The best way to combat elder abuse is to educate people in the community how to recognise the signs, and what to do when they suspect there is a problem.

Dr Daniel Reingold, CEO of the US-based Riverspring Health, told Mark Moran Group’s Elder Abuse Prevention Conference we need to talk about elder abuse, but cautioned the field is “challenging” and “filled with obstacles”.

“We’re not going to stop elder abuse,” Dr Reingold warned, but he urged more public conversation about the topic.

“It’s better to light a candle than curse the darkness”, he said, quoting Eleanor Roosevelt.

Reporting on “horrific cases” means “we can’t look away” any longer.

Dr Reingold said changes are coming from the “grass roots” in the US, but New South Wales government’s funded model was something to be proud of, and puts Australia ahead of the US in terms of its response to elder abuse.

Abuse is hidden

Elder abuse differs from other forms of abuse because it is largely hidden, Dr Reingold said. 

Older people often don’t have the same connections in society as younger people – they don’t go to school or work – so there’s less opportunity for abuse to be identified.

Elder abuse happens mostly in the home, mostly to those who live alone, and often it is perpetrated by a family member or carer, Dr Reingold said.

“Ironically, the most dangerous place for older victims of abuse is to be in their own home… The place you would think is the most safe is actually the most dangerous,” he said.

What to look out for

Though there is a lack of hard data of actual numbers of elder abuse, it is estimated that one-in-ten older people is a victim, regardless of the environment they live in, whether it be living in the community or in an aged care facility.

Dr Reingold went through some of the tell-tale signs of elder abuse at the conference. 

Signs of physical abuse including rope marks, repeated unexplained injuries, refusal of family or carers to take the person to the same emergency room, and family or carers being dismissive of concerns. 

Signs of emotional or psychological abuse may be an older person becoming uncommunicative, emotional or fearful. Lack of interest in social engagement, chronic mental health problems, and evasiveness can also be indications of abuse. 

Signs of sexual abuse include unexplained vaginal or anal bleeding or venerial disease. 

Financial abuse, exploitation and scams are “insidious” and “frightening”, Dr Reingold said. Data from the US estimates that $57 billion was stolen from older adults through scams. 

Signs of neglect include sunken eyes, extreme thirst and bed sores.

Despite common themes in elder abuse, every case if different, Dr Reingold said. “If you’ve seen one case of elder abuse, you’ve seen one case of elder abuse,” he said – “the facts of each case are different”.

The inherent vulnerability of older adults

There are a number of factors that make older people more vulnerable to abuse.

Cognitive impairment, which affects 10 per cent of older people, makes elder abuse more likely, Dr Reingold said. 

A deterioration in health can also make people more vulnerable, say if a person suffers a stroke.

Isolation can also be a factor, and often perpetrators deliberately isolate the victim from their support networks. People living alone in their own homes are particularly vulnerable.

Smaller, more dispersed families these days mean family is less present to step in and intervene if things start to go wrong. 

Dr Reingold also talked about changes in family dynamics that can lead to a greater incidence of abuse. For example, if physical abuse has always occurred, it may become more dangerous as people become frailer. 

Tragically, ageism in our society also makes older people more vulnerable to abuse. “We don’t like old people” in our society, Dr Reingold said. “We don’t accommodate for them, we don’t see them.”

A growing problem

More research is needed into the actual prevalence of elder abuse, Dr Reingold said.

There are currently four million people over the age of 65 in Australia, and that number is expected to triple by 2097. It follows that the number of cases of elder abuse will also rise.

The shelter model

Dr Reingold’s Riverspring Health is a “progresssive” care facility for older people, located on 23 acres on the Hudson River outside New York. The facility has introduced a number of groundbreaking innovations, such as programs for the use of medicinal cannabis, music therapy, and the sexual rights of older people.

In 2005, it began operating as an emergency shelter for victims of elder abuse, the first shelter of its kind in the US.

“The shelter model was created to get (victims) out of the unsafe environment temporarily while we make their home safe,” Dr Reingold told the conference.

The program has provided 150,000 days of shelter to victims of abuse since opening, demonstrating the magnitude of the problem of elder abuse in the US.

The shelter model is flexible, with victims housed wherever in the facility they will receive the care they need. For example, if they are living with dementia, they will be housed in the memory support area. If they need to regain physical abilities, such as the need to walk, they will be housed where rehabilitation takes place.

The aim of the shelter is to get the person back into their own home, but to ensure it is safe for them to do so. The program operates in partnership with a range of services, including but not limited to, geriatricians, financial institutions, social workers, lawyers, and police.

Dr Reingold said Riverspring occasionally had to disregard regulations in cases of life and death. “It’s important to bend the regulations because regulations don’t always adapt to the personal needs that are endemic in elder abuse,” he said. 

Dr Reingold said an emergency shelter must be part of the community response to elder abuse in Australia.

Coordinated community response the best defence

When the shelter first opened, Dr Reingold and his team expected to be inundated with requests for help – but none came. They realised they needed to train people in the community to identify the abuse.

Training ‘community responders’ to identify elder abuse and to know what to do when they suspect it is happening is a “critical” part of an effective response to elder abuse, Dr Reingold told the conference.

In New York, doormen were taught how to identify elder abuse and how to respond by completing an online training course.

Community responders are the people victims speaks to when the perpetrator is not present. Examples might be meals on wheels services, hairdressers, volunteer library staff who go to people’s homes, financial institutions, bank tellers, Uber drivers, staff at clubs, dentists, podiatrists, and even pub owners and staff.

“There’s no shortage of people who can be trained to identify abuse,” Dr Reingold said.

Neighbours are also part of our community, Dr Reingold said, and he encouraged people to check in on their elderly neighbours, particularly around holiday time as this seems to often coincide with a “spike” in abuse cases.

Elder abuse in aged care

Dr Reingold said even though elder abuse is most common at home, it does of course occur in aged care settings.

Aged care staff must be properly trained, and staff turnover should be minimised to reduce the likelihood of elder abuse, he said.

Even though it was important to have enough staff, Dr Reingold said there could always be more staff. Having volunteers visit the home is a good way to increase the presence of people who can help.

Cameras can also be a deterrent to abuse, but he said he does worry about the privacy implications of cameras in aged care.

When cases of elder abuse do occur, the consequences should be “very public and very loud” to send a clear message to other staff that mistreatment of older people will not be tolerated. 

When HelloCare caught up with Dr Reingold after his presentation, we asked him what aged care staff can do if they suspect someone they are caring for is a victim of elder abuse.

“If something looks wrong, speak up… trust yourself.”

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