Henry, a 75-year-old widower, had been living alone for the past 20 years. When he started exhibiting signs of dementia, his daughter Pam, 32, suggested he move in with her. Perhaps she was genuinely concerned that he needed help with daily living, but as she later admitted, she also saw an opportunity to greatly improve her standard of living.
Pam coerced her father into granting her power-of-attorney and quickly took advantage of the situation. During the following two weeks, she withdrew $500 each day out of his checking account—the maximum allowed using an ATM card—soon bringing the account balance to zero. She bought jewelry, designer clothing and electronic entertainment equipment, justifying what she did by telling herself that this money would eventually be hers by inheritance anyway. Besides, Dad had been a lot of trouble in recent years, so she deserved the money.
There was also Henry’s $2,000-a-month pension check. Pam used some of it to pay for her father’s food, doctor bills and medications, but she spent the majority on her own living expenses—including the monthly payments on a new sports car.
Pam knew she was putting her wants over her father’s needs, but she also knew she could get away with it. She did have power-of-attorney, and she could do what she wanted with his money as long as no one else found out about it. She made sure that the few relatives who called once in a while to ask about her father didn’t get to talk to him and that he didn’t get their phone messages. The only “outside” person Henry ever talked to was his physician during occasional medical checkups, but Pam had convinced him that nobody would believe a senile old man’s charges of abuse.
In the months that followed, Henry’s dementia worsened, and he also lost bladder and bowel control. It became harder and harder for Pam to care for her father—or even to tolerate him. He always seemed to need to go to the bathroom, and if he didn’t get there quickly enough, Pam would berate him with a barrage of expletives.
It got to the point that Henry could no longer be left alone, even for a few minutes, because that was just long enough for him to wander out of the house by himself or turn on the stove and accidentally start a fire. Pam knew he should go into a nursing home or an assisted-living facility where he would get 24-hour professional care, but she had become quite dependent on her father’s pension checks.
Rather than pay for the care Henry needed, Pam came up with her own solution. She tied her father onto the toilet and kept him there for several days at a time, to the point that he developed sores on his buttocks and became so dehydrated and sick that he was dying. Finally Pam felt she had no choice but to take her father to the hospital.
Although the names were changed by the social worker who related this appalling account, Henry and Pam’s story is very real. And it is just one example of a disturbing reality in today’s society—a growing problem that occurs daily in almost every community on the planet.
The Scope of the Problem
Elder abuse is defined by the U.K. advocacy group Action on Elder Abuse as “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.” It can take various forms, including physical harm, sexual abuse, emotional or psychological abuse, financial or material exploitation, and intentional or unintentional neglect (see “What Constitutes Elder Abuse?”).
“Very often the victim of one kind of abuse is also a victim of another kind of abuse,” notes Laura Mosqueda, director of the Elder Abuse Forensic Center in Orange County, California, and a professor of family medicine at the University of California, Irvine. For instance, “a victim of financial abuse might be verbally threatened to sign over his house or give up social security checks, or maybe there are threats that he will be hit or locked in his bedroom if he doesn’t cooperate.” In Henry’s case, he was not only abused financially but was also neglected and verbally assaulted.
No one knows exactly how many elderly people are mistreated, but the National Research Council’s Panel to Review Prevalence and Risk of Elder Abuse and Neglect estimated in a 2003 report that between one and two million Americans, aged 65 or older, have been injured, exploited, neglected or otherwise mistreated by someone on whom they depend for care or protection.
In the October 2004 issue of The Lancet, Cornell University gerontologists Mark Lachs and Karl Pillemer estimated that in the United States, between 2 and 10 percent of senior citizens have experienced some form of abuse in their home. Their conclusion was based on an analysis of case studies, samplings and surveys.
The figures for the United States are thought to reflect those in the rest of the world. The 2002 World Health Organization’s “Report on World Violence” puts the percentage of abused seniors at between 4 and 6 percent of the 65-and-over population for all countries across the globe.
“Obviously,” notes Elizabeth Podnieks, vice president of the International Network for the Prevention of Elder Abuse and a professor at Ryerson University in Toronto, “if a country’s population is younger—as in much of sub-Saharan Africa, where people do not have as high a life expectancy—there won’t be as high a number of elder abuse cases, because there aren’t as many elderly people. But of the older people who do live there, the percentage being abused will be about the same as for the rest of the world.”
She adds, “Even in many Asian nations, where there has traditionally been a high respect for the elderly, a lot of elder abuse cases are now being reported.” She speculates that there may not be as much respect for the elderly as there once was in Asia, so there are fewer social mores against treating older people badly.
Hidden and Unreported
Perhaps an even bigger factor is that the problem traditionally has been hidden from public view, regarded mostly as a private matter or a family secret. According to Podnieks, “today more people are talking about elder abuse and acknowledging that it exists. It’s being investigated and recognized more. It has always existed, but up until 20 or 30 years ago, people weren’t looking for it. Now we’re looking for it, and we’re finding a lot of cases. But it’s still a hugely underreported problem.”
In fact, many experts agree that the reported number of cases represents only the tip of the iceberg. The National Center on Elder Abuse, funded by the U.S. Administration on Aging, estimates that only one in six domestic elder abuse cases is reported to authorities. For instance, in 2003, 565,747 cases were reported to state Adult Protective Services agencies in the United States, whereas they believe the actual number of elder abuse victims for that year may have been closer to two million.
More often than not, the perpetrator of the abuse is a family member, which is why the majority of cases go unreported. According to a 1998 National Elder Abuse Incidence Study funded by the Administration on Aging, in 90 percent of known cases of elder abuse and neglect, the perpetrators were family members, and of those, about 75 percent were adult children or spouses.
