Slide 2: Elderly Abuse Prof A P Jain
DIRECTOR PROFESSOR And HEAD
DEPARTMENT OF MEDICINE
MAHATMA GANDHI INSTITUTE OF MEDICAL SICENCES
MAHARASHTRA Elder Abuse : Elder Abuse Elder abuse (“elder maltreatment”) encompasses
financial or material exploitation,
neglect, self-neglect and
abandonment. Slide 4: First mentioned in medical literature in a 1975 BMJ article entitled “Granny-battering”.
Executive summary of the National Elder Abuse Incidence Study, 1998, states a total of 449,924 elderly persons, aged 60 and over, experienced abuse and/or neglect in the community.
However, 84% of the cases are not reported to any adult protective services agency. Slide 5: Studies have found elder abuse more prevalent in those with
short-term memory problems,
alcohol abuse, as well as among
the widowed, divorced, or separated.
Subtle findings, fear, shame and denial – difficulty in diagnosing it. Slide 6: For many victims, hospital setting is only potential source of outside contact & support.
Despite this, medical staff is not adequately trained in detecting elder mistreatment or making appropriate referrals to social workers & protective service agencies.
Few medical schools provide formal training on elder abuse screening or interviewing techniques Slide 7: MGIMS GERIATRICS PROGRAM Slide 8: In January 2008, MGIMS started multi specialty Geriatric clinic as a part of Geriatrics Services.
It also initiated home based geriatrics care program in 2 villages, (Nagapur and Nadora) in hospital vicinity with total population of 1450 people.
The present study is a part of this Geriatrics program wherein 34 cases of elder abuse were identified. Slide 9: METHODS SETTING : SETTING Wardha district (MS) central India, houses 1.23 million people (rural 74%, literate 81%) -2001 census. With elderly forming 5% of the total population.
MGIMS, a rural medical school, is located in a village, Sevagram, 8 kms from Wardha town.
2 villages included in the study (Nagapur & Nadora) were in the vicinity having total combined population 1450 people. Study Protocol : Study Protocol First Phase - house to house field survey done- collecting basic demographic profile of the villages.
Next phase - all houses with elderly were identified & detailed pretested questionnaire was administered by a trained social worker & a Physician with the help of 2 social workers who were local residents & well acquainted with the study population Slide 12: The Questionnaire included the following points
Basic Demographic Screen
Chronic Disease assessment Screen
Geriatrics Depression Screen
Elder abuse Screening
Elder abuse was further classified into physical, psychological, financial and neglect – active and passive. Slide 13: Physical Abuse - Infliction of physical pain or injury such as slapping, pushing, sexually molesting, etc.
Psychological Abuse - Infliction of mental or emotional distr$ess such as threats, intimidation, verbal attacks etc.
Financial Abuse - Illegal or improper use of funds or other resources. Slide 14: Passive Neglect - An unintentional failure to fulfill a care giving responsibility, such as not providing food or health-related services because of inadequate knowledge or caregiver’s own infirmity.
Active Neglect - A conscious & intentional attempt to inflict physical or emotional distress by refusing/failing to fulfill a care giving responsibility, such as withholding food or medication. Slide 15: Slide 16: RESULTS Slide 17: What was documented is that 20.25% prevalence of elder abuse in the study population.
The geriatric population comprised of 12.8% of the total village population with a male: female ratio of 1.13.
The demographic profile of the population is depicted in Table 1 and Table 2 DEMOGRAPHIC PROFILE OF STUDY POPULATION : DEMOGRAPHIC PROFILE OF STUDY POPULATION AGE DISTRIBUTION OF GERIATIRC POPULATION : AGE DISTRIBUTION OF GERIATIRC POPULATION Slide 20: Prevalence of Chronic Disease in the consenting Geriatrics population was 69%.
Out of the 165 study population, 82 patients were with 3 or more diseases.
The detailed prevalence of chronic diseases in shown in Table 3. PREVALANCE OF CHRONIC DISEASES : PREVALANCE OF CHRONIC DISEASES Slide 22: The prevalence of Elder abuse was 20.2% in 34 individuals -
Of which 12 were males and 22 were females.
More than one type of abuse was present in more than 50 % of the elder population.
The various types of Elder Abuse prevalent in the study population are shown in Table 4. ELDER ABUSE – PREVALANCE & TYPES [COMBINED] : ELDER ABUSE – PREVALANCE & TYPES [COMBINED] Slide 24: CONCLUSION Slide 25: Elder Abuse, though not reported widely is a deeply seated social problem of our community.
Prevalence of Elder abuse was as high as 20.2% in our study with
neglect abuse and
among the major culprits for the same. Slide 26: An important finding was - passive neglect – is more common thereby re-emphasizing the fact the concept of elder abuse is relatively less known entity as far as rural India is concerned and
The responsibility for the same in majority of cases was unintentional conduct of the caregivers. Slide 27: This calls for urgent attention to this problem so as to increase the knowledge & improve the attitude and practices of the community as a whole. Slide 28: DISCUSSION Slide 29: Elder abuse is a type of domestic violence, where in senior receives
has sparse publications, and
low public awareness. Slide 30: Elder abuse is often defined as "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person”.
Core feature of this definition is that such abuse is defined by the 'expectation of trust' of the older person toward their abuser. Slide 31: Elder abuse is any intentional, unintentional, or negligent act or series of acts that cause harm or serious risk of harm to a vulnerable senior.
These acts may be active or passive.
In fact, the abuser may not even be aware they are doing it. Slide 32: Domestic abuse is a silent problem, hidden from view and cloaked in denial by seniors and family.
