Understanding Night-Time Problems in Dementia

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Elder Abuse: An Overview

What are elder abuse and neglect?

Elder abuse includes physical, emotional, or sexual harm inflicted upon an older adult, financial exploitation, or neglect of their welfare by people directly responsible for their care. More than half a million reports of elder abuse reach authorities every year in the U.S. alone, and millions more cases go unreported.

As older adults become more physically frail, they're less able to take care of themselves, stand up to bullying, or fight back if attacked. Mental or physical ailments can make them more trying companions for those who live with them. And they may not see or hear as well or think as clearly as they used to, leaving openings for unscrupulous people to take advantage of them.

Elder abuse tends to occur where the senior lives: their abusers are often adult children, other family members such as grandchildren, or a spouse or partner. Elder abuse can also occur in institutional settings, especially long-term care facilities.

If you suspect that an elderly person is at risk from a neglectful or overwhelmed caregiver or being preyed upon financially, it's essential to speak up. Everyone deserves to live in safety, with dignity and respect. These guidelines can help you recognize the warning signs of elder abuse, understand the risk factors, and learn how to prevent and report the problem.

Types of elder abuse

Abuse of the elderly takes many different forms, some involving intimidation or threats against the elderly, some involving neglect, and others involving financial trickery. The most common are:

Physical elder abuse – The non-accidental use of force against an elderly person results in physical pain, injury, or impairment. Such abuse includes physical assaults such as hitting or shoving and the inappropriate use of drugs, restraints, or confinement.

Emotional elder abuse – The treatment of an older adult in ways that cause emotional or psychological pain or distress, including:

·       Intimidation through yelling or threats

·       Humiliation and ridicule

·       Habitual blaming or scapegoating

·       Ignoring the elderly person

·       Isolating an elder from friends or activities

·       Terrorizing or menacing the elderly person

Sexual elder abuse – Contact with an elderly person without their consent. Such contact can involve physical sex acts, but activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse

Elder neglect – Failure to fulfill a caretaking obligation. This constitutes more than half of all reported cases of elder abuse. It can be intentional or unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as they do.

Financial exploitation – The unauthorized use of an elderly person's funds or property by a caregiver or an outside scam artist. An unscrupulous caregiver might:

·       Misuse an elder's personal checks, credit cards, or accounts

·       Steal cash, income checks, or household goods

·       Forge the elder's signature

·       Engage in identity theft

Typical scams that target elders include:

·       Announcement of a "prize" that the elderly person has won but must pay money to claim

·       Phony charities

·       Investment fraud

Healthcare fraud and abuse – Carried out by unethical doctors, nurses, hospital personnel, and other professional care providers. This can include:

·       Not providing healthcare but charging for it

·       Overcharging or double-billing for medical care or services

·       Getting kickbacks for referrals to other providers or for prescribing certain drugs

·       Overmedicating or under medicating

·       Recommending fraudulent remedies for illnesses or other medical conditions

·       Medicaid fraud

 Warning signs of elder abuse

Signs of elder abuse can be challenging to recognize or mistaken for symptoms of dementia or the elderly person's frailty—or caregivers may explain them to you that way. Many of the signs and symptoms of elder abuse overlap with mental deterioration symptoms, but that doesn't mean you should dismiss them on the caregiver's say-so.

Frequent arguments or tension between the caregiver and the elderly person or changes in the personality or behavior of the elder can be broad signals of elder abuse. If you suspect abuse but aren't sure, you can look for clusters of the following warning signs.

Physical abuse warning signs:

·       Unexplained signs of injury, such as bruises, welts, or scars, especially if they appear symmetrically on two sides of the body

·       Broken bones, sprains, or dislocations

·       A report of drug overdose or an apparent failure to take medication regularly (a prescription has more remaining than it should)

·       Broken eyeglasses or frames

·       Signs of being restrained, such as rope marks on wrists

·       caregiver's refusal to allow you to see the elder alone

Emotional abuse warning signs:

·       Threatening, belittling, or controlling caregiver behavior

·       Behavior from the elder that mimics dementia, such as rocking, sucking, or mumbling to themselves

Sexual abuse warning signs:

·       Bruises around breasts or genitals

·       Unexplained vaginal or anal bleeding

·       Torn, stained, or bloody underclothing

Elder neglect or self-neglect warning signs:

