Abuse of Elderly Cases Triple in a 5-Year Period

For the past five years, an 86-year-old man has been a regular at the VA Hospital in San Diego, dropping in to pick up medication or arriving for a physical. Occasionally, he would come in with a bruise on his frail body, and once he hobbled in with a broken kneecap.

Whenever physicians inquired about his injuries, the elderly man gave the same answer: “Oh, I just fell down.”

In November, the doctors found out the man was lying. When he came in that time, his chest, shoulders, arms and hands were tattooed with bruises. His wife had been beating him.

“She would hit me with my cane, with her fists, anything she could get her hands on,” the man said, speaking only on the condition his name not be published. His many ailments, which include arthritis, have left him defenseless.

Since 1984, the number of abused elderly people has tripled in San Diego County, according to statistics compiled by the county Department of Social Services. Last year, 864 people 65 and older were the victims of physical abuse, financial abuse, mental abuse, neglect or abandonment. Congressional studies have estimated that more than 1 million elders are abused nationwide each year.

Experts say the pool of potential victims is bound to grow as the American population continues to gray. The concern is even more acute in San Diego County, where the 65-plus age bracket is growing at an annual rate of 11.5%, contrasted with 10.8% nationwide.

As the numbers of elderly increase, young and old alike will be confronted with their care, and those who can’t or won’t meet the task become potential abusers, experts say.

Although he blames his 76-year-old wife’s drinking binges for the beatings she gave him, the 86-year-old man said other things also unleashed her fury.

“She resented me for growing old,” said the man, who served in the Navy years ago. His eyes brimmed with tears. “She hated it when I had to go to the hospital. She wouldn’t even drive me there.”

He finally confessed to Merrillyn Collins, a senior social worker with Adult Protective Services, a division of the Department of Social Services that is charged with investigating elder abuse. These days, Collins and her co-workers say, they hear of cases with alarming frequency.

Several Scenarios

In today’s society, social workers say, there are several scenarios in which elder abuse is likely to occur. Elderly couples, struggling to cope with their deteriorating health, can break apart as one spouse vents his or her fear and frustration at the other. Adult children who look after their aging parents are susceptible to “care-giver stress,” which can lead to abuse or neglect. Greedy offspring sometimes steal their parents’ Social Security checks or pensions.

Alcoholism and drug addiction fuel the rise of abuse cases, as well.

Although the 86-year-old man’s case is unusual--more often the victim is a woman--county social workers cite his account to emphasize that anyone, male or female, is easy prey when debilitated by age.

The spouse is the abuser in 15% of reported incidents, according to the National Aging Resource Center on Elder Abuse. Established just over a year ago in Washington, the center is the leading agency providing information about the problem. It offers training and expertise to state and local social workers to help them curb abuse.

According to the center, adult children are the most likely perpetrators of elder abuse, at 30%, followed by other relatives (18%) and spouses.

As hospitals release patients sooner to cut back on costs, more elderly people will be sent home to be cared for by their families, said Janlee Wong, program manager of the county’s Adult Protective Services. Neglect or abuse can begin when relatives are unable to handle the enormous demands placed on them by an ill person who needs constant attention.

“In the past, a family would go visit their sick grandmother at the hospital, then go home and watch a movie,” Wong said. “But now they have to take care of their grandmother 24 hours a day.

“Now you have an adult child who comes back from his 40-hour-a-week job and then goes straight to the grandmother, cleans her up, monitors her medications, takes her to the bathroom and listens to her complain,” Wong said. “It can be very trying, sometimes too much so.”

Although abuse stemming from “care-giver stress” is escalating, social workers say, more often it is simply a case of the young taking advantage of the old.

Last year, a San Diego family entrusted the care of a 90-year-old woman to her teen-age granddaughter.

The granddaughter, who moved into the grandmother’s house, stole the woman’s Social Security checks and other income, using the money to buy drugs, social workers said. She blocked visitation attempts by other relatives, who finally discovered that the neglected woman was suffering from a leg sore that threatened to become gangrenous.

The family took the woman to a hospital, and she has since been placed in a board and care facility.

The reasons behind the abuse cases are not always so easily explained.

“There are a lot of cases where alcohol, drugs or care-giver stress have nothing to do with abuse,” said Wolf, president of the National Committee for the Prevention of Elder Abuse, a national public awareness group. She is also the associate director of the University Center on Aging at the University of Massachusetts Medical Center in Worcester.

