It was Oliver’s* third admission to the hospital but this time the bleeding from his bowel was life threatening and he was taken to the ICU. A routine drug screen found warfarin in his system, which was unexpected, as Oliver wasn’t being prescribed the blood thinner by his doctors. Staff began to ask questions, which led them to suspect that Oliver’s daughter-in-law, a registered nurse, had been adding the drug to his corn flakes each morning. Oliver’s son had misused his power of attorney and spent his ill-gotten gains, and the pair decided they were better off if Oliver was out of the picture.
“That was a real eye opener for me,” says Professor Susan Kurrle as she recounts the story of Oliver, one of the first cases of elder abuse she encountered. “I think it sensitised a lot of us to the issue.”
Professor Kurrle, a geriatrician based at Ku-ring-gai Hospital, is a leading expert on the use of medicines as a form of abuse.
When she first came into contact with such cases in 1989, Professor Kurrle says that unlike physical, sexual or mental abuse, medicine was under-recognised as an agent of elder abuse – a situation which, arguably, largely persists today.
To counter that, the Australian Association of Gerontology (AAG) is hosting a special webinar next week looking at medication misuse as a form of elder abuse and how professionals can best respond.
Professor Kurrle, who is a speaker in the webinar, said she has seen 15 to 20 cases over the last couple of years, typically older people who are relying on a carer for their medications presenting to the emergency department with a worsening of their condition.
“It was seeing a number of examples that really brought home to me how common the problem was,” Professor Kurrle told Australian Ageing Agenda.
“In one case there was an older lady with heart failure who came in five times before we clicked that her daughter was very stressed and she would just withhold her mother’s medication for three or four days until she went downhill and needed to come into hospital. The daughter would get five or six days off – respite if you like – while her mother was in hospital.”
Professor Kurrle said she was participating in the webinar in order to help raise awareness of the issue. “Because this is out there, it’s happening. It’s a case of alerting nursing staff and medical staff to be aware of it. And we need to address some of the underlying situations.”
Those underlying situations, in many cases, have involved stressed out relatives or carers who were struggling to cope with the caring burden, compounded by a perceived lack of respite or support.
Professor Kurrle was keen to emphasise that “an awful lot of carers out there who are stressed are caring really beautifully for the person that they’re looking after, they provide excellent care”. But sometimes, she said, it all gets too much. “And if you know one tablet is going to settle your wife down for a little while, you may tend to make it two or three, to keep her quiet a little longer.”
She cites another example: a lady whose husband had significant Parkinson’s disease who required medications several times a day.
“She would only give him his medication last thing at night or first thing in the morning, so he would spend the whole day sitting in the chair and not getting in her way. She told the social worker he was a nuisance, he messed up the house, and she dealt with it by withholding his medication. Unfortunately he got pressure areas from sitting too long and came into hospital.”
While these examples were not as obvious as the incidence of poisoning in Oliver’s case, they were the most common examples of misuse of medicines she saw.
“I always come back to definition of elder abuse which is: ‘Any behaviour that causes harm to the older person within a relationship of trust’. If the behaviour, i.e. giving or withholding the medications is causing harm to an older person, then you need to say that is abuse.”
In such instances, Professor Kurrle said there were arguably two victims. “Obviously you have the person who has been given the medication, but if you look at the reason behind the behaviour, often it’s a very, very stressed carer or a very difficult situation, or a very difficult behaviour on the part of the older person.”
For this reason, understanding the instances in which this form of abuse can occur, and addressing the need for appropriate support services and respite, was crucial, she said.
Professor Kurrle will appear in the webinar next week alongside Anne Muldowney, policy advisory with Carers Victoria, and Dr Faizal Ibrahim, geriatrician at The Queen Elizabeth Hospital, South Australia.
Use and Abuse of Medicine: Maintaining Dignity in Care takes place next Wednesday at 12am AEST.
Australian Ageing Agenda is the media partner of the AAG.
*Name has been changed