·       Unusual weight loss, malnutrition, dehydration

·       Untreated physical problems, such as bed sores

·       Unsanitary living conditions: dirt, bugs, soiled bedding and clothes

·       Being left dirty or unbathed

·       Unsuitable clothing or covering for the weather

·       Unsafe living conditions (no heat or running water; faulty electrical wiring; other fire hazards)

·       Desertion of the elder in a public place

Financial exploitation warning signs:

·       Significant withdrawals from the elder's accounts

·       Sudden changes in the elder's financial condition

·       Items or cash missing from the senior's household

·       Suspicious changes in wills, power of attorney, titles, and policies

·       Addition of names to the senior's signature card

·       Financial activity the senior couldn't have undertaken, such as an ATM withdrawal when the account holder is bedridden

·       Unnecessary services, goods, or subscriptions

Healthcare fraud or abuse warning signs

·       Duplicate billings for the same medical service or device

·       Evidence of overmedication or under-medication

·       Evidence of inadequate care when bills are paid in full

·       Problems with the care facility: poorly trained, poorly paid, or insufficient staff; crowding; inadequate responses to questions about care

Risk factors for elder abuse

It's challenging to take care of a senior with many different needs, and it's difficult to be elderly when age brings infirmities and dependence. Both the demands of caregiving and the elder's needs can create situations in which abuse is more likely to occur.

Many nonprofessional caregivers—spouses, adult children, other relatives, and friends—find taking care of an elder satisfying and enriching. But the responsibilities and demands of caregiving, which escalate as the elder's condition deteriorates, can also cause significant stress. The stress of elder care can lead to mental and physical health problems that leave caregivers burned out, impatient, and more susceptible to neglecting or lashing out at the elders in their care.

In addition to the caregiver's inability to manage stress, other risk factors for elder abuse include:

·       Depression in the caregiver

·       Lack of support from other potential caregivers

·       The caregiver's perception that taking care of the elder is burdensome and without emotional reward

·       Substance abuse by the caregiver

·       The intensity of the elderly person's illness or dementia

·       Social isolation—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 tendency toward verbal or physical aggression

 

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.

Preventing elder abuse and neglect

If you're a caregiver to an elderly person and feel you are in danger of hurting or neglecting them, help and support are available. Perhaps you're having trouble controlling your anger and find yourself screaming louder and louder or lashing out at the person in your care? Or have other people expressed concern with your behavior or the tension between you? Or maybe you feel emotionally disconnected or overwhelmed by the daily needs of the elderly person in your care? Recognizing that you have a problem is the biggest step to getting help and preventing abuse.

As a caregiver, the following steps can help you prevent elder abuse or neglect:

Take immediate steps to relieve stress and burnout. Stress is a significant contributor to elder abuse and neglect. You can help reduce your stress levels by regularly practicing stress-relieving techniques such as yoga, meditation, or deep breathing exercises.

Request help from friends, relatives, or local respite care agencies or find an adult daycare program. Every caregiver needs to take regular breaks from the stress of caring for an elder and attend to their own needs, if only for a couple of hours.

Learn techniques for getting your anger under control.

Take care of yourself. If you are not getting enough rest, you are more likely to succumb to anger. Eat a healthy diet, get regular exercise, and take care of your own medical needs.

Seek help for depression. Family caregivers are especially at risk for depression, but there are plenty of things you can do to boost your mood and outlook and overcome the problem.

Find a support group for caregivers of the elderly. Sharing your concerns and experiences with others facing the same challenges can help relieve the isolation you may be feeling as a caregiver. It can also be a great place to gain valuable tips and insight into caring for an elder.

Get help for any substance abuse issues. It's never easy, but there are plenty of actions you can take to address drug or alcohol abuse.

Get professional help. If you can't seem to stop yourself, no matter how hard you try, it's time to get help by talking to a therapist.

If you're a concerned friend or family member, the following can also help to prevent abuse of an elderly person.

Call and visit as often as you can, helping the elder see you as a trusted confidante.

Offer to stay with the elder so the caregiver can have a break regularly, if possible.

Monitor the elder's medications to ensure the amounts being taken correspond with the prescription dates.

Watch for financial abuse by asking the elder if you can check their bank accounts and credit card statements for unauthorized transactions.

Identify the warning signs of abuse or neglect and report it without delay.

