Mildred, 82, is tied to her bed while her brother is outside working on the farm. She cries a lot. Scars, mixed with open flesh wounds, mark her wrists. This is obviously not the first time that she has been tied to her bed. She is a victim of Alzheimer's disease and her brother ties her to her bed because she wanders away from the house.

Louise, 74, wears sunglasses to hide the bruises on her face from the driver who delivers her noon meal. The driver notices a tear coming from under the glasses, "what's the matter Louise"? Louise begins sobbing and closes the door. She financially supports her 52 year old alcoholic son who lives with her. He regularly threatens to put her in a nursing home if she doesn't give him money. Although she feels trapped in her home, she can't make her own son move. Yesterday, in a drunken rage, he demanded money, then slapped her when she refused. She gave him the money.

Esther, 69, leans over the bed in her nursing home room and rings for the nurse. No one comes. She rings again. She is lonely and knows that she calls the nurses station a lot, but this time she really needs someone. A few moments later, a woman storms into Esther's room, "Esther, that's the fourth time today that you've rang that bell for no reason, if you ring it one more time I won't bring your mail to you!" With a broken hip, Ester tries to move away from the pool of urine in her bed.

John, 89, wakes up in an ambulance, the last thing that he remembers is getting ready to cook lunch. The paperboy had called the police when John's paper began to pile up for 5 days. John becomes disoriented and loses consciousness when he does not take his medicine. His medications cost $440 a month, and his Social Security is only $510. Sure, John has some savings, but he feels that he may need that some day.

Mildred, Louise, Esther, and John are all victims of Elder Abuse, a grossly under reported crime that affects one out of 20 older Americans each year, according to a 1990 report by the House Subcommittee on Health and Long-Term care of the Select Committee on Aging.

Victims are usually dependent upon the abuser for daily care and isolated from society with little social support. They can be frightened, embarrassed, or mistrustful, and have a fear of outside contacts. They are ambivalent about dependency versus independence, and have internal conflict about being cared for like a child.

The Ohio Department of Human Services, through it's Adult Protective Services program, which investigates abuse complaints for older persons living in the in the community, indicates that over 12,700 elderly Ohioans were reported as having been abused, neglected, or exploited, during 1992. Since it is estimated that only one in eight cases are actually reported, the 12,700 reported cases becomes a staggering indicator of how widespread the problem really is.

Facts About Elder Abuse
Elder abuse occurs with a rate and frequency only slightly less than child abuse. Although any older person can become a victim, the frail and impaired, especially women, run a grater risk of becoming victims. Abuse may consist of physical, verbal, or psychological abuse, neglect, violation of rights, financial exploitation or self-neglect.

The Ohio Revised Code defines elder abuse as, "Abuse means the infliction upon and adult by himself or others of injury, unreasonable confinement, intimidation, or cruel punishment with resulting, physical harm, or mental anguish".

There is no single cause of elder abuse. Usually a combination of different factors contribute to it's development. They may include:

• stress of providing care to the older person
  
• mental illness, drug or alcohol abuse
  
• unresolved family conflict
  
• long-standing patterns of violence in the family
  
• vulnerability and dependency of the older person

"In the Ohio study of elder abuse, 90% of the abusers were relatives; the highest number were daughters, followed by sons, granddaughters, husbands, and siblings", relates Georgia Anetzberger, Ph.D., Associate Director, Community Services, The Benjamin Rose Institute, and Adjunct Professor of Medicine, at the Case Western Reserve University. Anetzberger also notes that family members, or the older person, may seek to hide the abuse out of fear, guilt, or shame. "They (victims) can be frightened, embarrassed, or mistrustful, and have fear of outside contacts. They are ambivalent about dependency versus independence, and have internal conflict about being cared for like a child".

There are four main types of elder abuse:

1. Physical Abuse, which includes, physical injury; malnutrition; severe dehydration; lack of personal care; withholding of necessary medical care; and failure to give proper medication. What to look for (a pattern or combination of events).
   • Signs of Physical Abuse or Neglect
     • rope burns
     • bruises, especially on upper arms or clustered on trunk of body, or a combination of what appears to be old and new bruises
       
     • illnesses which seem chronic, long-term, and untreated
       
     • abrasions or lacerations
       
     • burns
       
     • fractures
       
     • sagging skin or skin deterioration
       
     • any injury that is not compatible with the story given
       
     • an injury not properly cared for
       
     • unkempt appearance (uncombed hair, unshaven face)
       
     • poor hygiene (dirty skin, untrimmed nails)
       
     • evidence of dehydration/malnutrition
       
     • ravenous eating habits of elder
       
     • evidence that elder is confined unwillingly to bed/chair/room without freedom of movement (restraints at wrist or ankles, muscle contracture's)
   • Signs of Self-Neglect
     • complaints from area merchants/neighbors who report loitering or wandering
       
     • no food in house or lots of food in house which is spoiled
       
     • prescription medication not taken
       
     • evidence of alcohol or drug abuse

2. Psychological Abuse, which includes, threats of physical harm or nursing home placement; isolation; harassment; intimidation; withholding of affection and/or security; and refusing to allow the older person outside the home or allow visitors to see the older person. Signs of psychological abuse include:
   • expressions of fear, anger or resignation
     
   • elder embarrassed or fearful when asked about injury
     
   • family member afraid to leave you alone with elder
     
   • family member acting as if elder did things on purpose, ie..
     
