Crime and Abuse Against Seniors:
A Review of the Research Literature With Special Reference to the Canadian Situation
5. CRIMES AND FORMS OF ABUSE POSING THE GREATEST THREAT TO SENIORS
5.2 Abuse by Relatives and Caregivers
The vast majority of elder abuse incidents occur in the community and not in nursing homes or other institutional settings (American Psychological Association, 2009; House of Commons Health Committee, 2003 2004). Elder abuse tends to occur in the home and the usual perpetrators are family members or professional caregivers. Sometimes the abuse is part of a longstanding pattern of physical and emotional abuse in the family. Often, it is related to changes in the physical and cognitive condition of seniors and their growing dependency on family members for care (American Psychological Association, 2009). While seniors who are physically frail and cognitively impaired face an elevated risk of abuse, seniors without these risk factors are still victims of abuse.
5.2.1 Types and Signs of Abuse
Elder abuse is the infliction of physical, emotional, or psychological harm on an older adult. It can also involve financial exploitation or neglect (whether intentional or inadvertent) of an elderly person by the caregiver.
220.127.116.11 Physical Abuse
Physical abuse can range from slapping or shoving to severe beatings and restraint with ropes or chains. When a relative or caregiver uses sufficient force to cause unnecessary pain or injury, regardless of the reason, the behaviour can be regarded as abusive. Physical abuse can include hitting, beating, pushing, kicking, pinching, burning, or biting. It can also include over- or under-medicating, depriving the senior of food, or exposing the person to severe weather (American Psychological Association, 2009).
The following may be signs of elder physical abuse:
- Obvious lacerations, abrasions, fractures, bruises, discoloration, or swelling;
- Pain or tenderness on mere touch;
- Burns caused by cigarettes, ropes or other bonds;
- Detached retina, bleeding, or scalp wound;
- Repeated unexplained injuries;
- An elder becomes withdrawn or protective of a family member suspected of abuse;
- Repeated minimizing of injuries and the refusal to go for treatment (American Psychological Association, 2009; Los Angeles County DA's Office, 2009).
18.104.22.168 Emotional/Psychological Abuse
Emotional abuse consists of verbal attacks, threats, and intimidation. Emotional abuse also includes the social isolation of the senior. Emotional abuse can range from name-calling or giving someone the "silent treatment" to intimidation and threats. When a relative or caregiver unnecessarily causes fear, emotional pain or distress, the behaviour can be regarded as abusive. Emotional abuse can include treating the senior like a child and isolating the person from family, friends, and activities, whether through force, threats or through deceit (American Psychological Association, 2009).
The following may be signs of emotional abuse:
- The senior appears depressed, withdrawn, or afraid;
- He/she displays unusual mood changes and anger;
- He/she seems afraid of being touched or approached by others;
- He/she is uninterested in social contact;
- He/she has chronic physical and mental health issues (American Psychological Association, 2009; Los Angeles County DA's Office, 2009).
22.214.171.124 Sexual Abuse
Sexual abuse can range from exhibitionism to sexual assault. Sexual abuse can include inappropriate touching, photographing the person in suggestive poses, forcing sexual contact with a third party, or any non-consensual sexualized behavior. Sexual abuse is not often reported as a type of elder abuse (American Psychological Association, 2009).
The following may be signs of sexual abuse:
- Bruising or bleeding in the genital area;
- Bruises on the breast;
- Torn underwear;
- Sexually transmitted diseases.
126.96.36.199 Financial Exploitation
Financial exploitation is one of the most prevalent forms of abuse and can range from misuse of an elder's funds to embezzlement. It includes fraud, forgery, forced or deceitful property transfers, purchasing expensive items with the older person's money without his knowledge or permission, or denying the older person access to his own resources. It also includes the improper use of legal arrangements, such as powers of attorney.
The following may be signs of financial exploitation:
- Unusual banking activity;
- A lifestyle that does not match the senior's apparent resources;
- Changing legal arrangements (e.g., titles to property, powers of attorney, joint accounts).
