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I'm the Co-Director of the National Center on Elder Abuse
and I am a faculty member at
the University of California Irvine School of Medicine.
I started working in elder abuse when I had a patient
who'd been abused, and I was shocked and outraged
by the lack of response.
And as I started looking into it, this was very early
in my career, I realized that I was a big part of the problem
in terms of lack of knowledge, lack of response, that
really physicians didn't know very much about elder abuse
and there was very little science behind it.
So I started working with some of the social service folks
and criminal justice folks and it all evolved
into some the center work that I do now.
One thing I learned when I was surprised at lack of pursuit,
was that the folks who are entrusted to do this,
the adult protective service workers, are woefully
underfunded, oftentimes haven't received the education
and training that they need, and part of the reason for that
is we don't have enough good science and research
behind really knowing what the root causes are
and what the best solutions are as well.
I think it's difficult to talk about elder abuse, first of all,
because oftentimes just have this visceral reaction to it,
that just can't be really happening,
or it can't ever happen to us or to someone that we love.
Yet, it's really happening
much more commonly than we realize,
and it is happening to people that we care about and love.
It's often hard for us to imagine that somebody could hit
a vulnerable elder or sexually assault a vulnerable elder
or neglect somebody to death, but that's happening as well.
I think one of the problems in our society is that
there still is a lot of ageism;
there's a lot of fear of growing older;
there are a lot of myths about what it means to grow old.
And so we have to ask ourselves
what we want to do to grow old in a healthy way,
to minimize our risk of becoming victims of abuse.
But the other thing that we really, I think,
are afraid to confront as a society is, any of us could be
abusers as well, and I think that most people who abuse
older adults are not bad people who need to be locked up.
They're stressed, they're overwhelmed,
and they don't know what else to do.
This doesn't excuse it at all, but it helps me understand
what we might be able to do to prevent abuse from occurring
and to help people at early stages.
Financial abuse is probably one of the more common types
of elder abuse that occurs and there is this slippery slope
that happens where. well I'm going to get
that inheritance anyway, what difference does it make
if I get it just a little bit earlier?
Or Mom, I think, always liked me the most,
so I'm just going to start helping myself
to a little bit more without my siblings knowing about it.
And people start perhaps knowing it's a little bit wrong
and then it can build and build and build.
I think one thing we really need to do is educate people to say
this is wrong; if it feels a little bit wrong, don't do it.
And have other people involved; don't be doing this in secrecy.
And sometimes when people are helping Mom,
they start helping themselves to a little bit more as well.
And, and I think the other thing
people don't realize about financial abuse,
are the devastating consequences
it can have not only emotionally,
but physically on an elder as well.
Elder abuse is the harm that occurs to an older adult,
physically, emotionally, and otherwise,
as a result of an act by another person.
And there are a lot of different types of elder abuse, financial,
physical, emotional, *** assault and neglect as well.
I think neglect is one of the really most, excuse me,
is one of the least understood forms of elder abuse
that occurs, and that's when an older adult isn't provided
with what they need in order to have
just a reasonable life going on.
So people who are neglected are often found
in very filthy circumstances, sometimes end up
with horrendous wounds, malnourished, dehydrated, etc.
Financial elder abuse can occur by a family member,
which is actually fairly common.
It can also occur by unscrupulous sorts
of scam artists who are around.
One recent example was a plumber who was called upon
by an older adult, a woman in her early 80s
who needed help, and she didn't want her children to know
that she couldn't handle it.
So really out of a concern of losing her independence,
she wanted to handle this on her own.
The plumber brought her a bill and the bill
started to go up and up and up.
So what started as something like an $800 job,
escalated into thousands and thousands of dollars.
And then he started demanding payment of her,
started knocking on her door, started calling her.
And what did she do?
She withdrew, she stopped answering her door,
she stopped answering her telephone.
Her kids didn't know why it was hard
to get in touch with Mom now.
She missed her doctor's appointments,
she ended up in florid heart failure, hospitalized
and ended up in a nursing home as a result.
The thing that she most dreaded,
being put in a nursing home,
losing her independence, is what occurred.
And who would ever imagine that this woman, who now is
fairly demented and living in a nursing home,
you could trace this
directly back to the plumber who scammed her.
It occurred, unfolded over a period of about 9 months,
but there's just an absolute direct link back to this event.
