A Hidden Crime

By Marie-Therese Connolly
Sunday, January 27, 2008

Bette Davis once said old age ain't for sissies. She was right.

As though declining health, impending mortality and other challenges weren't hard enough, too often old age is also plagued by abuse, neglect and exploitation.

Science has extended our lives dramatically: In 1900, Americans' average life expectancy was 47. By 2000, it was 77, and it's still rising. But our energy and resources have been disproportionately focused on living longer rather than living better -- a phenomenon called " the longevity paradox."

Consider the travails of the late socialite and philanthropist Brooke Astor. Even her fortune couldn't protect her. Modern medicine helped her live to 105, but her friends and grandson assert that she languished with Alzheimer's on a reeking couch, subsisting on pureed peas and oatmeal because her son didn't pay for adequate care; the Manhattan district attorney has indicted him on charges of grand larceny for pilfering her assets.

Eight years of working on issues involving abuse of the elderly at the Department of Justice taught me that while Astor's life may have been uncommon, her alleged plight in old age was not. Estimates of the prevalence of elder abuse vary wildly, but by some reports there could be up to 5 million cases a year, with 84 percent going unreported. All other factors being equal, victims of even relatively minor mistreatment are three times more likely to die prematurely than those who are not victimized.

Furthermore, our nation is in the midst of three seismic demographic shifts that will put seniors at even greater risk for mistreatment. Older people are living longer, until they're frailer and more vulnerable. They are increasingly alone in old age, given that families are smaller and more geographically and emotionally dispersed. And the pool of potential caregivers is aging and shrinking. We need 30,000 geriatricians: We have only 9,000.

Although elder abuse typically conjures visions of nightmarish nursing homes, the term actually encompasses a far broader spectrum of trouble, including physical and psychological abuse, neglect and financial exploitation. Practitioners report that most elder abuse occurs at home at the hands of family and that the most frequent perpetrators are adult male relatives with mental health or substance abuse problems.

We are perhaps in greatest denial about elder sexual abuse. When the perpetrator is a son or grandson, these cases are met with disbelief, given the taboo-busting, worse-than-Oedipal nature of the offense. Take the case of 96-year-old "Miss Mary." To get out of a nursing home, Miss Mary moved into the Jacksonville trailer home of her grandson and his wife. She cooked and cleaned for them and contributed part of her Social Security check to the household; they sold off her belongings and stole her burial payments. One night in 2004, when his wife was gone, Miss Mary's grandson raped and assaulted her for six hours, then threatened to kill her. Instead he fell asleep, and Miss Mary called 911.

Despite serious injuries and abundant evidence of the attack, her entire family took the grandson's side. Prosecutors worried that the jurors wouldn't believe her either. But they did, convicting the grandson of sexual battery, for which he was sentenced to 40 years in prison. Until her death last year, Miss Mary lived in the place she had most wanted to avoid -- a nursing home.

Neglect may sound more benign than abuse, but it usually lasts longer, is harder to prove and prosecute, and can be just as lethal.

When paramedics were called to the Des Moines home of 68-year-old Blossom Deering in early 2000, they found her kneeling on the ground. Her legs were crossed and stuck to the floor by a glue that had formed when her waste fused with cloth and newspaper. She had been there about two weeks, covered in huge pressure sores, many to the bone. Deering's infection was so severe that she died three days later.

Deering wasn't living alone. A 51-year-old man lived in her house rent-free in exchange for "helping" her. He had been writing checks to himself from her account. While she lay on the ground, he spent her money on gambling and shopping sprees. He claimed that, while she was on the floor, he had brought her food and that she had declined help, worried that she'd be taken from her home. Eventually he pleaded guilty to abuse and neglect of a dependent person and was sentenced to 10 years in prison.

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