Mary Shaw, PhD, ARNP, CS, associate director of The Geriatric, Research, Education and Clinical Center at the Gainesville Veterans Affairs Medical Center in Florida, once assisted in an investigation involving a 62-year-old man whose health declined dramatically soon after being admitted to an assisted living facility. Dr. Shaw
explains, "When he
was admitted, the man could walk, talk, feed himself, dress himself, and knew himself and his
wife.But within 3 months, he
weighed 86 pounds and was hospitalized with contractures, pressure ulcers, bruises and lacerations.He
died a week later."
Thanks to the efforts of Dr. Shaw
and an investigator from the state, the institution was closed 18 months after the patient's death.The facility owner, convicted of felony manslaughter and abuse and neglect of an elder, received a 15-year prison term for the crime.
Why Aides, Caregivers Abuse In a telephone survey of nursing home aides and nurses published in The Gerontologist about a decade ago (Pillemer K, Moore DW.Abuse of patients in nursing homes: findings from a survey of staff.1989; 29(3):314-320), 10% admitted they had physically abused patients.
According to Dr. Shaw
, institutional abusers are of two basic types: the pathological abuser and the reactive abuser.Pathologic abusers often have histories of violence and arrests and have difficulty holding jobs."These are sick, pathological people who should never be working in an institution, or with elderly people at all," says Dr. Shaw
."One person I heard about would wake up a patient every day by punching his
ribcage, and another stuffed washcloths down patients' throats to keep them quiet."
More common are reactive abusers, emotionally and physically exhausted people who abuse when pushed passed their already low tolerance levels.Poor wages, lack of recognition and heavy workloads typically plague the majority of nursing home aides, who provide 80% to 90% of patient care, Dr. Shaw points out.And many have home situations that present additional pressures.The combination of stressors can produce sparks of abuse when conflict becomes too strong.
"I believe a lot of elder abuse occurs that we just don't know about," Dr. Shaw
says."It's not reported, not detected and sometimes not even recognized as elder abuse--particularly the emotional and verbal abuse."
To help end institutional abuse, Dr. Shaw
suggests adding staff and allowing employees to better pace their work-and to take breaks to reduce stress.In domestic situations, the potential for abuse decreases when more than one person is involved in caregiving.Multiple caregivers can provide social support, help monitor one another for inappropriate conduct, and reduce a senior's dependence on one person, making the victim less fearful to speak out if abuse does occur.
Finally, health care providers need to monitor and assess patients for potential abuse, as well as muster the courage to take action when necessary.