Aged people are the most neglected lot not just in India but whole of the world. Nobody seems to want them around themselves. Their plight is worst in India. India has no social security for them and most of the older population lives with their sons & daughter-in-laws who treat them like unwanted elements without realising that some day they too would be like their parents.
A report [Integrated Programme for Older People] by the Ministry of Social Justice & Empowerment shows that "There has been a steady rise in the population of older persons in India. The number of elder persons has increased from 19.8m in 1951 to 76m in 2001 and the projections indicate that the number of 60+ in India will increase to 100m in 2013 and to 198m in 2030. The life expectancy, which was around 29y in 1947, has increased manifold and now stands close to 63y." In this context the aged population is at an increasing risk of neglect and abuse.
Elder abuse is important social problem. It raises many complex ethical, legal, and clinical questions. It has challenged our understanding of such fundamental concepts as personal freedom, the role of culture in defining family responsibility, and society’s obligations to it members.
Elder abuse is any form of mistreatment that results in harm or loss to an older person. Elder abuse can be defined as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person”.
Elder abuse can be of various forms such as physical, psychological/ emotional, sexual and financial abuse. It can also simply reflect intentional or unintentional neglect. Several types of mistreatment may occur simultaneously. The personal losses associated with abuse can be devastating and include the loss of independence, homes, life savings, health, dignity, and security. Victims of abuse have been shown to have shorter expectancies than non-abused older people.
Though elder abuse occurs across all socioeconomic, racial, and religious lines, yet it is
typically under-reported in most cultures. Although estimates vary, it is generally believed that about 10% of the elderly are abused. More than 70% of victims of elder abuse are women.
Health and Medical Professional play a key role in the identification and treatment of abuse The trust and respect that patients often have for their health care providers places these professionals in a key position to help. Addressing elder abuse is a challenging task. There has to be a high index of suspicion. Abuse is frequently denied. The assessment must be as holistic as possible.
Risk factors for abuse include a history of mental illness or alcohol/drug abuse, poor health, functional impairment, family history of violence, isolation of the victim, and recent stressful events in the life of the victim or abuser. Physician has to develop a rapport with the patient and the caregiver and take an initiative in finding the problem. The clinician must always speak to the patient and the caregiver separately. Patient’s behavior and available social support has to be observed. Help of Medical Social Worker can be utilised and is very benificial.
Physical examination findings suggesting abuse would be fractures, dislocations, lacerations, abrasions, burns, injuries to scalp / head / face, bruises, genital area pain / itching / bleeding or sexually transmitted diseases. Signs of neglect are poor personal hygiene, over or under medication, malnutrition, dehydration, urine burns, fecal impaction, decubitus ulcers and contractures. Physician should provide education and proactive interventions to prevent and manage this significant crisis. Physician should also discuss the problems, stresses, and strains of caregivers of the elderly.
Non-Governmental Organizations (NGOs) can play a vital role in bringing down the incidence of elder abuse. They can provide support services to the aged victim and the family caregivers of the victim.
Physician will have to coordinate with other professionals, social workers, N.G.O.s, law enforcement personnel and the media to deal with elder abuse. There is an urgent need to increase the awareness of elder abuse, neglect, and exploitation and to guide programs that protect older people. The ability of all professionals especially health and medical professionals should be increased to handle elder abuse.
In order to prevent and decrease the incidence of elder abuse, neglect, and exploitation, dissemination of information on best practices should be encouraged along with development of special programs.
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