Abuse of Patients with Alzheimer’s Disease or Dementia

More than 6 million Americans live with dementia or Alzheimer’s disease, many of whom live in nursing homes. Nursing home residents who have dementia are at a higher risk for abuse and neglect. Knowing the signs and what to do if you suspect a loved one with Alzheimer’s or dementia is a victim of nursing home abuse will allow you to stop the abuse and bring perpetrators to justice.

Elderly woman in grief

Alzheimer’s disease and dementia are tragic diseases that lead to permanent cognitive decline, primarily in the elderly. According to the Alzheimer’s Association, 55 million people worldwide live with Alzheimer’s and other dementias, including 6.5 million Americans over the age of 64. Due to their high level of need, dementia patients account for approximately 48 percent of nursing home residents.

In a 2020 study by the World Health Organization, approximately two out of three nursing home employees admitted to abusing residents in the past year. It is believed that as many as five million elders are abused in nursing homes annually. 

Exact figures are impossible to obtain because not all elder abuse is reported. Recent studies have found that for every reported case of abuse, 24 unreported cases exist, and unreported instances of neglect are likely even higher, with an estimated 58 unreported cases for every one reported.

Patients with Alzheimer’s disease and related dementias are less able to advocate for themselves and face the highest risks of becoming victims of nursing home abuse.

Are Alzheimer’s and dementia the same disease?

Dementia is a broad term that describes numerous conditions characterized by cognitive impairment, confusion, behavioral changes, and memory loss. The Alzheimer’s Association states that Alzheimer’s disease is the most common type of dementia, accounting for 60 percent to 80 percent of cases.

Symptoms of Alzheimer’s disease include:

  • Difficulty remembering newly learned information
  • Progressive cognitive decline with increasing confusion and memory loss
  • Undue suspicion of others
  • Mood changes
  • Disorientation
  • Behavioral changes
  • Difficulty walking, speaking, and swallowing

Other common types of dementia include vascular dementia, Lewy body dementia, Huntington’s disease, and Parkinson’s disease. The risk of developing dementia increases with age.

People with Dementia Are Especially Vulnerable

Caring for people with dementia requires 24-hour vigilance and specialized care from trained professionals. This is the main reason families of dementia patients make the difficult decision to place their loved ones in nursing homes in the first place.

Abusive Staff Believe They Won’t Be Caught

Patients with dementia experience confusion and memory impairment, which lead abusers to assume the patient will not remember the abuse. Furthermore, perpetrators may think no one will believe the patient and will instead attribute reports of abuse to the paranoia and hallucinations experienced by some people with dementia.

Patients with Dementia Have More Stringent Care Requirements

Patients with dementia require an elevated level of care and supervision. These additional needs can strain nursing home staff, who are often already overworked due to staffing shortages — a key cause of nursing home abuse. Nursing homes often pay staff members a low amount without offering sufficient training for the specific needs of memory-impaired patients.

Sundowning

Sundowning is a common symptom in Alzheimer’s patients, in which they experience heightened agitation beginning at dusk and continuing throughout the night. Without proper supervision, patients may wander and end up in inappropriate places, such as in another patient’s room, in a janitor’s closet, or even outdoors. 

They will often become confused about where they are and unable to find their way home. This can be a life-threatening situation, especially if they are not found within 24 hours. For example, patients could freeze to death or be hit by a car if they go outdoors.

Behavioral Challenges

Dementia patients can become easily agitated due to the fear they experience when they do not recognize nursing home staff or their surroundings. They may become suspicious of staff and refuse to cooperate with basic routines, such as bathing or changing clothing. They may even become physically or verbally combative. With the proper training, these situations can be managed in a professional manner that helps patients maintain their dignity.

Increased Frailty

As dementia patients age, they become increasingly frail and dependent on caregivers. An understaffed facility may not provide for all the patients’ needs. As dementia patients progress, they may lose bladder control, the ability to speak, and have difficulty with mobility.

These patients require extra support to ensure the following needs are met:

  • Proper hygiene, such as clean diapers and linens
  • Opportunities for socialization
  • Bedsore prevention

In addition, frail patients are easy targets for poorly screened abusive staff. Abusers can perpetrate multiple forms of abuse with relatively low resistance and blame a fall or the patient’s medical conditions for any resulting physical evidence.

