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Recognizing elder abuse among our patients

Toronto, December 11, 2014

By Marisa Cicero

Marisa Cicero, social worker
Marisa Cicero, social worker

Elder abuse isn’t known for having a high profile; people don’t really talk about it and we tend not to ask about it.

So, what is elder abuse and why should we worry about it? The World Health Organization defines elder abuse 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. Elderly people can be victims of: neglect, physical, emotional, sexual and financial abuse. We know from the research that many elderly patients are victims of more than one type of abuse and that the most likely perpetrators are adult children and a current spouse.

It’s believed that between two and 10 per cent of older adults are abused in some form. Those who work with or assist older adults believe the number to be closer to 10 per cent.

Older adults experiencing abuse may be reluctant to talk about their experiences for a variety of reasons, including because they:

  • fear of more abuse
  • feel humiliated or ashamed
  • blame themselves for the abuse
  • fear a loss of affection from their abuser who may be a loved one
  • worry about what will happen to them and/or to the abuser if they disclose
  • believe that family honour is at stake and will be lost if they ask for help.

Given that our population is aging and that elder abuse normally flies under the radar, the need to familiarize ourselves with the issue and get comfortable with the topic is becoming increasingly important. At St. Michael’s, 30 per cent of our inpatients at any time are elderly, with the highest concentration of patients in:

  • Cardiology
  • Medicine
  • Orthopedic surgery

Marginalization can increase the risk of being abused for elderly patients. We are attuned to risk factors such as:

  • Social isolation
  • Increased vulnerability, e.g., frailty, diminished capacity
  • Caregiver stress or resentment of caregiver role
  • Dependence of the victim on the abuser (e.g. the caregiver is the abuser) or dependence of the abuser on the victim (e.g. an adult child with financial dependence on the parent is the abuser)
  • Pathology of the abuser, such as alcohol or other substance abuse, cognitive impairment and/or mental health problems

So how do we help older patients whom we suspect is the victim of abuse?

We’ve developed two online courses for our staff. The first e-learning module is called Elder Abuse Awareness and is meant to help learners become more aware of elder abuse and why it is important. At the end of this module, staff will be able to recognize who is at risk, define the different types of abuse and be more comfortable asking for help and guidance. The second course is Responding to Elder Abuse: Your Responsibility as a Health-Care Provider and is designed for regulated health-care professionals. We also offer a telephone consultation service for staff to discuss complex cases and have a decision making tree available with resources to help out staff out of hours.

Here is an easy mnemonic to help integrate into our practice how to better identify elder abuse:

  • R - Routinely integrate questions
  • A - Ask direct questions
  • D - Document findings
  • A - Assure safety
  • R - Refer to community resources/supports as needed

What are your organizations doing to raise awareness on this issue and to help manage these cases? If your organization doesn’t have a social worker with expertise in this area, there are a number of resources you can contact for support:

  1. PC Fleischmann, Toronto Police Service
  2. Advocacy Centre for the Elderly
  3. Senior Safety Line, 1-866-299-1011
  4. Office of the Public Guardian and Trustee
  5. Crisis Outreach Service for Seniors
  6. Senior Crisis Access Line

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.