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When caregiver stress leads to abuse

by Sue Lanza

Caregivers of the elderly or those with chronic medical conditions require a unique blend of compassion, coaching skills and at times, strength and endurance. The endless tasks of care giving can bring even the most robust person to their knees. What happens when the routine frustrations of care giving turn into abusive behavior?

So many of us have walked the caregiver's tightrope by balancing between loving, caring attentiveness on one side, and the sheer exhaustion that comes from constant demands made on our time and energy on the other. What are the differences in the millions of caregivers who deal with the challenges, and the smaller group of caregivers who can't cope and use abuse as a way to handle the stress?

I realize that this is not a topic that everyone likes to discuss. No one does; not even trained professionals. In fact, secrecy is one of the factors that keep some abused elderly from seeking help. Would you feel comfortable reporting the person who is solely responsible for your daily care and quality of life? As bad as things are, some elderly persons or even family members are significantly frightened to think that the consequences of reporting their caregiver could mean retaliation or something worse.

How Stress Can Build Up

Research indicates that females represent almost three-quarters of all caregivers and about half are in the role of spouse. Other caregivers could be adult children, especially daughters.

No one is denying the difficult nature of care giving tasks such as assisting with activities of daily living (ADL's) such as dressing, toileting and bathing. The caregiver's range of responsibilities may also include ensuring that medications are taken, transporting to and from appointments, shopping and handling the monthly expenses. Typical caregiver stresses that may set the stage for abuse include anxiety or depression symptoms as well as poor nutrition, inadequate sleep and general fatigue. Most caregivers manage to cope with these issues without resorting to verbal, physical or even financial abuse, but some can't.

What to Watch For

There are factors to watch for in the care giving relationship that could yield clues that abuse could occur. Here are a few caregiver questions to ask:

  • Is the caregiver a spouse? Some studies suggest a trend of abuse being more likely to be caused by a spouse rather than adult children.
  • Does the caregiver suffer from low self-esteem? This seems to be a risk factor for abuse but the research has not clarified whether the abuse is caused by the low self-esteem or if the opposite is true.
  • Are there unresolved subjects from the past between the caregiver and the person receiving care? Having problems from long ago that are still not solved only places more pressure on the care giving relationship.
  • Does the caregiver feel that they face care giving tasks alone and do they perceive their role as burdensome? Studies have shown that the risk for abuse increases as the amount of care needed increases.
  • Are there verbal warning signs from the caregiver about potential behavior such as, "I am worried that one day I will just snap." Research indicates that about 20 percent of the caregivers are worried that they could abuse their care recipient. That number swells to 57 percent if the caregiver has experienced abuse or violence from the person they are caring for.

When the answer to the above questions is "yes" and the person receiving the care has behavior problems or dementia, these can be further warning signs of potential danger. Social service organizations would term this scenario as an "at risk" family, where both parties could be volatile and prospectively hazardous to each other.

How to Reduce the Risk of Abuse

Each care giving dynamic is unique but there are a few general suggestions on abuse prevention:

1. Ideally, family members and eldercare agencies should observe for the "perfect storm" of circumstances where abuse may occur so an intervention can be planned.

2. Arrangements should be made for additional relief help from other family members, or even paid assistance, to lighten the care giving load.

3. Attendance at support groups or educational sessions should be encouraged for caregivers to learn beneficial coping skills.

If you suspect an elderly person may be in an abusive situation, you should discuss your concerns with Adult Protective Services or your area Office on Aging. The National Office on Elder Abuse (www.elderabusecenter.org) can also be a resource for you.

If someone you love is on the care giving tightrope and swaying toward the abuse zone, with education, you will be more prepared to help them navigate safely to the other side.