Elder abuse: Identifying the signs in general practice

‘If we accept the family comes in many forms, so does family violence,’ Sue Clifford, Chief Executive Officer of Family Safety Victoria, said at the recent World Elder Abuse Awareness Day breakfast in Melbourne.
 
One of the forms family violence can take is elder abuse, which can be particularly complex due to the vulnerability of the victims; the fact they are often dependent on their abusers; and, in some cases, the additional complicating factor of cognitive impairment.
 
This complexity, combined with a lack of awareness of elder abuse as a form of family violence, can render it all but invisible to care providers within the community, and difficult even for perpetrators and victims to recognise.
 
Professor Dimity Pond, a GP with a special interest in dementia and aged care, outlined some signs for which GPs can look in order to detect physical, sexual or emotional abuse.
 
‘Bruising, especially fingertip marks on the arms,’ she told newsGP. ‘Weight loss, depression.
 
‘Sometimes the older person comes in with their abusive carer and they will keep very quiet, and that can be a bit of a sign.’
 
However, elder abuse is not always physical – a common form is financial. Professor Pond provided an example that many GPs may find familiar.
 
‘I have a patient in her 70s whose son is in his 50s and has been living with her forever,’ she said. ‘She looks after him, cooks for him and supports him out of her pension. He tends to spend a lot of it on alcohol.
 
‘I think she understands what’s going on, she hasn’t got dementia, and she certainly has support – her two daughters are in the legal profession, they both know about it.
 
‘But when I talk to her, she doesn’t want to change it.’
 
This type of situation can present a delicate situation for GPs.
 
‘It’s always a difficult balancing act, trying to work out if you need to report it,’ Professor Pond said.
 
‘And if the patient has cognitive impairment and isn’t able to make that decision, then it’s even more tricky.’
 
Luke Wright, Relationship Manager for State Trustees Victoria, is very familiar with financial abuse of older people, as his company is often appointed as independent financial administrators in severe cases.
 
State Trustees has marked this year’s World Elder Abuse Awareness Day with the release of two videos about the subject, made in partnership with Dementia Australia, designed to help medical practitioners recognise the signs.
 


‘We see cases involving transfer of property and theft of hundreds of thousands of dollars from our clients’ bank accounts; to cases where the older person is deprived of access to their pension and is at risk of eviction because their rent hasn’t been paid,’ Mr Wright told newsGP. ‘Often the financial abuse is perpetrated by the person’s son or daughter.
 
‘The financial abuse rarely happens in isolation and there is an incredible emotional toll on the older person, who is often dependent on the perpetrator and knows the only alternative may be entering aged care.
 
‘Therefore, they may be more willing to tolerate the abuse and usually do not want the perpetrator to get in trouble.’
 
Mr Wright acknowledged that while detecting financial abuse can be very difficult, there are some signs that can help to uncover it.
 
‘The older person may hint at controlling behaviours or pressure for financial support from the perpetrator,’ he said. ‘They may display outward signs such as looking uncharacteristically dishevelled or complaining of having no money. 
 
‘Often the perpetrator lives with the older person and may attend the consultation with the victim.
GPs should consider this when conducting the consultation.’
 
Professor Pond suggests considering a home visit, either by the GP or a practice nurse, if elder abuse is suspected.
 
‘A home visit tells the most amazing story. It can often pick up the dynamics of the house so much better [than a consultation],’ she said.
 
There are also a number of organisations and specialists that GPs can contact for advice and referral if elder abuse is suspected (refer to list, below).
 
But Mr Wright is unequivocal about what to do if risk is considered severe.
 
‘In more serious cases, where the older person is at significant and ongoing risk, it may be appropriate to report the case immediately to police,’ he said.
 
Resources and organisations for GPs

• The RACGP’s Abuse and violence: Working with our patients in general practice (White Book) provides information and guidelines on how to handle abuse and violence in general practice, including an Elder Abuse Suspicion Index.
• The RACGP’s Medical care of older persons in residential aged care facilities (Silver Book) is designed to help improve the quality of life of those in aged care.
• GPs can refer patients to an Aged Care Assessment Service in their area.
• Dementia Australia can provide advice to health professionals 24 hours a day.

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