Elder Abuse

Elder abuse and non-voluntary euthanasia is happening around New Zealand in domestic homes, nursing homes and hospitals and is on the rise.
  • Cases of medication errors, neglect, lack of hygiene and physical abuse have been reported.
  • Elderly people may refuse to take any action against the person abusing or neglecting them due to a fear of being abandoned.
  • Routine killing of the elderly who do not have terminal illness is happening.
  • The elderly are frequently dying three days after being admitted to the hospital, overdosing is common.
  • Dehydration can cause death in as little as three days.
In April 2004 in New Zealand, a report from the organisation Age Concern drew attention to the fact that "...about a quarter of elderly people who put someone they trust in charge of their personal and financial affairs are then abused by that person."

Elder abuse and neglect is defined by Age Concern New Zealand as "when a person aged 65 years or more experiences harmful physical, psychological, sexual, material or social effects caused by the behaviour of another person with whom they have a relationship implying trust."

Data was collected over an 18 month period which indicated that levels of abuse and neglect are increasing. Men and women of all age groups experience elder abuse and neglect, although it appears to be most common among those in their 70s and early 80s, and women are over-represented by 42% among Age Concern elder abuse and neglect clients, 29% more than they are in the general population overall. 1

Contributing factors
A diverse and complex array of factors contribute to the incidence of elder abuse and neglect, among them:
  • dependency of the older person on others for all or part of their care
  • carer stress
  • dysfunctional family dynamics, including a history of violence
  • social isolation and lack of self esteem on the part of the older person and/or the abuser
  • mental health and psychosocial problems on the part of the older person and/or the abuser
  • drug and alcohol abuse on the part of the older person and/or the abuser 2
Physical disability is identified as the most frequent contributing factor, followed by impaired communication, especially for cases where the main form of abuse is psychological abuse. 3

It is not unusual for elderly people to refuse to take any action against the person abusing or neglecting them due to a fear of abandonment.

Elder abuse and neglect is very rarely a crisis situation. It has probably been happening for a long time until one day someone says enough is enough.

Institutionalised abuse and neglect
Elderly people and mentally impaired persons are placed in hospitals and nursing homes when they require special care and attention.

When a patient is 'difficult' or under-staffing means nurses are having to work harder, some institutions resort to sedation of patients. Over the past decade, incidents of nursing home abuse have been on the rise. Cases of medication errors, neglect, lack of hygiene and physical abuse have been reported.

If you suspect incidences of abuse or neglect in a rest-home or hospital:
  • Discuss the situation with the older person if possible and put your concerns to senior management
  • Ask to see the home’s/hospital’s complaints procedure
  • If your concerns are not addressed by the home or hospital, ring the local Licensing Office of the Ministry of Health to make a formal complaint
  • If the complaint is very serious and you feel immediate action is required, ring the Police
  • Contact your local Age Concern, the NZ Licensed Rest Home Association and the NZ Hospital Association for advice and support
  • If things cannot be resolved, you may wish to contact an advocate of the Health Advocates Trust, Phone: (06) 378 6970 or (04) 237 0418. You can also reach the Health and Disability Commissioners office on freephone 0800 112 233 for further information 4
Prevention
Staff are likely to be more diligent and much less willing to participate in rationing if they know they can be identified later. Always keep a notebook and pen handy, and keep them visible.

Write down the name of the person you are talking to. Ask for the name of the consultant responsible for the patient, and also ask for the name of the doctor who will be responsible for the day to day management of the case.

If you ask all these reasonable questions in a friendly manner, you can expect straightforward civil answers. If you feel you are getting fobbed off with excuses like 'it's confidential' or 'too busy' or 'you don't need to know' then do not get upset.

Visit your relative and stay constantly, take pictures and tape any conversations. Note down everything in detail.

"Old age" syndrome
Routine killing of the elderly who do not have terminal illness IS happening. Although the following story takes place overseas, there is plenty of evidence to suggest that this is taking place in New Zealand.

