Elderly Abuse: The Sad Reality

Last week a member of the SAGE community (and a dear friend) reached out to ask for prayers. In the past few years, her father has developed a condition that rapidly induces dementia and Alzheimer’s.  Sadly, a fight over both his care and money has broken out among family members and taken a lot from her. She could use our prayers as she fights those in his life looking to profit off of the situation.

After having discussions with her and reflecting on my own grandparents, I thought that a deeper dive into Elderly Abuse was something we could tackle here in the SAGE community.  I was shocked to find that elderly abuse was more common in those who had both suffered abuse in their lives and those who perpetrated it.    

So lets take a closer look…

The Stats

According to the National Council on Aging, up to 5 million older Americans are abused every year!  Can you guess what the estimated annual monetary loss in the US is?  An INSANE 36 BILLION DOLLARS.  That’s right BILLION.  Elderly abuse costs seniors billions of dollars.

Why is it only an ‘estimate’?  Good question.  The reason these numbers are only estimates is because elder abuse often goes unreported. Elder Abuse is classified into many categories.  It is easy for abuse to go undetected and therefore unreported.  Only an estimated 1 in 24 cases are actually reported.

Contributing Factors

There are a lot of risk factors for elder abuse, but the biggest culprits are social isolation and mental impairment due to dementia or Alzheimer’s. 

My grandmother was blessed, depending on her mood, to live until she was 95. During her last few years, she needed more assistance than my mother could physically handle so we found an assisted living facility nearby to help with care.  My mom went every day and there was a steady stream of visitors to keep Grandma occupied, but it was still hard.  While she retained most of her faculties and carried on lively conversation, she found it difficult to connect with other residents, leading her to isolate in her room.

Even with all the visitors and staff I know she struggled with being alone.  Her freedoms to move about like she pleased were gone.  Most of her friends had passed away and she found it difficult to carry on conversations with many of the other residents.

Although she didn’t always show it, I know my grandma was happy to have our family and friends as consistent visitors.  She would comment on the number of residents who said their children were too busy or who were simply alone.  Its sad to realize how true this is for so many elderly people in the United States. 

Let’s take a deeper dive into Social Isolation.

Social Isolation

In the book, Social Isolation and Loneliness in Older Adults, The National Academy of Sciences describes social isolation as “the objective state of having few social relationships or infrequent social contact with others.” They define loneliness as “the subjective feeling of being isolated.”  The book went on to site seniors who lacked a friend group, church community or a link to the outside world as the most vulnerable.  To add insult to injury older adults who are socially isolated had an increased risk of mortality.  It is suggested in the book that healthcare systems can play a bigger role in creating community among the elderly as a form of treatment/potential disease prevention.  Society should be able to help with that as well.

When I was in high school my church started a youth volunteer program at the local assisted living center where we would help take the residents from their rooms to the chapel every Sunday.  We would sit with a group of a few seniors and help them manage their hymnal and follow along as needed.  This wasn’t a particularity exciting way for a teenager to spend an afternoon but looking back I see how special that was.  Some residents wanted to tell you all about their lives and how their week was.  Others never said a word.  I can’t help thinking what a difference it would make if more of us spent time with them.  We could lift the loneliness, if only for a few minutes.

It is important to note that not everyone over 65 is lonely or experiencing social isolation, however, it is one of the biggest risk factors to elder abuse and mortality.  Maybe we can make a difference.

Immigration/Ethnic Differences

While researching this article I came across a study out of Canada that provided a look into elder abuse among immigrant communities titled Elder Abuse Risk Factors: Perceptions Among Older Chinese, Korean, Punjabi and Tamil Immigrants to Toronto.

The article explained that migration to a new country often changes the family dynamic.  The younger generation is expected to take on different roles such as cultural liaison, interpreter, and caretaker.  The study argued that migrant parents are more reliant on their children now than they would have been if they stayed in their home country. If the children and family are unwilling to play that role, this increases the risk for elder abuse or neglect. It is also important to highlight that many older immigrants do not qualify for social programs like Social Security or Medicare. 

