By Aine Cryts
There's a 1 in 10 chance that the seniors coming to your practice are victims of emotional, sexual or financial abuse, according to a review article published in The New England Journal of Medicine.
Many seniors struggle with dementia or live away from the watchful eyes of neighbors who otherwise might see those bruises or witness their inability for pay for groceries. As a result, many cases of elder abuse go unreported.
The paper urges physician practices to pay closer attention to seniors and coordinate the appropriate services when necessary.
"Fragmentation of care is a huge problem," lead author Mark Lachs, M.D., director for the Center of Aging Research and Clinical Care at Cornell University, told NPR. "I've seen situations where patients have been victims of abuse at home, they go to a hospital [and] there's understandably a pressure to get people out of the hospital. They might go to an environment for rehab where the receiving providers don't have an understanding that the family member is physically, emotionally or fiscally abusive because of that fragmentation."
The NEJM piece suggests assessment strategies for patients they think may be victims of elder abuse, such as:
- Interview patients separately and alone. The caregiver may be the abuser and the patient may be hesitant to reveal mistreatment when the person is present, according to the research.
- Ask indirect questions at first. Questions such as ""Do you feel safe at home?" or "Does someone handle your checkbook?" are less threatening and may help patients open up about what is happening at home.
- If necessary ask direct questions similar to the qustions asked when you suspect other forms of domestic abuse. You may ask "Does anyone in your home hurt you?" or "Has someone not helped you when you needed their help?"
- Formally assess cognition and mood. Dementia increases the risk of elder abuse, according to the paper, and depression is common among older adults.
- Adopt a sympathetic, nonjudgemental approach with the suspected abuser until you know all the facts.
- Arrange for a home visit. If you can't conduct the visit, arrange for one via adult protective services.
If elder abuse continues undetected, it can only get worse for the senior because of the increased risk of death and physical harm, which may land them in the hospital or the emergency room, according to the NPR article. Financial abuse may leave elderly patients unable to buy medications or food, which can also have an adverse impact on their health.
Since many of these seniors are coming to primary care practices, physicians need to do more than just fix their patient's broken arm or attend to their bruise. They may also need to help coordinate housing or notify the patient's bank if they believe someone is taking advantage of the older person financially, according to NPR.
To learn more:
- read the NEJM article
- check out the NPR article