Enhanced support for responding to elder abuse

The most recent report from the Royal Commission into Aged Care Quality and Safety contained ‘damning’ stories of abuse and neglect of older people in Australia, and led to calls for a fundamental reform of the aged care sector and several recommendations.
 
One outcome of the recommendations is a new online training package, funded by the Department of Health and developed for GPs and other healthcare professionals – Abuse of the older person: eLearning program for health professionals.
 
The Older Persons Advocacy Network (OPAN) developed the training content in collaboration with Age Discrimination Commissioner Dr Kay Patterson, representatives from the RACGP and Aged Care Quality and Safety Commission, along with other aged care professionals. The training was also developed in response to outcomes from the 2017 Law Reform Commission elder abuse report.
 
A free, self-paced program for healthcare professionals, the package is designed to enhance skills to support older people at risk of or experiencing abuse. 
 
Dr Patterson said the training has been developed to better support healthcare professionals who are at the coalface to identify the signs of abuse and ‘take appropriate action’.
 
‘It is important to remember that a visit to the GP, optometrist, audiologist or other allied healthcare provider, could be one of [the] few opportunities for an older person experiencing or at risk of abuse to access outside help,’ she said.
 
‘Professionals I have spoken to in health and other services who come into contact with older people often express reservations or uncertainty about raising the alarm on suspected abuse out of fear they may be breaching confidentiality or privacy laws. Others are simply unaware of appropriate referral pathways.
 
‘This new learning program addresses these barriers and is designed to equip health professionals with the knowledge and confidence to prevent and respond to abuse.’
 
RACGP Specific Interests Aged Care Chair Dr Khayyam Altaf agrees it can be challenging for GPs to recognise or broach the area of elder abuse.
 
‘It is really difficult to raise these concerns, particularly due to the fear associated with making allegations which turn out to be incorrect, as well as potentially jeopardising relationships with our patients, their families and carers,’ he told newsGP.
 
Dr Altaf said the training offers important and timely guidance for GPs to address such challenges.
 
‘Traditionally, training [for GPs] tends to focus on the crucial area of child abuse; however, training on elder abuse doesn’t receive the same level of attention,’ he said.
 
‘By providing such training it will really assist in highlighting how much of an issue this is, and provide GPs with a better understanding of what they need to look for and what resources are available to assist them when faced with such issues.’
 
In response to the royal commission hearing, the Serious Incident Response Scheme (SIRS) was implemented. From 1 April 2021, residential aged care providers have been required to report Priority 1 incidents under SIRS to the Aged Care Quality and Safety Commission within 24 hours of becoming aware of the incident.
 
A May 2021 insight report from the commission reveals 4496 SIRS notifications from residential aged care providers from April to May 2021, with 1876 (42%) considered to meet the criteria for a Priority 1 reportable incident.
 
The majority of these reported incidents (778) fell under the category ‘unreasonable use of force’.
There were 448 incidents of ‘neglect’, 192 incidents of ‘unexpected death’, 163 incidents of ‘unexplained absence’ and 149 incidents categorised as ‘unlawful sexual contact or inappropriate sexual conduct’.
 
Raised as key concern in the aged care royal commission hearing, ‘unlawful sexual contact’ estimates were over 2500 in 2018–19, around 50 per week.
 
Dr Altaf says the RACGP’s Silver Book and White Book offer guidance for GPs on the signs of elder abuse to look out for.
 
‘Changes in general behaviour [include] being afraid of one or many people, [being] irritable or easily upset, worried or anxious for no obvious reason, depressed, apathetic or withdrawn,’ he said.
 
‘Change in sleep patterns and/or eating habits, [as well as] avoiding eye contact, contradictory statements not from mental confusion and a reluctance to talk openly.’
 
GPs can also be aware of the signs of neglect, and physical, sexual, emotional and economic abuse, detailed in the RACGP guidelines, for which the new OPAN training also builds on, according to Dr Altaf.
 
The OPAN training program covers 40 topics each with a subject matter expert, and the option to select a topic of interest or complete an entire module as part of continuing professional development to broaden knowledge and detect the signs of abuse of older people, and improve capacity to support patients in seeking help.  
 
Dr Altaf said incentives such as SIRS and the OPAN training package are ‘always welcome’, but prevention of elder abuse should remain a key goal.
 
‘There needs to be effective resources in place to ensure suspicion can be raised to an appropriate body who can provide advice and ongoing support to GPs,’ he said.
 

• 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
• RACGP aged care clinical guide (Silver Book) includes a chapter on the abuse of older people

aged care elder abuse family violence royal commission