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When we think of elder abuse, it’s typically the caregiver harming the care recipient. Right? But a horrifying story this week in the press made me wonder, how often are the tables turned and under what circumstances? And, if those being cared for do occasionally hurt family caregivers, what are the warning signs?

Here’s the story that triggered those questions: a New York City wheelchair-bound 69-year-old with memory loss threw acid on his daughter, his sole caregiver. He has confessed, saying she abused him, while she remains in the hospital with third degree burns and nerve damage. According to news reports, relatives claim his daughter was a devoted and loving caregiver and that her father had become “delusional.”

This incident is extreme and creepy. Reverse violence is also uncommon, but sadly, not unheard of. According to Paul Greenwood, Deputy District Attorney and Head of Elder Abuse Prosecutions for the San Diego District Attorney’s Office, “unfortunately, we are seeing that one of the byproducts of escalating mental deficits may be an aggressive streak.”

Dr. Mark Lachs, professor of medicine at Weill Cornell Medical College, agrees. He believes that more care recipients with dementia and/or other medical conditions may be physically aggressive. “The assault might not be their fault. It might be brain disease,” he says. In these cases, rather than an adult child in the New York incident, the abused is often the elderly caregiving spouse.

Dr. Lachs is publishing a paper later this year, currently under review, on the aggressive behaviors of nursing home residents toward staff. He believes that depression can set off violent behavior, as can medication. “Heart disease unraveling can present with aggressive behaviors,” says Dr. Lachs. The solution may be a change of medication or a different dosage. So it’s not exclusively dementia that is driving these incidents.

Here are five points to consider:

  1. When the person receiving care shows increased signs of memory loss, confusion, sadness, irritability, impatience, sudden flashes of anger, or aggression, hightail it to the physician to have them evaluated, and participate in medical visits.
  2. Many with dementia have impairments in the frontal lobes resulting in impulsiveness. They may get into arguments easily. Low frustration tolerance can also be a sign of depression, presenting as irritability rather than sadness. Fortunately, depression is treatable.
  3. Caregiving is stressful work and can be isolating. You need a support system of relatives, friends, other caregivers, as well as a physician, to discuss your concerns with, and to help out. And you need breaks.
  4. Never be too private or too protective of your loved one when your personal safety is at risk. Document all incidents.
  5. To spot more red flags, speak with your local Adult Protective Services or your local chapter of the Alzheimer’s Association Other resources include the Eldercare Locator  (800-677-1116) and the National Center on Elder Abuse  or 855-500-3537.

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