Elder abuse: do general practitioners know or care?

Family physicians' knowledge levels about elder abuse and neglect in a province of Türkiye and hesitations in reporting

BACKGROUND

This study aimed to investigate the knowledge, attitudes and reservations of family physicians (FPs) in reporting elderly abuse and neglect (EAN).

METHODS

Our cross-sectional study was conducted with 161 FPs in Kütahya, a city in Türkiye. A questionnaire including demographic characteristics, the frequency with which Elder Abuse Suspicion Index (EASI) questions were asked and knowledge level of EAN was applied to the FPs.

RESULTS

Only about a quarter (24.2%) of the FPs felt competent regarding EAN. The rate of participants who had encountered EAN victims before was 46%. Of these, 40% reported psychological violence, 24.3% reported physical and psychological violence and 21.6% reported only physical violence. FPs also reported that inconsistency in anamnesis (87.0%), inconsistency between anamnesis and physical examination findings (85.1%) and frequent visits to the emergency department (59.6%) raised suspicion about EAN. It was also observed that 68.9% of the FPs knew that healthcare professionals had a legal obligation to report elder abuse. Only 23.0% of the FPs who encountered cases of violence and abuse stated that they had made a legal report. Among the FPs who did not report, 40.4% stated that they did not report because they had some reservations or did not know how to do so (35.1%).

CONCLUSION

Due to a lack of knowledge and some concerns, the rate of reporting EAN to judicial authorities was also low. FPs were not aware of the importance of EAN in terms of elderly health.

Accidental Injury or "Shaken Elderly Syndrome"? Insights from a Case Report

Subdural haemorrhage (SDH) as result of a traumatic brain injury (TBI) is a common cause of death in cases of fatal physical abuse. Since intracranial bleeding is a common finding in elderly due to age-related intracranial changes or increasing prevalence of anticoagulant medication, differential diagnosis between inflicted and non-inflicted head injury is challenging. A case of an elderly woman's death caused by TBI is reported. Autopsy showed multiple polychromatic bruises and a frontoparietal hematoma with bilateral subacute SDH. History excluded paraphysiological or pathological non-traumatic conditions that could justify SDH, while iatrogenic factors only played a contributory role. Since polychromatic bruises distributed on the face, the upper extremities and the chest were consistent with forceful grasping/gripping or repeated blows and SDH can form in absence of impact or by mild/minor blows, SDH was considered the result of repeated physical abuses. Differential diagnosis between traumatic and non-traumatic SDH is still challenging for forensic pathologists. As largely accepted in the pediatric population and occasionally described also in adults, however, violent shaking should be also considered as a possible mechanism of SDH-especially in elderly who do not have any sign of impact to the head.

Factors associated with health care providers speaking with older patients about being subjected to abuse

Health care providers have difficulties responding to elder abuse. This study aimed to investigate factors associated with health care providers speaking with older patients about being subjected to abuse, and what facilitating measures staff preferred to help them achieve this. A cross-sectional questionnaire survey was conducted among hospital health care providers (n = 154) in Sweden. Half of the respondents had experience of speaking about elder abuse. A high sense of professional responsibility (OR 3.23) and being less concerned about inflicting damage to the therapeutic relationship (OR 3.97) were associated with having spoken with older patients about being subjected to abuse. Written guidelines about elder abuse and a patient information sheet were the most preferred facilitating measures. Our findings indicate that increasing care providers' sense of responsibility and addressing concerns about damaging the therapeutic relationship might be important factors to target in future interventions to improve health care response to elder abuse.

[Sexual abuse of care-dependent patients : Results of a nationwide cross-sectional study among general practitioners on responsibility and subjective confidence in dealing with suspected abuse]

Hintergrund

Gewalt gegen pflegebedürftige ältere Menschen ist häufig. Hausärzte/-ärztinnen können bei der Prävention von Gewalt eine Rolle spielen. Insbesondere sexualisierte Gewalt ist stark tabuisiert und wenig untersucht.

Ziel der Arbeit

Ziel dieser Arbeit ist es, die Einstellung von Hausärzten/-ärztinnen zu ihrer Verantwortung bei sexuellem Missbrauch pflegebedürftiger Patienten/Patientinnen zu untersuchen. Zugleich sollen die subjektive Sicherheit hinsichtlich des Vorgehens bei einem Missbrauchsverdacht sowie die Fortbildungsinteressen von Hausärzten/-ärztinnen zum Thema erhoben werden.

