The purpose of this article is to inform the reader about the subject of elder abuse. It tends to be an uncomfortable topic and yet most readers want to believe that they would never knowingly put their elders at risk for what could be defined as abuse.

Anyone can be effected by elder abuse. It is the mistreatment or neglect of an elderly person by their own hand or by a relative or caregiver.

There are four categories of abuse:

1. PHYSICAL ABUSE
   Hitting, slapping, kicking an elderly person. Keeping an elderly person restricted from freedom of movement or social interaction.
2. NEGLECT
   Failure to give the person adequate food, shelter, medical treatment or personal care.
3. MENTAL ABUSE
   Intimidating behavior, threats or verbal harassment directed at the elder.
4. FINANCIAL EXPLOITATION
   Money mismanagement or stealing property.

WHO ABUSES?
Often the abuser is a relative or someone living with the elder. The abuser might feel overwhelmed by personal problems. These problems might involve drug or alcohol abuse, a dependency on the elder for housing or financial aid or there can be family pressure that becomes, seemingly, out of control.

WHAT ARE THE KEY SIGNS OF ELDER ABUSE?
Physical: visible burns, head injuries, bruises, malnutrition.
Behavior: fear, withdrawal, depression and/or confusion.
Misuse of assets: unpaid bills when someone is responsible to pay them. Inappropriate clothing when the elder can afford appropriate clothes. Personal belongings missing.
Family Interaction: isolation by caregivers. Speaking for the elder. Angry attitude by caregiver toward the elder

WHAT CAN BE DONE?
Concerned individuals can visit and talk to the elderly. They can be concerned about the elder's well being. Trust yourself. If you suspect that an elderly person is being abused or neglected, call in a professional to help. Don't try to handle the situation alone.

If you are wondering if neglect is occurring, consider the personality style and medical condition of the individual. Consider the personality style of the family they rely on. Do family members have a hard time talking about conflict? Does talking about illness or a lowered capacity for thinking and acting bring up conflict for these people? Might they believe that if one does nothing about conflict it goes away? Is death a secret in this family? Denial does not make death go away.

Is there a caregiver for the person? Has the caregiver willingly chosen to do that job or has that person been drafted? These kinds of issues can cause conflict. A professional may need to be asked in to help the family identify the problem and make decisions about what to do that is in the best interest of the elder.

Medical doctors and mental health professionals can help with a medical evaluation and a psychiatric evaluation. Treatment with a professional includes a beginning assessment for depression, to rule out medical/physical causes of depression. An assessment can be done for drug/substance use, which can be the cause of mood disorder symptoms. If you recognize any of the following symptoms of depression, obtain a psychiatric evaluation.

DEPRESSION CHECKLIST

• Loss of interest in things once liked.
• Feeling worthless, guilty, sad or blue.
• Change up or down in appetite or weight.
• Difficulty with memory, concentration or decision-making abilities.
• Less energy or tired all the time, feeling unable to sit still.
• Trouble sleeping or sleeping too much.
• Irritable, hostile or anxious.
• Headaches, unexplained aches and pains.
• Excessive crying or rapid mood swings.
• Thoughts of death or suicide.

Dr. Beirich is a psychotherapist in practice in Pasadena. She is a member of the Independent Psychotherapy Network.

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