimated today that only 1 out of 14 incidents come to the attention of authorities, and criminal prosecution rarely occurs because by the time law enforcement gets involved, the incident has passed and the family doesn't want to press charges nor bring attention to their disgraceful family secret.

It is not surprising then, that only an estimated 16.3% of all reported cases of domestic elder abuse come from family members and relatives of the victim. The rest is by concerned friends and neighbors, law enforcement, clergy, banks/business institutions, and the victim.

A newer 2005 report estimates between 1 and 2 million Americans age 65 or older have been injured, exploited, or mistreated by someone on whom they depended for care and protection. And, the reporting of financial exploitation is only 1 in 25 cases, translating to at least 5 million financial victims a year.

MEDIA ATTENTION NEEDED
As our population ages, unless a concerted effort is made to deter it, elder abuse will undoubtedly increase. It's an issue that has to be examined as closely as the issue of domestic violence, which has been deterred by abundant public service announcements on radio and television. Also, the availability of shelters and counseling for battered women has made a huge difference in the awareness of the issue. The same is needed for elder abuse, and through education and public awareness, another taboo subject can be brought out in the open so offenders will think twice before they lash out, and ideally seek the help of a mental health professional before they cross the line.

CAREGIVER STRESS
Overburdened caregivers of chronically ill loved ones ride a roller coaster of emotions: feeling overwhelmed, out of control, angry, guilty, sad, and never free of being in demand. They lose touch with friends who don't understand, their careers suffer when they must take time off work, they suffer from sleep deprivation, and they don't get adequate nutrition or exercise. They live with the oppressive feeling of impending death and the overwhelming frustration of not being able to make loved ones better.

NCEA reports that the rate of depression for caregivers of non-demented patients is 35.2%, which is twice that of the general public. Among dementia caregivers, the rate is 43-46%. The "Caregiver Health Effects Study" (Schulz and Beach, 1999) revealed the finding that caregivers who experienced the greatest levels of stress were 63% more likely to die within the next 4 years than non-caregivers.

ELDER RAGE
Caregiving is challenging in the best of circumstances, but when a patient becomes aggressive and difficult to manage, the caregiver has yet another level of frustration to cope with. One study from Columbia University in 1997 found that agitation occurred in 40-60% of demented patients, and aggression from 5 to 20%. Since there are nearly 5 million people with Alzheimer's Disease (only one debilitating illness), and since 7 out of 10 are being cared for at home, is it any surprise that elder abuse can occur when an overstressed caregiver reaches their limit with a challenging or aggressive elder? People who would have never dreamed of crossing the line are finding themselves lashing out in utter frustration.

NCEA reports that 20% of caregivers live in fear that they will become violent themselves and this rate increases to 57% among caregivers who have experienced violence from those they now care for (Pillemer and Suitor, 1992). The researchers concluded that violence by the care receivers appears to move persons who are fearful of becoming violent to actually commit violent acts.

DENIAL OF EARLY STAGE DEMENTIA COSTLY 
Compounding the problem is the fact that most people are in denial about dementia until it has progressed to the point of a crisis. They don't realize that with the proper treatments and medication (Aricept, Exelon, Razadyne or Memantine), dementia symptoms can be slowed down, keeping a patient independent and in Stage One longer, which is intermittent and mild. 

Also misunderstood is the fact that Alzheimer's is typically preceded by MCI, Mild Cognitive Impairment, which can last five to ten years. A large percentage of these patients will progress to Stage One Alzheimer's, which typically lasts 2-4 years. Stage Two: 2-10 years (requires full-time care), and Stage Three, 1-3 years is the end usually in a nursing home. Unfortunately, most of the time, the professionals don't get the call until after a crisis, but by then the patient has already progressed further into the dementia and there is no going back--even with medication.

Seeking help early from a geriatric dementia specialist can save families a lot of heartache and money, and save our society the burden of caring for so many elders who decline sooner than need be. Statistically families (and many doctors who are not dementia specialists) ignore the early warning signs because they incorrectly believe that these intermittently odd behaviors are just a normal part of aging and untreatable senility. It is a costly mistake in every regard.

The Alzheimer's Association reports that by delaying the onset of Alzheimer's for five years, we could save 50% in annual health care costs. Even a one-month delay in nursing home placement could save $1 billion a year.

The bottom line is that when caregivers have fewer frustrations and difficult behaviors to cope with (because dementia was diagnosed and treated early), elder abuse will be drastically reduced.

SOLUTIONS
* Doctors and professionals, who are not dementia specialists, need to understand the early warning signs of dementia--and be open to referring their patients to geriatric dementia specialists for early diagnosis and treatment.

* With national education, extensive media awareness and community support, the over 50 million American caregivers can learn how to cope with the challenges of caregiving.

* Family doctors and therapists should screen their patients for caregiver burnout--so stress, frustration and depression can be addressed immediately.

* Eldercare workers in the home or in professional settings should be required to undergo extensive criminal background checks.

* Anyone who suspects any type of elder abuse must be encouraged to report it immediately.

* Support groups (in person and online) can help caregivers cope.

* Stressed out caregivers should be encouraged to seek alternate respite care for their patient, so they can recharge before caregiver stress causes abuse to occur.

* Refer caregivers and professionals to The National Center on Elder Abuse (www.ElderAbuseCenter.org), which provides resources to find assistance, publications, data, and answers to elder abuse questions.

TEN WARNING SIGNS OF ALZHEIMER'S
(Reprinted With Permission of The Alzheimer's Association)
1.   Memory loss
2.   Difficulty performing familiar tasks
3.   Problems with language
4.   Disorientation of time and place
5.   Poor or decreased judgment
6.   Problems with abstract thinking
7.   Misplacing things
8.   Changes in mood or behavior
9.   Changes in personality
10.  Loss of initiative

Jacqueline Marcell Author Elder Rage www.ElderRage.com
Host Coping With Caregiving Radio Show www.wsRadio.com/CopingWithCaregiving

Also, check out this upcoming conference on aging issues: http://www.agingconference.org/agingconference/jc06/index.cfm

Tell us your story!