Physical abuse occurs when an elder is hit,
sometimes burned, and shoving,
those are some of the forms of physical abuse,
having things thrown at them, occurs as well.
And this is when we'll see people who have bruising,
broken bones, and one of the real tragedies
about elder abuse is that many of the changes of aging
that are either normal or common, can mask
or mimic signs of physical abuse in particular.
So older adults do bruise more easily;
older adults do have weaker bones and a fracture,
have broken bones more easily.
And so one of the, one of my fears is that
we miss elder abuse because we say,
"Well, they're just old."
My other fear is that we accuse people unfairly
of having abused an older person
when that really hasn't occurred.
So we really have to have a team approach
between physicians and social services
and the criminal justice system,
so that we are finding the right balance between
appropriate protection and help and not unfairly
accusing people, because that can happen as well.
Family members can help by helping us understand
what the needs are of an older adult.
And I know that when I'm seeing a patient
who does bruise very easily, that I might be making notes
in my chart, sort of indicating what's going on
and that I don't have concerns about elder abuse.
I think family members, first of all, are the most common
perpetrators of abuse, and so we tend to think
it's that paid person who's doing this to Mom.
Well the reality is, it's most often by a family member.
And again, I don't think family members
are evil people, for the most part,
but what happens is they just get so frustrated.
They're getting asked the same question
over and over and over again, or they have somebody
pulling at them, or they are trying to help
somebody get dressed who becomes resistant
and they get frustrated and end up hitting, shoving,
knocking a person back, who ends up with a broken bone.
This doesn't excuse treating somebody roughly,
but by understanding this,
I think we can really move toward prevention.
*** abuse in older adults is one of those things
that we just don't like to think about.
We just, you know, as awful as child *** assault is,
a lot of people can't believe
that this happens to older people too.
We know it does occur in nursing homes,
we know it does occur in private homes,
and in people who have a dementing illness,
such as Alzheimer's Disease, it can occur
and they might not be believed if they say it happened,
because after all, they have Alzheimer's Disease.
Or they might not even be able to tell somebody it happened.
I know I've seen pictures sent to me by family members
who live across the country, sending me a photo saying,
"Do you think something is wrong here?"
because know I work in this field.
And they'll show horrible genital bruising that occurred
and it was discovered at their mom's death.
She was sent to the mortuary and the mortuary said,
"Something is wrong here; your mom was bruised,
"were you aware of this?"
And photographs were taken and she had
awful bruising in the genital area.
And when the family brought this to the attention
of the nursing home where Mom was living, they said,
"Well that sometimes happened with catheters."
That is not true; that does not happen and it really deserved
a full investigation that never occurred.
It is hard to comprehend
how anybody could sexually assault an older adult,
be it in an attempt to make fun of them,
or belittle them, or just for somebody's sick gratification.
But we do know that there are some people
who have serious pathology in terms of their,
their own mental health who do this,
and despite our aversion to even thinking about it,
we have to acknowledge
that this can occur and take it seriously.
It doesn't make a whole nursing home bad,
but it does mean that you have somebody working there
who needs to be really dealt with
by the criminal justice system, who's very dangerous.
You can bet if they've done this to one person,
they haven't stopped there.
I think that just like pedophiles find ways
to get to the most vulnerable children, there are people
who do that with older adults as well, and they'll seek out
the most vulnerable older adults,
who often are both physically and cognitively impaired.
I think background checks make a lot of sense,
depending on what state you live in
they may or may not occur.
Depending on the type of background check,
they may or may not be effective,
and I think there do need to be more stringent rules
related to this for protection really,
of some of the most vulnerable members of our society,
which just currently don't exist.
Same with licensing sorts of requirements.
Well the first thing when it comes to issues in facilities,
is I still want to emphasize that the majority of abuse
and neglect occurs at home, not in facilities.
And the majority of facilities are not being staffed
by bad people with psychopathology,
but there are these folks who slip in,
and I think they slip in because they know they can
get to vulnerable adults in some of these facilities.
So I think family members need to ask questions;
they need to listen to their relative
when they say something is wrong.
One thing I really look for in people who have a dementia
such as Alzheimer's Disease is a sudden change of behavior.
All of a sudden they seem agitated, or they react
with fear to one particular person.
Again, you don't want to unduly accuse somebody,
but you have to pay attention
to those sorts of clues and take it seriously.
