It isn't a comfortable conversation to have. You, a caregiver, are putting in time, love, and effort towards caring for your aging loved one, or you are a professional going about doing your job with dignity and genuine concern. Most days go by without major incidents, with both you and the person being cared for getting along fairly well and passing the time between activities with a measure of closeness. Then one day, and perhaps for many days after that, you become the victim of abuse. This may take the form of physical harm such as being struck, scratched, or bitten; it may also be verbal or emotional abuse, wherein the elderly person says things that hurt your feelings and degrade your self-esteem. Either way, you find yourself facing an uncomfortable solution: someone who needs your help is harming you.

The first step is recognizing how common this type of abuse is. This is not an altogether rare occurrence, which is unfortunate. Placing your situation in the context of abuse by the elderly is important, because it will help you complete the following steps in regard to how to deal with the abuse. Remember that, while we do not have absolute numbers for this type of scenario, word-of-mouth and anecdotal evidence tells us that many caregivers experience some form of abuse from a person they care for. It is an unfortunate part of some people's caregiving experience.

The second step is to recognize that you have a right to be treated with respect and kindness. Caregiving expert Joy Leverde calls it "getting angry," since you have a right to be angry if you are treated unfairly or cruelly. The trick in this step is not to cease your caregiving immediately or to allow this emotion to overtake you; the trick is to feel it and allow yourself to feel it, because your emotions--whatever they are--in response to this treatment are valid and must be acknowledged.

Thirdly, remember not to take it personally. Although the work of caregiving is intensely personal by nature, it is true that abuse has nothing to do with the victim and everything to do with the abuser. Healthy, happy, adjusted people do not become cruel and hurtful, so the abuse is a sign of something going on in the life of the abuser--much like the common trope of the schoolyard bully having a tough home life. You did nothing to prompt this treatment, and you are not at fault, so do not burden yourself with guilt or take abuse personally. If you were not there, it would likely be aimed at someone else--or perhaps already is, if you share caregiving duties with other people.

Identify the problem that is causing this behavior. Some medications can cause mood swings or violent outbursts; perhaps your loved one is showing signs of confusion, memory loss, or dementia, all of which can prompt viciousness in otherwise kind folk; or there may be a substance abuse problem that has not been addressed, which is more common in the elderly than many might think. Whatever the true cause of the behavior is, identifying it can help you stay calm in the heat of the moment. Repeat the reason to yourself: "I do not deserve this treatment, and I did not cause it. [Insert reason here] caused it and I am going to help solve this problem."

There may be multiple causes, such as untreated pain coupled with memory loss or substance abuse and a mental illness. Elderly people are human, too, and they suffer from many of the same flaws as their younger counterparts, many of which require treatment and experts to resolve. The reprehensible behavior may also be caused by the elderly person receiving abuse from other caregivers. This kind of treatment can prompt inappropriate outbursts of bad behavior, just as it does in many children.

Last, but certainly not least, find a solution. You may need to consult an expert for this, such as a psychiatrist, primary care physician, or therapist. You should not allow yourself to be abused as a form of sacrifice for an elder, and should always protect yourself first, since caregiver burnout is a real danger to your health and the health of your loved one. Since you may have identified the problem, it is important to solve it in order to have a healthy and productive relationship with the person for whom you provide care. The plan may be simply to set firm boundaries about what is or is not acceptable to say or do, and to stick to that plan regardless of circumstances. The solution may also be to change or add a medication regimen, see a therapist together or separately, or to spend more time during the day apart in order to maintain healthy emotional lives outside of caregiving. Regardless of the form it takes, the solution needs to work for both of you, and make life better each day rather than worse.

Caregiver abuse is not an easy thing to diagnose or to resolve. Unfortunately, it can put us in a conundrum wherein we are choosing between our health and the health of someone who needs us. However, it should be our goal as caregivers to work to find a solution while also keeping ourselves healthy, which will always result in better care and a better life.

Sources:

Lestch, Corinne, Trapasso, Clare, and Kemp, Joe. (September 2, 2012). Police: wheelchair-bound dad douses his daughter with acid. New York Daily News. Available at http://www.nydailynews.com/new-york/brooklyn/police-wheelchair-bound-brooklyn-man-douses-daughter-acid-claims-abusing-article-1.1149770. Retrieved May 28th, 2016.

Loverde, Joy. (February 22, 2012). Family Caregivers: Is Your Self-Respect Intact? CCAL-Advancing Person-Centered Living. Available at http://www.ccal.org/featured-expert/family-caregivers-selfrespect-intact_02-22-2012/. Retrieved May 28th, 2016.

National Center on Elder Abuse. Fact Sheet on Elder Abuse. Institute on Aging. Available at http://www.ncea.aoa.gov/Resources/Publication/docs/fact_sheet.pdf. Retrieved May 28th, 2016.

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