“Victims are often reluctant to report the abuse because they are ashamed of what the family member did to them, or just embarrassed that they made such a huge mistake by trusting this person and allowing themselves to be used,” Mosqueda says.
Some victims simply do not want to get their children in trouble with the law. “The thought of their son or daughter going to jail may be worse than enduring the abuse,” speculates Sharon Brangman, professor of medicine and division chief of geriatrics at the SUNY Upstate Medical University in Syracuse, New York.
Deana Johnson, who is regional consultant for the Ontario Network for the Prevention of Elder Abuse and executive director of the Council on Aging in Windsor, Ontario, adds that “a lot of victims will try to protect their adult children at all costs.” That includes making up excuses for their children’s behavior and even blaming themselves for what their children did to them.
She explains: “A mother might say to herself, ‘What have I done that my child would treat me like this? I must have been a bad mother.’ So somehow she thinks she did something to deserve the mistreatment, because as a parent she created the child.” Even in cases of physical abuse, older people sometimes try to minimize the situation by telling themselves things like, “Oh, he didn’t mean to hit me so hard.”
Other elderly victims choose to keep quiet simply because they feel dependent on the abusers for their physical care. “The victim knows he’s being abused, but he also knows that the one who’s abusing him is the same one who’s providing his care,” Johnson says. “It comes down to ‘If I don’t have my child taking care of me, I’ll end up in a nursing home.’ This is a generation that’s coming from the view of ‘the home’ as the warehouse where you go to die. Now, a lot of nursing homes today are really nice and have a lot of activities and beautiful surroundings. But these are not the kind of nursing homes that older people picture in their minds. They’re still thinking ‘the home,’ and anything’s better than going there.”
A Growing Concern
While it may be true that more elder abuse cases are being reported than in years past, many experts believe that the actual number of cases is sure to increase in the years ahead, as many countries’ populations age and the number of elderly people increases.
Older Americans constitute a larger proportion of the U.S. population than ever before, and the numbers will continue to rise as the baby boom generation grows older and Americans continue to enjoy longer lives. Many baby boomers, who may be anywhere from their early 40s to 60 years old today, can expect to live well into their 80s and 90s. By 2011 the first baby boomers will be ready for retirement, and by 2025, experts forecast that there will be twice as many over-65s as teenagers. Canada, Australia, Europe and Japan are all experiencing similar trends.
“As the elderly population continues to grow, and as health care and senior living arrangements increase in costs, more people will assume responsibility for those who raised them,” predicts Carmel Bitondo Dyer, associate professor of medicine at Baylor College of Medicine in Houston and codirector of the Texas Elder Abuse and Mistreatment Institute. “With few alternatives and no training in how to handle their new-found caregiving responsibilities, many will inflict pain.” (See “Who’s at Risk?.”)
Adding to the problem is the increasing focus on youth and, as a corollary, the decreasing respect for the elderly in much of the world. How does this play out with regard to elder mistreatment? “If you don’t see the older population as valuable, viable and worthy, then the next step is that you start to show that disrespect,” says Lee Stones, a gerontologist based in Thunder Bay, Ontario, and regional consultant for the Ontario Strategy to Combat Elder Abuse. “It can then escalate into a regular psychological abusive scenario or worse.”
Doing Something About It
What can we do as a society to curb the problem of elder abuse? The first step is education. “We need to get to the point where everybody knows what elder abuse is and is aware that it exists,” Podnieks states. “The more we talk about it, the more real it becomes and the more people are shocked by it, and then the more committed we as a society are going to be to doing something about it,” she says.
Caregivers may need to be educated as well. While many take the responsibility seriously and do a remarkable job in the face of what may seem an impossible and thankless task, others may quickly find themselves over their heads. “We need to make sure caregivers are connected to resources in the community that can help them, so they’re not stressed in their responsibilities,” Johnson says. Many communities have caregiver support groups, educational programs, etc., to help caregivers in their roles.
Senior citizens, too, should educate themselves. They need to know what resources are available in their community to protect themselves. Many cities, for instance, have an elder abuse task force that investigates reports of suspected abuse and provides support and practical help to seniors in abusive situations.
On a more basic level, children need to be educated and taught that old age is not a bad time, adds Stones. “Getting older is a fascinating time, and people of all ages should be respected and cherished,” she says. “If the younger generation truly understands and respects the older generation, they’re going to be much more likely to hold older people in high regard and be far less likely to mistreat them.” (See “Prescription for Elder Abuse.”)
This gets down to what is actually the more fundamental issue. Ultimately the solution doesn’t lie in acknowledging the issues and teaching people how the elderly should be cared for, helpful as those may be. Education can’t fix the problem if people don’t reassess their values. Is self-gratification more important than concern for the needs and rights of others? Are youth and beauty to be valued more highly than the wisdom that comes with age and experience? Can greed and the exploitation of others ever be justified?
Eliminating elder abuse will take a commitment on the part of people everywhere to take responsibility for their thoughts and actions. Surely then abuse cases wouldn’t get to the stage that Henry’s did. Henry was taken to the critical care unit of a nearby hospital where local officials got involved, literally rescuing him by revoking his daughter’s power-of-attorney and then moving him to a facility where he could get the ongoing care he needed.
Podnieks believes everyone should keep watch for people like Henry. “We need to be each other’s keeper,” she urges. “Elder abuse is not a private matter. In practical terms, that means if you haven’t seen your elderly neighbor lady in a while, don’t be afraid to go knock on her door, just to see how she’s doing. Let her know you’re there for her and that you care. Be willing to get involved. After all, that could be any one of us just a few years down the road.”