Tom and Annie were long-standing patients at our clinic. They had moved into their triple-front brick veneer in the south-eastern suburb of Melbourne when they married in the early 1950s.
This suburb was market-garden territory until the subdivisions hit. There was little or no talk of green wedges at that time, and a railway line and station were already in place, unlike some of the infrastructure “catch up” problems we now face in our ever-expanding metropolis. After all, this suburb is only 16km from the CBD, unlike the current outer-metro sprawl which extends beyond 50km.
Tom and Annie’s family grew, as did their community. Their three children (two daughters and a son) were all delivered in the local hospital by GPs from our clinic. This community hospital is now a cancer centre. Babies no longer enter the world in this place; sadly, many people leave it. GPs have no role to play in this organisation.
Tom was a tall, strong, good-looking man who had completed a carpentry apprenticeship after returning from the Second World War where he served in the Pacific. He was a talented athlete whose skills were sought by several football clubs immediately after the war. Had he lived today, he may well have played football at an elite level and would have secured a lucrative contract. Recently married and soon with a growing family, Tom instead turned to his vocation as a carpenter to earn a living and support his family.
In her mid-70s, Annie began to show early signs of dementia. Tom highlighted the difficulty she was having remembering where she placed things, she could no longer be trusted to go shopping on her own or cooking meals and progressively needed reminding about showering. A series of tests and visit to a geriatrician confirmed the diagnosis of Alzheimer’s dementia.
It was at this stage that Joy, their eldest daughter stepped in to help. She offered to take her mother shopping on a regular basis, once or twice a week, sharing coffee and sandwiches on these outings. Tom was very appreciative as it gave him time to spend in the garden or share some memories with old mates at the local RSL.
Joy’s siblings, Janice and Eric, were also happy, particularly as they had full-time jobs and could not afford the time to care for Annie.
This arrangement continued happily for eight or nine months, until Tom received a call from the bank asking him if he was aware that their savings account which was linked to Annie’s credit card had been progressively depleted over the past six months with $35,000 being removed over this time, through a mixture of regular cash withdrawals and credit card payments to an online betting agency. There was now only $5000 left in the account.
Tom came to see me. He was tearful, shaking, shocked and mortified. He had confronted Joy, who admitted to a gambling problem and promised to pay the money back. Her siblings wanted the matter reported to the police. Tom could not bear the thought of a court case and the possibility of Joy spending time in jail. He agreed to accept Joy’s offer, who, together with her husband James, undertook to pay the money back over a 12-month period. Life for the family was never the same again.
Elder abuse is becoming increasingly common as our population ages. With almost 15% of the population aged over 65, and up to 20% of people aged over 80 expected to suffer some form of dementia, the potential for elder abuse increases.
Elder abuse is not confined to family settings and often takes place in institutional settings. The Victorian Royal Commission into Family Violence devoted a section to elder abuse with important submissions from Victoria Police and Senior Rights Victoria.1
Abuse may be physical, sexual, emotional or financial in nature, as was the case with Annie. When it occurs in family settings, it is often under-reported to police. Shame takes over. It is estimated that 5% to 6% of elder Australians may be affected by some form of abuse, with women affected more than men.
Generally, males are the perpetrator, with the exception of perpetrators in the 50-54 year age group where women are more likely to be perpetrators.
Joy, Annie’s daughter was 52. Joy fits nicely the pattern described in The Senior Rights Victoria Study. Most elder abuse victims are aged 70-84, most perpetrators are aged 35 to 54, 92% of perpetrators are related to the victim, 40% are sons of the victim and 27% are daughters. Only 5% are husbands.
Many GPs will have older patients who have been abused, or will be abused in the future.
It is important that, in certain circumstances, we tactfully raise the subject with elderly patients by asking some simple questions:
“How are relations in your family?”
“How do you get on with your children?”
“Do you manage your own finances?”
“Have you arranged power of attorney?”
Tom trusted his daughter. That trust was misplaced and abused and family relations were permanently destroyed.
Tom’s health deteriorated rapidly over the next six months and Annie was admitted to nursing home. A year later both were dead.
I was left wondering what to write on the death certificates as the true cause of death.
1. Royal Commission into Family Violence. Summary and Recommendations. Vol 5, Chap 27 pp1353-1384 March 2016
Dr Leon Piterman is Professor of General Practice at Monash University and has been in clinical practice for almost 40 years
Do you have any similar professional experiences you’d like to share? Please email: [email protected]