Redefining "Abuse"

I have seen this (a friend caring for an abusive family member). We naturally think about the vulnerability created by age (and yes, that's very real). This points out the vulnerability to abuse created in some cases by caring.

For abuse to occur there needs to be be intent. A person with dementia has no intent to harm. I suggest you redefine your terms.

There may not be intent any longer, but the behaviors persist and have the same effect as intentional abuse. How would you redefine the dynamic?

How do you support caregivers, whether family or staff, who are the targets of abusive behavior?

These questions aren't random snark - I'm really interested in your thoughts, since I and my crew deal with this on a daily basis.

For abuse to occur there needs to be be intent. A person with dementia has no intent to harm. I suggest you redefine your terms.

There may be some legal or policy and procedure manual that says somewhere there needs to be intent, but I don't believe all definitions of abuse come to that same conclusion. Many define abuse as misuse or mistreatment.

I think one concept that is probably relevant is that the target of whatever type of abuse finds it hard or impossible to escape the behavior they are being abused by.

In this case feelings of care, moral duty, familial relationship or job description are the factors that bind the target to the person exhibiting abusive behavior.

Whether the person doing it knows what they are doing or not, the issue here is the effect it has on others. Their intent may be as simple as doing whatever they need to do to avoid something they don't want but something that others have determined that they need: prevention of elopement, wound care, life saving medical care that someone has determined it is legal to give them even if they are refusing.

I too would be very interested to hear how you would define this.

Hi CapeCodMermaid,

Actually, intent is not a requirement for abuse outside of legal situations. The only time intent matters is if you take an abuse case to court, the courts must prove "criminal intent" or "intent of harm".

All of the terms used in this article are the current standard terms applied to abuse from various sources including the Merriam Webster Dictionary.

Also, the article isn't only about people with dementia (and dementia doesn't always equate abuse!) but also those who are cognizant of what they are doing. I suggest you read the article more thoroughly :).

Thanks for your interest and reading nonetheless!

Hey heron,

These are great questions you've posed! And I wish I could give you an answer to them, but unfortunately I can't.

I wish to raise awareness. The first part of addressing a problem is recognizing it and I feel that the abuse some caregivers received is not recognized.

I would be interested in hearing other people's ideas regarding these questions though!

Thanks for all your comments!

For abuse to occur there needs to be be intent. A person with dementia has no intent to harm. I suggest you redefine your terms.

I agree with this in terms of patients with Dementia. Most times they are acting in what they believe is self defense. They don't remember who we are and why we are in their "home". If they were A&Ox3, most of them would not be striking staff.

Honestly, some of the nurses and aides I work with take it too personally. I have a resident that spews hateful comments when she is in a mood but I don't take it personally. She isn't of sound mind at the time. My grandfather was a wonderful man but when he was in the late stages of dementia, you would have never known it. He hit staff and called them names. He wasn't really fighting them because he didn't know who they were. He was fighting people from his past.

@CaringGerinurse: you make good points, but I think you oversimplify things a bit.

First, an intellectual understanding of the disease process only goes so far when you've just been kicked, verbally abused or lied about out of sheer malice. The experience can be intensified if the caregiver is currently being abused in other areas of his/her life. Even if the caregiver is a survivor of past abuse, there can be a certain element of ptsd that makes particular behaviors difficult to tolerate regardless of one's "understanding".

Secondly, we're not just talking about time-traveling elders who get frightened in situations they don't understand. We also have to deal with people for whom abusiveness has been a life-long behavior which is now enhanced by the disinhibition common in dementia.

IOW, it ain't that simple. Neither professional nor family caregivers have the option of leaving the abusive patient. I read the OP as acknowledging this and asking for ways to support caregivers so that they are able to stop taking it personally.

I want to be clear that, in my opinion, the workplace is NOT a therapy group. If someone is being abused or suffering from ptsd from past experiences, they need more help than a job can or should provide.

I do believe, however, that there are reasonable, "job-appropriate" measures that can be taken to help workers cope and care properly for people with these problematic issues.

On this site I have seen a lot about "abuse" which is really not abuse. Unsympathetic care, and irritability while providing care are not abuse. I think the standard should be higher for professionals than for family members who provide care, but I have seen people label un-professionalism as abuse. It isn't.

If we really want to help people have healthy relationships, we need to curb our usage of the word abuse, and our judging attitudes toward the people we want to help. Family dynamics are complicated and often rife with conflict. Conflict is not abuse. Major stressors on caregivers can lead to frayed nerves, and temper outbursts which are only compounded by abuse witch hunts.

The solution is not to define unsavory behavior in elders as abuse, but to stop the judging and start supporting. When we use the term abuse, we separate compassion from the person who is losing their temper and we stop helping them. I am not suggesting that a caregiver who puts bruises on her mother, who truly abuses an elder, should not be punished. But one who simply yells or name-calls, or otherwise acts out in frustration that does not cause significant harm should not be labeled an abuser. Why is caregiver respite not addressing "the underlying issue"? We decided that there was such a thing as "underlying issue" when we stopped having compassion and decided to see overworked caregivers as monsters. If the research has shown that giving caregiver respite improves health for all concerned, why is there a need to find an underlying issue?

So yes, I think we need to redefine abuse. But not this way. Abuse is a crime. It is not committed by a demented person who has no idea what they are doing. It is not a loss of temper, nastiness or inappropriate language. Abuse causes significant harm to the person who receives it, and warrants intervention from law enforcement. Family conflict is when family members fight, name call, it might even involve minor physical altercation, but no one gets hurt. In the case of paid caregivers, the standard should be higher, but abuse is still abuse and inappropriate behavior is unprofessional, and should be corrected without legal intervention.

Hi Invitale,

Thanks for your feedback. I wish to address one thing first; unfortunately current research on respite care isn't so promising in terms of enhancing caregiver outcomes . I am not sure which research you are referring to, but I have read a few recent studies and they really didn't show any qualitative or quantitative results that were statistically significant in terms of positive outcomes for caregivers. I feel like any positive outcomes from respite care is the result of placebo effect. Healthcare providers view respite care as a godsend and this transcends onto users of respite care. Thus, because healthcare professionals recommend and praise it, patients and caregivers see only good that can come for it.

And I feel your analysis of the term abuse is very cold, unforgiving and not compassionate. For someone who seems to be heavily advocating compassion, it does not reflect in your use of the term abuse. In fact, your entire comment seems kind of vitriolic.

And I am not sure the moral of your comment in the first place? So... what, a caregiver being physically and verbally abused by a demented parent or spouse should suck it up and remain compassionate? Let the spouse or parent continue to violently beat them but the minute that this caregiver does not show compassionate, they are an "over-worked monster"?

Also, you're focusing too heavily on dementia. Dementia does not always equate abuse. Some people are just nasty people, whether mentally cognizant or not.