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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Selfishness vs. Narcissism: How Can I Tell the Difference?

You hear the word “narcissist” a lot these days in contexts like this:

  • My husband didn’t check on the baby like he said he would, he is such a narcissist!
  •  My girlfriend is a total narcissist. She’s always posting selfies on Instagram or making TikTok videos. It’s so frustrating.
  • I couldn’t get a word in edgewise during that conversation with my father in law. His narcissism never ceases to amaze me.

It’s true, narcissism is on the rise in the United States and in other western countries but it’s also true that not every selfish person is a narcissist.  I’d argue that we’re using the term narcissist too casually and that can be dangerous. Dealing with a true narcissist is an incredibly toxic, negative and damaging experience.

We talk about narcissism a lot at SAGE because many abusers are narcissists. (And, interestingly, many of the people they abuse are empaths. To learn more about empathic personalities, read this SAGE article) So what is the difference between selfishness and true narcissism?

Selfishness Defined

Being selfish is a part of being narcissistic, but only a small part. Selfishness is defined as being excessively or exclusively concerned about yourself rather than considering the needs and wants of others. Being selfish is part of being human. It’s not hard to think of examples of our own selfishness. Maybe you didn’t listen to a friend’s story about her tough day because you were too focused on your own drama.  Perhaps you are so focused on your own professional success that you fail to celebrate the successes of your teammates. Normal people, when they catch themselves being selfish, apologize for their behavior and try to do better next time.  

Narcissism Defined

You may be familiar with the Greek myth of Narcissus, the boy who was so obsessed with his image in a mirror that he couldn’t look away. Sounds a lot like social media addiction, doesn’t it? But there is a big difference between vanity and Narcissistic Personality Disorder (NPD).  

The Mayo Clinic defines NPD as, “a mental condition in which people have an inflated sense of their own importance, a deep need for excessive attention and admiration, troubled relationships, and a lack of empathy for others.” 

There is some debate in the medical community regarding whether people with personality disorders, including NPD, respond to talk therapy treatment.  Unfortunately talk therapy is also the only form of treatment most experts recommend. Some narcissists self-treat with alcohol, drugs or other destructive behaviors. It’s that self-treatment that sometimes lands them in a therapist’s office. 

As someone who survived an abusive relationship with a narcissist, I am highly skeptical that people with NPD can change or be cured. I also believe that the sooner you understand that, the faster you can learn how — and whether or not — you’re going to continue to invest in that relationship.

How to Recognize Narcissism

How can you tell if it’s selfishness or narcissism? According to the Mayo Clinic, narcissists often: 

  • Have an exaggerated sense of self-importance
  • Have a sense of entitlement and require constant, excessive admiration
  • Expect to be recognized as superior even without achievements that warrant it
  • Exaggerate achievements and talents
  • Be preoccupied with fantasies about success, power, brilliance, beauty or the perfect mate
  • Believe they are superior and can only associate with equally special people
  • Monopolize conversations and belittle or look down on people they perceive as inferior
  • Expect special favors and unquestioning compliance with their expectations
  • Take advantage of others to get what they want
  • Have an inability or unwillingness to recognize the needs and feelings of others
  • Be envious of others and believe others envy them
  • Behave in an arrogant or haughty manner, coming across as conceited, boastful and pretentious
  • Insist on having the best of everything — for instance, the best car or office

If you’ve made it this far, chances are that you suspect that someone in your life is a narcissist or has narcissistic personality disorder. It is important to remember that NPD, like any other personality disorder, is a spectrum. There exists a wide range in severity of  “symptoms” including communication, reactivity, malice, anger and frustration. Narcissists may not exhibit every tendency on the above list, but I trust you to judge to what degree the narcissist in your life is negatively impacting themselves and those around them.  

Diagnosing NPD

NPD is extremely difficult to diagnose. Narcissists are often very intelligent, manipulative and excellent at lying. They crave attention so they’ve learned to present exactly what their audience wants to see. Even if you manage to get them to go to a therapist (which won’t be easy), they may manage to fool even the most well educated psychiatric professional. Remember, just because your narcissist doesn’t have a diagnosis, doesn’t mean they don’t have this disorder.  

The Irony of Narcissism

Think back to the definition of narcissism from the Mayo Clinic. So far, I’ve only shared the first half, which focused on the narcissist’s inflated sense of self. Here’s what the Mayo Clinic explains: “Behind this mask of extreme confidence lies a fragile self-esteem that’s vulnerable to the slightest criticism.”