Who is most at risk?

Cognitive impairment is an important risk factor for nursing home abuse and neglect.

Dementia patients with the following characteristics face the highest risk of nursing home abuse and neglect:

  • Poor health
  • Mental health problems
  • Functional disabilities
  • Lower socioeconomic status
  • Financial dependence
  • Prior exposure to trauma
  • Limited social support
  • Lack of family checking on them frequently
  • Women
  • African Americans

Reporting Abuse

Nearly every nursing home resident who experiences abuse faces challenges when attempting to report abuse. These challenges include fear of retaliation, retaliation actually occurring, and the issue not being addressed. 

In 2018, a nursing home resident who does not have dementia, Mae Vahl, reported nursing home neglect she experienced to the state of Texas. In response, the nursing home attempted to drug her with sedating antipsychotic drugs she didn’t need and ultimately forcibly discharged her.

Dementia patients experience even greater challenges due to the nature of their conditions.

Difficulty Recognizing Abuse

Patients with Alzheimer’s disease and other types of dementia experience blank areas in their memories, confusion, and difficulty differentiating between dreams and reality. When they experience abuse, they may be unaware it is happening or they may be unsure of whether it really happened. They also may not recognize neglect or that certain behaviors constitute abuse.

Credibility Questions

Dementia patients sometimes experience hallucinations and delusions. They may accuse nursing home staff of harming them, stealing from them, or planning to harm them. When they report abuse, nursing home staff may routinely dismiss these claims without investigating them. This is a terrible mistake because abusers may take advantage of the vulnerability.

Abuse allegations are outrageous, and nursing home staff may believe their facility is immune to such conduct. While this approach may be easier for nursing home staff, it renders dementia patients powerless to report or escape abuse, and it increases their risk of experiencing it.

Types of Abuse Perpetrated on Dementia Patients

Dementia patients experience the same types of abuse as other nursing home patients, but they are targeted more often due to their increased vulnerabilities. Nursing home abuse can be inflicted by nursing home staff, other residents, and family members who come to visit. Regardless of who inflicts the abuse, the nursing home is responsible to protect patients from abuse.

Physical Abuse

Physical abuse occurs when bodily harm or pain is inflicted on a patient. This can include any of the following:

  • Punching
  • Slapping
  • Pinching
  • Pulling hair
  • Grabbing
  • Pushing
  • Inappropriate use of restraints
  • Inappropriate use of sedating medication

Inappropriate Use of Antipsychotic Medication

New York Times investigation found that as many as 21 percent of all nursing home patients receive antipsychotics, and most of these are dementia patients. These drugs keep patients asleep throughout the day, but the drugs’ black-label warnings specifically state that they increase the risk of death in dementia patients.

They are so dangerous that nursing homes are required to report when they are prescribed for off-label uses. However, the New York Times investigation uncovered that nursing home doctors skirt this requirement by adding a diagnosis of schizophrenia to patients’ charts. The drugs are essentially used as chemical restraints and a substitute for staff.

Nursing homes are required by law to only provide medication that serves the best interests of their patients, not the best interests of nursing homes or their employees.

Sexual Abuse

Nursing home sexual abuse includes any nonconsensual sexual contact. Dementia patients cannot legally consent to sex when they are not lucid, which means any sexual contact with these patients by nursing home staff, residents, or even family members is sexual abuse. 

Examples of sexual contact include the following:

  • Fondling
  • Rape
  • Sodomy
  • Coerced nudity
  • Sexual harassment
  • Sexually explicit photography

Emotional Abuse

Emotional abuse in nursing homes manifests as any verbal or nonverbal act that creates emotional harm or mental anguish. Dementia patients may have needs that demand more time, and their behavior can be challenging, but nursing homes have a responsibility to ensure their staff is properly trained and well qualified to manage cognitively impaired patients’ needs.

Staff members qualified to work with Alzheimer’s or other dementia patients should meet the following criteria at a minimum:

  • Training in memory care
  • A clean background
  • No prior history of abuse against dementia patients

Nursing homes are responsible for being well staffed with qualified workers who have the necessary tools to provide a high quality of care. Nursing home staff are more likely to lose patience and emotionally abuse victims when they are poorly trained, inexperienced, overworked, and underpaid.