The study went on to ask members of each community what the biggest issue was, in their opinion. For the Korean community the most prevalent risk factors were social isolation, financial dependance on family and lack of English.  However, for the Chinese population financial dependence, physical dependence and emotional dependence were the biggest concerns. For the Tamil population, English proficiency was the biggest issue and for Punjabi it was social isolation.

Regardless of ethnicity, we owe it to all elder communities to make sure they are protected later in life.

Now let’s talk about Types of Abuse

Physical and Sexual Abuse of the Elderly

Elderly physical abuse is defined as an illness, pain or injury caused by hitting, kicking, pushing, slapping, and burning.  Elder sexual abuse is defined as forced or unwanted sexual interaction when the victim is over 65 years old.

We never ever want to hear these kinds of stories, but they happen and it’s important to talk about it in hopes of stopping future abuses.  According to the CDC, from 2002 to 2016 more than 643,000 older adults were treated for abuse in the ER and there were over 19,000 homicides that resulted.  Men had a higher rate of hospitalization compared to women and men in minority groups were more likely to be victims of a homicide. 

As far as sexual abuse goes, most cases are left unreported, about 70%.  You might be surprised to learn that most of the sexual abuse is by a family member and/or primary caregiver.  The victim often does not report because either they don’t have the mental capacity or they fear they won’t be believed.  The lack of options and outside support leave the elderly extremely vulnerable.

If any elder abuse is suspected the best course of action is to call adult protective services.  To find more information and local resources visit the National Adult Protective Services website.

Abandonment

For some of us we cannot fathom abandoning a loved one in need.  But it happens and according to the CDC the largest risk factors as to why a spouse, child or other family member might choose abandonment is past family conflict.   Often this includes past alcohol or drug use by either party, past disruptive behavior, and inadequate coping skills by one or both parties.  Childhood trauma both inflicted by and perpetrated by the parent is also a cause of abandonment.

Financial Abuse

Sadly, in many cases the fight over money takes center stage.  Money can be very stressful and figuring out what money goes where and to whom can often put elderly persons into dire straits.  Children and spouses are forced to decipher an algorithm of assets that they were never meant to understand.  What are the bank records? Who needs to be paid? Where does the money go?

Then you have the family members who misuse funds for their own gain.  If the elderly person has any type of memory issue, this is extremely concerning as they are no longer in control of their day-to-day bills.  Money could be spent elsewhere, and they would never know and suddenly they don’t have enough money left for basic care.  Financial Abuse is almost always perpetuated by a child or spouse.

Although its never easy, planning for your future with a lawyer or accountant can help eliminate potential financial abuse in old age.

Neglect and Self-Neglect

Neglect is defined by the CDC as a failure to meet an older adult’s basic needs i.e., food, water, clothing, hygiene, and essential medical care. There is debate about the definition of Self Neglect but the NIH defines it as the ‘inability, due to physical or mental impairment or diminished capacity, to perform essential self-care.” Unfortunately, elder Self Neglect is a growing problem in the United States. 

Think about all the elderly people out there who don’t have family or don’t have family who is willing to help care for them. Perhaps family doesn’t have the ability to care for them or the mental capacity to find appropriate help.  As you can imagine, social isolation only contributes to the problem of self neglect so check in on your elderly loved ones if you can.  Neglect and Self Neglect are easy to slip into and hard to correct.

Conclusion

If you made it all the way to the conclusion, thanks, I know this is a very hard topic to discuss.  There are so many different types of abusive relationships and part of our mission at SAGE is to educate without judgement.  Some of you, like my friend, may be fighting for your loved one’s safety and security.  Others may be dealing with fractured and broken relationship with an elderly parent and reckoning with past abuses.  This article was simply intended to highlight elderly abuses in hopes of making a difference.

