Editor's Note: This is the third installment in a series of columns addressing elder abuse. You can read the first two installments at www.seacoastonline.com.

A Happy New Year! I trust you readers will have a grand and happy 2019.

The previous two installments discussed the grossly divided causes of “abuse” against elders. One type of abuse is caused by willful intention, be it physical and/or emotional momentary rise of anger or frustration. The second type is caused by a rather complex combination of component causes, each one of which is derived from the fact that elders are weak societally and physically, and cannot really muster their voice to complain. This type of treatment of elders is most definitely categorized as abuse, in fact in my mind, it is a solid abuse first class.

There are some useful definitions of various abuses against elders. For example, the National Council on Aging publishes a short and comprehensive writing on abuses. Here I quote their booklet:

There are seven categorizable abuses against elders: 1. Physical Abuse, 2. Sexual Abuse, 3. Emotional Abuse, 4. Confinement, 5, Passive Neglect, 6. Willful Deprivation and 7. Financial Exploitation Abuse.

Here I am copying the description by NCOA and getting a bit uneasy about their so-called pseudo-scientific approach to define abuse. These subdivision definitions of abuses might do some good to professionals who ply the waters of so-called “abuse” and its preventions, but it leaves me cold as it lacks cause and its effects.

In this third installment discussing abuse against elders, the author wishes to expand the subject into a much broader interpretation of how elders’ suffering affects their mental health and even their physical health. What I am saying is that the elder abuse is so much more prevalent in this country and most definitely affecting their health, both physical and mental, detrimentally.

Now my refutation. I am not at all against these subcategories of elder abuses. But I also strongly believe such categorization lacks the very simplified and powerful picture of why abuse happens and what results from them.

My theory is very simple. All abuse subcategories, such as NCOA defines one’s ability, either physical or mental or combination of both, are surpassed by what the environment forces you to deal with. The largest abuse occurs when your physical strength, including impaired balance, is exceeded by the physical strength you need to deal with. One can hardly walk on the ice-covered street without the intense fear of falling down. The TV broadcast on the current weather forecast by the attractive young lady speaking a-mile-a-minute doesn’t quite sink in your mind. Or perhaps a radio commercial which you want to contact the vendor disappears before you could remember the phone number. Or, you get to a restaurant with a bunch of friends and you don’t quite understand what they are talking about against the loud background music, etc.

The end result is simple. You get slightly depressed as you feel you are gradually pushed out of the society where you have lived happily all your life. You had a spouse, who passed away a few years ago, and you have continued to live alone in the same environment. And then you start to notice signs that the balance of forces has been getting out of kilter.

In all cases of abuse, regardless how they are categorized by NCOA, the clear result is “depression.” Whether it happens gradually or suddenly is immaterial to the discussion. It happens period. It isn’t “if,” but clearly it is a matter of “when."

We can prosecute the perpetrator of physical abuse by intensifying the surveillance if that is at all possible. If the perpetrator is a family member, which is often the case, that might be very difficult. Although he or she might be suffering and depressed, they may not wish to reveal who is the abuser. But one thing is very clear; the sufferer is either depressed now or will be depressed soon.

Depression is a universal source of many diseases and ailments. Without first dealing with depression of elders, our nation would face a serious Medicare funding issue in the very near future.

In the current system of American medicine, dealing with any psychiatric illness is passive at best. A patient or a relative needs to report the ailment to a PCP (Principal Care Physician), who then sends the patient to a proper physician, be it a psychiatrist, psychologist or therapist. The problem is that the patient is referred to such a specialist only when the symptom is clearly detectable. Unfortunately, the elder’s depression might not be that easily detectable and they may just be channeled aside with some elementary remedy, which has little to do with the illness.

I am pointing out the structural defect of this nation’s medical system. For some reason, we do not seem to pay attention to preventable medical care. Instead, we seem to want to wait till the illness or ailment becomes a clearly detectable and easily categorizable issue to which a standardized remedy process format could be applied.

I have a dream. (Please don’t laugh.) I would like to see a large army of nurse practitioners trained in psychiatry and go around interviewing all (yes, ALL) elders over 65 and find out the degree of depression they are going through. The size of such a group of practitioners would need to be only 1,200 to 1,500 and the cost would be only $75 million per year, chicken droppings for the vast Medicare annual loss.

This series of columns on elder abuse will be continued in next week's Seacoast Sunday features section. Please send your thoughts and complaints about aging to Sasano@umelink.com, Sam Asano, P.O. Box 26, New Castle, NH 03854 or (cell) 781-389-2356 or email Sam at sasano@umelink.com.