For many, growing older is a time to stop and smell the roses. It's also a time to reflect on past accomplishments and enjoy the supposedly quieter years that are left.
But for a number of elderly citizens, it is also a time of neglect, vulnerability and even abuse - particularly at the hands of a spouse. In fact, say the experts, elderly people may be at increased risk of abuse if they are cared for by a spouse, especially if that spouse is coping with his or her own physical or mental-health problems, according to a new study at the University of Pittsburgh's Center for Social and Urban Research.
The study further discovered that caregivers who were married to the person they were looking after were more likely to be abusive than other caregiver family members, such as adult children.
Another study, published in The Journal of the American Geriatrics Society, found that older adults providing home care to their spouses may be more inclined to act in ways that could harm the impaired partner - inadvertently or on purpose.
Ira Sharp, M.D., attending physician at Abington Memorial Hospital and a specialist in geriatrics, says the problem may be more common than we realize but underreported, although people are at least acknowledging it.
"A study I recently read (but not sure where) estimated that as many as 450,000 elderly persons age 60 and over experienced abuse in domestic settings in l996," says Sharp. "And of that number, only approximately 71,000 cases were reported, while the remainder were not."
Verbal Abuse and More
He says that elderly patients being looked after by a spouse who do report abuse were likely to report that their caregivers screamed or yelled at them, used a harsh tone of voice, swore at them or called them names.
"That's probably the most common form of abuse where people are humiliated or intimidated, and sometimes threatened," he says.
"Neglect is also a common form of abuse, where the caregiver is unable or unwilling to provide for the well-being of their spouse, perhaps because the caregiver has his or her own medical issues and financial resources may be at a minimum," explains Sharp.
And often, adds Troy Thompson, M.D., professor of psychiatry and human behavior at Jefferson Medical College and Hospital, aging issues often exacerbate what was already there.
Says Thompson: "Mental and emotional abuse may be simply a continuation of what happened earlier in the relationship. One partner may have been the more dominant and the other more submissive.
"So as they get older, particularly if they get a little demented, they each may become a caricature of themselves, and do more of what they used to do. Or they may now hate what they have to now put up with.
"Often, they are both sick, and neither of them is the person they were 40 years ago - emotionally or physically," continues Thompson. "If they're a little irritable to start with, as they get older and perhaps a little more depressed, they may get more volatile, more intolerant, more rigid, and, yes, even more abusive."
The experts suggest that family members and doctors should begin to pay close attention to situations where an elderly person is looking after a spouse. It may also be a good idea to screen the couple, and provide intervention if there are any signs of trouble.
According to Sharp, "It is not unusual for chronic medical problems to cause the caregiver to burn out. I remember two elderly people I knew who were in an assisted-living facility with the wife having many illnesses and the husband doing all the caregiving. He eventually got so burned out that he ultimately ended up taking both their lives."
That, of course, is the ultimate form of abuse, but it can happen. So what can society or family members do to prevent such an occurrence?
States Thompson: "I know nobody likes to hear this, but if the elderly person is so sick that the spouse just cannot take care of their needs, they should be put in an institution.
"Arrangements should be made in a setting where the individual will be able to be cared for competently by others. If not, often the physical well-being of the caregiving spouse tends to deteriorate rapidly.
"Education is the key," he adds. "We also must begin providing these caregivers with alternatives that might ease the burden of caregiving, such as putting them in touch with support groups or arranging for other family members, friends or formal service providers to perform respite care.
"We don't live in a Utopia," he concludes. "Every person has their own set of needs but, with time and tolerance, hopefully we can help take care of them."