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Elder Abuse and Its Prevention: Workshop Summary (2014)

Chapter: II.7 Elder Abuse and Neglect: A Role for Physicians--James G. O'Brien

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Suggested Citation:"II.7 Elder Abuse and Neglect: A Role for Physicians--James G. O'Brien." Institute of Medicine and National Research Council. 2014. Elder Abuse and Its Prevention: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18518.



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).

Suggested Citation:"II.7 Elder Abuse and Neglect: A Role for Physicians--James G. O'Brien." Institute of Medicine and National Research Council. 2014. Elder Abuse and Its Prevention: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18518.
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Elder Abuse and Its Prevention is the summary of a workshop convened in April 2013 by the Institute of Medicine's Forum on Global Violence Prevention. Using an ecological framework, this workshop explored the burden of elder abuse around the world, focusing on its impacts on individuals, families, communities, and societies. Additionally, the workshop addressed occurrences and co-occurrences of different types of abuse, including physical, sexual, emotional, and financial, as well as neglect. The ultimate objective was to illuminate promising global and multisectoral evidence-based approaches to the prevention of elder maltreatment. While the workshop covered scope and prevalence and unique characteristics of abuse, the intention was to move beyond what is known about elder abuse to foster discussions about how to improve prevention, intervention, and mitigation of the victims' needs, particularly through collaborative efforts. The workshop discussions included innovative intervention models and opportunities for prevention across sectors and settings.

Violence and related forms of abuse against elders is a global public health and human rights problem with far-reaching consequences, resulting in increased death, disability, and exploitation with collateral effects on well-being. Data suggest that at least 10 percent of elders in the United States are victims of elder maltreatment every year. In low- and middle-income countries, where the burden of violence is the greatest, the figure is likely even higher. In addition, elders experiencing risk factors such as diminishing cognitive function, caregiver dependence, and social isolation are more vulnerable to maltreatment and underreporting. As the world population of adults aged 65 and older continues to grow, the implications of elder maltreatment for health care, social welfare, justice, and financial systems are great. However, despite the magnitude of global elder maltreatment, it has been an underappreciated public health problem. Elder Abuse and Its Prevention discusses the prevalence and characteristics of elder abuse around the world, risk factors for abuse and potential adverse health outcomes, and contextually specific factors, such as culture and the role of the community.

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