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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 overmedicating 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 , humiliation , 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 , clothing , shelter , medicine or health care , either intentionally ( active neglect ) or because of lack of experience , information or ability ( passive neglect ).
These aren ’ t mutually exclusive . Seniors might experience 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 , unkempt appearance or poor hygiene .
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 appointment 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 of a screening index . “ The purpose is to raise suspicion to the point where you talk to the patient and agree for them to see someone to be assessed at a more comprehensive level ,” says Dr . Yaffe . EASI includes six questions . The first is a primer , to get people thinking about their living conditions . The last is for the doctor to answer .
1 Have you relied on people for any of the following : bathing , dressing , shopping , banking or meals ?
2 Has anyone prevented you from getting food , clothes , medication , glasses , hearing aids or medical care , or from being with people you wanted to be with ?
3 Have you been upset because someone talked to you in a way that made you feel shamed or threatened ?
4 Has anyone tried to force you to sign papers or to use your money against your will ?
5 Has anyone made you afraid , touched you in ways that you did not want , or hurt you physically ?
6 Elder abuse may be associated with findings such as poor eye contact , withdrawn nature , malnourishment , hygiene issues , cuts , bruises , inappropriate clothing or medication compliance issues . Did you notice any of these today or in the last 12 months ?
A ' yes ' response to any of questions 2-6 can ring alarm bells and prompt a conversation . That can be a deli-
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DIALOGUE ISSUE 1 , 2018