The Doctor’s Surgery

My audition for Dr Death

Watch out for relations who want to harm – or kill – patients theodore dalrymple

As someone who can no longer disguise, even from himself, the fact that he counts as elderly, I was naturally interested to read in the British Medical Journal an article about what is now called ‘elder abuse’.

There are many forms and gradations of it, ranging from theft to abusive over-control to outright violence, affecting (so the article said) one in six people over the age of 60. The Office of the Public Guardian investigated about 12,000 cases of possible or alleged abuses of powers of attorney between 2015 and 2021, though unfortunately the article does not say how many of these were found to be baseless.

Geriatricians are familiar with both the devoted care that many families provide for their oldest members and also, unfortunately, the greed for inheritance that sometimes motivates mistreatment of old people.

It takes every form that the ingenuity of wickedness can suggest or invent. It isn’t always easy to spot violent abuse, given that the old are inclined to fall or to bruise themselves.

To accuse carers, even only by implication, when they are innocent, is horrible, as well as unjust. But to fail to recognise and stop such abuse where it is inflicted has horrible consequences, too. It is not by any means easy to know what to do for the best.

Until recently, the Office for National Statistics did not collect data on domestic abuse of people over the age of 74 – presumably on the grounds that it was unthinkable, or that if it did occur it didn’t matter very much. The ONS has since changed its policy and is now trying to collect such statistics, which will no doubt in due course horrify us, as statistics usually do.

The lack of a baseline makes it difficult to know whether abuse of the elderly is increasing, decreasing or remaining constant.

The BMJ also published an article not long ago citing the case of an old lady with severe Alzheimer’s disease who married her exploiter. Under English law, a marriage immediately invalidates all previous wills, and the spouse becomes, by default, the person’s legatee.

Registrars of marriages usually make little effort to ascertain that the contracting parties to a marriage both have the necessary mental capacity, and if they both look happy enough, they generally assume – no doubt often correctly – that all is well.

The mental capacity to make a decision is not the same as sound judgement, of course. Because of cases such as the one above, it has been suggested that registrars of marriages – and no doubt clergymen – should be more assiduous in assessing the mental capacity of bride and groom to tie themselves together.

The term elder abuse does not delineate a natural species. The elderly may abuse one another, either as the continuation of a lifelong pattern, or as a manifestation of a disease. Very early in my career, I had an elderly patient who tried to kill his wife with an axe as she lay in bed. He was motivated by jealousy, believing her to be engaged in affairs.

This jealousy turned out to be a manifestation of his Parkinson’s disease. Every case has to be judged on its merits.

The only time I have been asked to kill a patient was around the same time. The relatives were fed up with difficulties a demented patient was causing them – difficulties that were real enough. I answered lightly that such ‘treatment’ was not available on the NHS, to which they retorted, quick as a flash, ‘Can’t we go private, then?’

Notwithstanding that powers of attorney may be abused, it is advisable for every ageing person to grant them to people whom he or she trusts.

The alternative, should it ever be needed, is worse.

‘Chasing, digging, rolling, fetching … have you no experience doing absolutely nothing at all?’