Your life may be in danger if you are admitted to a hospital, especially if you are over 65 or have a chronic illness or a disability. The elderly are frequently dying three days after being admitted to the hospital. Some attribute it to "old age syndrome" while others admit that overdosing is all too common. Euthanasia is not legal but it is being practiced.

Mary Therese Helmueller, an RN from Minneapolis wrote an article in the Catholic magazine, Homiletic and Pastoral Review, in 1998. In the article she noted that while she was visiting in Mexico City in February of that year, her grandmother was admitted to a local hospital with a fracture above her left knee.

According to the hospital records she personally examined upon her return, her grandmother was alert and oriented upon admission. But, the report added, she became unresponsive after 48 hours, went into a coma. She was transferred to a hospice two days later. Carefully tracing the events that led up to her grandmother's coma, Helmueller discovered that her grandmother became unresponsive after each pain medication.

She was diagnosed as having a stroke and being in renal failure. Helmueller's grandmother died shortly after her arrival at the hospice. The hospital charts were normal. The CATscan was negative for stroke or obstruction. The EEG indicated no seizure activity. All the blood work was normal. She was not in renal failure. The only anomaly Helmueller found was the overmedication of her grandmother. She also noticed her grandmother was listed as a "No Code" patient.

Helmueller insists her grandmother had no terminal illnesses. Nevertheless, the hospice's admitting records reveal that two doctors stated that she was terminally ill and would die within six months. The first doctor, the director of the hospice, never examined or evaluated her. Nor did he even read her chart. The second doctor was on vacation when she was admitted. He did not return until three days after her death. Yet, in their expert medical opinion, she was terminal when she arrived at the hospice. 5

What to look for - it could save your loved one's life
Dehydration
can cause death in as little as three days, so it is important to spot it early. The first effect of dehydration is a sensation of thirst, so complaints about feeling thirsty should be taken seriously. The depression, confusion and delusions which follow as the dehydration deepens are also important signs which are often assumed by relatives to be part of some natural downhill progression.

One useful test for serious dehydration is to gently pinch some loose skin between thumb and forefinger. Dehydrated skin stays 'pinched' whereas normal skin returns to its original shape (try this on yourself first!). Other effects of dehydration include dry mouth and throat and shortness of breath (in turn making speech and swallowing difficult), deafness, swollen tongue, constipation and pneumonia.

Dehydration weakens skin, and once the patient is too weak to move, bed sores can quickly develop.

Bed sores (also known as pressure sores, decubitus ulcers) develop as a result of lying in the same position for too long. Constant pressure on the same spot reduces the flow of blood to the extent that the skin dies. If the pressure continues the area and depth of the tissue necrosis increases.

Necrotic (dead) tissue quickly becomes infected and this infection can spread to the blood. Poor nutrition and hydration increase the risk of bed sores. The risk of bed sore development should always be assessed and reassessed frequently, and staff who fail to do this or who fail to act appropriately to an assessment are clearly negligent.

Diamorphine, otherwise known as Heroin, is usually used in palliative care and heart attack patients. It is injected subcutaneously (under the skin) or intravenously (through a vein). Placing it through a vein makes the drug act faster. Its effects are multiple.

Used usually for pain relief, it can also depress respiration thus decreasing the drive to breathe. It also relieves anxiety eg in heart attack patients. It is a drug that is useful in heart failure enabling the load of the heart to be less thus relieving the problems of the failing heart coping with a large amount of blood.

Usual doses are 2.5-5mg. It may be placed in a syringe pump, usually in palliative care, (eg for terminal cancer patients) to relieve pain and distress. Diamorphine is contraindicated in people with respiratory conditions because it may cause respiratory arrest. 6

References:
  1. Elder Abuse and Enduring Power of Attorney A special report from the Age Concern New Zealand, April 2004
  2. Ibid
  3. Ibid
  4. Information produced by Age Concern NZ Inc, PO Box 10-688, Wellington, Phone: 04 4712709
  5. Mary Therese Helmueller Are you being targeted for euthanasia?
  6. http://www.patientprotect.org/