Addressing Cognitive Capacity and Elder Abuse
By Bonnie Olsen, Ph.D.
November 01, 2015
Dementia and elder abuse: As a civilized society, these are terms that should not ever occur in the same sentence, yet they do and with great regularity. As I travel home from visiting a relative that I haven’t seen for the past year, I am struck with the profound sadness and odd pleasure that perhaps I can help to make the journey that lays ahead a bit less chaotic, a bit more predictable, but mostly, more dignified by personal agency to the extent possible.
My relative had arranged a small dinner party for long-time family friends for my brief visit. They were all her compatriots and eager to hear about the latest news of my life and work in California. My relative had clearly struggled to keep track of the date and time of my visit, she couldn’t tell me precisely where she had spent the recent vacation with her grandchildren and I smiled when I saw the note on the dish of salmon in the fridge, “350 degrees for 40 minutes.” I noted the list of charities she had been contributing to monthly and the amounts, $10 and $20 to Wounded Warriors, ASPCA, NPR, etc. We talked as we walked through the fall leaves that afternoon. She admitted that something was wrong and she was having “trouble with her words”, but couldn’t really put a name to it. While she said she’d “go ballistic” if they told her she couldn’t drive, she admitted to willingness to stop driving at night. I applauded her good judgment and mentioned how I was sure her daughters appreciated this so they could avoid the worry. We talked about the difficulties of aging, laughed that it beat the alternative, and was so much about successful adaptation. I left feeling compelled to take note of her resilience, tenacity and how fortunate I am to have her in my life.
When people in our lives age and develop memory loss and ultimately dementia, there are complex worlds to negotiate. Family members now become caregivers and are thrust into the role of advocating and protecting them. It’s not easy or clear what that means. And it continues to change over time. If we err on the side of too little we are neglecting them. Too much and it’s unnecessarily intrusive and restrictive. If we fail to protect their assets, they may also become financially dependent. If we intervene too soon we are not respecting their independence. The intersection of dementia and elder abuse is tied up with the concept of capacity. This is not just a legal term, but as a family caregiver, it is tied to the hundreds of everyday decisions and tasks that may (or may not be) compromised. The idea of “supported decision making” is central to helping your family members retain the most autonomy and independence that they can safely manage. By seeking, really looking for ways to help them express their choices and do things safely on their own, you are protecting them from abuse, neglect and mistreatment.
When I speak with my relative’s daughter, I can reassure her that the note on the salmon was effective, that our relative can verbalize much more if she is encouraged to slow down, use humor and relax, that at least for now she seems okay to live on her own, and I can tell her daughter it would be wise to have access to her bank accounts, least our relative fall victim to a charity scam, and lastly that driving may soon become a difficult bridge to cross. As they take on more helpful aspects or safety measures, it will be important that our relative continue to go to her many clubs and cultural events to stay connected to friends. By supporting these “well” aspects of my relative, she will be more likely to engage in a collaboration of shared and supported decision making.