Taking action toward prevention of elder mistreatment

A report presented at the AMA Annual Meeting has increased focus on this public health problem that older, vulnerable patients sometimes face.

Editorial. July 28, 2008.

The disturbing stories surface in the news with too much frequency. The victims are elderly, and the abuse they face takes various forms. The insidious offenses, collectively known as elder mistreatment, are a pervasive, though still often overlooked, public health problem.

At its June Annual Meeting, the American Medical Association adopted policies to address this serious state of affairs. But before getting into these recommendations, it's useful to examine the complexity of the situation.

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The term elder mistreatment covers physical and sexual abuse, emotional abuse and financial exploitation. The unifying feature across this spectrum is that its victims are unable to protect themselves. It occurs in both community and institutional settings and cuts across geographic, class, gender and racial lines. And often, the abuse gains public attention only after it is too late.

Neglect, which also falls under this umbrella, can be perpetrated by a caregiver or by the vulnerable individual on himself or herself. When the latter situation arises, illnesses that affect cognition and function usually are in play.

The American Geriatrics Society notes that, although systematic studies of elder mistreatment in long-term care have not been conducted, community incidence rates range from 1.3% to 5.4%. Other estimates put the figure as high as 5 million cases a year. Because of demographic and disease trends, these numbers are expected to increase.

It's a dire picture. The report issued in June by the AMA Council on Science and Public Health noted that almost every physician has encountered older patients who they suspect may be mistreated. But little guidance exists to help them intervene.

Last month the AMA House of Delegates endorsed policies encouraging physicians and other medical professionals to become more proactive in recognizing and treating seniors who may be victims.

Although many state laws require physicians to report suspected cases, major barriers interfere. Two examples the report listed were that physicians face time pressures, and they also may lack awareness of the problem's extent. In addition, no biopsy or imaging test can detect or prove the mistreatment. Many physicians fear that by raising the issue, they will endanger the patient-physician relationship, lose control of case outcomes, be drawn into court or decrease the patient's quality of life.

To overcome all this, the AMA urges states to create interdisciplinary teams with representatives from medicine, nursing, adult protective services, criminal and civil law, and law enforcement to develop interventions and evaluate their effectiveness.

What's clear is that doctors cannot tackle this alone. Stepped-up education will make their involvement more effective. The AMA also will promote efforts across medical accreditation and education organizations to establish training for medical students and to encourage curricula development at the residency level and in continuing medical education.

Other challenges will have to be overcome. A major one is the lack of uniform definitions regarding elder mistreatment and related jurisdictional variations. Both make it very difficult to gain a true grasp of the problem. Thus, the AMA is encouraging a national effort to reach consensus on these terms.

The Association also urges more research into elder mistreatment and encourages the adoption of legislation that will further support such efforts.

No senior citizen should live in fear of abuse, mistreatment, exploitation or neglect. Looking out for the well-being of those in the path of such harm should be on the radar of physicians and other health professionals in the trenches.