Using screening tools to tackle elder abuse

Doug Hendrie

5/04/2018 3:58:49 PM

People become more vulnerable as they age. But how do healthcare professionals detect abuse of older patients?

Abuse can take a number of forms, including financial, emotional, physical, sexual and neglect.
Abuse can take a number of forms, including financial, emotional, physical, sexual and neglect.

The question of recognising elder abuse is not an abstraction for GPs. Day in, day out, Australia’s GPs see older patients, some of whom may be subject to abuse – whether financial, emotional, physical, sexual or neglect.
The challenge is figuring out which patient is at risk.
In an article in the April issue of the Australian Journal of General Practice (AJGP), ‘Elder abuse: The role of general practitioners in community-based screening and multidisciplinary action’, University of Technology Sydney Associate Professor of Law Nola Ries argues there is an urgent need for a proven clinical screening tool for GPs to use.
‘The abuse of older people in Australian communities is a serious and under-detected problem,’ Associate Professor Ries said. ‘In its various forms – emotional, financial, physical, sexual, neglect – abuse has profound individual and social impacts.
‘Abuse can deprive older people of their assets and increase their risk of injury, hospital admission, residential care placement and premature mortality.’
Existing screening tools involve direct questioning of older people, and Associate Professor Ries believes these can serve as a way for GPs to initiate conversation. However, most current tools have not been assessed for use with older adults with impaired cognition, a group likely to be particularly vulnerable to abuse.
In addition, Associate Professor Ries believes new approaches are needed to connect community service providers and strengthen GPs’ ability to support patients at risk of, or experiencing, abuse.
Professor Tania Winzenberg, Chair of the RACGP Expert Committee – Research (REC–R), believes screening tools for elder abuse could be investigated in general practice.
‘General practice settings are important sites for research, to understand patient and practitioner perspectives on elder abuse, to trial multidisciplinary collaborations, and to investigate the impact of screening and interventions on improved outcomes for older people,’ she said.
‘Funding for innovative models of service deliver should support robust evaluation strategies to determine their impact on identifying, managing and preventing elder abuse.’
A trial is currently running in Queensland at over 300 clinics in a bid to boost recognition of elder abuse and increase referrals to lawyers where needed.

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Dr Patricia Farrar   6/10/2018 10:43:40 PM

In my capacity as an Official Visitor under the Mental Health Act, I visit four psycho-geriatric units and I am frequently concerned about the lack of assessment for domestic violence. Although DV screening is mandatory for females over the age of 16, this screening is inadequate and inappropriate for elderly consumers. I often meet consumers who have been diagnosed as having paranoid delusions based on the histories reported by family members without these delusions being investigated. The more a consumer tries to explain the circumstances, the more entrenched the delusions seem to be evident. As the result of a literature search, I discovered the Elder Abuse Suspicion Index devised and evaluated in Canada in 2006. I propose that this could be implemented easily whenever an older person is admitted to hospital or an aged care facility.