“It is estimated that around 16% of the elderly worldwide have been victims of abuse. But there are few data on this, particularly in the least developed and developing countries in Southeast Asia, the Middle East, Africa, and even Latin America,” Andrea Prates, MD, told Medscape Portuguese Edition. Prates specializes in gerontology and has a master’s degree in health promotion from the London School of Hygiene and Tropical Medicine in the United Kingdom.
The United Nations created World Elder Abuse Awareness Day in 2011 to broaden the understanding of violence against elderly people. “The date designated to commemorate this fight is June 15, but we dedicate the entire month to activities that raise awareness of the seriousness of elder abuse. In Brazil, we call this campaign Junho Violeta,” Prates explained. In English, the name of the campaign directly translates to “Violet June.” According to Prates, the color violet refers to the bruises left by abuse and seeks to highlight the physical and emotional impact of violence toward elders. She spoke with Medscape about the subject.
What are the main advances in effect today to prevent abuse toward elders?
Andrea Prates: Abuse is found in several countries, but the difference is how each country defines it, which can vary according to cultural understanding. There are also differences in protection mechanisms in place to prevent and prohibit [abuse]. We see different actions taken in developed countries compared with the least developed countries. In the United States, the first National Center on Elder Abuse was established in 1988. Having an agency specialized in this area, one that conducts research and training sessions, shares information, and monitors incidents, greatly facilitates the prevention of this type of abuse. In Brazil, the Ministry of Human Rights and Citizenship has a telephone line that works well — Dial 100. It receives all complaints to do with human rights violations.
What are the numbers like in Brazil?
Prates: According to the data collected through Dial 100, 202,000 human rights violations against elders were filed in the first quarter of 2023 alone, a 97% increase compared with the same period in the previous year. The most common violations include health risks, mistreatment, abandonment, neglect, physical abuse, and lack of emotional support.
Who are the main perpetrators of abuse toward elders?
Prates: In 67% of reported cases, the aggressors are family members or people close to the elder. This circumstance makes it difficult to obtain accurate data. When elders live with their aggressors, they are often restrained, intimidated, and may even have difficulty recognizing the abuse against them. Nevertheless, there are cases where friends, neighbors, or close ones identify signs of violence and report the abuse.
What are some of the most common types of abuse?
Prates: The most common is neglect. This includes lack of basic care, such as withholding food and medications, lack of hygiene, lack of protection against the cold, and anything else involving basic personal care. Next is psychological abuse. This type of abuse involves an array of actions and expressions, including contempt, prejudice, discrimination, and verbal abuse. Third is financial violence, which is very common among family members, and manipulation by other people and financial institutions. Elders often fall victim to several types of scams, even ones involving romantic relationships. There are dramatic cases of manipulation and asset appropriation. It is important to note that, according to data across all studies and from [elder protection] services, women are more often the victims of this abuse compared with men. Women face many conditions specific to the female aging process and often have a lower quality of life and lack independence or autonomy.
How can clinicians identify possible cases of abuse during elder care?
Prates: First, we as clinicians must be aware of the seriousness and extent of this problem. Signs and behaviors are often subtle and can be overlooked during care. We must carefully observe the whole picture when treating an elderly patient. Individuals who have been socially isolated, who live with chronic diseases, have functional disabilities, or significant cognitive impairment are more vulnerable to abuse. The risk of mistreatment is higher if the elderly person lives or shares a residence with someone who has a dependent relationship with them. It further increases if this person suffers from psychiatric disorders or has a history of violence or drug or alcohol abuse. The situation is dramatic if we consider that in approximately 25% of cities, particularly smaller ones, patients older than 60 years significantly contribute to the household income.
What are some warning signs to watch out for during the interaction between the clinician, patient, and caregiver or family member?
Prates: Besides the known risk factors, the elder’s behavior can reveal signs of mistreatment. One of the signs to be mindful of is if the elder’s behavior is introverted. For example, the elder automatically shifts his or her gaze, looking to the family member or caregiver to answer any questions, and whether the family member or caregiver insists on answering questions asked to the elder or interrupts their answer. It is also important to watch for signs of anxiety, depression, or childlike behaviors. Discordant narratives provided by the patient and caregiver and the constant need for urgent care due to uncontrolled chronic disease can also suggest mistreatment. Moreover, it is important to be aware of situations in which the family member or caregiver struggles to leave the room when the clinician asks to speak with or examine the patient alone, particularly during a home or office visit. Unexplained delays in seeking medical care for health complaints can also indicate fear, coercion, or even manipulation by the abusers. In general, it is imperative to consider the elder’s history and context to distinguish what naturally occurs during the aging process from what may be the result of violence.
What measures can be taken when there is a highly suggestive or confirmed case of abuse?
Prates: The first measure is to offer emotional support and explain the situation [to the victim] individually, avoiding the presence of third parties. If the risk is not immediate, it is important to collect evidence, reduce existing risks, and, if needed, carefully administer medications, considering possible substance abuse, as it is very common for caregivers to sedate elders. Depending on the severity of the situation, the elder may require hospital admission, police intervention, or transfer to a safe place to ensure the elder’s immediate safety. I would like to stress the importance of involving an interdisciplinary team in these cases to ensure broad and effective intervention and benefit for the elder affected by the abuse.
How can prejudice interfere with healthcare?
Prates: It is essential to reflect on the clinician’s behavior, including his or her medical training. We live in a society where prejudice against elders is structural, and attempts to normalize situations of abuse are rampant. We need to reflect on this. Ageism, that is, age‑based discrimination, is a problem among healthcare professionals, too. When elders complain, these complaints are often ignored or attributed solely to their age. This reaction is a big mistake and reveals the existence of significant prejudice among healthcare professionals. This erroneous approach may result in a masking of the clinical picture, lack of clarity, or lack of intervention that could be helpful to this population. Moreover, several healthcare professionals, including doctors, could have attitudes that infantilize or neglect elderly patients, prioritizing other age ranges. We have to reevaluate our conduct toward elders and foster a culture that values longevity, especially as society is aging fast and demands adequate care for combating this abuse, which has, unfortunately, become increasingly common.
This article was translated from the Medscape Portuguese Edition.
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