Guest Column
Use these strategies when you suspect elder abuse
By Lorey Ridge, MSW, GSW
Social Worker, Emergency Department
East Jefferson General Hospital
Metairie, LA
When an exasperated daughter brought her elderly mother to the ED for treatment, the daughter began to vent frustration about caring for her mother who had been diagnosed with Alzheimer’s. In doing so, she divulged to the nurse that her mother had begun to wander. As the only caregiver, the daughter in her attempt to keep her mother "safe and out of trouble," had begun to tie her into chairs and sometimes to the bed.
The nurse promptly notified me, as the social worker on duty that shift. I spoke with the daughter for a while about the stresses that accompany caring for a loved one with Alzheimer’s. The daughter continued her venting. She received no outside help from other family members, friends, or community agencies. She also had almost no time away from the situation. She also did not realize that what she was doing was wrong, or at least, she didn’t admit it.
I informed her that a report would be made to Elderly Protective Services and that a caseworker would be visiting the residence. I also told her that I wasn’t making the report because I believed she was intentionally doing anything that would harm her mother, as I honestly didn’t. I believed that she and her mother needed some assistance.
As the age of the American population has increased, so has the incidence of elder abuse. It is estimated that 2.1 million older Americans are victims of physical, psychological, or other forms of abuse and neglect every year. However, like other forms of domestic violence, elder abuse is underreported.
Experts estimate that for every case that is reported to authorities, there may be as many as five cases that are not. Although some abuse does occur in nursing homes, most elder abuse and neglect takes place in private homes where the perpetrators are spouses, adult children, siblings, grandchildren, other relatives and household members, or paid caregivers.
Screening for elder abuse
Elder abuse is a complex problem, and it can be very difficult to detect. As people age, they typically have more health problems, require more care, and visit EDs more frequently. Bones are more brittle, skin easily tears, and bruises are commonplace. These factors can confound the detection of abuse, so it is important to pay attention to other possible signs as well.
The bottom line is, if a story doesn’t sound right, or a red flag goes up, something is probably amiss. Always go with your gut instinct.
In cases in which a patient is brought in by ambulance, the emergency medical technicians (EMTs) are a good source of information. EMTs often will give a description of the patient’s living conditions. Listen for reports of the patient hoarding items such as newspapers (which could indicate Alzheimer’s, dementia, or malorientation) and for reports of lack of heat, air conditioning, electricity, or water services. Reports that the residence was malodorous, filthy, or infested with insects or rodents also should be cause for concern.
What to say and do
One thing you must never do is confront a suspected abuser. If you do this and the patient is discharged, he or she could suffer repercussions. The best case scenario is for the patient to be admitted to the hospital. That gives the authorities time to investigate before the elder is returned to a potentially deadly situation. If the patient is being discharged, the decision must be made to whether to tell the caregiver that you are making a report. One way of doing this is to empathize with the caregiver. Tell him or her that caring for an elderly person is terribly stressful, and that you understand.
You also may give the person somewhat of an "out" by saying that sometimes people do things when under stress that they wouldn’t normally do under other circumstances. Explain that this doesn’t necessarily mean that they are bad people. It just means they need some help in caring for the elder, in getting some time away from the situation.
If the caregiver has responded well to these types of statements, then you may decide to tell the him or her that someone will be contacting them about coming to the residence to see what type of help may be available. Most elderly protective services will connect people with the services they need.
As in child abuse, many victims are frail and vulnerable because they have to depend on others to meet their basic needs. As health care professionals, it is our responsibility to screen all patients for abuse to help those who are unable to help themselves, as no one deserves to be abused or mistreated.
[Editor’s note: Ridge can be contacted at East Jefferson General Hospital, 4200 Houma Blvd., Metairie, LA 70011. Telephone: (504) 454-4377. Fax: (504) 456-8009. E-mail: [email protected].]
Resources
The American Medical Association (AMA) offers guidelines titled Elder Abuse and Neglect, which include strategies to recognize, manage, and prevent elder abuse. The cost is $5 for a single copy including shipping. To order, contact: The AMA, Science and Public Health Advocacy Programs, 515 N. State St., Chicago, IL 60610. Fax: (312) 464-5841.
The National Elder Abuse Incidence Study was released in 1998 by the National Center for Elder Abuse. The report gives information and statistics about elder abuse, neglect, exploitation, or self-neglect. A full copy of the report can be downloaded at www.aoa.gov/abuse/report/default.htm. Paper copies can be ordered for $35 including shipping. To order, contact: The Clearinghouse on Abuse and Neglect of the Elderly (CANE), Department of Consumer Studies, University of Delaware, Newark, DE 19716. Telephone: (302) 831-3525. Fax: (302) 831-6081. E-mail: [email protected].
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