Financial Exploitation

Dementia patients are easy targets for financial exploitation because their cognitive impairment is easy to take advantage of:

  • Easy to deceive
  • May blame their confusion or forgetfulness when money is missing
  • Very dependent on caregivers
  • Easy for family members to manipulate

Family members are the most common culprits in cases of financial exploitation. If the patient assigned power of attorney to the family member in the past or if the family member persuades the patient to assign them as power of attorney in a state of confusion, a bank may allow the family member access to the account, even if its validity could later be refuted. 

Nursing home staff who spend significant time with the patient may also be able to access personal financial accounts by using identifying information that is readily available through the patient’s records. Without a watchful family member or advocate available, anyone with access to a dementia patient’s financial accounts could drain them very quickly.

Neglect

Nursing home neglect occurs when staff refuse or fail to meet a patient’s needs, including food, clothing, medicine, shelter, supervision, medical care, and services essential to the patient’s well-being. Neglect also includes failing to meet the patient’s social needs.

Nursing home neglect has several telltale signs:

  • Bedsores: pressure ulcers that occur as a result of failing to reposition a nonambulatory person as often as needed—failure to clean up urine increases the risk of developing bedsores
  • Signs of malnutrition and dehydration: weight loss, dark urine, or extreme thirst
  • Strong odors that indicate a lack of proper hygiene, including urine, fecal matter, and body odor
  • Isolation of the patient from other residents
  • Unexplained rapid decline in the patient’s health status
  • The patient expresses that neglect is occurring

Patients without close friends or relatives who visit frequently are most at risk for abuse because of the lack of accountability inherent in the situation.

Signs and Symptoms of Abuse in Patients with Alzheimer’s Disease or Dementia

When visiting or caring for dementia patients, every caregiver and family member should be keenly aware of the possibility that abuse could occur. While the following signs may not indicate abuse when observed in isolation, if you see several different signs or the same ones repeatedly, it is important that you pay attention. Your loved one may be counting on you to recognize the signs and get help, and you may be their only source of hope.

Signs of nursing home abuse include:

  • Bruises, black eyes, or other obvious soft tissue injuries
  • Broken bones
  • Unexplained cuts
  • Sprains or dislocations
  • Broken glasses
  • Suspicious uses of medication
  • Increased depression, anxiety, or agitation
  • Personality changes
  • Social withdrawal
  • Behavioral changes such as sucking, biting, or rocking
  • Bruises around the breasts or genital areas
  • Irregular vaginal or anal bleeding
  • Unexplained venereal diseases
  • Fear or agitation around specific people
  • Blood on sheets, linens, or clothing
  • The patient reports the abuse

If the resident makes claims of being abused, err on the side of believing them, even if they have a history of unfounded suspicions due to their dementia, especially if the patient exhibits other signs and symptoms.

What should I do if I suspect my loved one is being abused in a nursing home?

If you suspect your loved one is being abused, report it right away. You don’t have to prove that your loved one is being abused. If you have a reasonable suspicion, that is enough. The agency with whom you file the report will take on the responsibility of proving the allegation.

You can report abuse through any of the following means:

  • A nursing home abuse hotline
  • A long-term care ombudsman
  • Your state or local adult protective services office
  • A trusted health-care provider who will work with you to report the abuse

Because abuse of the elderly, and especially those with dementia, is such a heinous act, many family members don’t believe it’s possible. Sadly, it is a common occurrence, and the only way it will end is if perpetrators are held accountable. If your loved one has been harmed in a nursing home, our legal specialists can help you do just that. Contact us today for a free case review.

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Reviewed by:


Dr. Patricia Shelton, MD

Dr. Patricia Shelton, MD, is a medical content creator. She holds a Doctor of Medicine degree and a Bachelors degree in neuroscience, both from the University of Washington in Seattle. Her career is now focused around medical communications. She primarily writes content for health-related websites, but has also written test prep materials, white papers, court documents, and more. She also teaches anatomy and physiology at the college level for the National Institutes of Health, as well as at the general public level in yoga teacher training programs. Her book, The Yoga Doctor, was published in 2015.

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Our fact-checking process begins with a thorough review of all sources to ensure they are high quality. Then we cross-check the facts with original medical or scientific reports published by those sources, or we validate the facts with reputable news organizations, medical and scientific experts and other health experts. Each page includes all sources for full transparency.