All medical practitioners, healthcare professionals, family members and RACF staff need to be able to recognise and identify older people who may be experiencing abuse. They should be aware that the risk of abuse of older people increases as people become frailer, more dependent on care and develop dementia.4 Some of the factors that contribute to the abuse of older people are shown in Table 1.
Factors that contribute to the abuse of older people5
There is also an additional risk if there was ongoing family violence prior, where, in some cases, the perpetrator becomes the victim.
The first step of the assessment of abuse of older people is to be aware of the risk that this is happening. It is important to look for signs such as:
- not able to pay for things (eg medication, other personal needs)
- unexplained falls
- weight loss
- bed sores
- decreasing levels of hygiene
- changes in the patient’s demeanour.
Further signs and symptoms of the abuse of older people are shown in Table 2.
Signs and symptoms of the abuse of older people
Be aware of the environment in which the conversation is had with the patient; make sure the conversation cannot be heard by anyone else, and reassure the patient about confidentiality. Tools such as the Elder Abuse Suspicion Index (EASI), which has been validated for older people without dementia, can assist this process.
A safety plan needs to be implemented if the GP establishes that there is a possibility that the older patient is experiencing abuse.
Older people with dementia who GPs believe are being abused are much more difficult to identify as the signs of abuse listed above may also be associated with dementia per se (refer to Part A. Dementia). However, it is important to note that abuse is common in people living with dementia.6 Abuse may be detected through a full history and physical examination, preferably in the presence of someone who is unlikely to be the perpetrator.7
Culturally and linguistically diverse populations
Patients from a culturally and linguistically diverse (CALD) population group may benefit from an ethno-specific worker who establishes a relationship with them and their family, and undertakes dementia education with the group (refer to Part B. Multiculturalism in aged care ).
Aboriginal and Torres Strait Islander peoples
Aboriginal and Torres Strait Islander peoples will benefit from discussion and support involving an Aboriginal health worker, who can provide a culturally safe intervention (refer to Part B. Older Aboriginal and Torres Strait Islander peoples).
Be aware of some of the barriers to disclosure of abuse of older people:
- Some patients will not identify what is happening to them as abuse.
- Some will be very afraid of the perpetrator and what might happen if they talk about the abuse.
- Some will be too ashamed to talk about it and consider it their own fault.
- Some will make excuses for the carer.
- Some patients will have dementia and be unable to tell their GPs what is happening.
Be aware of some of the barriers to asking older people about abuse:
- It is difficult to believe that older frail people are being abused by people who are their carers.
- It is hard or near impossible to believe that this could be happening in this family or RACF.
- There is no time to ask.
- Uncertainty about what to do if abuse of older people is discovered.