Material und Methoden

In einer Querschnittsstudie wurden 1700 Hausärzte/-ärztinnen in Deutschland zwischen September und November 2016 schriftlich befragt. Fragebogen von 302 Ärzten/Ärztinnen konnten ausgewertet werden.

Ergebnisse

Die Unsicherheit hinsichtlich des weiteren Vorgehens bei Verdacht auf sexuellen Missbrauch von pflegebedürftigen Patienten/Patientinnen ist groß. Nahezu alle Befragten sehen es als Teil der ärztlichen Verantwortung, bei sexuellem Missbrauch pflegebedürftiger Patienten/Patientinnen zu intervenieren. Hauptsächliches Fortbildungsinteresse besteht zur Differenzialdiagnose des sexuellen Missbrauchs sowie zum richtigen Vorgehen im Verdachtsfall.

Schlussfolgerung

Fortbildungen, insbesondere zu den Anzeichen sexueller Gewalt gegen Pflegebedürftige, können einen Beitrag leisten, die Handlungssicherheit von Hausärzten/-ärztinnen zu stärken und ihre Bereitschaft zur Prävention zu erhöhen.

Elder abuse: perception and knowledge of the phenomenon by healthcare workers from two Italian hospitals

With ageing population the number of elderly vulnerable to abuse is expected to grow. Hospital personnel play a crucial role in identifying mistreatment. The aim of this study was to establish the level of awareness and perception of elder abuse by healthcare workers, and to understand if they are able to recognize and properly report elder abuse, as well as to identify the physical signs of abuse and neglect. A 41-question survey was administered to healthcare professionals, working in the Internal Medicine and Geriatric Wards of two different University Hospitals of Southern Italy, representative of the Italian health public system. The data collection resulted in 98 questionnaires. For the majority, neglect represents a type of abuse, whereas 40% of physicians and 37% of nurses considered this concept false. All the professionals recognized the elder abuse as a violation of the human rights, but 46.94% were not sure about the existence of standard procedures for abuse reporting/treatment. The most of the nurses and the care assistants declared they never had suspected or witnessed abuse, while few physicians stated to have suspected/witnessed abuse 1-3 times in their career. In both the suspected and witnessed cases, the healthcare personnel did not made any action, neither reported them to public authorities nor adult protective service agencies. The level of awareness and perception of elder abuse by healthcare professionals are still poor especially regarding the reporting procedures. There is still strong need for education and specific training programs on elder abuse.

The Relationship between Nurses’ Recognition Regarding Elder Abuse and their Attitudes and Performance in Dealing with Elder Abuse Induced by Iranian Family Caregivers

Introduction:

Knowledge of nurses regarding elder abuse can be helpful in decisions about on-time and appropriate interventions. Our aim was to assess the relationship between recognition of nursing staff toward elder abuse and their attitudes, and performance in dealing with elder abuse induced by Iranian family caregivers.

Methods:

In this descriptive study, 400 nurses were selected, using cluster sampling, from nurses working in public or private hospitals in Iran. Data collection was performed using questionnaires measuring elder abuse symptom recognition, attitudes, and performance.

Results:

There is a significant relationship between the total scores for recognition of symptoms and elder abuse potential risk factors (p=0.05) and the nurses’ attitudes and performance scores (p = 0.001). There was no significant difference between the nurses’ performance and recognition scores (p = 0.14).

Conclusion:

Interventions to promote nurses’ recognition via in-service educational programs can improve nurses’ performance in different levels of abuse prevention and the quality of nursing care for the elderly.

Comparison of perceptions of domestic elder abuse among healthcare workers based on the Knowledge-Attitude-Behavior (KAB) model

It is generally agreed that healthcare workers are ideally positioned to recognize and diagnose cases of elder abuse. However, little is known about their knowledge and understanding of this issue. The objective of this study was to assess and compare the perceptions of different groups of healthcare workers toward elder abuse in Japan, using the Knowledge-Attitude-Behavior (KAB) model. Home-visit nurses, medical doctors, care managers, care workers, public health nurses, and social workers, with experience of dealing with elder abuse received self-administered questionnaire surveys that inquired regarding demographics, knowledge, attitudes, and behaviors regarding elder abuse. A total of 311 healthcare workers participated in this survey. To compare the differences among the groups, a one-way analysis of variance with a post-hoc Tukey’s test, and a Kruskal-Wallis with post-hoc Steel-Dwass tests were used in accordance with data normality. Multiple linear regression analysis was conducted to explore variables that predicted the healthcare workers’ perceptions, and covariance structure analysis was used to examine whether the KAB model can accurately predict healthcare workers’ perceptions. Multiple comparisons showed significant differences in knowledge, attitudes, and behaviors regarding elder abuse among the abovementioned six groups. Age, sex, and years of work related to the care of elderly were extracted as significant determinants of healthcare workers’ perceptions of elder abuse. The examination of the KAB model with covariance structure analysis yielded a model with strong goodness-of-fit. These findings emphasize the need to take effective measures to improve their perceptions as well as review the role of each healthcare worker so that they can be more concerned with and involved in the safeguarding of the elderly. Given the strong goodness-of-fit demonstrated by the KAB model, education of healthcare workers on both the knowledge of, and attitudes toward, elder abuse may help in improving healthcare workers’ behavior in dealing with elder abuse.

