Is it Elder Abuse?

By Hilary Wright

Abuse isn’t happening just to toddlers and young children, but is becoming more common among the senior citizens in this country. Unable to take care of themselves, they must rely on a professional or family caregiver to help them from day to day. If you have a loved one who must depend on care from someone other than yourself, you may want to know the tell-tale signs of the many forms of abuse that they may be afflicted with. 

Sometimes, an elder may report an incident of physical abuse; however, they often won’t, so you’ll need to look for other behavioral and emotional signs, like depression or withdrawal from family and friends, changes in behavior, i.e., mood swings or appearing frightened and teary eyed. Sometimes, the abusers themselves will give clues to possible abuse by their refusal to take the elder to the doctor when needed, by not allowing family and friends to see the abused person alone, by giving explanations which are found to be inconsistent with the abuse symptoms.  They may have bite marks and scratches themselves, from an elder fighting back.

Signs of physical abuse:

  • Cuts, lacerations, welt marks (a possible sign of using restraints)

  • Burn marks from cigarettes

  • Malnutrition or dehydration

  • Hair loss from someone grabbing/pulling hair

  • Sores on the body, open wounds

  • Weight gain or weight loss

  • Poor skin conditions

  • Unexplained injuries, such as fractures and breaks

  • Bruises, scratches, bite marks, finger prints

  • Frequent trips to the emergency room

  • Black eyes, broken fingernails

  • Over or under medicated

As much as people don’t want to think about it, sexual abuse does occur among the elderly. It’s considered sexual abuse when something happens either without their consent or when an elderly person is incapable of making such a decision on their own. Physical signs of sexual abuse may include:

  • Bruises around the breast or genital area

  • Cuts or lacerations around the breast or genital area

  • Clothes with blood stains or tear marks

  • Soreness around breast, genital, or anal areas

  • Difficulty with walking or sitting

Some older people may report sexual assault, while others may withdraw from family and friends, flinch at certain quick movements, or be frightened by the opposite gender. The abuser will usually have a story that will not match the physical or emotional evidence noted by family members, and they will generally not allow family or friends into the home or to be around the abused person alone.

Not all abuse can be seen with the naked eye. There’s also emotional and psychological abuse that occurs when a person is demeaning and dehumanizing to another person. Psychological and emotional abuse can also make someone withdraw into depression or even deny that anything bad is actually taking place. You may catch the abuser talking down to the person, calling them hurtful names, and begin to withdraw the elder from visiting with family and friends.

Behavioral signs of psychological abuse:

  • Continuously emotionally upset or disturbed

  • Nervous behavior and a repetition to their actions

  • Negative attitude

  • Agitation or anger

  • Rocking back and forth, sucking their thumb, or even biting (themselves or others)

Financial abuse occurs when a caregiver takes advantage of an elderly person financially, either through stealing money, lying about how much the elder needs for certain care, or cashing the elder’s checks without permission.

Signs of financial abuse:

  • Caregiver withholds money from the elder

  • Checks are cashed without permission of the elder

  • Personal belongings begin to disappear

  • Power of Attorney begins to be misused

  • Caregiver isn’t actually providing the services that are needed

  • Elders aren’t taken to the doctor when needed

  • You notice unusual items being charged on a credit card

  • You notice the elderly person requesting a transfer of assets or funds

  • There’s sudden and abrupt changes in a will

  • They are not aware of where all their money has gone

  • Suddenly, they are unable to pay their bills

  • They are unable to buy clothes, food, and other necessities

  • You notice withdrawals of a lot of money at the same time or within the same week

Another form of abuse is neglect and abandonment, occurring when an elderly person isn’t being cared for properly, like not being fed, bathed, or properly medicated.  Ignoring an elder is also considered a form of neglect and abandonment, because the caregiver refuses to give them any sort of care. The signs of neglect and abandonment can sometimes be noticed with a simple inspection of a loved one, where you may see things like untreated sores or bed sores, malnutrition and/or dehydration, unsanitary living conditions, or dirty bed linens and clothes. You may also notice a strong odor coming from a loved one, due to the lack of continual hygiene, or obvious weight loss or weight gain. Sometimes an elder will actually begin begging you for food, or tell you they have some medical or dental need that hasn’t been tended to.