And when I have a concern,
I'm getting that person undressed
and looking for any evidence of wounds or physical signs
that they're frightened when I'm looking at them
that might indicate that something bad has gone on.
Many of the age-related changes people have noticed,
people in their 70s and 80s might notice,
gee, I bruise a little more easily than I used to.
Or many are diagnosed with
a condition called osteoporosis,
weakening of the bones, and so it's not uncommon,
as we get older, to have things like hip fractures.
So these things can mask or mimic signs of elder abuse
because you also get bruised when somebody hits you,
you also end up with a broken bone if somebody
shoves you or treats you very roughly.
You can end up with a pressure sore
as a result of abuse or neglect.
Sometimes though, pressure sores happen
despite adequate care.
So it really takes a lot of effort
on the part of the scientific community,
meaning physicians, forensic nurses,
along with the criminal justice system
and social service system to understand
the context in which something has occurred.
If I see somebody who has bruises,
they might be on a medication that makes bruises look
really, really bad, such as aspirin or sometimes
medicines people are on for heart conditions
or to prevent stroke.
But even if that occurs, that you're on those medications,
why is it that you're bruised on your neck?
Why is it that you're bruised on your face?
Why is it that you're bruised under your arm--
places that you don't tend to bump?
And these are the kinds of things that we really
need to look at and say, "Well, how did this occur?"
And "Why isn't anybody able to provide me
"with a reasonable answer?"
So I'm often to looking to see if the wound or the injury
fits the history that I'm being provided.
In people who have Alzheimer's Disease,
or other types of dementia, they might not be able
to tell me what happened; they might not remember.
So I'm also looking at clues
based on how they're reacting.
Do they seem to withdraw in fear
every time a particular person comes by?
Or do they just seem like all of a sudden they're upset
and they hadn't been for the past several weeks?
Those are the kinds of clues that I look for.
I do think that we currently don't do a good enough job,
in terms of medical care, for older adults certainly,
and that you do end up with
a lot of different providers with poor communication.
I'm a firm believer that you want to have
one primary care physician
who knows you and your family and is
the quarterback along with the patient and the family.
This is a team sport; medical care is a team sport,
and really the leader needs to be our patient
and our patients' families,
to help us know what that person's values and goals are,
so that we're providing appropriate care,
that we're avoiding duplicative medications, that we're really
looking closely at medications that cause side effects
and we're not in that awful loop of treating the side effect
of one medication with another medication.
And you can sometimes trace
7 medications along that pathway,
and with devastating consequences for people.
I'm sure in my medical career I've stopped more medications
than I've ever started for my patients.
Having a primary care oversight, with a doctor,
nurse practitioner, whoever your primary care provider is
who knows you well, I think is a very important
and helpful way to, to be on the lookout for elder abuse
and also to prevent it from occurring.
I think if folks know that we're being vigilant,
if folks know that we're just going to ask questions,
not in an accusatory manner, but gee, do you
know how Mrs. So and So got that bruise there?
That that's being asked and attended to,
that just has to help.
It's often difficult to know how common elder abuse is
because we don't have a blood test for it.
We can't wrap something around your arm and say,
"Oop, you've got elder abuse," or draw a sample of blood
and say, "Well you've crossed the threshold."
So we're dealing then with a lot of definitional issues,
but what we do think is it's occurring
in about 1 out of maybe 10 older adults.
At some point during their life, after the age of 65,
are going to experience abuse, and that's a lot of people.
When we talk about people who have a dementia
such as Alzheimer's Disease, that number goes up
to about half of the people with dementia, at some point,
will experience some type of abuse;
the numbers are staggering.
It's estimated that for every report, at least 5,
and probably the really good studies now are showing
as many as 24 are going unreported,
so we have the tip of the iceberg sort of phenomenon.
And I think the other thing we know is that elder abuse,
by the time it is reported, identified
and something is being done,
it hasn't been going on for hours or days, or even weeks.
It's usually been going on for months or years,
and the consequences are devastating.
We don't know if elder abuse is becoming more common
because we just have the good data behind us to say that,
but here are some of the concerns I have
about the incidents of elder abuse.
We know that the fastest-growing segment
of the population in the United States
are people over the age of 85.
We know that about half of people
over the age of 85 have a dementia.
We know that a lot of people in this age group
also are dealing with physical frailty,
so we have this exponential increase in the number
of older adults, who are among the most vulnerable
to being victims of abuse.
At the same time, the number of caregivers is going down,
family members and paid caregivers.
