Public awareness, action needed to combat elder abuse

It is one of the best-kept secrets in some families: the abuse of an elderly person by another family member, usually an adult son or daughter. The cruelty can be mental, involving insults, threats, or stony silence. It can be physical -- slapping and kicking, denying adequate food, or neglecting other basic needs. Or it can be economic -- withholding money and diverting funds.

But whatever the form, elder abuse -- sometimes called granny battering or parent battering -- is emerging as a growing, if largely hidden, problem in the United States.

``Rational older people are ashamed of being victimized,'' says R. E. Pieroni, a physician at the University of Alabama, speaking on a panel at a recent conference of the Southern Gerontological Society here. ``They don't want to admit that the people they brought up are beating them.''

Many elderly victims also remain silent out of fear of being moved to a nursing home. Roughly half of all reported cases result in nursing-home placements, according to Carol J. Wallace, a lawyer for the elderly and a panelist.

Exact figures are hard to pin down, with estimates ranging from half a million cases a year to more than a million. But specialists in the field agree that the numbers are increasing, partly because of better reporting methods, partly because of the unprecedented growth in the over-75 population. ``It's hard to find cases of granny-battering if you didn't have a granny to batter,'' notes Lorin A. Baumhover, a sociologist with the University of Alabama.

Yet Mr. Baumhover cautions against overreacting, calling this ``a phenomenon that's been highly dramatized.'' Just as Americans ``discovered'' child abuse in the 1960s and spouse abuse in the 1970s, they are now becoming aware of elder abuse, even though, as Dr. Pieroni points out, ``it's been around a long time.''

Part of the problem stems from pervasive ageism -- a sense that an older person is no longer important. ``We are prejudiced as a society,'' says Mr. Baumhover. ``We're likely to say it's not as bad as beating up a three-year-old child.'' Indeed, although the incidence of child abuse and adult abuse is about the same, only 1 in 6 elder-abuse cases are likely to be reported, compared with 1 in 3 child-abuse cases.

Mr. Baumhover notes that abuse often follows a pattern within some families, occurring more often ``if family members have had rather tenuous ties to each other'' or in families ``where children were mistreated violently in childhood.'' He calls this ``retaliatory'' abuse, adding, ``Abusers are often the battered child grown up.'' Sometimes other family members know of incidents but don't report them -- an arrangement known as ``shielding.''

This growing challenge -- how to provide care at home for the dependent elderly -- stems partly from a declining birthrate, resulting in fewer adult care-givers. In 1850, Mr. Baumhover points out, mothers bore an average of eight children. In 1980 that figure had dropped to 1.8.

The typical abuse victim is a woman over 75 who is physically or mentally disabled in some way. Her abuser is frequently a middle-aged daughter or daughter-in-law who finds herself in what has been called the ``sandwich generation,'' caring for both dependent children and dependent parents, perhaps holding a job at the same time. Most of these women are untrained in care-giving and lack any relief from the demands of constant care.

For many care-givers, community-based services such as adult day care, respite care, home-delivered meals, and counseling could provide important help. Yet these programs are often unavailable or inadequate to meet local needs.

Not all abuse occurs in the home by family members. In nursing homes, oversedation -- what Dr. Pieroni calls ``chemical or pharmacological straitjacketing'' -- becomes a problem, he says, ``in cases where a nurse doesn't want to put up with a patient or considers him or her intractable.''

Panel members point out the need for increases in state and local protective-services budgets. Although almost 40 percent of all reported abuse cases involve adults and elderly persons, only about 6 percent of state budgets for protective services are committed to elderly abuse victims, according to Mr. Baumhover.

Another part of the solution, specialists say, lies in increasing public awareness. US Rep. Claude Pepper (D) of Florida, chairman of the Subcommittee on Health and Long-Term Care of the House Select Committee on Aging, told the Monitor, ``We need to arouse public interest so those who have knowledge of such abuse will disclose it to public agencies that have the investigative or corrective power -- or to the police.'' Noting that some incidences of elder abuse are ``gruesome, vulgar, and barbaric,'' he cites a need for laws similar to those that exist for reporting and punishing child-abuse cases.

Legislation requiring mandatory reporting has been adopted by 37 states. But even some legal specialists remain cautious about the value of a punitive approach. Calling protective-service statutes ``mainly emergency stopgap measures,'' Carol Wallace fears that there is ``a lot of room for abuse of these laws.'' Moreover, she says, ``The laws are new and haven't been challenged.

``Legal solutions alone are rarely the answer,'' she concludes. ``We simply cannot legislate kindness and compassion.''