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Doctors Can Be Sentinels for Elder Abuse

Report finds victims likelier to die within 3 years

THURSDAY, Sept. 30, 2004 (HealthDayNews) -- Elderly people who are abused are much likelier to die sooner than are their peers who are not mistreated, but medical professionals are in a powerful position to detect cases and even intervene.

So said the authors of an article appearing in the Oct. 2 issue of The Lancet, and it's a perception shared by other experts.

"Medical professionals in general, but physicians in particular, are an essential pathway, a sentinel, who in their daily contact field persons that might not be picked up by the formal system," said Sara Aravanis, director of the National Center on Elder Abuse in Washington, D.C. "They are trusted intermediaries."

Different studies have put the rate of elder abuse at 2 percent to 10 percent. At the same time, according to United Nations figures, the proportion of people aged 65 and older will have doubled in most of the world between 2000 and 2050. That means an estimated 29 percent of Europeans and 18 percent of Asians will be elderly by mid-century -- elderly and vulnerable to abuse.

According to the article, people who have been abused are 3.1 times more likely to die within three years compared with those who have not been mistreated. One group of researchers found that after 13 years, only 9 percent of abused elderly people were still alive, vs. 41 percent of elders who had not been abused.

Yet the phenomenon is just now gaining widespread attention. "It's an extremely undetected problem," said Fay Kahan, elder abuse coordinator in the department of social work at Mount Sinai Hospital in New York City. "Only one in 10 may be detected."

Elder abuse can take a number of different forms -- physical, psychological, sexual, financial and neglect -- and can take place in any number of settings, yet medical professionals are increasingly being recognized as the ones who are in a position to help. "Elder abuse is common enough to be encountered regularly in daily clinical practice," wrote the authors of the article. "A busy clinician seeing between 20 and 40 old people per day could encounter at least one clinical or subclinical victim of elder abuse daily."

But recognizing elder abuse is anything but clear-cut, making intervention and treatment difficult propositions. "There's a lot of detective work and intuition," Kahan said.

In an elderly population, many signs and symptoms of abuse are also signs and symptoms of conditions associated with aging. "Many [elderly] patients are on blood thinners and they can bruise easily, so they can come in with a bruise on their arm or leg and right away you think somebody pushed them down or hit them. But it could be they bumped themselves and it erupted into a big bruise," Kahan pointed out. Elderly people are also prone to falling, which can result not only in bruises but also broken or injured bones.

Many older people are abused by their caregivers -- often the very ones bringing them to the doctor. It can be challenging to interview the potential victim on his or her own. It can be even more difficult to interview patients with dementia, who are particularly vulnerable to abuse.

The authors of the article, Dr. Mark Lachs and Karl Pillemer, both aging experts at Cornell University, say the problem requires a multidisciplinary approach, perhaps involving adult protective services, mental health professionals, aging experts, law enforcement, and health and community services people. "No individual profession has the full picture," Aravanis said.

Kahan is part of a team that coordinates different areas of the hospital. She encourages health-care providers in other areas of the hospital to contact her department. Even though a bruise may just be a bruise, she said, "I always feel it is better safe than sorry. It's better they should call the team to further evaluate."

More information

The National Center on Elder Abuse has more on this topic.

SOURCES: Fay Kahan, L.C.S.W,. elder abuse coordinator, department of social work, Mount Sinai Hospital, New York City; Sara Aravanis, director, National Center on Elder Abuse, Washington, D.C.; Oct. 2, 2004, The Lancet
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