Elder Abuse and Dementia

Elder abuse is on the rise and the main predictor is the increasing number of older adults.  With the global population of older people (aged 60 and above) predicted to triple from 672 million in 2005 to almost 1.9 billion in 2050, it is expected that there will be a similar increase in incidence of abuse.

Cultural differences in attitudes towards older people and what people consider abuse make international comparisons problematic. With this caveat, international estimates of elder abuse in community settings from Canada, Finland, the Netherlands, the United Kingdom and the United States range from 4–6%. Globally we are anticipating that by 2050 there will be over 114 million older adults to have been abused.

As of 2010, there are an estimated 35.6 million people with dementia worldwide. This number will nearly double every 20 years, to an estimated 65.7 million in 2030, and 115.4 million in 2050.  Both elder abuse and dementia will form a part of our landscape.

There are many aspects of elder abuse. The landscape covers; prevention and legal prosecution; family dynamics and career con artists; health and economics; loneliness and vulnerability. Above all of these concerns—and an issue that cuts across all these issues—is the complication that dementia brings to elder abuse.

Dementia is a disease that slowly kills the brain. The term describes symptoms of memory and thinking that interferes with day-to-day activities. We still do not know the cause/s of dementia, and to this day, do not have any prevention or cure.

Dementia changes the dynamics of caregiving and care receiving. Although more than half of older adults with dementia live in the community, two out of three nursing home patients have dementia. Patients with dementia are more likely to end up in a nursing home or assisted living facility.

According to family members, one in four nursing home residents are likely to be abused. In some cases the patients themselves are the abusers—both resident-to-resident aggression as well aggression directed towards their caregivers.

For those that are still living in the community, caregiving becomes an added hardship. As the disease progresses, 15 to 75 percent of patients develop psychotic behaviors.  In addition, a third of patients will have delusion, in some cases resulting in aggressive behavior. Studies show that one in three caregivers reported that their patient become aggressive with them and as a result they were likely to physically retaliated.

The fact of having dementia increases the likelihood of abuse. But in some cases there is no abuse and the patient becomes uncertain of the facts. Did they misplace their wallet or did someone steal it? Distinguishing the facts is difficult especially when there is no one else involved in the caregiving. Even if there is obvious cause for concern—when there is physical abuse that is uncontestable—it is difficult to have the testimony of a person with dementia hold in a court of law.

We have very little information about the lives of people living with dementia who have also been abused—a testament of how weary district attorneys are to have their client evaluated especially since the defendant in the court case can subpoenas that information. Being judged as mentally incompetent diminishes their testimony in court.

But we cannot continue to deflect the issue that dementia affects everyone, and not just the patient. The only viable solution is more openness, education, and better information. In 2050 when we are projected to have over 114 million people who are abused and 115 million suffering from dementia, will we approach the problem as we are approaching it today?

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