It's no secret that the American population is ageing. As the number of older Americans increases, so does the number of older Americans who face the harsh realities of physical abuse, sexual abuse, neglect and financial exploitation at the hands of their caregivers. Often these people are physically frail and isolated, so contact with the health care system may be their first--if not their only--chance for help.
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Because the definition of elder abuse varies from state to state to state, it is hard to come up with precise statistics, but authorities estimate that between 1 and 2 million Americans age 65 and older have been mistreated by a caregiver, according to the National Center on Elder Abuse. It is also estimated that only 1 in 14 incidents of abuse and neglect come to the attention of police or social service agencies.
According to Dr. Monique I. Sellas and Dr. Laurel H. Krouse, writing for eMedicine, victims of violence see physicians twice as often as the rest of the population. This puts people in the health care profession, especially emergency room personnel, in the best position to identify and protect victims of elder abuse.
Although health care professionals have the best chance of identifying victims of elder abuse, many cases of abuse and neglect go unreported because doctors don't recognise the warning signs. Some doctors assume that patients who are being victimised will tell them what is happening. In fact, only about one out of six victims self-report, according to Sellas and Krouse, and of those who do self-report, some are not believed due to dementia or mental health issues.
Agencies that deal with elder abuse recommend that doctors always keep abuse in mind as a possibility when an older person is dependent on a caregiver. Additionally, women are slightly more likely to be abused than men, the risk for abuse increases with age, and the elderly who have dementia, mental health issues or substance abuse issues are also more likely to become victims of abuse.
So that health care professionals do not miss as many cases of elder abuse, the American Medical Association (AMA) recommends that physicians make it a routine part of their exams to ask elderly patients if anyone is hurting them, neglecting them or exploiting them, according to Sellas and Krouse. The physicians should ask these questions in a nonjudgmental tone and when the caregiver is in a different room to increase the chances that the patient will answer candidly.
Costs to the Health Care System
Not only are abused elders more likely to see their physicians than non-abused elders, they are also more likely to require hospital admissions. Sometimes the admissions are necessary to treat the injuries or illnesses that result from the abuse or neglect. Other times, however, these are "social admissions," meaning that there is no other safe place for the elderly person to go, so she is admitted to the hospital until other arrangements can be made for her care.
Health Care Professionals as Perpetrators
It should be noted that abuse or neglect occurs not only in domestic settings but also in nursing facilities and other care centres. In 2003, state ombudsman programs nationwide investigated more than 20,500 complaints of abuse, neglect and financial exploitation in nursing homes, according to National Center on Elder Abuse.
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