If you would like some more information or to volunteer, check out the American Society on Aging at https://www.asaging.org/

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Trauma, Stress and the Body

Today on the Sage Advice Podcast, my friend Rachael M Belliveau LMT (Moonstone Healing Arts and True Bleu Healing Arts of Richmond, Virginia) spoke to us about the effects of stress and trauma on the body.  As Rachel mentioned our body is broken up into the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS).  Both are part of the autonomic nervous system (ANS) which covers all the involuntary functions of the body.  The PNS restores the body to its calm state and prevents it from over exertion.  The SNS refers to how the body perceives and responds to a threat.

Trauma and the Body 

When we talk about abuse, we are not only talking about physical or sexual abuse, we are also talking about various forms of emotional and verbal abuse.  In any abusive relationship, the body has a response.  In physical abuse the wounds are easier to see and the fight or flight response is typically immediate.  With mental forms of abuse, however, there is a perceived threat, now or in the future, that can cause the same fight or flight response.  Let’s take a closer look into how our body responds to real or perceived threats.

What is Fight, Flight or Freeze?

As mentioned above, the Fight or Flight response is the body’s response to a dangerous situation.  Over the past decade or so researchers have added a third type of response, freeze.  The website Anxiety Canada, refers to Fight, Flight or Freeze as the F3 (kind of makes it sound like a superpower).  F3 has been instilled in humans since the beginning of time.  It is our biological defense system and is intended to keep us alive.   If you’re confused at all about F3, just remember back to when you have been afraid.  What did you do?  How do you handle haunted houses, for example?  Some people scream and flee, others may stay and fight.  Simply put, F3 is our brains mode of self preservation. 

What is Freeze?

The concept of fight or flight was presented in the 1920s after research studies into anxiety and the brain were conducted.   More recently scientists have added the freeze response.  As is explained in the Journal of Behavior Therapy and Experimental Psychiatry (ncbi.nlm.gov/pmc/articles/PMC2489204) :

            “freezing—or tonic immobility—may overwhelm other competing action tendencies…Similar to the flight/fight responses, a freeze response is believed to have adapted value.  In the context of predatory attack, some animals will freeze or “play dead.”

The article goes on to describe the loss of motor function, as well as vocal abilities.  It is also somewhat perplexing to compare oneself to a dead animal but in the end, we are all animals, and our responses are often biological in nature. While the freezing response has garnered far less attention than its counterparts fight and flight, there is one area in which freezing has received much attention, cases PTSD and Rape.

            “One exception is the PTSD/rape literature wherein several studies have described rape induced paralysis that appears to share many of the features of tonic immobility (Galliano, Noble, Travis & Puechl, 1993; Mezey & Taylor, 1998; Scaer, 2001; Suarez & Gallup, 1977).  This literature suggests that a relatively high percentage of rape victims feel paralyzed and unable to act despite no loss of consciousness during the assault (Burgess & Holmstrom, 1976; Heidt, Marx & Forsyth, 2005).  Since fear, predation, contact and restraint are common in both rape and the induction of tonic immobility in animals, it has been concluded that these phenomena are essentially isomorphic (Suarez & Gallup, 1979).”

Stress, Anxiety and the F3

What happens if our F3 survival instinct is triggered but there is no present threat or danger to our physical body?  As we learn more about anxiety from a scientific perspective it becomes clearer that anxiety can cause are body to enter its F3 mode when there is little to no physical threat of danger.  Being in a physically abusive relationship puts you in very real danger, there is no argument there, but verbal abuse or stalking cases can cause immense levels of anxiety and have been known to trigger the F3 response inside the body.

When I say inside the body, I mean that sometimes our muscles and/or our musculoskeletal parts can feel the effects of stress and anxiety before our conscious thoughts get there.  Our muscles can hold trauma and memories, just like our minds.  Think about a time where you have been in constant and sustained stress.  Did your muscles stiffen up?  Did you suddenly develop tension headaches or migraines?  These can be signs that your body is holding on to something your brain is not ready to deal with yet.

