By Mary Ann Hellinghausen
Illustration: Digital Stock
May 31, 1999

Asking the tough questions is sometimes the hardest part of being a health professional, but it can also be the most important—especially for those working with adults with disabilities.

Cathy Parsa, MA, RN, a rehab nurse in Long Beach, Calif., had worked with Gary Chambers, a quadriplegic patient, for years when he came to the emergency room with a broken arm.

After she pressed him for answers about how his arm was broken, his story came tumbling out. “His wife had broken his arm during a fight,” Parsa said. “It turns out she had been abusing him for 20 years, and we had never suspected anything.”

Chambers had been afraid to tell anyone about the abuse for fear he would end up in a nursing home. “He figured staying in his house with this abusive person was better than being in nursing home,” Parsa said.

Numbers are unknown

Although it’s hard to determine how many people with disabilities are abused, experts agree that it’s the most vulnerable members society who are often the most at risk. About 25 percent of all emergency room visits are due to abuse in the general population. That percentage is probably higher in the disabled population, said Glenda Walker, DSN, RN, director of the division of nursing at Stephen F. Austin State University in Nacogdoches.

“Certain types of abuse are hidden and are very difficult to get a handle on,” she said. “Not enough attention is paid to elder abuse and abuse of the handicapped.”

Advocacy groups for people with disabilities also caution that the healthcare provider can, even sometimes unwittingly, be the abuser. “Overmedication, mechanical restraints—these are major issues,” said social worker Aaryce Hayes, MS, a program specialist with Advocacy Inc., an Austin-based nonprofit group that campaigns for the rights of Texans with disabilities.

Many times people with disabilities—either mental or physical—are medicated or restrained to control agitated behavior, without getting to the root of that behavior. “Sometimes their problem is due to dental pain or a urinary tract infection, and they’re given medications to calm them down before [health professionals] even know what the problem is,” Hayes said.

An overwhelming sense of powerlessness and fear of how they will manage without their caregiver—even an abusive one–often contribute to the silence of abuse victims. “With the kinds of things [people with disabilities] have to overcome and the amount of energy it takes just to do the activities of daily living, it’s difficult to come forward and say you’re being abused,” Walker said.

Red flags

Because people who are being abused are often so reluctant to talk about it, it’s especially important for health professionals to be on the lookout for red flags that may signal abuse, including:

• Unexplained or conflicting accounts of cuts, bruises, burns, or fractures; bad hygiene, dehydration, or malnourishment; or frequent use of the emergency room or frequently changing healthcare providers (signs of physical abuse)
• A patient who is depressed, angry, withdrawn, fearful, anxious, or agitated ( a sign of emotional or psychological abuse)
• Failure of the caregiver to assist in personal hygiene, protect the patient from safety hazards, or seek medical attention when appropriate (signs of neglect or abandonment)

The behavior of the spouse or caregiver can be another sign of abuse. “If a husband is standing over a wife, refusing to leave, being very solicitous to his wife but hostile to you, that’s a signal,” Walker said.

Recognizing abuse often is like putting together pieces of a puzzle, and taking a good history of the patient can reveal those pieces, she said.

Sometimes it just takes a healthcare professional’s asking the right questions to prompt the victim to tell the truth. “We need to stop wearing blinders, thinking [abuse] doesn’t happen. The reality is, it does,” Walker said.

In Chambers’ case, he since has gotten out of his abusive marriage and lives in an apartment, leading an active life. He and Parsa have teamed up to educate health professionals about abuse of the disabled by presenting talks at conferences. They also have produced a video aimed at healthcare professionals called “Gary’s Story,” in which Chambers tells about his 20 years of being in an emotionally and physically abusive relationship.

For more information

To obtain a copy of the video “Gary’s Story” e-mail Cathy Parsa at cparsa@aol.com.