While a narcissist may at first appear to be successful and confident, to “have it all together,” within a very short amount of time that façade will start to crumble. They are desperately trying to hide their shortcomings, which often involves them lashing out at you and destroying your self-esteem and self-worth to elevate their own. This is dangerous behavior — don’t take it lightly. 

The Mayo Clinic offers these examples of how a narcissist reacts to criticism or injuries to their self esteem:

  • Become impatient or angry when they don’t receive special treatment
  • Have significant interpersonal problems and easily feel slighted
  • React with rage or contempt and try to belittle the other person to make themselves appear superior
  • Have difficulty regulating emotions and behavior
  • Experience major problems dealing with stress and adapting to change
  • Feel depressed and moody because they fall short of perfection
  • Have secret feelings of insecurity, shame, vulnerability and humiliation

My Experience With a Narcissist

Earlier I said that I don’t believe a narcissist can or will change.  Please know that this does not come from a place of negativity, but from my own experience.  I saw the good in the person I loved. I forgave the bad behavior and brushed off the hurtful words and insults. I believed him when he said he recognized his anger and would change but he never did. Somehow everything was my fault: if I only believed him more; if only I were a more supportive partner; if only I bought him expensive gifts; if only I forgot all the bad things he said to me. If I did all that he wouldn’t have to talk to me aggressively. He wouldn’t get so angry. 

Now I know that it is very hard for a narcissist to truly, deeply and honestly take responsibility for their actions and behavior the way we can. You must understand this.  They will never accept responsibility the way a healthy person would. That may sound harsh, but before you can affect real change, you have to accept that.

Next Steps

Only you know what to do with this knowledge. Only you know the intricacies of your situation. I needed time and encouragement to finally say, “Enough is enough.”  Your experience may be completely different or eerily similar.  You may think you can fix this but don’t focus on fixing the narcissist, focus on doing what’s best for you. What will make you happy? Lead with that and the rest will follow.

Want to hear my story? Listen to The SAGE Advice podcast — episode 1. 

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Our Five Favorite Books

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I didn’t read many self-help books while I was in my abusive relationship because my boyfriend would have gotten suspicious and angry. He didn’t even like it when I wrote in my journal. The only one of these titles that I read while I was with him was Your Sacred Self, because it focused on meditation. I can’t recommend the book or the practice highly enough. 

I discovered authors Wayne Dyer and Gabby Bernstein on Oprah’s Super Soul Conversation podcast, which I also recommend.  Emotional Blackmail and Should I Stay or Should I Go helped me process the verbal abuse I suffered. And, finally, I read Blue Mind because I’ve always felt calmer around water and I wanted to strengthen that mind-body connection. 

Emotional Blackmail: When The People In Your Life Use Fear, Obligation, And Guilt To Manipulate You
This book is a MUST for dealing with master manipulators.  The author Susan Forward PHD provides real world examples of emotional manipulation.  Everyone uses manipulation to get what they want, it’s human nature.  But at what point does that manipulation go too far?  Find out by reading Emotional Blackmail.
Should I Stay or Should I Go: Surviving a Relationship with a Narcissist
Ever wonder if you’re dealing with a narcissist?  In the very first chapter author Dr Ramani Durvasula PHD gives us a checklist to work from.  She then dives into the patterns and behaviors of those displaying narcissistic tendencies.  Can they really change?  See what Dr Durvasula thinks and then draw your own conclusions.
Blue Mind: The Surprising Science That Shows How Being Near, In, On, or Under Water Can Make You Happier, Healthier, More Connected and Better at What You Do
Water has been healing people for centuries.  Even prior to the modern age, the ancient egyptians heavily documented the soul cleaning and healing properties of water.  Do you ever just feel better sitting by the ocean? Well, there may be a science behind that. Explore more with Blue Mind.
The Universe Has Your Back: Transform Fear to Faith
If you’re not familiar with Gabby Bernstein, get familiar.  She is a master manifester and helps you open you soul to what you need.  The Universe Had Your Back is a great introductory book to manifestation or attracting what you want into your life.  Our biggest problem is fear we wont get everything we as for.  To find out more about how fear is holding you back, check out this book.
Your Sacred Self: Making the Decision to Be Free
An oldie but a goodie.  Dr Wayne Dyer began writing about spirituality in the 80s when no one really knew what it was.  This book is great for learning to get in touch with your highest self through meditation. 

Do you have a book to recommend to the SAGE Community?

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