Dealing with emotional, verbal, physical or sexual abuse is extremely stressful and taxing on the mind, body and soul.  It is important to listen to all three components.  Of course, no one can live completely stress free but often we neglect what our soul or common sense tells us.  It can be easy to turn a blind eye but when the pain becomes physical, it is hard to ignore.

What happens to the body?

When you are in an abusive relationship the chronic tension begins to affect you physically.  You might have constant shoulder pain where you never had it before.  You may be carrying stress in your feet when they have never bothered you.  The barrage of insults and attacks wear on your body as much as they wear on your soul.

According to the Cleveland Clinic when your body enters the F3 mode, or stress response, the following can happen:

  • Your heart rate and blood pressure increase
  • You are pale or have flushed skin
  • Blunt pain response is compromised (aka pain is delayed)
  • Diluted pupils
  • You are on edge
  • Memories can be affected
  • You are tense and trembling
  • Your bladder might be affected

Do you remember the last time you were cut off in traffic and had to slam on the brakes?  Do you remember the instant panic and frustration you felt?  That is exactly what it feels like to start fight, flight or freeze.

Can you imagine having that same feeling for days, months or even years?  Intense isn’t it.  That is what a lot of abuse survivors feel both when they are in the relationship and when they are trying to leave

How Can I Help Myself?

  1. Time: Did you ever notice that once you were finally done with a stressful project you got sick? My body experienced what I called the ‘rubber band effect’ after leaving my abusive relationship. My body was so happy to release all that pent up cortisol and serotonin that I ended up feeling sore and sick to my stomach for days. Once you remove yourself from the stressful situation, it still takes time for your mind and body to build back up.  The more removed from your relationship you are, the less chronic stress your body will have to endure.
  2. Exercise: For some people exercise is their lifeline.  Running can be therapy and moving your muscles is always a good boost for mental health.  To be honest though, for me exercise was an additional stressor.  I decided not to put more pressure on myself to be in the gym and that made me feel better.  After a few months I took up a hot yoga and it was perfect for my mind body and soul.  Remember whatever you decide to do, that’s ok.
  3. Talking: Whether you talk with friends and family, a SAGE mentor, participate in a group and/or find a specialized therapist, talking about your feelings to an understanding ear can help ease stress. Plus, you learn better coping skills and have supportive people around. 
  4. Massage: Massage can be beneficial for the mind, body and soul.  If you haven’t listened to the podcast with Rachael, you can find it here.  There are so many different types of massage and energy work that can help you relax and work muscles.
  5. Meditation: Guided meditation helped me get reacquainted with my inner self, that’s why I run the guided meditation class. It was essential to helping me learn what I needed and where to focus my healing.  Frankly, it helped me find myself again. At the very least, taking a quiet moment in a comforting place can be all you need to reset and refocus.   

Whichever way you find healing just remember these two things; that the fastest healer doesn’t win and what works for one person may not work for you.  Healing takes time, energy and effort but someday you will find yourself again only this time you will be a stronger, wiser and happier you.   

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Tips for Dealing with Law Enforcement and Emergency Situations

Please note, SAGE is NOT an emergency service.  If you are in immediate danger, call 911.  Also, go to our resources tab to find links to local and national emergency services.

Although SAGE is designed for those who are out of danger and ready to focus on their own healing, we do recognize that people will come to us for direction.  For that reason, with the help of local law enforcement services, we have compiled some tips for you in emergency situation:

Call 911 if…

you feel you are in physical danger or if someone has assaulted you, please call the police.  NOW!