Reporting elder abuse

If you are an elder being abused, neglected, or exploited, tell at least one person. Tell your doctor, a friend, or a family member you trust. Or call one of the helplines listed below. If you see an older adult being abused or neglected, don't hesitate to report the situation. And if you see future incidences of abuse, continue to call and report them. Each elder abuse report is a snapshot of what is taking place. The more information you can provide, the better the elder's chance of getting the quality of care they need. Older adults can become increasingly isolated from society, and with no work to attend to, it can be easy for abuse cases to go unnoticed for long periods.

Many seniors don't report the abuse they face even if they're able. Some fear retaliation from the abuser, while others view having an abusive caretaker as better than having no caretaker and being forced to move out of their own home. When the caregivers are their children, they may feel ashamed that their children are inflicting harm or blame themselves: "If I'd been a better parent when they were younger, this wouldn't be happening." Or they may not want children they love to get into trouble with the law. In any situation of elder abuse, it can be a real challenge to respect an older adult's right to autonomy while at the same time making sure they are properly cared for.

In the case of an elder experiencing abuse by a primary caregiver, such as an adult child:

Do not confront the abuser yourself. This may put the older person in more danger unless you have the elder's permission and can immediately move them to alternative, safe care.

Find strength in numbers. If a family caregiver is suspected of abuse, other family members may have the best chance of convincing the older adult to consider alternative care.

Feelings of shame can often keep elder abuse hidden. You may not want to believe a family member could be capable of abusing a loved one, or you may even think that the older adult would be angry at you for speaking up. But the earlier you intervene in a situation of elder abuse, the better the outcome will be for everyone involved.

In the case of self-neglect:

Even if the elder refuses your help, keep checking in with them. Enlist others to express their feelings of concern to them. Sometimes a peer or a neutral party, such as a geriatric care manager, may have a better chance of getting through.

Make sure the older adult is connected with medical services. Since self-neglect can have medical causes, share your concerns with the elder's doctor if possible.

Offer the elder home services on a trial basis. This can help them see the positive changes they can experience and open them up to considering alternative care. For example, encourage them to try housekeeping help for a month or a meal delivery service for a few weeks.

Tour assisted living or other senior housing facilities without immediate pressure to move. This may help dispel any myths or eradicate the older person's fears about moving. 

Consider legal guardianship. If you are concerned that a person's ability to take care of themselves safely is compromised, you can look into legal guardianship or legal conservatorship. If there is not an appropriate family member available, the court can appoint a guardian.

 

What are elder abuse and neglect?

Elder abuse includes physical, emotional, or sexual harm inflicted upon an older adult, financial exploitation, or neglect of their welfare by people directly responsible for their care. More than half a million reports of elder abuse reach authorities every year in the U.S. alone, and millions more cases go unreported.

As older adults become more physically frail, they're less able to take care of themselves, stand up to bullying, or fight back if attacked. Mental or physical ailments can make them more trying companions for those who live with them. And they may not see or hear as well or think as clearly as they used to, leaving openings for unscrupulous people to take advantage of them.

Elder abuse tends to occur where the senior lives: their abusers are often adult children, other family members such as grandchildren, or a spouse or partner. Elder abuse can also occur in institutional settings, especially long-term care facilities.

If you suspect that an elderly person is at risk from a neglectful or overwhelmed caregiver or being preyed upon financially, it's essential to speak up. Everyone deserves to live in safety, with dignity and respect. These guidelines can help you recognize the warning signs of elder abuse, understand the risk factors, and learn how to prevent and report the problem.

Types of elder abuse

Abuse of the elderly takes many different forms, some involving intimidation or threats against the elderly, some involving neglect, and others involving financial trickery. The most common are:

Physical elder abuse – The non-accidental use of force against an elderly person results in physical pain, injury, or impairment. Such abuse includes physical assaults such as hitting or shoving and the inappropriate use of drugs, restraints, or confinement.

Emotional elder abuse – The treatment of an older adult in ways that cause emotional or psychological pain or distress, including:

·       Intimidation through yelling or threats

·       Humiliation and ridicule

·       Habitual blaming or scapegoating

·       Ignoring the elderly person

·       Isolating an elder from friends or activities

·       Terrorizing or menacing the elderly person

Sexual elder abuse – Contact with an elderly person without their consent. Such contact can involve physical sex acts, but activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse

Elder neglect – Failure to fulfill a caretaking obligation. This constitutes more than half of all reported cases of elder abuse. It can be intentional or unintentional, based on factors such as ignorance or denial that an elderly charge needs as much care as they do.

