Calming The Storm Of Caregiver Stress To Prevent Elder Abuse

Content/Trigger Warning: Please be advised, the below article might mention trauma-related topics that may be triggering to sensitive individuals.

If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available 24/7 for support. Call 1-800-799-SAFE (7233) or text "START" to 88788. You can also use the online chat. 

According to the United Nations, the population of people aged 60 years are older is approaching one billion people, comprising around 13% of the global population. The world's rapidly aging population is projected to comprise one-quarter of its population by 2050 in nearly all regions except Africa. On top of these growing numbers is the predominant desire of elders to stay at home as they near the end of life, necessitating a demand for home-based care and caregivers. 

The American Association of Retired Persons (AARP) reports that 77% of adults aged 50 and older prefer to age in place in the homes they love rather than move to an assisted living or nursing home. As a result, family members may step up to care for these older adults or hire in-home caregivers to allow them to stay home.  

Due to the demand, low pay rates, and the potential stress of caregiving, caregivers may be at an increased risk of burnout, also called compassion fatigue. This symptom may put seniors at risk of maltreatment by their caregivers. Understanding the different types of elder abuse may help you recognize when it is occurring and how to take steps to protect older adults in your family or community. 

What Are The Different Types Of Elder Abuse? 

Physical Abuse

Physical abuse can include hitting, kicking, shoving, punching, pinching, or otherwise causing physical pain to an older adult. Tying someone to a wheelchair or bed, locking them in a room for an extended period, or intentionally mismanaging medications is also considered physical abuse.

Verbal, Psychological, Or Emotional Abuse

Verbal, psychological, and emotional abuse includes yelling, threatening, taunting, name-calling, using profanity, and ridiculing or talking down to the senior. Intentionally ignoring this individual and trying to micromanage and control them can also be examples of abuse.

Sexual Abuse

Sexual abuse means forcing sexual contact with another person, including rape. Sexual abuse can include forcing an elder to take their clothing off, watching pornography with them without their consent, or initiating unwanted sexual contact. In addition, some elders cannot consent to sex, such as those with impaired mental capacity. 

If you are experiencing sexual abuse or have experienced assault, note that the Rape, Abuse, and Incest National Network (RAINN) has a hotline dedicated to supporting individuals experiencing sexual assault, harassment, or intimate partner violence. You can contact them anytime by calling 800-656-HOPE (4673) or using the online chat.

Financial Abuse 

Financial abuse occurs when caregivers steal an older adult's money, property, bank accounts, or charge cards without permission. Unethical caregivers who forge an elder's signature or overcharge for home repair or medical services are guilty of financial abuse. Elders can be vulnerable as their cognitive abilities decline. Seniors with deteriorating health might not know their caregivers are dishonest or changing their legal documents like wills and powers of attorney without their consent.

Signs Of Elder Abuse

According to the National Council on Aging, elderly abuse statistics reveal that one in 14 elder abuse incidents are reported. Detection can be challenging because the effects of illness in the aging population may make it more difficult to know if changes are due to Alzheimer's, dementia, the effects of aging, or abuse. Below are the signs of different types of elder abuse. 

Physical Abuse

When tending to a senior's personal care needs, note any unusual or unexplained burns, cuts, bruises, or bleeding. You can also track any sprained or broken bones if you notice that injuries occur repeatedly. If the individual fears seeing a specific doctor or caregiver, it may be a sign of elder abuse and neglect.

Psychological Abuse

Psychological abuse is a type of elder abuse and neglect that often goes unnoticed. Look for signs that the individual is scared or withdrawn. People who experience elder abuse and neglect may try to self-soothe by rocking back and forth, sucking on items, or mumbling to themselves. An elder who often seems depressed, confused, or anxious may have experienced a traumatic event like abuse. 

Sexual Abuse

Senior caregiving is often personal in nature. It can require trust between the elder and the caregiver, which develops over time. Because senior caregivers spend time alone with elders, there is a risk of sexual abuse. Those caring for elders can look for torn or bloody clothing, including underwear. Any bleeding from the anus, vagina, or penis that cannot be medically explained is a cause for concern.

Bruises on both sides of the body or around the breasts and genitals could also be signs of sexual abuse. If a senior has sudden itching or discharge, you might ask the elder's physician to test for sexually transmitted diseases, which could indicate the presence of elder abuse.

Financial Abuse

Financial abuse may go undetected. A defense against financial abuse is accountability. Having more than one person manage and oversee expenses and allocations may protect the wealth and estates of aging seniors. 

