Monday, June 17, 2013

Can Elders Be Bullies?

Can Elders Be Bullies?

By Jessica Girdwain
Are older adults in long term care facilities intimidating other residents?
Concerns about bullying are nothing new. But usually bullying arises in schools or neighborhoods where young people insult, intimidate, or hurt others, namely their peers. But geriatricians and aging experts have observed elements of bullying invading elder communities as well.
Elder bullying can occur for numerous reasons. “There comes a time when older adults lose their freedoms. Being in a home or facility changes their lives, and that can be hard for them to handle,” says Matthew Coppola, MD, a primary care physician at Allegheny General Hospital in Pittsburgh. That, he says, possibly sparks bullying—a problem that can spread within long term care facilities. Coppola has been speaking out about what he calls an emerging and pervasive problem.
What constitutes bullying among older adults? “I define it as when the will of the bully is placed upon a senior in a way that they don’t seek out or wish for, and they want to avoid it. This can be verbal, physical, or emotional abuse,” Coppola says.
In verbal abuse, the bully may use mannerisms or words to “run the roost or control certain aspect of another elder’s day. It’s about the tone of their voice or what’s being said,” Coppola says. It’s not necessarily swearing—it may be as simple as one resident saying to another that he or she can’t sit at a certain table during bingo games.
Emotional abuse can be found in the familiar and nearly analogous cliques we all remember from high school. “There was the jock table, the nerd table, the geeks—and you sat in your section. It’s similar in an eldercare facility. Maybe one resident used to play at a specific bingo table with a group and suddenly that group no longer has a seat for them,” Coppola explains.
Among elders, physical abuse doesn’t have to involve willfully hurting another. Usually it occurs when an elder makes a physical gesture that’s intimidating, such as grabbing a wheel on another elder’s wheelchair or pushing a walker to get him out of the way.
Regardless of the type of abuse, health care providers should know that it’s disturbing to elders as Coppola has noted. He has recently made a series of presentations to older adult groups describing the problem and called “Bullying in Your Golden Years.”
Often the catalyst for elder bullying is the move into an eldercare facility. “Sometimes, seniors may act out physically or emotionally to make their point to their family,” Coppola explains. “I see elders struggling with the fact that their children are living a classic fast-paced yuppie life and not listening that Mom doesn’t want to go into that setting right now.”
Increasing Trend?
It’s not well known just how widespread elder bullying is. “In my experience, I don’t think the issue of bullying is very common,” says internist and geriatrician Andrea Fox, MD, medical director of the Squirrel Hill Health Center in Pittsburgh.
However, Fox admits that individuals who have a history of bullying or intimidating others aren’t likely to change with age. “Most likely, the elders that are considered bullies have been bullies their whole lives. Sometimes when you’re in a group living setting, your inner tendencies arise, and those underlying negative characteristics are always there,” she says. “Some of these people living at long term facilities have known each other since kindergarten. One woman has a boyfriend, and the others are jealous of her. She was always popular. The point is, it doesn’t change.” 

Coppola agrees that it’s not a widely pervasive or well-researched issue. Fortunately, he says, “We’re finding that more facilities are putting standard policies in place on how to handle bullying.” He talks to older adults about setting up a bullying committee (and recommends other facilities do the same), which accomplishes two things: It helps victims know they’re not alone and warns the bullies themselves.
Protecting Potential Victims
To identify individuals who might be bullied, health care practitioners should take notice if an elder withdraws from social interactions, Fox says. Maybe he or she used to go out but suddenly stops engaging in activities or remains in his or her apartment or room during mealtime. “Those are hallmark signs of elder abuse and are the same symptoms we’d look for in a bullying situation,” she says.
The most important issue related to bullying—and the reason health care practitioners should stay attuned to it—is that it may be a sign of an underlying medical condition, according to Fox. Providers should use a bullying incident as an opportunity to determine what the underlying issues may be. Use it as an opportunity to look for sudden changes in personality. For example, an older adult may have been a sweet person previously and then suddenly begins to act mean and out of normal character.
Of course, an illness or dementia should be considered. “Sometimes people who thought that that older man was just a mean and nasty guy, they really have a brain disease that doesn’t allow them to control their behavior, and they can’t be who they used to be,” Fox says.
Fox recalls a female patient who had a problem with the people with whom she sat during meals. The patient complained that she couldn’t understand one of her tablemates because of a heavy accent; she hated how another took her teeth out. “The thing was, she had been sitting with them for quite some time, and it suddenly bothered her,” Fox explains.
The patient had a history of depression, so Fox was alerted that she might be experiencing further depression. “Bullying is an indication that you need to dig deeper about what’s going on.” The answer also could lie in alcohol or drug dependence. “They may need an intervention,” Fox says.
Patients may be in danger when health care professionals fail to examine the issue of bullying and follow up appropriately. Fox, who presents expert witness testimony in various courts, recalls the case of two older men who lived in a long term care facility. “They hated each other, but the staff didn’t do much to intervene,” she says. “One day they got into an argument, and one suffered a fatal fall.”
Of course, such circumstances are rare, Fox says, but prove that health care practitioners should be aware of the consequences. “The staff kept telling them not to argue, but that doesn’t do much when it comes to older adults who are cognitively impaired. The two men needed to be completely separated,” she explains.
On the other hand, if a thorough mental and physical examination reveals no underlying medical condition, an elder resident may just not be a nice person. “In that case, a group setting may not be the right environment for someone,” Fox says. She recommends that health care practitioners ask family members about a resident’s personality, especially before he or she enters a care facility. Is the elder likely to be a socializer or a loner? If the latter, the elder may not thrive in a highly social situation.
“Healthy aging is about being adaptable and making new friends,” Fox says. “Socializing is one of the most important things for helping an elder stay on top of his or her game.”
— Jessica Girdwain is a Chicago-based freelance writer who has contributed health-related articles to several national magazines.

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