So we have this intersection that I think is very worrisome,
and it, to me it only means that elder abuse
is going to become more common.
As opposed to child abuse,
by the time you're an older adult, you've
already assumed your full autonomy and you get
to be treated as you should, as an autonomous individual.
So unlike child abuse, if we suspect something bad
is going on in a home, we have the authority
to take the child away.
The same is not true in elder abuse.
So some older adults would rather remain
in their own home and be abused,
than be moved into a nursing home.
And in elder abuse, it is often the elder
who get revictimized, because the only solution
is to pull them out of their home for their protection,
and they really might not want that to happen.
Instead of necessarily pulling out the perpetrator,
sometimes you pull out the perpetrator
and that person is also the caregiver.
So now, how are you also going to provide
the care that this person needs?
So we also know that with particularly things
like financial abuse, that older adults,
just like all, everybody under the age of 65,
has a right to make a bad decision.
Children don't have the same rights
to make bad decisions that we do as adults.
So how do you know when something crosses the line
and mom is making perhaps a bad decision,
versus she's really been scammed
and this is a form of abuse?
At what point do you have the right to take away
her autonomy to make bad decisions,
so that now for example, your father is changing the will
because he's in love with a 22-year-old woman
who claims to be in love with him?
It gets very, very difficult to figure out
when you cross this line and when we actually have
the right to protect somebody.
And in order to protect them,
take away their right to make their own decisions.
There's a lot of gray area that occurs, particularly
with financial abuse, so you have an adult child
who somehow never made it out of the home,
never was really able to sustain having a job
for a long period of time,
was always dependent on the parents.
And maybe one spouse dies, and this situation continues,
and now, even though they continue to be dependent
say, on mom, mom starts to become
more frail and require help,
and the child now starts taking over finances
and maybe helping themselves a little bit too freely
to the finances, to getting the code for the ATM card.
And it all just starts to happen gradually,
until it becomes much more obvious to the rest of the world
that something bad and wrong is going on here.
The interesting thing about, about elder abuse is why is it
that we even have this term elder abuse, and what is it
that's magic about the age of, depending on what state
you live in, 56, 60, 62, 65,
there's nothing magic about the age.
What does occur though is vulnerability to abuse
and neglect increases with age, and so if you're
a very healthy, active 80-year-old or 90-year-old,
you might not be all that vulnerable to abuse or neglect.
But we do know that that vulnerability does increase
as a consequence of aging.
As we get older, we become more vulnerable to abuse
and neglect for a variety of issues.
Some of those issues are physical--
you become more frail,
you might need more help with things.
Some of them might be cognitive,
where you're having some memory loss,
and require some assistance with handling
finances, and some of it is emotional and social,
which is you really want to stay home,
you want to stay independent, and people know how
to prey upon a lot of those different vulnerabilities.
It also means that you have more people involved
sometimes with very intimate aspects of your life.
So not only do you need help with grocery shopping,
you need to be handing over money or your ATM card
for them to help you with that,
but now you need help with bathing and grooming.
You need help with activities
where people are helping you get undressed,
where people are touching you a lot more,
where people are perhaps handling you, to help you
get out of bed, and maybe that handling becomes rough,
and maybe that can translate into true physical abuse,
where people are actually getting hit.
And this just gradually tends to happen
as we get older, when we need more help.
It also becomes an emotional leverage point,
so that if people know
your main objective is to remain in your home,
they can now threaten you, "If you don't sign this over,
"I'm going to put you in a nursing home,
"and I won't continue to help."
That's a very powerful and abusive sort of a message.
People with dementia have memory loss
and other forms of loss related to, to their cognition.
They may have trouble with judgment, reasoning,
finding their way around in the world in terms of
spatial relations, trouble with language, both saying things
and being able to understand things, to a point where
they're not able to function as they normally would have.
So these people become more vulnerable
to a variety of types of abuse.
One thing I've observed is that in the early stages
of a dementia, such as Alzheimer's Disease,
when you sort of look good
and you're physically still strong, this is
when you tend to be quite vulnerable to financial abuse.
You're losing it a little bit
in terms of memory and judgment
and people know how to manipulate you.
And a lot of folks have radar for folks who have,
are in this early stages of dementia
and really know how to get
their credit card number, social security numbers, etc.
