Dialogue Volume 14 Issue 1 2018 - Page 39

PRACTICE PARTNER Elder abuse happens more often than many people imagine. The victims come from all backgrounds and socio-economic status. Most are mentally competent and don’t need constant care. cate task. The question “Are you being abused?” may be too blunt to pose. And the victim may not use that language to describe the situation. Instead, try ques- tions like “How are you being treated?” “Do you feel safe?” “Do you trust the people around you?” “Have any incidents made you concerned or afraid?” Still, patients may not always be forthcoming. Many seniors are dependent on the people abusing them. Some might worry about losing their place of liv- ing, or retaliation from the abuser. Others might be ashamed. Or wonder if they’ll be believed or blamed. All that can shape a conversation too. A discussion about elder abuse, and how the patient can get help, might have to occur over several appoint- ments. That’s one reason to schedule more frequent follow-ups and use the EASI tool again. Reporting obligations for Ontario doctors aren’t the same as those required for suspected child abuse. The duty to report applies only when “they have reasonable grounds to suspect that a resident of a nursing home or retirement home has suffered harm or is at risk of harm due to improper or incompetent treatment or care, unlawful conduct, abuse or neglect.” In those cases, physicians must immediately report their suspicion, and the information upon which it is based, to the Registrar of the Retirement Homes Regula- tory Authority, or to the long-term care home director. Additionally, physicians have a duty to report sus- picions of misuse or misappropriation of a resident’s money or of funding provided to a licensee. Even without a formal reporting obligation, Ms. Etkin says doctors need to understand their broader role in the chain of accountability. Do they know enough about elder abuse? How to explore it? Have they trained staff to be aware of signs? Do they have policies to support possible abuse victims? To fully understand the issue and advise patients, there are important resources to consult and pass along: • Elder Abuse Ontario: elderabuseontario.com • Government of Ontario: ontario.ca/page/informa- tion-about-elder-abuse • National Initiative for the Care of the Elderly: nicenet.ca • Canadian Network for Prevention of Elder Abuse: cnpea.ca • Seniors Safety Line (24/7 information, referrals and support): 1-866-299-1011 Watch for biases When seeing older patients, Ms. Etkin cautions against being swayed by biases around the issue, vic- tims or abusers. Elder abuse happens more often than many people imagine. The victims come from all backgrounds and socio-economic status. Most are mentally competent and don’t need constant care. The abuser may be someone the doctor knows too. A study in 2012 in the Journal of Elder Abuse & Ne- glect looked at perceptions of elder abuse on the part of three professions: physician, nurse and social worker. Physicians thought that other health-care profes- sionals (and other doctors too) were more likely to see abused and neglected patients. If they saw such patients, they wanted to let social workers address it. But they worried about bringing an outside expert into the relationship, upsetting the patient or labeling suspicion as abuse. Talking to patients about possible abuse can be diffi- cult. The subject is sensitive. Patients might take offence at the line of enquiry. But this demands attention too. “Are you going to sit on your hands and say ‘Am I go- ing to insult the patient?’ In my mind, that’s irrespon- sible,” says Dr. Yaffe. “You have to look deeper.” MD ISSUE 1, 2018 DIALOGUE 39