Aging In Place And Family Caregiving

Staying in your home as you get older is called "aging in place." Some seniors want to live out their older years surrounded by their neighbors, friends, and communities, remaining as independent as possible for as long as possible. Cost can be another factor that solidifies a senior's choice to remain in their homes. Many seniors have little or no mortgage, so even when they need in-home healthcare assistance, their limited incomes make staying home more affordable than moving to a senior care facility.

However, staying home as a person ages comes with certain risks, including safety, ease of mobility, and accomplishing daily tasks. As an aging person's health declines, they may require additional help, such as a caregiver that can assist them either part-time or round the clock. While caregivers may provide excellent care for the people dependent upon them for services, some might choose to mistreat older people through abusive actions. Research has found that caregivers experiencing burnout may be more likely to abuse elders.  

What Are The Caregiving Stressors That Lead To Burnout?

In the 21st century, the number of aging people in need of care is increasing due to advances in healthcare and the generation known as "baby boomers" reaching retirement age. For some baby boomers, adult children may honor their wishes to let them age in place, taking on the role of caregiver. While caring for their elderly parents, they may also be working full-time, caring for their own families, and managing their own households. 

Caregiver burnout can be common in those who routinely offer support to another person. It can be characterized by mental, physical, and emotional exhaustion that might lead to a loss of compassion and empathy. Burnout often occurs when caregiving falls on only one person, limited by financial or physical resources. Below are a few causes of this burnout. 

A Lack Of Self-Care 

A potential cause of burnout is when caregivers do not take the time to care for themselves, leading to exhaustion and poor mental health. Other factors that may cause burnout include:

• A lack of control over resources 

• A lack of trained caregiving skills and coping strategies

• Unrealistic expectations

• Unreasonable demands 

Additionally, a caregiver may not know they are experiencing burnout and might not recognize the benefit of an external support system like therapy or caregiver support. 

A Change In Spousal Duties 

In some cases, a senior in need of care is cared for by their spouse. It might be assumed that a spousal caregiver poses less risk for harm than an adult child as a caregiver. However, this interpretation is often not true. After a spouse's medical crisis, the other spouse may be required to manage finances, the home, and work, often for the first time. Spouses may find that caring for their partner requires more hours than a full-time job, putting their safety and well-being at risk.

Past Tumultuous Relationships 

Past relationships may also be a factor in connecting caregiver stress with maltreatment. Some adult children may cave to their parents' or siblings' unreasonable caregiving demands. Adult children who need to move in with aging parents to care for them may feel resentful or guilty if family relations were stressful or non-existent before formal caregiving began.

Spouses who were unhappy or harmed during the marriage may use the season of spousal caregiving as a time for vengeance toward a fragile, helpless spouse. These challenges, paired together, can lead to elder abuse. However, regardless of how a relationship may have been in the past, abuse of an elder is never okay. 

Signs Of Caregiver Burnout That May Lead To Elder Abuse

When put in a position that can lead to a state of exhaustion, some people might feel more capable of inappropriate or harmful behavior. Senior caregiving is physically, emotionally, and mentally draining for some, especially when long-term. Senior caregivers report the following symptoms of eldercare burnout:

• Depression

• A negative attitude

• A weakened immune system

• A lack of enjoyment of previously enjoyed activities 

• Constant fatigue

• Hopelessness

• Isolation, including withdrawal from friends and society

• Sleeplessness

• Inconsistent eating habits

• Anger toward the senior

Caregivers who feel burned out may unintentionally make poor decisions. For example, they may seek escapist behaviors, which can lead to substance use to cope with stress. Because of the demanding nature of senior caregiving, it can be crucial for senior caregivers to get support and practice regular self-care. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

How To Find Support While Aging In Place 

Home care technology may be a welcomed support resource in the senior caregiving space. Elders and caregivers often utilize helpful senior care devices and systems to reduce burnout. In addition to technology, support entities can accommodate both the caregiver and the elder receiving care. 

Since some elders have difficulty with mobility and lack transportation options, online counseling through a platform like BetterHelp could be a beneficial solution to isolation, depression, anxiety, and other needs. Online counseling connects elders to a personal therapist who can offer them assistance in their homes, where they are comfortable and relaxed. In addition, scheduling may be more flexible, and the appointments may be more cost-effective, reducing barriers to care for older individuals. 

A study published in the journal Aging and Society reported that older clients who receive online mental health therapy show the same improvement in well-being as younger people. The study consisted of 277 British patients over the age of 65 who were experiencing depression and anxiety. Over two and a half years, 65% of the older clients with anxiety and depression reported clinical improvement, with 49% experiencing symptom remission altogether.