Exploitation and Manipulation 112320

This blog discusses the unfortunate circumstances of exploitation and manipulation in the elderly. Sam and Ethel have been patients of mine for more than 20 years. They had dedicated their entire careers to working for a large charitable organization, right up until their retirement. At some point within the previous ten years, they had moved from a condominium to a high-rise apartment about 10 miles from all of their friends.

Sam and Ethel each had a set of chronic medical problems and I managed most, but not all, of their ailments. Ethel had recently become physically feeble and Sam’s Alzheimer’s disease had worsened. I felt that it must have been impossible for them to manage on their own but, when I inquired, Ethel told me that she had “help” and they were doing just fine. With each visit I asked again, as it really did appear to be an impossible situation. Every few months Sam ended up in the hospital with pneumonia, and Ethel appeared at risk for the same.

“What would happen to Sam if Ethel required emergency hospitalization?” I would ask. Each time I inquired, the answer was “their help” was doing a good job caring for them. Over time, I learned that Ethel had mentioned wanting to move to an assisted living facility but either “her help” or the manager of her apartment building was coercing her into staying. Ethel was aware that she was being manipulated—she even told me so—but it appeared she felt too helpless, or possibly threatened, to do anything about it.

Fortunately, the organization to which she had dedicated her life had a support system and personnel to help relocating individuals. I contacted the organization’s support person who did an investigation and affirmed my suspicions and conclusions. Over the course of eighteen months we gradually helped Ethel and Sam to move to assisted living. The apparent grip the “help” and apartment manager had over Sam and Ethel was frustrating and sad but, unfortunately, not uncommon.

As noted in the article “Exposing Financial Exploitation of Impaired Elderly Persons” in the Spring 2000 issue of the American Journal of Geriatric Psychiatry, “Financial abuse accounts for up to one-half of all types of elder abuse in the United States, accounting for over 500,000 victims. Psychological abuse, including deception, intimidation, and threats, always accompanies financial exploitation. Despite the devastating emotional and financial losses incurred, physicians are reluctant to recognize, diagnose, and assist impaired elderly victims of financial exploitation.”

The manipulation and exploitation of Sam and Ethel was subtle and hard to prove. The “help” and management became defensive when my patients presented my assessment of the situation; I believe that is an affirmation of their guilt and poor behavior.

Do you know anyone in this situation?

What would you do?

To a long and healthy life…

David Bernstein, MD

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