Relatives and caregivers tend to have an ongoing relationship with the elderly victim. Financial exploitation occurs when a person in a position of trust steals, withholds, or in some way misuses the victim's money or property for personal benefit and to the disadvantage of the elderly person.
The offender's methods can include:
- Simply taking cash or valuables;
- Borrowing money and not repaying it;
- Denying services or medical care in order to save money;
- Misusing debit or credit cards;
- Signing or cashing pension checks without permission;
- Forcing or manipulating the elderly person to sign over property, including real estate, or to give the offender signing authority on bank accounts;
- Inducing the elderly person to make the offender the primary beneficiary of the senior's estate (Johnson, 2002).
The indicators of exploitation may include:
- A new acquaintance shows an interest in a senior's finances, offers care to the senior, and ingratiates him/herself with the senior;
- A relative or caregiver is experiencing financial problems and is showing undue interest in the financial affairs of a senior;
- A relative or caregiver expresses concern about the cost of caring for a senior and is reluctant to spend money on this care;
- Basic bills are not being paid;
- A relative or caregiver isolates the senior, by limiting access to him/her by phone or in person;
- Bank and credit card statements are sent to the relative or caregiver, rather than the elderly person;
- The elder is accompanied to the bank by a relative or caregiver and appears afraid to speak on his/her own behalf;
- The elder is concerned about missing money;
- There is an unusual amount of banking activity after joint accounts are set up or someone new begins to help the senior with finances;
- A senior does not understand a will or power of attorney that has been drafted (Price and Fox, 1997; Illinois State Triad, 1998).
Neglect by a caregiver is the failure to provide for the senior's basic needs, including food, shelter, and medical care or needs. It can also include withholding appropriate attention from the individual and frequent abandonment of the elderly person by one with a duty of care (National Center on Elder Abuse, 2005). If the caregiver has responsibility for paying bills for the older person, neglect also can include the failure to pay bills or to manage the elder person's money responsibly (American Psychological Association, 2009).
The following may be signs of neglect by a relative or caregiver:
- The senior feels isolated by a caregiver and cannot speak freely or spend time with others;
- A caregiver fails to assist with personal hygiene or in providing clothing for the elder;
- A caregiver has a history of violence, mental illness or substance abuse;
- A caregiver who is not a spouse is financially and emotionally dependent on an elder;
- He/she is indifferent to or hostile toward the elder;
- The senior shows signs of dehydration or malnutrition;
- The senior has bedsores;
- The elder has experienced a sudden weight loss;
- The elder lacks necessities, including glasses, dentures, prostheses, hearing aids, walkers, or other essential items (American Psychological Association, 2009; Los Angeles County DA's Office, 2009; National Center on Elder Abuse, 2005).
188.8.131.52 Violation of Rights
Some U.S. studies indicate that the rights of the elderly person can be violated by the caregiver. For example, the caregiver may withhold or read his/her mail or obstruct the elder in his/her religious observances (Woolf, 1998). This concept may not be directly applicable under Canadian law. For example, neither the Canadian Charter of Rights and Freedoms nor the various Human Rights Acts federally or at the provincial or territorial level would apply to interactions between individuals (e.g., family members obstructing religious observance). However, rights protected under statute, such as those concerning withholding mail or opening mail without permission, would be similar.
184.108.40.206 Additional Signs of Abuse
Signs of abuse may also be observed when the victim and caregiver are seen at the same time. The victim of abuse may sit at a distance from the caregiver and may allow the caregiver to answer for him or her at all times. The abusive caregiver may try to prevent conversation with or examination of the victim. The caregiver may provide implausible explanations for the senior's injuries. The caregiver may appear nervous or irritable and make demeaning statements about the senior (American Geriatrics Society, 2005).
5.2.2 Perpetrator Characteristics
Perpetrators who are related to the elderly victim are most often adult children (Aged Rights Advocacy Service, 1999). While there is no one profile of the perpetrator of abuse toward the elderly, abusive relatives or caregivers often display the following characteristics (National Center on Elder Abuse, 2005):
- Dependence on drugs or alcohol;
- History of domestic violence or abuse;
- Mental illness and dependency;
- Personality traits such as a volatile temper, being hypercritical, a tendency to blame others for problems;
- Financial and personal stresses.