The National Elder Abuse Incidence Study (1998) indicates that only one in 6 incidences of elder abuse neglect, exploitation, or self-neglect are ever reported, however, reporting is slowly on the increase. Slide 33: Prevention is imperative since the number of incidents is expected to increase due to the growing senior population. Unfortunately, society has been slow to address the practical issues of availability of elder care and who will perform or pay for it. Slide 34: The abuser is most often a family member, though paid & informal caregivers may also participate in abuse.
Families with histories of abusive relationships are predisposed to further victimization.
The caregiver may not be able to provide adequate care for a variety of reasons. Slide 35: The caregiver may have problems with
substance abuse, or alcoholism
Personal stressors such as
financial stressors, and
Abuse happens more often to those who are impaired & cannot fend for themselves. Slide 36: When a patient reports abuse, pay attention and listen, regardless of the level of cognitive impairment.
Patients with limited verbal and cognitive skills are in a high-risk category.
Even when care is adequate, problems may develop in diseases eg Alzheimer’s, Parkinson’s, dementia. Slide 37: There has been limited research into the nature and extent of elder abuse.
One study suggests that around 25% of vulnerable older adults will report abuse in the previous month, totaling up to 6% of the general elderly population.
Certainly, abuse increases with age, with 78% of victims being over 70 years of age. Slide 38: This is an important point because the domestic violence of older people is often not recognized, and consequently strategies which have proved effective within the domestic violence arena have not been routinely transferred into circumstances involving the family abuse of older people Slide 39: Physical Abuse
Bruises or grip marks around the arms or neck
Rope marks or welts on the wrists and/or ankles
Repeated unexplained injuries
Dismissive attitude or statements about injuries
Refusal to go to same emergency department for repeated injuries CLUES THAT CANNOT BE EXPLAINED MEDICALLY MAY SIGNAL ELDER ABUSE Slide 40: Emotional/Psychological Abuse
Uncommunicative and unresponsive
Unreasonably fearful or suspicious
Lack of interest in social contacts
Chronic physical or psychiatric health problems
Evasiveness Slide 41: Sexual Abuse
Unexplained vaginal or anal bleeding
Torn or bloody underwear
Venereal diseases or vaginal infections Slide 42: Financial Abuse or Exploitation
Life circumstances don’t match with size of the estate
Large withdrawals from bank accounts, switching accounts, unusual ATM activity
Signatures on checks don’t match elder’s signature Slide 43: Neglect
Sunken eyes or loss of weight
Bed sores Slide 44: First recognize that no one of whatever age should be subjected to violent, abusive, humiliating/neglectful behavior.
In addition positive steps include
educating people about elder abuse,
increasing the availability of respite care, HOW TO PREVENT ELDER ABUSE? Slide 45: promoting increased social contact and support for families with dependent older adults, and
encouraging counseling and treatment to cope with personal and family problems that contribute to abuse. HOW TO PREVENT ELDER ABUSE? Ctd.. Slide 46: Education is the cornerstone of preventing elder abuse.
Respite care essential in reducing caregiver stress
Social contact & support- a boon to the elderly, family members & caregivers. Slide 47: Counseling for behavioral or personal problems in the family play a significant role.
If there is a substance abuse problem, treatment is first step in preventing violence against older family member. Slide 48: Because elder abuse is an independent risk factor for death, correct management is critical.
Victims are found in various clinical settings, including emergency Department, physician’s office, or at home during a physician’s visit. GUIDELINES FOR CLINICAL MANAGEMENT Slide 49: Physicians should learn to recognize the common signs and symptoms of elder abuse, many of which can be subtle.
When the physician suspects a problem, he should conduct a thorough history and physical exam, and the caretaker should be asked to leave the examining room during the interview GUIDELINES FOR CLINICAL MANAGEMENT ctd.. Slide 50: Victims may not expose truth immediately, instead asking directly, physician should begin with questions about nature of relationship with the caregiver, conditions of the home, and circumstances surrounding her physical signs and symptoms. Slide 51: A cognitive assessment is recommended. If patient has significant dementia, physician should seek out someone other than the suspected perpetrator who could provide additional medical or social history.
When abuse is suspected, a physician’s highest priority is to ensure safety of the patient. Physician should ascertain the degree of danger, and if it is immediate and life threatening, should separate the abused from the abuser and legal authorities should be notified. Slide 52: A multidisciplinary team recommended for managing abuse is comprised of a
primary care physician,
psychiatrist or psychologist,
The advantages of a team - varieties of expertise and lessening demands on the primary care provider by sharing the burden among team members. Slide 53: SUMMARY Slide 54: Elder abuse is a public health concern in our country, particularly among women.
As the population continues to age, number of victimized patients are likely increase.
Physicians play key roles in identifying elder abuse. They are often the only contacts for frail elderly patients besides their family members, who frequently are the abusers. Slide 55: Unfortunately, physicians don’t identify or report elder abuse, as they lack the knowledge, time, and skills to detect/handle these cases.
Health care professionals need to heighten their awareness of this problem and expand their “comfort level” in questioning patients about family violence. Slide 56: The general community need to be made aware of elderly abuse.
The media could play an important part in calling attention to this often undetected social problem. Slide 57: Effective management requires a multidisciplinary approach that covers broad areas of
mental health care,
social services, and
legal assistance. Slide 58: Effective techniques & programs are needed to adequately train health care professionals in detecting & managing suspected cases of elder maltreatment.
Elder abuse is an escalating problem in our society, but one that often remains in the shackles of the closed house doors. Slide 59: ELDERLY ABUSE …..
Is a crying shame Slide 60: THANK YOU