Approach
Your Organizational Guidance
ebpracticenet urges you to prioritize the following organizational guidance:
Maltraitance à l'égard des personnes âgéesPublished by: Domus Medica | SSMGLast published: 2013Ouderenmishandeling in de thuissituatiePublished by: Domus Medica | SSMGLast published: 2013Older adult abuse is often an ongoing process. If the diagnosis of abuse is being considered, caregivers must be informed of all relevant investigations and referrals. Management includes immediate care, long-term assessment and care, education, and prevention. National Center on Elder Abuse Opens in new window University of Delaware: Clearinghouse on Abuse and Neglect of the Elderly (CANE) Opens in new window Nursing Home Abuse Guide: elder abuse Opens in new window
Reporting to authorities
Doctors are required to share information with other agencies (social workers, law enforcement bodies, and legal professionals) to ensure that the older person’s needs are met and that the patient is protected from harm.[39][54] A challenge for many physicians is a lack of familiarity with reporting requirements and procedures.[35] The requirements are often different from state to state and from country to country, although not all regions require mandatory reporting for confirmed older adult abuse. In the US, when cases of abuse are confirmed, most states require healthcare providers to report the case to Adult Protective Services.[23] Some states, such as California, encourage anyone, and require physicians and all healthcare personnel, to report even suspected cases of abuse. Social workers and Adult Protective Services take on the reporting aspects when involved.
Intervention strategies
These are best accomplished using a multidisciplinary team approach, and should be individualized to each older adult.[35] In locations of limited resources where multidisciplinary teams are unavailable, a team approach can be established through relationships with local community resources like home care and senior services. In managing abused older people, it is important to ensure the patients' safety and honor their dignity. Depending where the patient is being evaluated, there may be several options: temporary hospitalization, obtaining a court protective order, or placing the patient in a safe home in the community. Occasionally, the patient wishes to return home and refuses intervention. This type of refusal can lead to complex ethical dilemmas for professionals.[55] However, if the patient has decision-making capacity and understands the choices being offered, the patient's decision needs to be respected and the patient can return home after appropriate education.[35] Appropriate education and close follow up are recommended.
The following may be considered:[35][56]
Linkages with appropriate resources, such as home health services, adult day care, or respite care.
Assistance with development of informal support systems.
Guardianship.
Referral to counseling and interdisciplinary support groups.
Financial or legal assistance.
Housing assistance.
Placement in a convalescent home.
Emergency responses for housing, food, and physical and mental health.
Dietary assistance.
Resolution of disposition problems resulting from caregiver exhaustion.
Counseling the abuser.
Data assessing the effectiveness of interventions for older adult abuse are limited. One review of the literature indicated that interventions failed to reduce and may have even increased the likelihood of recurrence.[57] It is important to note that the studies reviewed had significant methodological limitations and more research is needed to validate this finding.
Injury management and specialist consultation
Individual injuries should be managed as appropriate, irrespective of whether they are caused by abuse or accident.[46][58] However, where abuse is considered, the physician should ensure that an appropriate search for additional or hidden injuries is also carried out.
Patients with dementia, depression, or disorientation will require psychiatry consultation or a comprehensive evaluation by a geriatrician to determine issues of capacity. Those with fractures will require orthopedic consultation, and those with signs of neurologic injury will require neurology or neurosurgical consultation. Any signs of volume depletion, infection, malnutrition, pressure ulcers, or genital injury from sexual abuse need to be addressed.
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