On the basis of beneficence and non-malfeasance, I believe it is important to educate future healthcare professionals how to recognize and intervene to help and elder who has been abused or neglected. A study showed more than 60% of physicians had not even asked their elderly patients if they ever experienced abuse (Schmeidel et al., 2012).
It can be difficult to report a suspected case of elderly abuse because there is the risk of damaging the doctor patient confidentiality relationship. Dementing illness is not uncommon in the elderly population, so this poses another barrier to evaluating if a suspected injury actually occurred how an elderly person explains it, or if is a result of abuse. However uncomfortable it might be, I think physicians should question the relationship between an elder and their caregiver(s) because victims of elder abuse have higher mortality rates (Rosen et al., 2018). The baby boomer population is reaching retirement age, so the cases of potential neglect or abuse are expected to increase (Rosen et al., 2012).
As a healthcare professional, I encourage you to check in with your elderly patients, because 5 to 10 percent of them are silently suffering (Wang et al., 2015).
References:
Don X. Medical implications of elder abuse and neglect. Clin Geriatr Med. 2005
May;21 (2):293-313. doi: 10.1016/j.cger.2004.10.006. PMID: 15804552.
Rosen, T., Stern, M. E., Elman, A., & Mulcare, M.R. (2018). Identifying and Initiating Intervention for Elder Abuse and Neglect in the Emergency Department. Clinics in geriatric medicine, 34(3), 435-451. https://doi.org/10.1016/j.cger.2018.04.007.
Schmeidel, A. N., Daly, J. M., Rosenbaum, M. E., Schmuch, G. A., & Jogerst, G. T. (2012). Health care professionals' perspectives on barriers to elder abuse detection and reportin in primary care settings. Journal of elder abuse & neglect, 24(1), 17-36.
Wang, X. M., Brisbin, S., Loo, T., & Straus, S. (2015). Elder abuse: an approach to identification, assessment and intervention. CMAJ: Canadian Medical Association journal = journal de l'Association medicale canadienne, 187(8), 575-581.
https://doi.org/10.1503/cmaj.141329
ReplyDeleteIt very unfortunate that this occurs. I would hope humans would treat other humans with respect and non-maleficence. This hits close to home for me because recently my grandma who suffers from Alzheimer’s and Diabetes was placed in a nursing home. It's even more upsetting as due to COVID-19 we are not allowed to visit and we can only set up one video chat a week. In her situation, a personal cell phone is out of the picture as with her increasing memory loss the nursing home cannot tend to it. While she has a phone in her room, it’s the video that she responds to with her memory being triggered by seeing our faces. Lately, she is just very sad and we (my family) try to tell her if we could be there every day we would.
I know COVID-19 is stressful for everyone including the nursing home employees. Hopefully, this does not lead to increased rates of negligence as you tend to see when people get exhausted and corners are cut. Choosing a nursing home for your loved one is another issue, typically the ones with the best reviews are also the most expensive. While we all want what is best for our loved ones sometimes (most of the time) families are unable to afford them. This is why retirement and savings are important.
One research found that it is extremely important for health care workers to maintain a residents autonomy and focus on using a person-centered approach in their care. With this type of care, the resident can feel seen and recognized by the staff. (Kitwood, 1997)
Nursing homes might just need to add Cura Personalis to their trainings!
Kitwood, T. (1997). On being a person In Kitwood T. (ed.), Dementia reconsidered: The person comes first. Milton Keynes: Open University Press, pp. 7–19.