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Can Caregiver Stress lead to Elder Abuse?

User Category: General HealthOn: February 6, 2013

Each year in the United States, millions of cases of violence against older adults are reported and the problem is only increasing. Elder abuse can have devastating side effects including severe injury, loss of dignity and independence, loss of financial security, and even death. Research shows elderly victims of abuse have shorter life spans than non-abused seniors even in the absence of chronic conditions or terminal illness. Like many other forms of violence, elder abuse is a complex problem that is surrounded by misconceptions. While most people think elder abuse is confined to nursing home and institutional settings, the fact is that 95% of violence against the elderly takes place at home at the hands of adult children, spouses, and other relatives. Can caregiver stress lead to elder abuse? Approximately 28.7% of the US population, or 65.7 million Americans, serve as unpaid caregivers to family members. Family caregivers account for 80% of at-home care and typically devote an average of 20 hours per week to elder care, performing a range of activities from housekeeping to nursing duties. While studies estimate that family members account for 65% to 90% of elder abuse cases, it is not clear how many of these family members are caregivers. Some research suggests 5% to 23% of all caregiver are physically abusive and agree that the stresses of providing care contribute to increased instances of violence. Caring for an older adult, especially a person of advanced age or with multiple chronic conditions can be an intensely rewarding yet stressful endeavor. Many caregivers find themselves in poor health as a result of their responsibilities, and consequently, stressors can potentially trigger harmful behaviors that place seniors at risk for abuse.  When under intense amounts of anxiety and pressure, the body’s flight or fight response kicks in to protect itself. The body goes on “high alert”, speeding up essential functions like heart rate and respiration while shutting down the immune system. While moderate amounts of stress are normal, chronic stress can cause fatigue and burnout, rendering caregiver to face a slew of mental health and physical problems including irritability, depression, and infection. What risk factors are associated with caregiver stress and elder abuse? The American Psychological Association suggests a caregiver’s personal problems may predispose them to violent behavior.  Caregiver’s who suffer from mental illness, alcohol or drug addiction, or another personal crisis such as job loss or bankruptcy may abuse frail, vulnerable seniors as a way to solve their problems. A past history of a poor relationship between the caregiver and care recipient can also contribute to more stress. In the face of caregiver stress, many caregivers do not receive adequate information about how to balance personal needs with those of a loved one. Unarmed with proper coping skills, caregivers who feel trapped and hopeless resort to using force to manage the situation. Some caregivers report specific behaviors of the care recipient are more likely to trigger them, among those are wandering, combativeness, incontinence. What are the warning signs to watch for?  Research shows that caregivers who may be at risk for committing harmful behavior:

  • Fear that he or she will become violent
  • Report having low self esteem
  • View caregiving as a burden and report to have little help from others
  • Experience burnout or depression
  • Have unresolved anger or resentment towards to care recipient 
How can elder abuse by caregivers be prevented? Although the link between caregiver stress and elder abuse is not yet fully understood, utilizing the following prevention strategies can help ameliorate caregiver violence.
  • Find a support group – In-person and online support groups can help caregivers find social support and information as to how to manage difficult behaviors and negative feelings surrounding caregiving. 
  • Identify “triggers” – Act as an “outside observer” and begin to notice what situations or behaviors trigger your anxiety. Learning to understand your triggers is key to reducing stress.
  • Use tools to find peace of mind - Digital tools can capture such comprehensive information about a senior’s care, assisting caregivers in identifying patterns that contribute to increase stress. For example, with the use of a real-time care tracking tool caregivers can document eating behaviors along with mood and toileting patterns. If a caregiver can see how incontinence is related to food intake, medication management or another variable, the caregiver can more effectively manage stress and devise an intervention.
  • Seek respite care – Respite programs provide paid personnel of volunteers to sub-in while caregivers get a break.
  • Cultivate health and wellness – Regular exercise, healthy diet, and adequate rest can help caregivers cope with the stresses of caregiving. Making time for relaxation and self-care is equally important.
  • Work with a care manager – Care managers can help coordinate services that match with a care recipient’s needs. A geriatric care manager can intervene if problems arise and conduct routine assessment to remove some obligations from the caregiver’s shoulders.