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
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