In the more middle stages of a dementia,
when you might have behavioral problems,
where you might be a bit combative,
where you might not understand what's happening
and be resistive to care, this is when we tend to see
physical abuse occurring.
People are getting hit, shoved, handled very, very roughly.
In the later stages of dementia, when you might be
totally dependent for care, is when we often see neglect.
So somebody who can't get their own food or water,
somebody who can't get out of bed, and then those people
may become malnourished, they may end up
with very awful pressure sores, and so we tend to see neglect.
And so as you go through different stages of dementia,
you actually can go through a sequence of different types
of elder abuse that become more common.
There's no doubt that people who have a dementia
such as Alzheimer's Disease, can end up abusing others.
They don't understand what's going on
and they might end up hitting somebody.
There are cases where they've shot somebody who they love,
because they didn't recognize them.
And so abuse by a person with dementia absolutely can occur.
The question then becomes, what do you do about it?
And these are not people that you want to lock up
and put in criminal justice system because they don't,
truly don't understand what it is, what it is that they did.
But you also need to deal with it head on
and protect the person who's being abused
and also figure out how
you're going to help stop this from happening.
Sometimes it's a matter of, I would say
not even sometimes, it's a matter of a combination
of a number of different things you have to do.
The combination to prevent this usually involves
education of the caregiver, making sure the person
with the dementia doesn't have some underlying illness
that isn't being adequately treated.
It might mean stopping a medication;
it might mean starting a medication.
It might mean looking at the physical environment
they're in because sometimes the physical environment
is actually causing some agitation and upset as well.
So you have to take this holistic approach
when somebody with a dementia
is having violent sorts of behaviors.
Neighbors, family members, our society as a whole,
has a responsibility to our aging society.
As soon as we all step up to the plate and recognize
as we grow older we might need a little bit more help,
but we still deserve all the dignity and respect
and kindness and love
that everybody in our society should be afforded.
We can start having attitudes that say,
it is not acceptable for you
to be stealing from your mother.
It is not acceptable to hit an older adult,
even if they struck out at you.
It is not acceptable to allow somebody to die
under circumstances where they're covered in feces,
have a pressure sore
or malnourished because they're old
and they were going to die soon anyway.
We need to have a society that will not tolerate
that type of behavior.
And we need to work together with our politicians,
the criminal justice system, the healthcare system,
social service system, to say this is so important,
we're going to fund you and we're going to help you
make sure that older adults
are not suffering abuse and neglect anymore.
Law enforcement that involves folks like police
and detectives, need, I think, a lot more training
in just how to interview an older adult.
So this is where we really need to form much more
team-based care, so that folks in the medical and
social service communities, who understand
a lot more about interviewing older adults,
can help law enforcement do that.
We also need to help law enforcement prioritize
what's happening with older adults and not think that well,
just, they're old so I don't have time and this is not
where I'm going to spend my time right now.
I know that when I talk to police officers,
many of them, if you give them a choice
between going into a dark alley where somebody
might have a gun or going into a nursing home,
where somebody has Alzheimer's Disease,
they'll take the dark alley.
Because they've been trained for that;
they know what's involved there and I really feel for the police
who have to just know so many different things
and deal with so many different people.
So sometimes I worry about saying
here's one more thing you have to do,
but I'm sorry, here's one more thing you have to do.
You have to learn how to respectfully interview
older adults and take it seriously and understand
that this is a crime.
And that when something bad may have occurred,
be it in a nursing home or somebody's private home,
that it needs to be treated like a crime scene
and people can't be allowed to clean up evidence,
which often occurs.
At the level of prosecutors and judges, I think we need
to have attitudes of this is a crime that we won't tolerate.
We do need to send a message to some of the bad guys
out there that society will not allow this to occur.
So I think it needs to be prosecuted,
some of these crimes need to be prosecuted more vigorously
and we also need to educate judges, so that they
understand that these are important cases
to have coming through their courtroom.
We certainly need better laws.
I don't know whether or not we need more laws.
I think we need something at the federal level
and not just at every state sort of deciding what it means
to be elder, what it means to be abused,
and we need more federal guidance
and more federal leadership on this.
At the state level,
we need to understand our own communities,
to know what some special circumstances may be,
and what the most effective preventive
and early intervention strategies
might be at the local levels.
I think whether we're in law enforcement, medical care,
whatever field we're in, we need to respond in a way
that's empathetic and calm and quiet.