Perpetrators who are relatives and caregivers exploit the bond developed with the elderly person to commit their fraudulent acts. A survey conducted in the United States has found that the offenders are usually considerably younger than the elderly victim. About 40 percent are under 40 years of age and another 40 percent are between the ages of 41 and 59. The majority are males and about 60 percent are relatives of the victim (National Center on Elder Abuse, 1998).
There are three general categories of offenders:
- Adult children, grandchildren, and other relatives;
- Professional caregivers; and
- Close friends or others in a position of trust.
The majority of offenders fall in the first category (Sklar, 2000). Regardless of the category of offender, there are two basic types. The first type includes individuals who have substance abuse issues or stresses, including those stemming from the responsibility of caring for the elderly person, and who do not seek out elderly victims but will passively exploit opportunities that arise. The second type of offender seeks out vulnerable seniors and systematically gains control over their assets (Tueth, 2000).
5.2.3 Factors Contributing to Elder Abuse by Relatives or Caregivers
Family situations and stresses faced by caregivers may contribute to elder abuse. Conflicts in the family may also be created by the senior's presence. The lifestyle adjustments and financial stresses can be enormous. In some cases, elder abuse is simply a continuation of a pattern of violence that has been occurring in the family over many years (American Psychological Association, 2009). A long history of spousal abuse may persist because the victim is not likely to report abuse when she is very old or in poor health. Spouses and offspring of perpetrators may turn the tables and vent their rage or withhold nourishment from their former abusers (Quinn and Tomita, 1986).
An elderly couple may experience stress when they must share a home with their adult children. Or, the relocation of an elderly person can create tension between an adult child and his/her spouse. When stresses mount, the potential for abuse or neglect increases. Victims may remain silent in relation to offences by those close to them due to fear or conflicted feelings which lead them to protect the perpetrator.
Social isolation can increase the likelihood of abuse (American Psychological Association, 2009). While it can be a deliberate strategy for keeping abuse secret, it may also be an accidental result of the stresses of caring for a dependent older family member, leaving less time for the caregiver to socialize. Isolation cuts off family members from the support they need to cope with the stresses of caregiving. It also prevents outsiders from intervening and protecting an elderly person in an abusive situation and from offering help to the victim and abuser.
Caregiver stress is a major risk factor for abuse and neglect (American Psychological Association, 2009). As most family caregivers lack appropriate training and are without both the information on balancing the needs of the older person with their own needs and the resources and community supports to do so, they can experience intense frustration that can culminate in a range of abusive behaviors.
The risk of elder abuse becomes magnified when the caregiver is responsible for an older person who is ill or impaired (Woolf, 1998). Caregivers without adequate family and social supports could feel trapped in such situations and may resort to force or verbal abuse to manage difficult situations. Sometimes the caregiver's own self-image as a "dutiful child" may compound the problem by causing them to feel that the older person deserves and wants only their care, and that considering respite or residential care is a betrayal of the older person's trust.
When the caregiver is dependent financially on an impaired older person, there may be financial exploitation or abuse. When the reverse is true, and the impaired older person is completely dependent on the caregiver, the caregiver may experience resentment that leads to abusive behavior (American Geriatrics Society, 2005; Kurrle et al., 1997).
Psychological problems of the caregiver can put the caregiver at risk for abusing an older person in their care. A caregiver who is addicted to drugs or alcohol, or has a personality disorder, is more likely to become abusive or neglectful when confronted with the frustrations of caring for an elderly person, rather than reaching out for help (American Psychological Association, 2009; Kurrle et al., 1997).
Societal attitudes and cultural factors may play a role in elder abuse that occurs within the family. Very often, abuse within the family is regarded as a private matter. Different cultural groups have varying ideas as to what abuse is and there are differences in terms of the tolerance of abuse against women in general (American Psychological Association, 2009). Finally, social attitudes that devalue the elderly and view them as dispensable also facilitate disrespect and abuse toward seniors (American Psychological Association, 2009; House of Commons Health Committee, 2003 2004).
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