Although it’s no excuse, caregiver abuse, either by a family member or by a professional, often occurs due to caregiver burnout, caregiver stress, substance abuse, emotional and mental issues of their own, economic conditions or living arrangements. This doesn’t mean that all caregivers are abusers, because very few are; but it’s better to be informed and educated for the safety of your loved one. If it’s a family member who is a caregiver for someone disabled or elderly, you can take some preventative measures in order to prevent it from occurring, or to at least notice it at the very earliest stages. Educate yourself on the signs and symptoms of caregiver stress; make sure the caregiver is receiving help from others, so they don’t have to do everything on their own, which can quickly lead to caregiver burnout; and investigate other living arrangements, in order to take an elderly loved one out of a toxic, ultimately unsafe environment. Elderly people don’t have to be a target for others, especially by those who are supposed to care for them. Older people can also take some important steps on their own in order to make sure they remain safe from abuse of all kinds:

  • Don’t live with a family member who is or has been abusive in the past.

  • Speak to friends often, especially when you feel as though you are being taken advantage of.

  • Review your will. If changes are made, be sure it is because you want them to take place, not because of pressure from family members.

  • Have friends and/or neighbors visit you often.

  • Seek legal advice when making decisions.

  • Have your Social Security or pension check deposited directly into your account.

  • Speak directly to your attorney first before signing a Power of Attorney.

  • Don’t sign anything until you’ve read it. If you have difficulty understanding the legal terms, make sure to seek out an attorney and have them explain it to you.

Leave a comment

Filed under Uncategorized

Older Adults and Alcohol

A national 2008 survey found that about 40 percent of adults ages 65 and older drink alcohol. Older adults can experience a variety of problems from drinking alcohol, especially those who:

• Take certain medications
• Have health problems
• Drink heavily

There are special considerations facing older adults who drink, including:

Increased Sensitivity to Alcohol
Aging can lower the body’s tolerance for alcohol. Older adults generally experience the effects of alcohol more quickly than when they were younger. This puts older adults at higher risks for falls, car crashes, and other unintentional injuries that may result from drinking.

Increased Health Problems
Certain health problems are common in older adults. Heavy drinking can make these problems worse, including:

• Diabetes
• High blood pressure
• Congestive heart failure
• Liver problems
• Osteoporosis
• Memory problems
• Mood disorders

Bad Interactions with Medications
Many prescription and over-the-counter medications, as well as herbal remedies can be dangerous or even deadly when mixed with alcohol. Medications that can interact badly with alcohol include:

• Aspirin
• Acetaminophen
• Cold and allergy medicine
• Cough syrup
• Sleeping pills
• Pain medication
• Anxiety or depression medicine

Drinking Guidelines for Older Adults
Adults over age 65 who are healthy and do not take medications should not have more than:

• 3 drinks on a given day
• 7 drinks in a week

Drinking more than these amounts puts people at risk of serious alcohol problems.

If you have a health problem or take certain medications, you may need to drink less or not at all.

Source: NIH National Institute on Alcohol Abuse and Alcoholism

Leave a comment

Filed under adult children of aging parents, alcohol and seniors, Alzheimer's Disease, anxiety and the elderly, care giving, care planning, caregiver burnout, caregiving, dementia, Depression and the elderly, driving retirement, elder care raleigh nc, elder nutrition, family meetings, Geriatric Care Management, Having a conversation, long term care planning, medication reminders, moving in with family, NC, Raleigh, Sandwich Generation, senior care, senior driving, Seniors and driving, sibling relationships, support groups

Helping Children Understand Alzheimer’s

By  Michael Plontz

Your loved one has been diagnosed with Alzheimer’s.  The first thing you want to do is find out all you can about the disease, and all about what you can do to take care of your loved one.  It’s a bitter pill to swallow, but, at least you’re an adult and you can understand what’s happening.  What about your children?  How can you help them cope?

The way in which Alzheimer’s may affect children has to do largely with their relationship with the person before.  If they are close to the loved one, the mentally debilitating illness could cause fear, anger, sadness, and confusion.  If the loved one is living in the home of the caregiver, it can cause these feelings to intensify.

Fear is usually the first emotion to surface.  From the fear of their grandparent or other loved one arises feelings of anger, guilt, and jealousy.  All of these feelings can lead to sadness and even depression.  Also, feelings of despair and helplessness may result from the loss of the loving relationship between child and loved one.

