Elder Abuse: A hidden health and social issue

Abuse of the elderly is not a new phenomenon, however it has, more recently, been receiving increased attention by the media and the community. Abuse of the older population is gaining greater recognition as a significant health and social problem for our society, due in part to our aging demographics.

Currently seniors (65 years and older) comprise 13 per cent of the Canadian population. Statistics Canada predicts that by 2026 this number will increase to 21 per cent. Both regulated and non regulated health-care professionals who work in a hospital setting need to be sensitive to elder abuse and to understand what indicators to look for and how to respond to their patient.

The World Health Organization (WHO) in 2004 defines elder abuse as any action or lack of action by a person in a position of trust which causes harm to an older person. The abuser is typically a family member, friend or paid caregiver. According to WHO, five per cent of seniors world wide are experiencing some form of abuse. Subsequent studies have reported incidences as high as 25 per cent. Most researchers feel that even 10 per cent is a conservative estimate and an underestimation of the actual prevalence.

Elder abuse respects no boundaries. It is not exclusive to any particular situation, socio-economic status, religion or ethnicity. The three most common factors found in cases of elder abuse and neglect are an unequal balance of power between the victim and abuser, a relationship of dependency, (the victim depends on the abuser for care and personal needs or the abuser might depend on the victim for shelter and other financial resources) and isolation. Isolation is the hallmark of elder abuse as the abuser tries to isolate the victim from other people and resources.

Abuse is rarely a one time occurrence, but rather a pattern of behaviours that has existed over a period of time. Most abused older adults don’t report the abuse even if they are in a supposedly “safe” environment like the hospital. They feel very vulnerable and frightened and unsure of who to trust. They fear retribution either from a family member or the care provider and so remain silent. Risk factors for abuse

• Family history of abuse/domestic violence

• Drug, gambling, or alcohol addictions, including abuser or victim • Mental health issues, including abuser or victim

• Isolation

• Financial Stress

• Physical or cognitive frailty

• Widowed, over age of 75

Responding to elder abuse: What is my role?

Recognize indicators, Interact with patient, Respond. (R.I.R.)

Every hospital has policies and procedures in place for elder abuse. Ignorance is not acceptable. Ensure you know the policy and how to respond. If you are a regulated health-care professional, then you also have standards set by your College. It is your responsibility to understand them. In any work setting you need to be able to answer these questions about elder abuse:

• What is your role in the chain of accountability?

• What are your responsibilities in that role?

• Have you been trained in your organization’s policies and procedures?

• What does the organization and/or your College expect from you?

• What supports and resources are available to you from your organization/team/supervisor/College? Having dementia does not preclude a resident from disclosing abuse. If you see abuse or there is a disclosure of abuse:

• Listen carefully to the patient, respond to the patient’s feelings even if they are unable to express it in words, let them know you believe them.

• Reassure them that the abuse is not their fault.

• Patients have the right to feel safe and live in a safe and secure environment;

• Reassure the patient that you will protect the confidential nature of the information that has been disclosed. Tell them what action you will take and explain any limits on confidentiality. (Typically the patient will want you to promise not to tell any one else. Let them know that you must report it to a supervisor or whatever your policy states but no action will take place without their knowledge and consent. This applies only to a competent patient.)

• Continue to inform the patient of the results of your actions, whether it is you or a delegated person.

• Document and report.

What if a patient refuses any help?

If they are competent, reassure them that you will respect their wishes but there are options for them to consider and help is available when they are ready. Ask the patient if you/or another team member can bring the topic up again in a future visit or interaction. Elder Abuse is a complex, multi-sectoral issue. This article provides a brief overview of some of the issues and resources. Remember elder abuse is not just a problem for the elderly but impacts our whole community. All of us have older relatives and friends who may be affected by this. If we don’t make changes now then we will face these same issues as we age. It’s time for elder abuse to come out of the closet. Please make your voice heard.