   • elder refuses to walk
     
   • elder is incontinent on purpose
     
   • elder fails to get attention

3. Financial Exploitation, such as theft or misuse of the person's property or funds. Signs of material/financial neglect include:
   • elder's rent is overdue on more that one occasion; utility and other bills have not been paid
     
   • noticeable discrepancy between what is known about the elder's financial status and how they now appear
     
   • discrepancy between resources available to elder, and how he or she is cared for
     
   • condition of home
     
   • level of personal care, nutrition, medical care, clothing, transportation, opportunities for social interaction

4. Violation of Rights, such as usurping decision making powers of the older person or involuntary confinement of the older person to the bed, room, or chair. Signs of violation of rights include:
   • unreasonable confinement to a bed, chair, room, or other part of the house
     
   • possibility that elder is denied visitors or freedom to go out of the house, to visit friends or to go to church
     
   • elder has no awareness of his/her financial affairs or what is being done with money or property

   Who is most vulnerable?
   It appears that middle-class women, age 75 or older, who are severely disabled (mentally or physically), and/or dependent on others for daily care, are at greater risk, however, any older person can fall victim to elder abuse.

   Signs of Elder Abuse, What To Look For:
   Individual signs by themselves are not enough, the key factor in identifying elder abuse is to look for a pattern of signs, symptoms, or events. AARP, in their brochure, Domestic Mistreatment of the Elderly, Towards Prevention, Some Do's and Don'ts, identified several signs and symptoms:

   • Increasing Depression
     
   • Withdrawn or Timid
     
   • Physically Injured
     
   • Longing for Death
     
   • Vague Health Problems
     
   • Shopping for Physicians
     
   • Anxiety
     
   • Hostile
     
   • Confused
     
   • Unresponsive
     
   • New Poverty
     
   • Anxious to Please
     
   • New Self-neglect
     
   • Conflicting Stories
     
   • Mounting Resentment
     
   • Excusing Failure
     
   • Shifting Blame
     
   • Aggressive/Defensive Behavior
     
   • Substance Abuse
     
   • Unusual Fatigue
     
   • New Affluence
     
   • New Health Problems
     
   • Preoccupation with Depression
     
   • Withholding Food or Medication

   What To Do
   Fortunately, there are agencies that are involved in identifying and preventing elder abuse. If you suspect that an older person, living in the community, is being abused, call Adult Protective Services, located in the local Department of Human Services.

   If the abuse is occurring in an institutional setting, such as a nursing home, call the Long Term Care Ombudsman. If you feel that the older person is in immediate danger, or you're not sure who to call, call your police, or sheriff's office, or 911, if it is available in your area. If you fail to report abuse you may be fined.

   You can find the phone number of the Adult Protective Services and your area Long Term Care Ombudsman from your local Area Agency on Aging. You will find them listed in the "yellow pages" of your telephone directory under the classification of "Senior Citizens' Services & Organizations.

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   State of Ohio Specific
   The following information is specifically for Ohio residents. Under the Ohio Revised Code, it is the duty of professionals to report abuse. The ORC outlines 19 professions that are required to report the abuse, failure to report elder abuse could result in a fine. Basically, if you serve older persons in a work situation, you are a required reporter.

   In 1992, a coalition for the prevention of elder abuse was formed by the Area Agency on Aging Region 9, Inc., to battle elder abuse in Belmont, Carroll, Coshocton, Guernsey, Harrison, Holmes, Jefferson, Muskingum, and Tuscarawas counties. A planning committee, with representatives from various communities throughout the nine counties, developed and held, two major conferences to inform area citizens about elder abuse. Currently, the committee is planning the 1994 East Central Ohio Conference on Elder Abuse, Untie The Elderly, which will address physical and chemical restraints on the elderly.

   If you would like more information on elder abuse, or become a part of the Area Agency's elder abuse prevention initiative, call or write
   

   Jim Bentley
   Director of Development
   Area Agency on Aging Region 9, Inc.
   60788 Southgate Road
   Byesville, Ohio 43723
   E-mail Jim Bentley -- bentley@cambridgeoh.com

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