Seniors' self-administration of the Elder Abuse Suspicion Index (EASI): a feasibility study

This study explored the feasibility of seniors aged 65 and over with MMSE ≥24 completing the EASI-sa, a self-administrable version of the Elder Abuse Suspicion Index (EASI). A convenience sample of 210 was stratified by age, sex, and language (English and French). All completed the EASI-sa within an estimated 5 minutes, 82.9% within 2 minutes. Completion time decreased with higher education, but was not affected by age, sex, language, or measured physical or mental health. No questions went unanswered; no words were poorly understood or discomforting. The EASI-sa completion was associated with a significantly increased understanding about elder abuse (p < 0.0001).

Health care professionals' perspectives on barriers to elder abuse detection and reporting in primary care settings

The purpose of this study was to explore health care professionals' perspectives on elder abuse to achieve a better understanding of the problems of reporting and to generate ideas for improving the detection and reporting process. Through a mailed survey, nurses, physicians, and social workers were invited to participate in an interview. Nine nurses, 8 physicians, and 6 social workers were interviewed, and thematic analysis was used to identify the following core themes: preconceptions, assessment, interpretation, systems, and knowledge and education. Participants suggested a reorganization of the external reporting system. More frequent and pragmatic education is necessary to strengthen practical knowledge about elder abuse.

Identifying and handling abused older clients in community care: the perspectives of nurse managers

BACKGROUND

Abuse of older people can lead to an increased need for health care services, and early identification of and intervention with abused, older clients should be a priority.

OBJECTIVES

To gain knowledge about how nurse managers and their staff identify and handle abused older clients.

DESIGN

Qualitative study.

METHODS

Fifty-two participants were interviewed, the text transcribed and analysed using manifest qualitative content analysis.

FINDINGS AND DISCUSSION

The identification and handling of older victims depended on individual nurses and the involvement of the participants and are based on clinical experience and less on knowledge through professional training and education. The participants emphasised the need for an individualised approach to older victims suspected of abuse. The important role of the nurse managers in the handling of abuse is discussed as well as the need for support of the nurse managers and the staff in community care by increased interdisciplinary collaboration to handle complex cases.

CONCLUSION

The identification and handling of abused older clients are a challenging issue for community care, and more knowledge and support are needed.

IMPLICATIONS FOR PRACTICE

The concept of elder abuse must be clarified, and strategies for its identification and intervention must be developed.

Attitudes and knowledge of medical and nursing staff toward elder abuse

Although physicians and nurses are best positioned to recognize and diagnose cases of elder abuse, the level of reporting these cases is much lower than its true incidence. Our aim was to assess and compare knowledge and attitudes of physicians and nurses toward this phenomenon. Two hundred and thirty-five nurses and physicians were asked to participate in the study. One hundred nurses and 57 physicians ultimately completed the questionnaires. The main finding was that participants had a low level of knowledge of elder abuse issues and the relevant laws and regulations (mean correct answers 5.36+/-1.45 of 10 and 4.67+/-1.34 of 8, respectively). No significant differences were found in the physicians' knowledge according to medical specialty, hospital type, years in the profession and geriatric experience. Licensed practical nurses knew less than registered and academic nurses relating to the abuse issue and state reporting laws (p=0.003 and 0.02, respectively). No significant differences relating to the knowledge of elder abuse were found between nurses and physicians nor between general and geriatric hospital employees. Both physicians and nurses tended to have neutral attitudes regarding this issue. However, employees of geriatric hospitals had better attitudes than general hospital workers (p=0.008). Most responders believed that the unwillingness to get legally involved had been the main reason of not reporting suspected cases. This study emphasizes the need to take more efficient measures to improve the knowledge of the medical and nursing staff concerning elder abuse and to encourage medical personnel to be more concerned and involved in the safeguarding of the elderly.