Financial exploitation – The unauthorized use of an elderly person's funds or property by a caregiver or an outside scam artist. An unscrupulous caregiver might:

·       Misuse an elder's personal checks, credit cards, or accounts

·       Steal cash, income checks, or household goods

·       Forge the elder's signature

·       Engage in identity theft

Typical scams that target elders include:

·       Announcement of a "prize" that the elderly person has won but must pay money to claim

·       Phony charities

·       Investment fraud

Healthcare fraud and abuse – Carried out by unethical doctors, nurses, hospital personnel, and other professional care providers. This can include:

·       Not providing healthcare but charging for it

·       Overcharging or double-billing for medical care or services

·       Getting kickbacks for referrals to other providers or for prescribing certain drugs

·       Overmedicating or under medicating

·       Recommending fraudulent remedies for illnesses or other medical conditions

·       Medicaid fraud

 Warning signs of elder abuse

Signs of elder abuse can be challenging to recognize or mistaken for symptoms of dementia or the elderly person's frailty—or caregivers may explain them to you that way. Many of the signs and symptoms of elder abuse overlap with mental deterioration symptoms, but that doesn't mean you should dismiss them on the caregiver's say-so.

Frequent arguments or tension between the caregiver and the elderly person or changes in the personality or behavior of the elder can be broad signals of elder abuse. If you suspect abuse but aren't sure, you can look for clusters of the following warning signs.

Physical abuse warning signs:

·       Unexplained signs of injury, such as bruises, welts, or scars, especially if they appear symmetrically on two sides of the body

·       Broken bones, sprains, or dislocations

·       A report of drug overdose or an apparent failure to take medication regularly (a prescription has more remaining than it should)

·       Broken eyeglasses or frames

·       Signs of being restrained, such as rope marks on wrists

·       caregiver's refusal to allow you to see the elder alone

Emotional abuse warning signs:

·       Threatening, belittling, or controlling caregiver behavior

·       Behavior from the elder that mimics dementia, such as rocking, sucking, or mumbling to themselves

Sexual abuse warning signs:

·       Bruises around breasts or genitals

·       Unexplained vaginal or anal bleeding

·       Torn, stained, or bloody underclothing

Elder neglect or self-neglect warning signs:

·       Unusual weight loss, malnutrition, dehydration

·       Untreated physical problems, such as bed sores

·       Unsanitary living conditions: dirt, bugs, soiled bedding and clothes

·       Being left dirty or unbathed

·       Unsuitable clothing or covering for the weather

·       Unsafe living conditions (no heat or running water; faulty electrical wiring; other fire hazards)

·       Desertion of the elder in a public place

Financial exploitation warning signs:

·       Significant withdrawals from the elder's accounts

·       Sudden changes in the elder's financial condition

·       Items or cash missing from the senior's household

·       Suspicious changes in wills, power of attorney, titles, and policies

·       Addition of names to the senior's signature card

·       Financial activity the senior couldn't have undertaken, such as an ATM withdrawal when the account holder is bedridden

·       Unnecessary services, goods, or subscriptions

Healthcare fraud or abuse warning signs

·       Duplicate billings for the same medical service or device

·       Evidence of overmedication or under-medication

·       Evidence of inadequate care when bills are paid in full

·       Problems with the care facility: poorly trained, poorly paid, or insufficient staff; crowding; inadequate responses to questions about care

Risk factors for elder abuse

It's challenging to take care of a senior with many different needs, and it's difficult to be elderly when age brings infirmities and dependence. Both the demands of caregiving and the elder's needs can create situations in which abuse is more likely to occur.

Many nonprofessional caregivers—spouses, adult children, other relatives, and friends—find taking care of an elder satisfying and enriching. But the responsibilities and demands of caregiving, which escalate as the elder's condition deteriorates, can also cause significant stress. The stress of elder care can lead to mental and physical health problems that leave caregivers burned out, impatient, and more susceptible to neglecting or lashing out at the elders in their care.

In addition to the caregiver's inability to manage stress, other risk factors for elder abuse include:

·       Depression in the caregiver

·       Lack of support from other potential caregivers

·       The caregiver's perception that taking care of the elder is burdensome and without emotional reward

·       Substance abuse by the caregiver

·       The intensity of the elderly person's illness or dementia

·       Social isolation—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 tendency toward verbal or physical aggression

 

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.

