Hurting the one you love

June 10, 2013
elderly lady giving money

Being a carer of a wife who suffered dementia brought out the best in my father-in-law. He’d always been the sick one, the grumpy one. He was a typical man of his generation. Yet caring had transformed him into a paragon of gentleness and self-sacrifice. He’d even taught himself to cook. It went on for 15 years but we never heard him raise his voice or show impatience.

It can be like that for many spouses, daughters and sons who care for elderly loved ones. They dip into reserves of love and kindness they didn’t know were buried within. But some carers – a small minority – are abusive, neglectful and financially exploitative. What’s behind such behaviour will be explored at a major conference in Adelaide next week for World Elder Abuse Awareness Day. A recent Queensland case has brought the subject home. It throws the spotlight on severe carer neglect of the kind my father-in-law, and most carers, would find incomprehensible.

The Queensland case confounds the stereotypes. Here was a daughter, a live-in carer with two degrees – in journalism and business. A low IQ was not at issue. Her 88 year-old mother had dementia and was found by ambulance paramedics screaming in pain, covered in faeces and pressure sores, malnourished, and with a broken leg. Since a fall three weeks earlier she had been bedbound but no doctor had been called; in fact the mother, totally reliant on her daughter, had not seen a doctor for years.

The mother died two weeks after the paramedics took her to hospital, and the matter ended up in the Queensland coroner’s court. The deputy state coroner, Chris Clements, said: “In a time of an ageing population and pressure on access to services to care for the elderly, there is likely to be an increase in circumstances where families take on the care of their elderly relatives. The responsibility can be a difficult challenge for a family.”

We don’t know how common severe carer neglect is in Australia. Unlike the UK we’ve carried out no national prevalence study of elder abuse. In the mosaic of maltreatment, it’s likely to be a small part of the picture. More usual, according to elder rights services, is financial exploitation by sons and daughters who wrest control of a parent’s money and treat it as their own. I’ve touched on this before. Psychological abuse is also more common: “It’s the constant demeaning and devaluing of the older person – threatening to put them into an aged care home, calling them a ‘stupid old fool’, telling them they don’t know what they’re doing and they’re losing their marbles,” Jennifer Blakey, manager of Senior Rights Victoria, told me.

Behind elder abuse can be long-term family dynamics, including a history of domestic violence; and a carer’s drug, alcohol or mental health problems. Research has pointed to the characteristics of the carer rather than the stress of caring as the main cause. And the recent case of a homeless alcoholic man in Brisbane who bashed his 87 year-old father to death over money is an example of this. A keynote speaker at the Adelaide conference is Paul Greenwood, a prosecutor from San Diego. This is how he has described a typical abuser: “My number one perpetrator of physical elder abuse is the son living at home with his widowed mother. He is between 35 and 50. He is either a single son who has never ever left home, or a divorced son who complains that he cannot pay alimony so he comes back home. Or he has just returned from prison. In every case he is lazy and unemployed. He’s addicted to drugs, alcohol or gambling. He steals from his mother in order to feed his addiction. The first thing he takes is her jewellery, which he pawns. Then he steals her cheque book and cashes her pension cheques. When his mother finds out, and she confronts him, he hits her in the face.”

But how true is it that only ‘loser’ carers with pathological problems cause all the abuse, neglect and exploitation? And that ‘nice’ carers never strike out, no matter how stressed, nor steal their parents’ money, nor demean or intimidate them?

Research by Dr Claudia Cooper, of University College London, tells a different story. She finds carer stress is a factor in elder abuse. Most of the 220 carers in her study reported some abusive behaviour and one-third admitted to “important levels of abuse.” Verbal abuse was most common but three carers admitted to physical abuse. And these figures are likely to be under-estimates. Her previous work has shown that male carers were at higher risk of lashing out, especially if caring for someone with dementia who wanders or follows them around. And health professionals may miss all but the most serious abuse. Given carers appear willing to admit some of their behaviours, Dr Cooper makes a simple suggestion: “Routinely asking family carers about abuse is more likely to lead to its detection.”

Yet not everyone agrees on what elder abuse is. Dr Briony Dow, of the National Ageing Research Institute in Melbourne, asked 120 health professionals whether it was abusive behaviour for a son to lock his mother in the house alone all day while he went to work. Forty per cent of the health professionals didn’t think so; and was it abusive for the carer to sit his mother in an armchair with a table over her lap so she couldn’t get up while he went shopping? Twenty per cent said no.

The most extreme cases hit the headlines. But elder abuse exists on a spectrum. Robbing parents blind, threatening them, screaming at them, and treating them like fools count as abuse, too. Stressed and depressed carers need support and education so they don’t hurt the one they love.

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