Elder Mistreatment

Ardy Wildan
Narasumber: dr. Edy Rizal Wahyudi, SpPD, K-Ger
Elder Mistreatment
• Around 1 in 6 people 60 years and older experienced some form of
abuse in community during the past year
• Rate of elder abuse are high in institutions such as nursing homes and
long-term care facilities with 2 in 3 staff reporting that they have
committed abuse in the past year
• Elder abuse can lead to serious physical injuries and long term
psychological consequences
• Elder abuse in predicted to increase as many countries are
experiencing rapidly ageing popilations

WHO. Elder abuse. 2018

WHO. Elder abuse. 2018
Lachs MS, Rosen T. Elder mistreatment. In :Hazzard Geriatric Medicine and Gerontology. 2017
Lachs MS, Rosen T. Elder mistreatment. In :Hazzard Geriatric Medicine and Gerontology. 2017
Copyrights apply
Screening and Assessment
• The aim of screening and assessment for mistreatment and self-
neglect is to determine the following:
• Is someone who is expected to help and protect the person abusing,
neglecting, or exploiting them?
• Does the person have an impaired capacity for self-care and protection,
rendering them vulnerable and in need of supplemental support?
• If an individual is identified as a vulnerable person, is there a condition or
behavior that causes or may cause harm to them?

Lachs MS, Rosen T. Elder mistreatment. In :Hazzard Geriatric Medicine and Gerontology. 2017
 American Medical Association

Lachs MS, Rosen T. Elder mistreatment. In :Hazzard Geriatric Medicine and Gerontology. 2017
Abbreviated Screening
• Do you feel safe where you live?
• Who prepares your meals
• Who handles your checkbook?

Lachs MS, Rosen T. Elder mistreatment. In :Hazzard Geriatric Medicine and Gerontology. 2017
Screening Instruments
• The Brief Abuse Screen for the Elderly (BASE)
• Elder Assessment Instrument (EAI)
• Conflict Tactics Scale (CTS)
• Caregiver Abuse Screen (CASE)
• Hwalek-Sengstock Elder Abuse Screening Test (H-S/EAST)
• Elder Abuse Suspicion Index (EASI)

Lachs MS, Rosen T. Elder mistreatment. In :Hazzard Geriatric Medicine and Gerontology. 2017
Management
• There are no RCT of reasonable quality addressing interventions for
elder mistreatment
• Clinician confronted with a confirmed case of elder abuse is best
served by resourceful approach that combine experience, clinical
judgment, and local resources
• A more sensible approach may be the multipronged strategy
increasingly used to treat other geriatric syndromes that have
multifactorial etiologies
• There may be multiple host and environmental contributors
Management
• The first step in confronting any confirmed case of family violence is
ensuring the safety of the victim
• A safety plan is critical in the management of family violence
• One of the most frustrating situations for professionals working with
the victims of family violence is the individual who retains decision-
making capacity and insist on remaining in abusive environment 
clinician role to educate the patient
Special Situations
• Elder mistreatment may also occur in the institutional settings
• The physician and nurse have roles in detecting these cases as well
Prevention
• 2011 WHO report notes that there is lack of high-quality studies of
interventions designed to reduce or prevent elder mistreatment
• Prevention of abuse may be promoted by programs that provide
respite for caregivers, support for informal caregiver, and encourage
positive attitudes towards older people within a culture
Prevention
• Some approach:
• Recognition that clinicians from any discipline who have contact with older
adults, not just geriatricians or those working in elder care institutions, are in
a position to make an important impact
• Education to address and overcome the barriers to reporting suspected elder
mistreatment
• Education targeting clinicians as well as non-clinical personnel who have elder
contact, including individuals in the banking industry, mail carriers,
salespersons, emergency medical services workers, police officers, and long-
term care facility employees
• Awareness that most long-term care facility abuse occurs from resident to
resident
• Education and administrative interventions to address conditions in
institutions that may promote resident elder mistreatment by staff members
Thank you for your attention