elderly abuse

Category: Education

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Elder Abuse : 

Elder Abuse Elder abuse (“elder maltreatment”) encompasses physical, sexual, and psychological abuse, financial or material exploitation, neglect, self-neglect and abandonment.

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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.

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Studies have found elder abuse more prevalent in those with short-term memory problems, psychiatric diagnoses, alcohol abuse, as well as among the widowed, divorced, or separated. Subtle findings, fear, shame and denial – difficulty in diagnosing it.

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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

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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.

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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

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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.

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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.

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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.

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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





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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.



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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.



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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 financial abuse among the major culprits for the same.

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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.

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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.

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Elder abuse is a type of domestic violence, where in senior receives little recognition, little funding, has sparse publications, and low public awareness.

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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.

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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.

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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.

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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.

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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.

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The caregiver may have problems with mental illness, substance abuse, or alcoholism Personal stressors such as unemployment, financial stressors, and inadequate housing, Abuse happens more often to those who are impaired & cannot fend for themselves.

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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.

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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.

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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

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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

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Emotional/Psychological Abuse Uncommunicative and unresponsive Unreasonably fearful or suspicious Lack of interest in social contacts Chronic physical or psychiatric health problems Evasiveness

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Sexual Abuse Unexplained vaginal or anal bleeding Torn or bloody underwear Bruised breasts Venereal diseases or vaginal infections

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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

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Neglect Sunken eyes or loss of weight Extreme thirst Bed sores

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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?

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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..

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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.

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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.

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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

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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..

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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.

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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.

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A multidisciplinary team recommended for managing abuse is comprised of a primary care physician, geriatrician, psychiatrist or psychologist, Nurses, and social worker The advantages of a team - varieties of expertise and lessening demands on the primary care provider by sharing the burden among team members.

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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.

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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.

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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.

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Effective management requires a multidisciplinary approach that covers broad areas of medical treatment, mental health care, social services, and legal assistance.

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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.

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ELDERLY ABUSE ….. Is a crying shame

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