The best thing you can do for your child or teenager is to be completely honest and keep the lines of communication open.  If children don’t understand, they could act out by doing badly in school or withdrawing or becoming impatient with their loved one.  Physical or psychosomatic ailments such as stomachaches or headaches may manifest themselves as well.  They may have to be reminded several times that Alzheimer’s is a disease, and that the disease is what’s affecting grandma or grandpa.

It is helpful to have answers ready for an inquisitive child’s difficult questions.  The following questions are just the tip of the iceberg, but it’s a start.

Q – Is grandma crazy?

A – No. Alzheimer’s is a disease. Older adults are prone to illnesses that may make them forget things or act differently.

Q – Is it my fault?

A – Certainly not.  If grandma told you that, it is just the disease talking.

Q – Can I, or my mom or dad catch Alzheimer’s disease?

A – Alzheimer’s is not contagious, so, no, you can’t catch it like you would a cold.

Q – What will happen next?

A – Here the parent must judge how much information the child can handle.  The best thing to do is reassure them that you love them mo matter what happens.

With teenagers the questions will probably be a bit more complicated.  They can see things from different perspectives.  The best thing to do is to inquire about how they’re feeling, and what can be done to make them feel better.  Regardless of the age of the child, open communication is the key to success in weathering the Alzheimer’s storm.

Leave a comment

Filed under Uncategorized

What to Do When Parents Must Live Separately: 6 Tips to Help Them Cope

By Dave Singleton, Caring.com author

After decades of living together, one parent needs more care than the other can provide. It’s not only hard on the parents; it’s a devastating situation for children and loved ones, too. You want to help, but you feel helpless in the face of what amounts to a forced separation.

What can you do to ease the trauma and provide support for parents facing this circumstance? Recently, I spoke with two eldercare experts who’ve counseled dozens of families and offer these six practical tips:

  1. Determine in advance how the relationship will continue.

    “Before anyone makes a move, encourage your parents to map out how the marital bond will carry on,” says Mary Koffend, president of Accountable Aging Care Management. Of course, if a parent has dementia or Alzheimer’s, it could be impossible for them to make such a plan. But assuming they can, “if Dad now lives in assisted living, then maybe Mom comes over every day for dinner.” Or perhaps she joins in on a regular activity that they can both enjoy on-site, such as discussions, book clubs, craft sessions, games, gardening, playing cards, or watching television.

  2. Ensure that the facility supports the couple.

    “The key is to promote the couple’s identity as a couple as much as possible, or desirable, for both partners,” says Cheryl Woodson, author of To Survive Caregiving: A Daughter’s Experience, A Doctor’s Advice. “Make sure the facility is convenient for the healthy partner in terms of transportation, access, and schedule.” If transportation to and from the new living facility is an issue, arrange in advance for a loved one or paid caregiver to drive, so that your parents get time together. “Even if it’s brief, at least they talk a bit, kiss good-bye, and off one of them goes,” says Koffend.

  3. Help your parent with feelings of guilt and inadequacy.

    Chances are the parent remaining at home feels tremendous guilt as well as sadness over the separation. “A parent might feel like he’s no longer honoring his wedding vows, or that he isn’t doing enough,” says Koffend. You can be supportive by being the voice that reminds Dad that he’s doing all he can. Give him a dose of what Koffend calls “reality therapy” — in other words, talk him out of wishing for what can no longer be. “Help parents understand the choices they are faced with, and reaffirm that they made the right choices, emotionally and logically,” says Koffend.

  4. Get your parents outside help if needed.

    Sometimes your best efforts might not be enough, and you need to engage outside support. “No matter how cooperative the facility is, no one can understand how bereft these couples may feel,” says Woodson. “Families should encourage the healthy partner to talk to clergy, behavioral health professionals, and/or to participate in support groups with other spouses in similar circumstances.”

  5. Help foster private time, if desired.

    Contrary to popular opinion, the need for intimacy doesn’t end when a separation like this occurs. It might be a little awkward for family members to address (understatement!), but help the couple work through whatever issues might be present in order to get deserved privacy. “For example, if a spouse can’t leave the facility for whatever reason, kids can step in and have a very straightforward conversation with the facility’s administrators about arranging alone-time for the couple,” says Koffend. It’s important to understand the concerns of the facility, which might be liable for falls or health issues that occur under their watch. Koffend cites one example of a wife who brought Viagra to her husband in an assisted living facility, which resulted in him having a strong adverse medical reaction. Address concerns and see if you can set fair boundaries.