Very often, when people are in extremely high tension,
emotional sort of circumstances,
you need to let it sort of calm down a little bit,
sit down, allow the person to tell you the story,
and if the story doesn't make sense,
to say to them can you help me understand
really what may have occurred here?
And we have to also understand
that when the person who abused you
is somebody that you love, and somebody
that has a dementia, what might they be thinking?
They might be thinking that if I told the police
this is what happened, that they're going to arrest
my husband who has Alzheimer's Disease.
I think we need to address that up front as well,
which is, if this occurred by your husband
who has Alzheimer's Disease,
if the law enforcement folks know that,
I want you to know that this is what we would do
and to address some of those fears up front.
And I think this becomes very important
in all sorts of circumstances.
One thing that is interesting to me whenever I talk about
elder abuse and dementia, is the first thing
I tend to hear is well people with dementia are abusers.
People with dementia can end up abusing,
and that is absolutely true.
It is interesting to me
that we tend to be much more comfortable
to talk about those circumstances
in which somebody who's impaired is the abuser,
when the reality is, the more common kind of abuse
that's occurring is really
people with dementia who are the victims of abuse.
So while it does go both ways,
I think it's also very important
to keep in mind that the more common scenario
is the fact that somebody with dementia
is being abused by a caregiver.
Elder abuse is a worldwide problem.
Unfortunately, the vulnerabilities
that accompany aging, occur anywhere you live,
and we do know that this is occurring around the world,
and many countries have published different studies
and they all show similar sorts of vulnerabilities,
similar sorts of rates.
We do know that different cultures view aging differently,
although I have to say, everybody always tells me
that their culture respects the elderly.
So I haven't met anybody who has a culture
that disrespects the elderly, so that's the good news.
The bad news is, sometimes it makes us feel like
that would never happen in my culture
because we have such high respect for the elderly.
And that, unfortunately, is never the case.
I think how we interpret our responsibilities
for older adults is different in different cultures
and in different countries, expectations may be different,
family structures may be different.
And so it does need to be understood
through that country or through their cultural lens.
Some of the most important things we can do
to first protect ourselves
from becoming victims of elder abuse,
is to exercise, stay as healthy as you can,
plan for the future, have your finances
well taken care of with people that you trust,
and to anticipate what might be happening
in your future as you get older and plan, plan, plan.
What we can do to protect ourselves
from becoming abusers is once we become caregivers,
we need to again, take very good care of our health,
reach out to others for support, recognize
when we're becoming stressed and overwhelmed.
I now, in my clinical practice routinely ask caregivers
questions such as
I can see that your mom is a real handful for you.
This is done privately now, I'm pulling them out separately
and asking privately, "How are you doing?
"Have you ever gotten to a point where you feel like
"you might hit your mom?
"Have you ever hit your mom?"
And depending on their response,
we're dealing with it right then and there.
So I think it is very important for physicians
to be asking these questions of everybody as well,
but we all have to recognize that we have the potential
to be a victim, and we all have the potential to be an abuser
as well, no matter how nice a person we are,
that this can happen to any of us.
And then if we have hired caregivers or our parents
are living elsewhere, we need to be vigilant,
we need to be involved, we need to develop relationships
and respect the people who are caring for our parents.
We need to remind the people who are caring for
our parents and grandparents that even though
they might be seeing them now
at the age of 90 with a dementia, that this person
has a whole history, a remarkable history,
and allow them to get to know
who this person was as a human being.
There's such a tendency
to dehumanize people as we get older
particularly if we have Alzheimer's Disease.
And to start treating people in middle and end stages
of dementia as furniture instead of as people,
that you can just move around.
We need to keep reminding each other
that they have a humanity
and a life and a history that needs to be respected.
And I think this can help
prevent abuse from occurring as well.
I wish we could tell who an abuser is
by looking at them, and looking at their background
and knowing this person is an abuser.
Unfortunately, what we've learned is that
anybody can end up being an abuser.
They can be people who are
just cruel, immature, cheerleaders,
who end up doing something awful like this.
They can be somebody who is a real sociopath,
who ends up sexually assaulting folks.
But you don't know what these people look like.
They can be men, they can be women,
they can be any ethnicity, they can be any age.
So it means that we have to have
a healthy dose of concern and suspicion
so that we're not unfairly accusing people,
but that we're also applying proper protection,
and that we keep our mind open recognizing
that anybody can be an abuser
and anybody can be a victim.