Question: My brother and I are concerned about out parents’ ability to continue to take care of themselves. In the past months, they appear to have slipped very quickly. Dad has had three automobile accidents; they have both lost weight and are unclean; they are forgetful and have gotten lost when they leave the neighborhood; and their clothes are dirty, Yet, they will not allow us – or anyone else -- in their home. They meet us at the door, and we visit on the porch. At 83 and 85, they will not hear of going to assisted living. Dad is adamant that he has things under control. We are out of ideas and filled with concern.

Answer: The increase in the size of our elderly population is being accompanied by an increase in the number of elder abuse cases that impact our public health and social welfare systems. Your situation -- which is shared by hundreds of thousands having parents in their 70’s, 80’s, and 90’s – points up the need to address self-abuse in the elderly as a problem of epidemic proportion in the United States today.
But, unlike child abuse and domestic violence which receive significantly more public, medical, and social service attention, elder abuse – including self-abuse and self-neglect – is often ignored until the chronic problems become acute – an individual falls and breaks a hip, becomes dehydrated and malnourished, has skin breakdown, is hospitalized, etc.

Self-neglect -- or self-abuse -- is defined behavior by an elderly person that compromises his or her health and safety by refusing to accept needed assistance with various activities of daily life. Since the affected elderly individual may have capacity to make some of his or her own decisions, an ethical dilemma arises when balancing the individual’s right of autonomy against his or her actual best interests.

Just how prevalent is the problem? According to a 1998 study, more than 550,000 seniors aged 60 and older were affected by abuse, neglect, and/or self-neglect in a one-year period, and reports to adult protective services (APS) agencies of elder abuse increased 150 percent between 1986 and 1996. Yet, only one of four cases were reported to social service authorities even though adult protective services clients are among the most vulnerable of populations, unable to protect themselves from abuse and harm due to the extent of their disabilities, dementia and other limiting conditions.

What to do? As you have learned, when a child is found to be “interfering” with a parent’s autonomy and control, interpersonal difficulties arise. Therefore, we suggest that you try to get third persons whom your parents trust to intercede: For example, try to get your parents to see their physician on a regular basis so their conditions can be monitored. Because of a physician’s duty of confidentiality, you may not get much information from their doctor, but we think it’s a good idea to let their medical team know about the problem so that, hopefully, the physician, a nurse, or a physician’s assistant will proactively attempt to get your parents into the office.

Try to get your folks evaluated by an independent geriatric care manager who, hopefully, can build a trust relationship with them. Try to introduce a cleaning service and “Meals on Wheels” into their lives to make sure they are properly nourished.

There may be protection available in your local probate court or family court depending on the law of your state. As a last resort, contact your local department of social services and find out their position about self-abuse and self-neglect, but you may find with budget cutbacks, these folks may be less available.