  6. Expect the unexpected.

    Finally, “Don’t assume that this transition ends once the initial decision and move are over,” says Koffend. “Be prepared for whatever your parents’ needs are afterward, when there’s sadness or frustration on either side.” For some who’ve spent years caring for a spouse, the transition to living alone can be jarring and rudderless. When primary caretaking is replaced by a facility, you might need to help the parent remaining at home to feel needed and purposeful, whether by encouraging her to see friends or volunteer or simply by facilitating more involvement with her spouse’s new life at the facility. “Help your parent realize they have a practical role in the care and upkeep of their spouse who’s now living in a new place,” says Koffend. “It gives purpose to the visits, even if it’s as simple as bringing a few products and a hairbrush to help maintain physical appearance.”

Leave a comment

Filed under adult children of aging parents, Adult day care, Aging In Place, Alzheimer's Disease, anxiety and the elderly, assessments, care giving, care planning, caregiver burnout, caregiving, dementia, Depression and the elderly, elder care raleigh nc, family meetings, Geriatric Care Management, Having a conversation, long term care planning, moving in with family, NC, Nursing Homes, nursing homes and assisted living, paying for home care, Power of Attorney, Raleigh, Sandwich Generation, senior care, sibling relationships, support groups

Laughter is the Best Medicine

By  Helen Hunter, ACSW, LSW

When was the last time you had a really good laugh?

The scientific definition of laughing is a “successive, rhythmic, spasmodic expiration with open glottis and vibration of the vocal cords, often accompanied by baring of the teeth and facial expression”. That doesn’t begin to tell the story of what laughing does for us, however. The bottom line is that laughing is medically beneficial.

Laughter establishes or restores a positive emotional climate and a sense of connection between two people. In fact, some researchers believe that the major function of laughter is to bring people together – the more social a person is and the more social support a person receives, the more likely that laughter will result from that social connection. Mutual laughter and play are an essential component of strong, healthy relationships. By making a conscious effort to incorporate more humor and play into your daily interactions, you can improve the quality of your relationships.

What are the Physical Effects of Laughing?

Laughing makes people feel good for a reason. Studies have shown that laughter boosts the immune system and triggers the release of pleasure-inducing neurochemicals in the brain. The immune system, which contains special cells that are responsible for defending the body against infection, have been shown to increase during the act of laughing. In the central nervous system, the brain releases powerful endorphins as a result of laughing. Endorphins are natural, morphine-like compounds that raise the pain threshold, produce sedation and induce euphoria (commonly called a “natural high”). In other words, we feel better when we laugh because endorphins reduce physical and mental pain. While this may be a wonderful feeling, laughing has other benefits as well:

During a laugh, respiration, heart rate and blood pressure temporarily rise. This causes oxygen to surge through the bloodstream that then results in lower blood pressure.

Laughter improves the function of blood vessels and increases blood flow, which can help protect against a heart attack and other cardiovascular problems.

Laughter reduces pain and allows toleration of discomfort.

Laughter reduces blood sugar levels, increasing glucose tolerance in diabetics and non-diabetics alike.

Laughter relaxes the whole body, relieving tension and stress. It has been shown that following a good, hearty laugh, muscles in the body are relaxed for up to 45 minutes afterward.

Laughing burns calories – laughter is sometimes referred to as “inner jogging”. A hearty laugh gives the muscles of the face, chest, shoulders, stomach and diaphragm a good workout.

Laughter also helps to create a positive mood. It allows the expression of happiness and the release of anxiety. Humor eases tension and is a great antidote to a stressful situation. Laughter is often seen as a temporary vacation from everyday problems, bringing us to a paradise in which worries do not exist. Humor and laughter are natural safety valves that shut off certain hormones that are released during stressful situations. In fact, your sense of humor is one of the most powerful tools you have to make certain that your daily mood and emotional state support good health.

Here are some ways to bring more humor and laughter into your life:

Smile: Smiling is the beginning of laughter. Like laughter, it’s contagious. When you look at someone or see something even mildly pleasing, practice smiling!

