ELDER ABUSE AND NEGLECT: A ROLE FOR PHYSICIANS
James G. O’Brien, M.D.
University of Louisville, Kentucky
Elder abuse continues to be neglected as a problem that adversely affects older adults, robbing them of quality of life and, on occasion, resulting in death. Self-neglect is the orphan in the spectrum of abuse and neglect; it is perhaps the most challenging to deal with, and in some states is excluded from definitions of abuse and neglect.
Until recently, physicians appeared to play a very minor role in detection and reporting of cases of elder abuse, in contrast with child abuse, where pediatricians had and continue to have a major role in detection, intervention, research, reporting, and development of creative model programs for combating the problem. In addition, they have been instrumental in launching a massive public health initiative to acquaint the public with the problem. By contrast, elder abuse and neglect receives a fraction of the funding from states and remains chronically underfunded in the area of research.
Physicians are perceived to contribute very little as judged by frequency of reporting, but this may not accurately reflect the contribution of physicians. Some recent studies of elder abuse and neglect in Ireland have identified physicians as being eighth in rank of reporting (Clancy et al., 2011). Yet, a study of general practitioners revealed significant involvement in terms of identification and intervention.
A survey of general practitioners in Ireland in 2010 revealed nearly two-thirds had encountered cases, with 35.5 percent encountering a case in the past year (O’Brien et al., 2013a). Most cases were detected by the general practitioners during a home visit. In addition, 13.3 percent had been threatened by a perpetrator or family member. Nearly three-quarters, 73 percent, perceived their role to becoming involved beyond medical care. Finally, 70 percent of general practitioners believed the situation for the victim had improved after intervention.
A survey of geriatricians in Ireland and Scotland in 2010 regarding self-neglect revealed most had encountered cases in the past year, with personal neglect and refusal of services being common presentations. Interestingly, 40 percent of cases were thought to contain elements of abuse, which is not surprising given the vulnerability of the individuals. Dementia, lifelong personality traits, depression, and alcoholism were cited as the most common underlying causes. Comprehensive geriatric evaluation was identified as the most appropriate intervention. The respondents identified the need for more education for geriatricians and others in health care (Bartley et al., 2011).
