A Growing Trend : The Abuse and Neglect of the Elderly

Anybody in a position of trust to older people is also in a position to abuse them--and usually in a position to hide the abuse.

That was the thrust of a program on “Elder Abuse and Neglect” at the Western Gerontological Society’s 31st annual meeting here. The leader was Mary Joy Quinn, R.N., M.A., an investigator for the San Francisco Superior Court who handles 30 to 40 neglect and abuse cases a month--95% of which involve the elderly “and most of those over 75, the fastest-growing population,” she said.

Quinn differentiated between abuse and neglect.

A Subtle Difference

“Neglect usually is viewed as less serious in intent, as something that is not deliberate but an omission of care,” she said. “Some experts, however, think it can be deliberate and vicious.

“Abuse is intentional, an act of commission.

“Intent is critical when trying to decide a case in court. But the effects are the same: The person is damaged physically, financially and always psychologically.

“There are various types of abuse: Physical, which is bodily harm. Psychological, which is mental distress. Financial--assets are misappropriated. Violation of rights--not being able to vote, to receive mail unopened, to practice the religion of one’s choice.”

The incidence of elder abuse and neglect is unprecedented, Quinn said, largely because no similarly large older population ever existed before.

“A person born in 1900 had a life expectancy of 49.2 years,” she said, going on to explain that having attained a certain age, one’s prospects for additional longevity increase. “By 1980 a person 65 could look forward to living another 16.4 years, one 75 had another 10.4 years and one 84 an additional 8.2 years. The fastest-growing population in our society is 75 or over.

“Four-generational families are becoming common, and there is evidence of a transgenerational nature of family violence.”

Imprecise Figures

Statistics on elder abuse, like those for child abuse, remain imprecise, Quinn said.

“Estimates of the incidence of abuse and neglect range from 4% to 55%,” she said. “I don’t know if we will ever have accurate figures. This is a hidden phenomena. No one reports it.”

Quinn, who was aided in the presentation by Susan K. Tomita, a Seattle social work executive and clinical assistant professor at the University of Washington, gave a laundry list of the physical symptoms of malnutrition to her audience, primarily professionals who work with the elderly. Other physical symptoms of abuse--bruises, head injuries, failure to thrive--parallel those of child abuse cases.

“I think malnourishment and dehydration are widespread among the elderly,” Quinn said. “I remember the case of one woman with hallucinations. We got Meals on Wheels involved, the woman got good food and the hallucinations stopped.

Clues of Abuse

“Often the person providing care to an elder won’t let you see the elder alone. Caregivers are evasive or verbally aggressive, and conflicting accounts about the elderly person’s state are a good indicator of abuse or neglect.

“The caregiver also blames the client for whatever may have happened. We had a case in which a son was kicked out by his wife, went home to mother and took her out of a rehabilitation center.

“The caregiver often blames the client for incontinence, then withholds liquids, causing dehydration.

“Psychological abuse is difficult to prove. In some families they’ve always yelled at each other. But the suicide rate for elderly women is going up worldwide. When older people threaten suicide they usually complete it. The most common suicide is a man in his 80s who lives alone.”

A Case History

Quinn related the case history of a 74-year-old woman who fractured her skull in a fall and had a steel plate inserted, had to be fed and catheterized: “In all respects she was dependent on others totally,” Quinn said.

“The woman and her son Harry lived in a two-bedroom apartment in a nice part of town,” she said. “But it was full of clutter and dirt and there was no place to sit down.

“The mother had dehydration and malnutrition. Harry hit her--and admitted it. She was often hospitalized and these hospitalizations all coincided with Harry’s trips to Southern California to see his spiritual counselor. She would do well in the hospital and respond to treatment, but inevitably she would return to her debilitated state.

“A Visiting Nurse once noticed that the woman’s arm was bruised and misaligned. Harry, who was a great big, heavy man, said he fell on her and pushed her arm out of the way. He said he called the doctor, who refused to treat her because she was old and it wouldn’t be worth it. She lost all use of her arm.

“She continued to disintegrate. Harry went to Southern California again and his mother went back to the hospital. She had another bruise on her chin and Harry said, ‘I had to help her close her mouth.’

“Now, all this time Harry never said he was his mother’s conservator. We found he was conservator and had a court hearing. She was found to be in need of 24-hour nursing care and it was recommended the son be removed as conservator.

“She was removed immediately to a nursing home, before Harry could get home and mistreat her. She improved and no longer cringed when he came in to feed her. But we watched him carefully; we also wondered if the original fall had been an accident.

“Harry was never prosecuted. There is more and more concern over cases that are not being prosecuted. The judge had a great propensity to disbelieve my report--and you (as social workers) are not going to believe some of the things you see yourself.”

Quinn repeated the theory of a “transgenerational nature of family violence” and cited an anonymous old English rhyme about a man who recalls living with his Granny who “hided” (beat) him as a child. It goes on:

Now I am a man and I live with my granny

And do to ma granny what she did to me .

“There is a theory of revictimization,” Quinn said, “a feeling that a woman who was a child abuse victim is a spouse abuse victim, and perhaps an elder abuse victim as well.”

She said that alcohol abuse and drug dependency often play roles in abuse and neglect of the elderly by caregivers, who also may be sociopaths who take no responsibility for their actions or who are mentally impaired.

Reinforcing--or ignoring--the abusers are societal attitudes: ageism, gerontophobia, a negative attitude toward the disabled, sexism (“women are disproportionate victims”)--and greed. Caregivers also tend to be clever about hiding their neglect and abuse of seniors, Quinn said.

Legal problems also bedevil the matter of elder care, and Palo Alto attorney Michael Gilfix, an expert in the area, conducted a daylong program on the subject at the Western Gerontological Society meeting. In one session he spoke of the problems of single people with no relatives or whose families are too far away to be of any real help as either personal or financial caretakers.

“Sometimes out of loneliness elderly people become too trusting,” Gilfix said, “placing confidence in the wrong people. Or they name a bank that can deal with the financial but not the personal care. Social workers serving as conservators is becoming a business, a real growth industry.”

Even those with family ties face problems, he said, citing “a real case” in which Mr. and Mrs. Smith have a monthly income of $1,420 from Social Security and pension, own their home, have $50,000 in bank accounts and $30,000 in undeveloped resort property.

At the behest of their daughter, a divorcee with two children, the Smiths seek legal advice. Smith has Alzheimer’s disease; his mental capacities are questionable. His wife is a passive person who doesn’t say much. Their son contends that his father is incapable of signing any legal document at this point.

Conflicts of Interest

“We have here potential conflicts of interest,” Gilfix said. “Who is the client? Is this a matter between son and daughter? Mother and children? Parents and daughter? Are all in the family clients?

“Maybe you represent all of them, maybe some or none. I try to do all I can to give them a one-stop legal shopping center.”

Gilfix also spoke of the ethical problems attendant to cases involving the elderly and their caregivers and conservators.

“There are some requirements, as there are for doctors and others, to report elder abuse,” he said. “And if you do, are you violating the attorney-client relationship?”