“A case in one of our studies involved a 55-year-old son who was living with his elderly mother because he was out of a job,” Wolf said. “He was living off her money and living in her house. One time he hit her because the food was too cold when she served it to him.”

‘Discovered’ in 1979

Although elder abuse is receiving increasing attention these days, experts say they are still concerned that the problem remains largely hidden.

In fact, the problem of elder abuse was not “discovered” until 1979, when the late Rep. Claude Pepper (D-Fla.), a leading advocate for senior causes, held hearings in Boston to learn more about the problem.

Subsequent congressional studies have encouraged states to pass mandatory reporting laws requiring social workers, law enforcement officers and health practitioners, among others, to report potential cases of such abuse to authorities. Although similar reporting laws have long been in place for child abuse, such laws aiding the elderly took effect only within the past six years, said Kathy Gardner, staff director of the health and long-term care subcommittee of the U.S. House Select Committee on Aging.

Even with mandatory reporting laws in place, detecting elder abuse can prove difficult. Elders are often reluctant to notify authorities because they are embarrassed or ashamed to admit they are being abused by their own children or other relatives. In many cases, they are simply isolated and remain invisible to authorities.

“They’re sick and bedridden. . . . It’s not like they go to school where they can be spotted by teachers,” Gardner said.

Even when cases are identified, social workers are often prohibited--by the victims--from offering help.

Unlike suspected child abuse cases in which social workers have the authority to remove a victim from his or her environment if there is evidence of abuse or neglect, authorities cannot help elders in a similar predicament without their consent.

Getting such permission is no easy task, and it is even harder to persuade elderly people to press charges against their abusers, said Robert Kiddoo, an investigator supervisor with the state attorney general’s office in San Diego.

“Let’s say an adult son, a drug addict, moves back in with his elderly mother and starts stealing her Social Security checks to buy drugs; he doesn’t feed her and he strikes her, too,” Kiddoo said. “But the mother is coherent and mentally competent and says she doesn’t want your help. You’re out the door.

Often, Kiddoo said, elders refuse assistance because they are afraid of retribution from their abuser or because they deny to themselves that a problem exists.

“And even if you get them to accept some immediate help, medical care, for instance, it’s a whole different story when you ask them to press charges,” Kiddoo said. “Pressing charges against a loved one is extremely difficult. Take an elderly woman who is asked to prosecute her own son. You’re asking her to say, ‘I’m a failure as a parent.’ ”

‘A National Disgrace’

The congressional studies have pushed the federal government to take preliminary steps to fight elder abuse.

In 1987, Congress passed a measure that would provide funding for states with agencies that offered prevention and assistance programs for elders. Although the amendment passed, it was never funded.

“The rising incidence of elder abuse is nothing short of a national disgrace,” said Rep. Ed Roybal (D-Calif.), who succeeded Pepper as chairman of the health subcommittee.

“We can’t stand by any longer while our most vulnerable seniors have their health, psychological well-being and, in some cases, their lives threatened,” said Roybal, who is urging that the amendment receive funds.

According to a 1985 congressional report, states spent an average of $22 per child abuse case and $2.90 for each elder abuse case, even though 40% of all abuse cases involve dependent adults or the elderly.

In one case, the relationship of a well-to-do Rancho Bernardo couple in their mid-60s deteriorated when the wife began suffering from Alzheimer’s disease. Her deteriorating condition and loss of memory frustrated the husband, who struck his wife and yelled at her. Social workers were able to persuade the husband to participate in group counseling and assisted him in finding help in caring for his wife.

Raising public awareness about elder abuse is the most important task at hand, said Wolf, the president of the National Committee for the Prevention of Elder Abuse.

“People have to be told that this does happen, and victims have to be told that there are places to call for help. . . . We have to learn how to take care of our elderly,” Wolf said. “Remember, we’re going to get old, too.”

In San Diego County, suspected cases of elder abuse can be reported to Adult Protective Services by calling the agency’s hot line at (619) 476-6266 or 1-800-523-6444.

ELDER ABUSE

Confirmed cases of abuse against the elderly have more than tripled in San Diego County since 1984. During 1989, 864 people age 65 and older were victims, a third of those cases involving actual physical abuse. ‘84: 256 ‘85: 361 ‘86: 539 ‘87: 634 ‘88: 671 ‘89: 864

Types of Cases in 1989: Physical Abuse: 33% Financial Abuse: 25% Mental Abuse: 22% Neglect of Abandonment: 20%

Source: San Diego County Social Services Dept.