Count your blessings: Literally make a list. The simple act of considering the good things in your life will distance you from negative thoughts that are a barrier to humor and laughter!

When you hear laughter, move toward it: People are very happy to share something funny because it gives them an opportunity to laugh again and feel the humor in it. When individuals hear laughter, they seek it out and ask “What’s funny?”

Spend time with fun, playful people: These are people who laugh easily, both at themselves and at life’s absurdities and who routinely find humor in everyday events. Their playful point of view and laughter are contagious!!

Bring humor into conversations: Ask people: What’s the funniest thing that happened to you today? This week? In your life?

Laugh at yourself: Share your embarrassing moments.

Attempt to laugh at situations rather than bemoan them: Look for the humor in a bad situation, the irony and absurdity of life. This will help improve your mood and the mood of those around you.

Surround yourself with reminders to lighten up: Keep a toy on your desk or in your car. Put up a funny poster in your office. Choose a computer screensaver that makes you laugh. Frame photos of you and your family having fun.

Keep things in perspective: Many things are beyond our control, so make the best of a situation and find the positive in the situation.

Deal with stress: Stress is major impediment to humor and laughter.

Pay attention to children and emulate them: They are the experts on playing, taking life lightly and laughing!!

Here is a simple prescription for a healthy life:

Thirty minutes of exercise at least 3 times a week, and 15 minutes of laughter on a daily basis!!

The bottom line – laughter may just be the best medicine on the market today!

Leave a comment

Filed under adult children of aging parents, Alzheimer's Disease, anxiety and the elderly, assessments, care giving, care planning, caregiver burnout, caregiving, caregiving and the holidays, dementia, Depression and the elderly, elder care raleigh nc, employee stress, family meetings, Geriatric Care Management, Having a conversation, humor, laughter in caregiving, long term care planning, moving in with family, NC, Raleigh, respite, Sandwich Generation, senior care, sibling relationships, support groups

Who’s Most Likely to Feel Caregiver Stress?

~Paula Spencer Scott

Does caregiving actually cause stress? Some surprising new research says no, the real source of the stress lies within the person, not the situation.

After looking at more than 1,200 female caregiving twins, Peter Vitaliano, professor of psychiatry and psychology at the University of Washington, concluded that how stressful caregiving is for you psychologically is more a matter of your genes and your upbringing. Caregiving itself does not cause stress, he says. This new study appears in the Annals of Behavioral Medicine.

Who’s most at risk, according to this research? People who:

  • Have a history of depression. “Like putting salt in a wound,” says Vitaliano.
  • Grew up with parents who showed a lot of avoidance and fear in response to big stressors (like losing a job).
  • Lack resources to help them cope, like social support and finances.

The study also found that caregiving can cause anxiety, which is in turn linked to depression.

This all may sound like splitting hairs. Though this research confirms Vitaliano’s earlier work debunking a causal connection between caregiving and stress, it flies a bit in the face of many, many other studies that link them. There’s even a name for it: caregiver stress syndrome.

This study didn’t specifically look at Alzheimer’s caregiving, whose duration and unique challenges can wear down even the best-adjusted family member. I wonder, would the results look different?

Bottom line: It doesn’t strike me as terribly helpful to be told your stress is the fault of your genes or your family history. If you’re feeling it, you’re feeling it. It’s nobody’s fault — the real question is what to do about it.

File this info in the nice-to-know category. Then go hide in the bathroom for a little deep breathing, a few bites of dark chocolate, and a wish for some respite time to come your way this week.

Leave a comment

Filed under adult children of aging parents, Adult day care, Alzheimer's Disease, anxiety and the elderly, care giving, care planning, caregiver burnout, caregiving, dementia, Depression and the elderly, elder care raleigh nc, employee stress, family meetings, Geriatric Care Management, Having a conversation, long term care planning, NC, Raleigh, respite, Sandwich Generation, senior care, support groups

Should You Tell a “Fiblet” to a Parent With Dementia?

From our earliest days we are taught never to lie, especially to our mother or father. However, a recent survey of aging experts reveals that telling a “fiblet” can actually be therapeutic when adult children are faced with telling painful truths to aging parents who have a cognitive impairment such as Alzheimer’s disease.