Preventing elder abuse and neglect

If you're a caregiver to an elderly person and feel you are in danger of hurting or neglecting them, help and support are available. Perhaps you're having trouble controlling your anger and find yourself screaming louder and louder or lashing out at the person in your care? Or have other people expressed concern with your behavior or the tension between you? Or maybe you feel emotionally disconnected or overwhelmed by the daily needs of the elderly person in your care? Recognizing that you have a problem is the biggest step to getting help and preventing abuse.

As a caregiver, the following steps can help you prevent elder abuse or neglect:

Take immediate steps to relieve stress and burnout. Stress is a significant contributor to elder abuse and neglect. You can help reduce your stress levels by regularly practicing stress-relieving techniques such as yoga, meditation, or deep breathing exercises.

Request help from friends, relatives, or local respite care agencies or find an adult daycare program. Every caregiver needs to take regular breaks from the stress of caring for an elder and attend to their own needs, if only for a couple of hours.

Learn techniques for getting your anger under control.

Take care of yourself. If you are not getting enough rest, you are more likely to succumb to anger. Eat a healthy diet, get regular exercise, and take care of your own medical needs.

Seek help for depression. Family caregivers are especially at risk for depression, but there are plenty of things you can do to boost your mood and outlook and overcome the problem.

Find a support group for caregivers of the elderly. Sharing your concerns and experiences with others facing the same challenges can help relieve the isolation you may be feeling as a caregiver. It can also be a great place to gain valuable tips and insight into caring for an elder.

Get help for any substance abuse issues. It's never easy, but there are plenty of actions you can take to address drug or alcohol abuse.

Get professional help. If you can't seem to stop yourself, no matter how hard you try, it's time to get help by talking to a therapist.

If you're a concerned friend or family member, the following can also help to prevent abuse of an elderly person.

Call and visit as often as you can, helping the elder see you as a trusted confidante.

Offer to stay with the elder so the caregiver can have a break regularly, if possible.

Monitor the elder's medications to ensure the amounts being taken correspond with the prescription dates.

Watch for financial abuse by asking the elder if you can check their bank accounts and credit card statements for unauthorized transactions.

Identify the warning signs of abuse or neglect and report it without delay.

Reporting elder abuse

If you are an elder being abused, neglected, or exploited, tell at least one person. Tell your doctor, a friend, or a family member you trust. Or call one of the helplines listed below. If you see an older adult being abused or neglected, don't hesitate to report the situation. And if you see future incidences of abuse, continue to call and report them. Each elder abuse report is a snapshot of what is taking place. The more information you can provide, the better the elder's chance of getting the quality of care they need. Older adults can become increasingly isolated from society, and with no work to attend to, it can be easy for abuse cases to go unnoticed for long periods.

Many seniors don't report the abuse they face even if they're able. Some fear retaliation from the abuser, while others view having an abusive caretaker as better than having no caretaker and being forced to move out of their own home. When the caregivers are their children, they may feel ashamed that their children are inflicting harm or blame themselves: "If I'd been a better parent when they were younger, this wouldn't be happening." Or they may not want children they love to get into trouble with the law. In any situation of elder abuse, it can be a real challenge to respect an older adult's right to autonomy while at the same time making sure they are properly cared for.

In the case of an elder experiencing abuse by a primary caregiver, such as an adult child:

Do not confront the abuser yourself. This may put the older person in more danger unless you have the elder's permission and can immediately move them to alternative, safe care.

Find strength in numbers. If a family caregiver is suspected of abuse, other family members may have the best chance of convincing the older adult to consider alternative care.

Feelings of shame can often keep elder abuse hidden. You may not want to believe a family member could be capable of abusing a loved one, or you may even think that the older adult would be angry at you for speaking up. But the earlier you intervene in a situation of elder abuse, the better the outcome will be for everyone involved.

In the case of self-neglect:

Even if the elder refuses your help, keep checking in with them. Enlist others to express their feelings of concern to them. Sometimes a peer or a neutral party, such as a geriatric care manager, may have a better chance of getting through.

Make sure the older adult is connected with medical services. Since self-neglect can have medical causes, share your concerns with the elder's doctor if possible.

Offer the elder home services on a trial basis. This can help them see the positive changes they can experience and open them up to considering alternative care. For example, encourage them to try housekeeping help for a month or a meal delivery service for a few weeks.

Tour assisted living or other senior housing facilities without immediate pressure to move. This may help dispel any myths or eradicate the older person's fears about moving. 

Consider legal guardianship. If you are concerned that a person's ability to take care of themselves safely is compromised, you can look into legal guardianship or legal conservatorship. If there is not an appropriate family member available, the court can appoint a guardian.