Aging Well: Awareness key to stopping elder abuse

Former Adult Protective Services supervisor suspects cases are going unreported in Routt County

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Moffat County Social Services:

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Routt County Human Services:

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Vickie Clark, new director of the Routt County Department of Human Services, recently was surprised to learn that only six referrals regarding possible abuse of at-risk adults were made in the county in the last year.

"When people ask me why : I'm going to guess that part of it is a lack of awareness to what the issues are and the resources that are available," she said.

Clark, a former supervisor of Adult Protective Services in Mesa County, noted that all the reports turned out to be situations of self-neglect. However, she suspects there are more possible adult abuse cases in Routt County that are not being reported.

Her experience has shown that referrals typically increase as the public becomes more conscious of elder abuse problems. She hopes expanding adult protection and abuse awareness programs will help bring to light any other instances of adult mistreatment or self-neglect.

Who is at risk

Elder abuse is any intended or careless act that causes harm or serious risk of harm to an older person. It includes physical, mental and sexual abuse, financial exploitation, neglect, abandonment and self-neglect, according to the National Center on Elder Abuse.

Between 2002 and 2004, more than 50 percent of clients of Adult Protective Services programs in Colorado were at least 75 years old.

In 2006, more than half of Colorado APS cases involved situations of self-neglect. About 22 percent involved caregiver neglect, while financial exploitation accounted for about 16 percent of cases and other abuse about 9 percent, according to data from Colorado Adult Protective Services.

Elder abuse can happen to anyone, but certain factors can make a person more vulnerable. These include illness, frailty, physical disability, mental impairment such as dementia or Alzheimer's disease, and living with or depending on a person with a history of mental illness, hostility or alcohol or drug abuse.

While some abuse occurs in long-term living facilities, most cases involve abuse in the home by family members, old or "new" friends or service providers in a position of trust, according to the American Psychological Association.

Although there are extreme cases of elder abuse, most situations are more subtle, making the difference between interpersonal stress and abuse sometimes difficult to discern.

Some elder abuse may be a continuation of marital or family violence that has taken place over many years, or it may be the result of stress triggered by lifestyle adjustments and the difficulty of caring for an increasingly dependent older person, the association notes.

Every state has laws dealing with elder abuse, neglect and exploitation. Colorado statutes require enhanced punishments for crimes against at-risk adults.

Recognizing and reporting elder abuse

Referrals of possible elder abuse to APS typically come from medical staff and community groups, concerned individuals and members of the criminal justice or government communities.

There are many warning signs of elder abuse, such as slap or pressure marks or certain kinds of burns or blisters that may indicate physical abuse. Untreated bed sores, the need for medical or dental care, dirty clothing, poor hygiene and grooming and unusual weight loss are possible signs of self-neglect or neglect by a caregiver.

Emotional abuse or neglect may cause a person to withdraw from normal activities, be less alert or behave unusually. Exploitation may be signified by sudden changes in a person's finances and accounts, altered wills and trusts, unusual bank withdrawals or loss of property, according to the National Center on Elder Abuse.

A person may be abusive if he or she seems to control an elder's actions, isolate the elder from family and friends and be emotionally or financially dependent on the elder. Abusers also may appear indifferent to the elder, seeming apathetic or hostile, call the elder names or threaten the elder's pet.

Although it's been difficult to pinpoint how many older adults are abused, research suggests only one in 14 elder abuse incidents in the home are reported to authorities.

Several factors that may contribute to the lack of reporting elder abuse incidents include isolation of older adults in rural areas, as well as cultural and societal attitudes emphasizing autonomy and privacy.

Kathy Rickart, coordinator of Colorado Coalition for Elder Rights and Protection, which provides education and resources about elder rights issues, said these attitudes can be common in ethnic and immigrant populations.

Abuse awareness among friends and family can be particularly important in rural areas where they can be a support and resource to victims in place of lacking programs and services, she said.

Older adults may fear being stigmatized as victims or losing what little independence they may have if authorities are notified of an abuse situation.

"The skill of the professional is key, along with creating abuse awareness among the general public," Rickart said. "Mental illness used to be hidden in the closet, but with education, more and more people no longer feel stigmatized if they have a mental illness. Abuse will have to travel the same educational path."

Once a county department of social/human services (some have adult protection teams) receives a referral about possible abuse, the staff can access the situation and determine what kind of services in the community, such as medical care, counseling, home health or other programs, will help the person in his or her situation. More dire or extreme circumstances may require the help of law enforcement or other agencies.

"Basically, our job is to go out and advocate for the rights of that person a lot of times," Clark said.

She emphasized that competent adults have the right to refuse some or all help offered to them by APS, even if the staff thinks it is not in the person's best interest. Finding the least restrictive help or intervention is among APS's priorities.

Preventing abuse

Competent older adults can take steps to prevent themselves from being mistreated. These include staying busy and engaged in life, cultivating a strong network of family and friends, and taking care of themselves to stay as independent as possible.

Older adults also should refuse to allow anyone to add their name to the person's bank account without their consent and should never make financial decisions under pressure or sign over money or property to anyone without getting legal advice, according to recommendations from the National Center on Elder Abuse.

Overall, older adults should assert their right to be treated with dignity and respect and not be afraid to ask for help if they need it.

Elder abuse within the home can be averted by proactive family choices, such as seeking counseling or helping change long-time patterns of behavior, conflict or addictions or dealing with current stresses, recommends the American Psychological Association.

Caregivers should do their best to minimize stress by taking time for themselves. Many communities offer adult day services or respite programs that will care for older adults while caregivers work or tend to their own needs. It's also helpful for families to stay social and connect with other families in similar situations.

Concerned citizens can prevent or end abuse by reaching out to vulnerable neighbors, friends or family members, especially those isolated because of physical, cultural or geographical circumstances. They also may volunteer with community programs that provide older adults companionship and help in their homes.

Finally, if they suspect someone is being abused or is neglecting him- or herself, they should report the situation to the county department of social/human services where that person lives. Referral sources are kept confidential and may be anonymous.

Tamera Manzanares writes for the Aging Well program and can be reached at tammarie74@yahoo.com. Aging Well, a division of Northwest Colorado Visiting Nurse Association, is a community-based program of healthy aging for adults ages 50 and older.

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