The National Association of Professional Geriatric Care Managers (NAPGCM) recently surveyed 285 professional geriatric care managers about the most common and difficult situations faced by families who are helping aging parents. Geriatric care managers help these families deal with some of the most sensitive and challenging issues.

More than 90 percent of the professional geriatric care managers surveyed said they have used or recommended the “fiblet” strategy to relieve stress and anxiety and protect the self-esteem of an elderly person. The situation cited most by experts in the survey as an appropriate and helpful use of a “fiblet” is when a senior is refusing clearly needed care or assistance at their home. For example, telling an aging parent with Alzheimer’s that a paid caregiver is coming to their home for their spouse’s benefit or for another concrete role can help the elder maintain pride and reduce anxiety.

The following were identified by care managers as situations when it can actually be therapeutic to tell a “fiblet” to an aging parent:

  • When they are refusing needed care and assistance at home. Telling them the caregiver is there for their spouse’s benefit or for another concrete role can help them maintain pride and reduce anxiety (identified by 83 percent of those surveyed).
  • When they can no longer safely drive, yet insist on doing so. Telling them their car is in the shop getting repaired can reduce confrontations (68 percent).
  • When knowing the cost of in-home care prevents them from accepting the needed service (68 percent).
  • When it would only cause worry and stress to tell them about family problems they can’t solve, e.g., unemployment, financial upheaval, divorce, drug abuse, incarceration (64 percent).

According to the National Institutes of Health, as many as 5 million of the 43 million Americans age 65 and older may have Alzheimer’s disease, and another 1.8 million people have some other form of dementia. Americans feel increasingly challenged by the need to communicate difficult information to aging family members with dementia.

“A therapeutic ‘fiblet’ is just that—it is therapeutic because it calms and reassures, reduces anxiety and protects self-esteem,” said NAPGCM President Emily Saltz. She added, “You would use a ‘fiblet’ only with parents who have a cognitive impairment such as Alzheimer’s disease.”

Geriatric Care Managers Share Their Experiences

As part of the survey, geriatric care managers were asked to provide comments about their own experiences in recommending the use of a “fiblet.” A universal theme of the comments was that family members should navigate this clearly delicate area with help from a support group or from an experienced professional care manager. Care managers also stressed that one should only use a “fiblet” to protect and support a family member rather than for personal benefit or gain.

The following are from among more than 200 stories collected through the survey about geriatric care managers’ experiences of using a “fiblet” in the course of their practices:

  • “I’ve used therapeutic ‘fiblets’ in many instances, but probably (most often) when the death of a loved one is beyond a person’s capacity to understand. For example, if a person is looking for a deceased loved one, I tell them that I haven’t seen that person today but when I do, I’ll tell them that the person is looking for them. This serves to validate their experience and provide reassurance that someone cares.”
  • “When an adult son was diagnosed with cancer, the decision was made to not inform his frail, memory-impaired nursing home-bound father of the diagnosis. At the same time, the son increased his visits to his father during treatment, as he had more free time available for visits. The son and father enjoyed more time together without stressing the father with a scary diagnosis.”
  • “A client wanted to see their mother who had passed away many years ago. Instead of telling her that her mother had died and causing her to grieve again, we told her she was out and would return later. She accepted that and went on with her day.”

Source: The National Association of Professional Geriatric Care Managers (NAPGCM). NAPGCM was formed in 1985 to advance dignified care for older adults and their families. Geriatric care managers are professionals who have extensive training and experience working with older people, people with disabilities and families who need assistance with caregiving issues. For more information, visit http://www.caremanager.org. –

Raleigh Geriatric Care Management in Raleigh, NC  www.rgcmgmt.com

Leave a comment

Filed under adult children of aging parents, Adult day care, aging drivers, Alzheimer's Disease, anxiety and the elderly, assessments, bathing and seniors, care giving, care planning, caregiver burnout, caregiving, dementia, Depression and the elderly, driving retirement, elder care raleigh nc, employee stress, family meetings, Geriatric Care Management, Having a conversation, humor, long term care planning, medication reminders, moving in with family, NC, Nursing Homes, nursing homes and assisted living, paying for home care, Power of Attorney, Raleigh, respite, Sandwich Generation, senior care, senior driving, Seniors and driving, sibling relationships, support groups, travel with seniors