Dialogue Volume 14 Issue 1 2018 - Page 38

PRACTICE PARTNER can be explained by other factors. That makes it even more necessary to probe sensitively, but thoroughly. Watch for the signs Start with an understanding of the types of elder abuse. They generally fall into these categories: •  Physical abuse – violence and rough treatment that cause injury or discomfort. This can also include over- medicating and inappropriate use of restraints. • Psychological/emotional abuse – acts or treatment that diminishes a sense of identity, dignity and self-worth (e.g., confinement, threats, verbal assault, insults, humil- iation, intimidation, excluding competent seniors from decision-making). • Sexual abuse – sexual behaviour directed at an older adult without their full knowledge or consent (e.g., sexual assault, sexual harassment, fondling, sexual comments or jokes). • Financial/material abuse – misusing funds and assets without the person’s full knowledge or consent, or not in that person’s best interests (e.g., fraud, theft, coercion). • Neglect – withholding basic necessities like food, cloth- ing, shelter, medicine or health care, either intentionally (active neglect) or because of lack of experience, infor- mation or ability (passive neglect). These aren’t mutually exclusive. Seniors might ex- perience more than one type of abuse simultaneously. Anyone can be a victim in any setting. The abusers can be friends, neighbours, paid care providers, landlords, anyone in a position of trust or authority and, most often, a family member. The signs of elder abuse depend on its nature. With physical harm, there may be unexplained injuries, bruising or pain. All abuse can cause changes in mood or behaviour, like fear, sadness, anger, passivity, silence or detachment. Neglect can be manifested by weight loss, bedsores, missing or broken aids (e.g., hearing aids, glasses, dentures, walker), poor mobility, un- kempt appearance or poor hygiene. 38 DIALOGUE ISSUE 1, 2018 Doctors can explore and question best when they’re alone with the patient, which isn’t always simple. Someone being abused may be accompanied to an ap- pointment by their very abuser. That individual may be the one who explains away a suspicious injury, seems to be speaking for the senior, or doesn’t want the senior seen in private. Those explanations themselves could be warning signs, says Ms. Etkin. Go EASI Doctors needn’t be certain of abuse just from seeing signs. How could they be? That’s why Dr. Yaffe calls his tool a suspicion index instead وHܙY[[[^ 'H\H\Z\H\X[ۈH[\B[H[H]Y[[YܙYH܈[HYHYKBۙHH\\Y]H[ܙH\Z[]H][ 8'H^\‘XYKPTH[Y\^]Y\[ۜˈH\\H[Y\™][H[[X]Z\][ۙ][ۜˈB\\܈H܈[\H]H[H[YYۈ[H܈[HوH[΂][\[[[[܈YX[Œ\[[ۙH][Y[HH][ \YYX][ۋ\\X\[ZY܈YYX[\K܂HZ[][H[H[YH]Œ]H[HY[\]X]\HY[ۙH[Y[B[H^H]XYH[HY[[YY܈X][Y\[[ۙHYYܘH[HYۈ\\܈\B[\[ۙ^HYZ[[\[H\[[ۙHXYH[HYZY XY[H[^\][HY[ ܈\[H\X[O[\X\HX^HH\X]Y][[X\œ܈^YH۝X ]]ۈ]\KX[\\Y[ YY[H\Y\]Z\\[\X]H[›܈YYX][ۈ\X[H\Y\ˈY[HXH[Bو\H^H܈[H\ L[۝H Y\\ۜH[Hو]Y\[ۜ M[[[\B[[\H۝\][ۋ][HH[K