If your partners behavior scares you…

Ask a trained professional.  Whether the alleged behavior is criminal or just frightening, you can contact your local police department or victim’s advocacy group to help you.  They will aid you in processing the behavior and help you determine the best path forward.  If stalking is your concern, please check out the stalking article posted on sage. community

Victims Advocate Groups are…

nonprofit organizations staffed with professionals and volunteers who are trained to support victims of crime.  They generally offer emotional support, counseling services, legal services, and guidance on how to navigate the court system. The police department can book you with a victim advocate, but you can also search your local community groups and reach out on your own.  They are always friendly, ready to help and full of great information

Ask for a Domestic Violence Officer

Each police department is different, and some departments have specialized officers just for domestic violence.  It doesn’t hurt to ask for a specialized officer to help with your case.  Their training and level of understanding will be invaluable.  If your police department does not have specialized officers, don’t fret, there are many qualified detectives outside of special victims.  Your victims advocate will be able to help you with this as well

Tell a Friend

I get it, you’ve been keeping this a secret for quite some time.  Its normal to want to do this alone and continue to hide the truth.  BUT don’t be afraid to tell someone.  More than likely friends and family will want to help you with moral support, and you are going to need it.  If you don’t have a friend you can trust, your victims advocate can provide emotional support as well. 

Are you seeing a theme here of how important victims’ advocates are?

Tell Everything

When you are speaking with police and giving your testimony, there is no detail too small.  To help you, the police need to know everything.  Its hard to say out loud, but you can do it. 

How do I get a Restraining Order/Protective Order?

This is a very complex question.  Do not expect this process to be simple.  Each jurisdiction is different but in Virginia, this is a general overview of the path to a Permanent Protective Order:

  • Depending on the severity of the incident, a police officer (or you) can go to the Magistrate to request an emergency (typically 72 hour) order.  Be prepared to be sworn in under oath and recount why you are in fear for your safety.  The magistrate evaluates your testimony and will issue an emergency protective order.  Once the offender is served, the order is valid.
  • Before the emergency order expires, you need to obtain a temporary protective order.  You may have to go in front of a judge, but your local rules and regulations will take precedence.
  • Next before your emergency order expires, you’ll need a Permanent Protective Order.  First, it’s not permanent.  Someone can correct me if I’m wrong, but I don’t know of any state that has a lifetime protective order.  In Virginia, the most you can get is 2 years and you must go in front of a judge with new evidence to renew it.   The offender usually has the right to appear in court and testify on their own behalf.  This will be entirely dependent on the circumstances of your case and whether it is criminal or civil in nature. 

Do I need evidence?  Will they think I am lying?

A judge once said to me, “You are the evidence.  You are sworn in, under oath and give your testimony about the events that transpired.”  The offender gets that same opportunity.  It is then up to a judge to decide the truth and it is their job to determine whether a ‘reasonable person’ would fear for their safety.  Most domestic violence cases do not have physical evidence or outside witnesses.  If all you have is your honesty, that is good enough.  The justice system isn’t always fair, but don’t let that deter you from trying to seek justice.

Do I need a Lawyer?

Again, the Victims Advocate office can advise you based on the locality you live in and the specifics of the incident.  Lawyers for victims in these cases can be difficult to find, so keep that in mind.  Personally, I didn’t need a lawyer for my court appearances but do your own research and ask the advocate office for guidance.

Research. Research. Research.

Know your rights.  Knowledge is power so remain strong and learn everything you can.  Head to the resources tab and get started.

Lastly, I wanted to shine a light on a very important question: What if I want to drop the charges?

It happens.  You love your offender and don’t want to see them in jail or punished so you change your mind.  In some areas that may be possible, but each jurisdiction is different.  Some counties have a ‘no drop’ rule in place that ensures the perpetrator is investigated regardless of the victims wishes.  Before you drop charges, remember, you are worth justice.  It’s not your fault.  There were days when I was completely done with going to court, but I couldn’t stop thinking of the next girl.  If I stopped pushing, there would be no record of what transpired, and it would all be for nothing.  How could I put the next girl through this if I could make a difference now?

We have a lot more Law and Order information yet to come on The Sage Advice Podcast. Send any questions for Detective Meg to hello@sage.community and we will try to answer them in an upcoming episode.

Stay Safe. Stay Strong. Know the whole SAGE Community is behind you.

PODCAST

Listen to recent episodes of The SAGE Advice.

NEED HELP NOW?

1.800.799.SAFE | www.thehotline.org

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NEED OTHER HELP?

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