Wednesday, January 18, 2012

Conceptual Solution to Elder Abuse


Nothing makes it faster into the newspapers then a sensational story of physical or sexual abuse of a vulnerable person. We find such atrocities repugnant. Each incident diminishes our expectations of ourselves as civilized—we become less human. 

What distinguishes elder abuse from any other type of abuse is that—sadly—it is all too predictable. We can predict with some level of accurately who is prone to elder abuse in terms of both becoming a victim, and becoming abusive. Unlike any other type of abuse, elder abuse is predictable.

The few statistics that we have show that those who become abused are more likely to be isolated female with some form of vulnerability, whether that is physical or mental. Also, an abused older adult suffering from dementia makes it less easy to prosecute. By the time the case makes it through the ponderous legal system there is a likely chance that cognitive impairment has become more pronounced. People who experience violence tend to suffer dementia earlier, faster.

On the other hand, those who abuse are more likely to be male family members, most often the victim’s adult child or spouse. The familial relationship makes it that much harder to report. Research has shown that the abusers in many instances are financially dependent on the elder’s resources and have alcohol and drugs problems. A study by Arnold S. Brown from Northern Arizona University, showed that a large number of people who commit elder abuse have themselves been abused as children. Abuse is a learned behavior.  

How we deal with abuse as a society is unfortunately outdated. The response grew from treating elder abuse like child abuse.  The current system of prosecuting cases in court is untenable. There is also a dark side of how law is used. In terms of financial abuse, there is growing anecdotal evidence suggesting that older adults are being denied access to their bank funds because of concerns that they are withdrawing too much money. There is a fine line between protecting the older adults and treating them as children. 

Even if there is financial abuse and the case—as an exception—makes it to court, in virtually all cases little of the stolen money is recovered.  In cases of physical abuse the ponderous slowness of the legal profession that does not protect the victim from escalation and in some cases fatality. But the overwhelming concern is the demographic revolution that will overwhelm the system purely on the number of frail older adults that are emerging.

The solution is therefore to prevent abuse from happening. Being predictable helps us to prevent it. Canadians are ahead of us here. They developed an effective “buddy system” where volunteers befriend vulnerable older adults. In order to not loose our humanity we need to be more social. Perhaps the reason we feel less civilized is because we have become less civilized, we have lost our social capital.  An excellent summary of such a program is to be found at the University of California at Irvine website, www.centeronelderabuse.org.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com


Sunday, January 15, 2012

The Age of Psychology

Human populations across the world are changing. They are becoming older, both in terms of the number of older adults and in terms of how many older adults there are to the younger population. Such changes have an effect on numerous issues such as funding and provision of housing, transportation, income and health.

Health is perhaps that most important of these changes because it affects us personally, is usually irreversible, and affects all the other issues directly. With an aging population, pattern of diseases have changed.  Throughout our life, most have experienced a death of a close acquaintance due to an infection or an accident. We all remember some great epidemics that have hit the Unites States.  Killing 500,000 people, the 1918 outbreak of Spanish influenza was the worst single U.S. epidemic. This was followed in 1949 by the polio epidemic when 42,173 cases were reported with 2,720 deaths.  More recently, another polio epidemic three years later in 1952 that killed 3,300 with 57,628 cases reported.

We are going through another epidemic now. An epidemic that was discovered in 1981 with AIDS, with a total estimated 988,376 U.S. AIDS cases with 550,394 deaths. The most recent epidemic was the 2009 H1N1 epidemic known as Swine Flu, affected more than 70 countries with 22 million Americans contracting the virus, and when about 3,900 Americans died.

Such seemingly catastrophic and unnecessary deaths pail in comparison to deaths from chronic diseases which are becoming more and more common because of an aging population. Chronic diseases--such as heart disease, stroke, cancer, diabetes, and arthritis--are among the most common, costly, and preventable of all health problems in the U.S.  Seven out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year.
And chronic diseases not only cause death they diminish the quality of life. In 2005, 133 million Americans--almost half of all adults--had at least one chronic illness.  Arthritis is the most common cause of disability, with nearly 19 million Americans reporting activity limitations. Diabetes continues to be the leading cause of kidney failure, non-accident lower-extremity amputations, and blindness among adults.

Out of this changing situation, the fastest growing cause of death in America is however due to dementia. Unlike heart disease and cancer death rates--which are continuing to decline--deaths from Alzheimer’s disease are on the rise. Alzheimer’s disease is the 5th leading cause of death for adults aged 65 years and older. Driven by the sheer numbers of older adults, an estimated 5.4 million Americans have Alzheimer’s disease. This number has doubled since 1980, and is expected to be as high as 16 million by 2050. Julie Bynum, from the Dartmouth Institute Center for Health Policy Research estimated that Medicare and Medicaid spending for individuals with Alzheimer’s disease in 2011 is $130 billion.

While clinical intervention have proved inconsequential in reversing this trend, psychology, and the science of neurology will become more significant disciplines in addressing this new age.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com