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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