Abuse, within the context of geriatrics and especially long-term care, is a well-documented global phenomenon. Geriatric citizens are already a marginalized and oppressed demographic, so it's not surprising that abuse is interwoven throughout the lives of these individuals. There is a plethora of research available documenting this phenomenon and suggesting and identifying key contributing factors within the context of caregiver abuse towards individuals. However, what is surprising is the lack of research and attention on elder abuse of family and caregivers themselves.
Before moving forward, it is important to have a clear understanding of what defines "abuse". The term abuse is used quite frequently when dealing with geriatric clients, especially in a healthcare setting. However, it is unclear as to whether or not the individuals using this term have a very clear understanding of what defines abuse.
The Merriam Webster dictionary outlines five definitions of the word abuse. These include: "1) a corrupt practice or custom, 2) improper or excessive use or treatment, 3) a deceitful act, 4) language that condemns or vilifies usually unjustly, intemperately and angrily and 5) physical maltreatment".
When people think of abuse, they generally think of physical violence; however, this is the 5th definition of abuse, according to Merriam Webster. So it is clear that abuse is more dynamic and complex than simply "violence". In terms of geriatrics and "elder abuse", The Ontario Network for the Prevention of Elder Abuse uses the WHO's definition, defining elder abuse as a "single or repeated acts, or lack of appropriate action, occurring within a relationship where there is an expectation of trust, which causes harm or distress to an older person."
Considering these definitions, one can see the complexity in the term "Abuse". The Ontario Network for Prevention of Elder Abuse also outlines numerous types of abuse, from physical to sexual and financial. However, when examining the numerous definitions and examples of abuse collectively, an overlying group of themes can be seen and thus help paint a complete picture of what really constitutes "Abuse". Using these themes to create a holistic and comprising definition of abuse would give a similar definition to this; "subjective or objective representation of mistreatment (whether verbal, physical or sexual in nature) causing an individual physical, emotional and/or moral distress and discomfort and creating unhealthy relationships between abuser and abused".
The term abuse and the idea of abuse itself need to be redefined to be more including of, not only elders, but of those caring for elders. Elders are generally viewed as ones whom which are enduring abuse and never the ones of who inflict the abuse. However, this is not always the case; therefore, it is important to approach the topic of abuse with an open mind and understanding and to not immediately assume the "stereotypical" scenarios.
Many times it is the caregiver who suffers, not only abuse, but also emotional and sometimes financial distress, as they are placed in a situation in which they must not only care for, but also support their loved ones. The National Initiative for Care of the Elderly (or NICE) have created a caregiver abuse screening tool for use by healthcare personnel to screen for possible elder abuse; however, there is no initiative in place to screen for the opposite.
Furthermore, physical aggression and violence is all too common against those caring for individuals suffering dementia. Dementia is becoming a common diagnosis amongst the elder population, especially those individuals older than 80 years of age (Lobo, et al., 2000) and is becoming a specialist area, requiring added skills and knowledge. The introduction of the Gentle Persuasive Approach (GPA), which is becoming a mandatory course for most caregivers caring for the aged in both institutions and in community, has proven that fact. Though GPA can improved how we care for those suffering dementia and can provide solutions to mitigate common aggressive and non-aggressive dementia behaviours, it does not completely solved the physical (and verbal) violence that can present in some demented people.
It is unrealistic to assume that the abusive behaviour associated with certain individuals suffering dementia can be completely solved or "cured" (unless of course a cure for dementia is found!) but recognition of this phenomenon and its significance to caregivers should be considered. That's not to say that support does not exist for caregivers struggling with violent behaviour, but there seems to be insufficient recognition of the psychological and physical impact this has on all caregivers.
Respite care is something commonly offered to those caregivers caring for loved ones in the home setting, especially when caregiver "burnout" is suspected. However, this is only a short term solution for a long term problem. Respite care may provide a day (or days) free from abuse and stress, however, the psychological and physical impact will remain and eventually become further exacerbated when respite care ends. Respite care also does not acknowledge the root causes of caregiver "burnout" and is really only a band-aid solution.
That said, dementia is not a necessary prerequisite for physical and verbal abuse of family and caregivers. Sometimes, elders may exhibit abuse towards family and caregivers despite being fully competent and cognizant of their actions. The reasons for this are many and vary; for example, it may be that they wish to maintain control of their situation, internally acknowledging their reliance on the caregiver for basic activities and being resentful. These individuals may also be resentful in general of their aging and declining health. Or, it may just be as simple as it is who they are. Not everyone is kind and caring!
Furthermore, abuse can stem from the individual utilizing and controlling the caregiver's finances. Sometimes, these individuals have little to no life savings and rely on a family member (who may be their caregiver) in order to provide for them financially. Sometimes, these individuals may take advantage and control the finances of their caregivers. This is sometimes dependent on the caregiver enabling the individual, but it can quickly spiral out of control.
There is much progress to be made in the area of defining abuse, identifying abuse and understanding abuse. However, the current trend in abuse, within the context of geriatrics, seems to be placing too much emphasis on elders and their being abused, and neglecting the possibility that it is they who is the abuser. This can be detrimental for healthcare personnel, as they may miss the opportunity to screen and identify caregivers who are being abused. It is already known that abuse can lead to feelings of oppression, isolation and distress; therefore, it is vital that we identify these issues and intervene appropriately. The best way to do this, may be to redefine abuse and how we look at abuse in the healthcare community. Though redefining abuse will not solve all of the problems that exist in terms of geriatric and elder care, it may provide a means to better understand, acknowledge and accept the problems that exist within the care of elders.
Lobo, A., Laurner, L., Fratiglioni, L., Anderson, K., Carlo, A., Breteler, M., . . . Hofman, A. (2000). Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology,54(11).
Merriam-Webster Dictionary (n.d.). Retrieved March 24, 2015, from Abuse | Definition of abuse by Merriam-Webster
Nicenet - National Initiative for the Care of the Elderly. (n.d.). Retrieved March 24, 2015, from Nicenet - National Initiative for the Care of the Elderly
ElderAbuseOntario.com. (n.d.). Retrieved March 25, 2015, fromElderAbuseOntario.com