Geetika Sharma
For elderly people with Dementia and Alzheimer's, the chances of abuse are much higher than their elderly counterparts without these disorders (Dong et al., 2014). Due to them often being in a state of confusion or maybe even anger, caregivers or caretakers of people with neurocognitive disorders tend to ‘lash out’ or mistreat patients either out of frustration or the awareness of a lack of accountability as abuse is harder to detect in the cases of patients with conditions such as Dementia and Alzheimer’s (Cooper et al., 2009).
It is a rather commonly known fact that people with neurocognitive disorders such as Alzheimer's and Dementia often face abuse at the hand of their caretakers. However, living without such a caretaker does not lessen the chances of abuse occurring, as self-neglect or not being able to take care of one’s own self in terms of daily life activities such as bathing or cooking can also be recognised as a form of abuse (Papaioannou et al., 2012). In the case of harm inflicted by someone other than the person with a neurocognitive disorder, abuse comes in many forms: financial, sexual, physical and psychological.
Financial abuse comes in the form of taking uninformed consent from the patient with regards to financial transactions like loans or even the direct theft of their funds and property (Dementia Australia, 2014). In many cases, caretakers can gain or have access to the patient’s bank accounts and use them to pay off their loans or use their funds without even informing the patient (Bonnie & Wallace, 2003). Although legislation attempts to protect the patients through a requirement of witnesses while signing paperwork, often, these witnesses are other family members with vested interest in the patient’s finances being taken out of their hands (Bonnie & Wallace, 2003). This form of abuse tends to be more common at the hands of family members and other trusted people of the patient (Dementia Australia, 2014).
There are many debates regarding patients with advanced Dementia and Alzheimer’s when it comes to sexual activity. Many argue that all instances of sexual contact with such patients should be considered assualt due to there being a grey area regarding their ability to fully consent to sexual activities. Sexual abuse amongst patients with advanced cognitive deficits is hard to detect without a physical examination, due to the observation of changes in their behavioural state being an unreliable metric to detect abuse (Haddad & Benbow, 1993). But it happens regularly in in-patient facilities like old age homes nonetheless. Around 40% of the elderly residing in a long term environment have been abused in some capacity or the other with only 70% of the victims either choosing to or having the mental faculties to report the abuse (Mileski et al, 2019).
Physical abuse in patients is easier to detect, although it is unclear whether such abuse occurs more commonly than sexual abuse or simply is reported more often due to it being more detectable. The most prevalent form of abuse, however, is emotional or psychological abuse of the patients at the hands of close contacts and caretakers such as family members. In a study conducted by Cooper et al in 2009, out of 220 families of dementia patients that were being taken care of at their home, it was found that most carers fulfilled mild criterias for psychological abuse, and one third of the carers’ behaviours could be classified as serious abuse (Cooper et al., 2009).
In the wake of the awareness regarding the prevalence of elder abuse in long term facilities, there have been interventions proposed in order to effectively combat and prevent these instances from happening any further. Some estimations predict that as many as 40% of all patients in long term care facilities have been mistreated or abused by either staff or other residents, but the rate of reporting these violations is a mere seven percent (Mileski et al., 2019). Evidently, one of the most important areas to address then becomes the issue of detection and reporting of abuse. There have been some promising developments in the field: a study conducted by Lavingia et al in 2020 explored the benefits of introducing standardised patient interactions as practice for psychiatry residents to recognise abuse in elderly patients and its results showed that residents felt significantly more confident in their ability to recognise and report abuse in elderly patients with cognitive deficits after standardised patient interactions (Lavingia et al., 2020).
In conclusion, the issues surrounding the prevention of elderly abuse are complex: in cases of financial abuse, the caretakers have legal rights to access the patient’s bank accounts and sometimes patients simply may not be able to communicate their issues effectively to a concerned authority. In case of sexual abuse, the US Federal law recognises any occurences of sexual activity under instances of ambiguous consent from patients with dementia and Alzheimer’s to simply be ‘accidents’. The eradication of elderly abuse therefore, has to be multifaceted, involving changes within the legal system and the rights of those with advanced neurocognitive disorders (Mileski et al., 2019). There are many associations such as dementia australia that actively advocate for faster procession of cases regarding elder abuse and the revision of laws to prevent abuse such as higher accountability from financial caretakers using court interventions.
References
Bonnie, R. J., & Wallace, R. B. (2003). Elder mistreatment: Abuse, neglect, and exploitation in an aging America. National Academies Press.
Cooper, C., Selwood, A., Blanchard, M., Walker, Z., Blizard, R., & Livingston, G. (2009). Abuse of people with dementia by Family Carers: Representative Cross Sectional Survey. BMJ, 338(jan22 2). https://doi.org/10.1136/bmj.b155
Dementia Q&A 22 - preventing financial abuse of people ... (n.d.). Retrieved April 17, 2022, from https://www.dementia.org.au/sites/default/files/helpsheets/Helpsheet-DementiaQandA22-PreventingFinancialAbuseofPeoplewithdementia_english.pdf
Dong, X. Q., Chen, R., & Simon, M. A. (2014). Elder abuse and dementia: A review of the Research and Health Policy. Health Affairs, 33(4), 642–649. https://doi.org/10.1377/hlthaff.2013.1261
Haddad, P. M., & Benbow, S. M. (1993). Sexual problems associated with dementia: Part 2. Aetiology, assessment and treatment. International Journal of Geriatric Psychiatry, 8(8), 631–637. https://doi.org/10.1002/gps.930080803
Lavingia, R., Bryan, J., & Asghar-Ali, A. (2020). Teaching psychiatry residents to recognize and respond to elder abuse through a standardized patient encounter. The American Journal of Geriatric Psychiatry, 28(4). https://doi.org/10.1016/j.jagp.2020.01.125
Mileski, M., Lee, K., Bourquard, C., Cavazos, B., Dusek, K., Kimbrough, K., Sweeney, L., & McClay, R. (2019). preventing the abuse of residents with dementia or alzheimer’s disease in the long-term care setting: A systematic review. Clinical Interventions in Aging, Volume 14, 1797–1815. https://doi.org/10.2147/cia.s216678
Papaioannou, E.-S. C., Räihä, I., & Kivelä, S.-L. (2012). Self-neglect of the elderly. an overview. European Journal of General Practice, 18(3), 187–190. https://doi.org/10.3109/13814788.2012.688019
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