Professions show different enquiry strategies for elder abuse detection: implications for training and interprofessional care

In a project to develop and validate a tool to assist family physicians' identification of elder abuse, nine prospective questions underwent critique and ranking in focus groups comprised of 31 social workers, doctors, and nurses working with elder abuse. Differing attitudes to the questions were discernible amongst the three professions. The social workers' approach appeared based on need to advocate for clients. Nurses' viewpoints seemed influenced by utilitarian concerns for practicality and directness, desire to respect doctors' time constraints, and discomfort that some physicians' questioning might impose on nursing fields of interest. Physicians' concerns tended to be holistic, tempered by practicality and time management issues. However despite such differences expressed during lengthy group discussions, members of all three professions, when asked to independently rank the top five questions, favorably ranked the same five (though not necessarily in the same order). Since there are known barriers to successful elder abuse enquiry the differences and concerns seen in this study may represent another potential obstacle. Programs that address elder abuse might therefore consider sensitizing trainees to the potential predispositions within their own and their colleagues' professions. This proactive strategy might facilitate interprofessional approaches to elder abuse detection.

Training in elder abuse: the experience of higher specialist trainees in Geriatric Medicine in the UK

Little is known about elder abuse training in post-graduate medical education in the United Kingdom. A questionnaire survey was conducted among Specialist Registrars (SpRs) in Geriatric Medicine attending a single training day within five UK Post-graduate Deaneries to assess self-report experience of elder abuse training during their post-graduate medical education. The questionnaire included quantity, quality and self-report confidence in dealing with elder abuse issues. A total of 112 questionnaires were returned (response rate 100%, representing 78.9% of eligible trainees within these five deaneries). The majority of the participants rated low scores for both quantity and quality of training they received. This finding was consistent across all 5 years of training with no significant difference in rating scores in more experienced (years 3-5) SpRs. The majority (62.5%) of final year SpRs reported feeling inadequately prepared to deal with cases of elder abuse. The results of our survey suggest that the provision and quality of training regarding elder abuse is poor for trainees in Geriatric Medicine. The majority of SpRs approaching the completion of their training felt ill-prepared in managing such cases. Our study highlights the requirement of structured approach in elder abuse training for trainees in Geriatric Medicine.

Knowledge, detection, and reporting of abuse by health and social care professionals: a systematic review

The authors systematically reviewed the 32 articles fitting predetermined criteria that investigated health and social care professionals' knowledge, detection, and reporting of elder abuse. These included 21 surveys (of 5,325 professionals), nine analyses of elder abuse reports to statutory bodies, and two intervention studies. Compatible results were pooled in a meta-analysis. Professionals consistently underestimated the prevalence of elder abuse. Only a quarter of U.S. physicians were aware of American Medical Association elder abuse guidelines. The authors found that 33.7% (95% confidence interval: 27.5-40.1) of health care professionals had detected a case of older adult abuse in the last year. This was slightly higher when only studies judged to be most representative, which all surveyed physicians, were included (39.9% [23.4-57.7]). About half of the detected abuse cases were reported. Professionals who recalled receiving any training on abuse were no more likely to detect abuse than those who stated they had not had training, although they were more likely to report the abuse if they detected it. Interventions that taught professionals about the management of abuse by face-to-face training were effective in increasing knowledge, whereas giving written information was not. No intervention studies have investigated whether detection and reporting of abuse can also be increased through education. Current evidence would support the development and testing of interventions to increase professionals' detection and reporting of abuse. These would encourage them to ask older people about abuse, and address professionals' concerns about the impact of reporting on therapeutic relationships, victims; and legal consequences for the reporter.

"No secrets" and beyond: recent elder abuse policy in England

This paper provides an overview of English elder abuse policy including guidelines developed for adult protection by their Department of Health in 2000, a report released from the House of Commons Health Committee in 2004 on elder abuse, related policy changes affecting older adults, the mentally incapacitated, and social care regulations, and the launching of public awareness campaigns. In contrast to the U.S., English policy subsumes elder abuse within the larger category of vulnerable adult protection, steers clear of mandatory reporting, emphasizes abuse by formal caregivers rather than domestic violence, relies on a multi-agency approach to investigation and intervention, and supports more remedial, less punitive regulatory oversight.

Abuse of vulnerable people with dementia by their carers: can we identify those most at risk?

OBJECTIVE

We wanted to explore possible associations between characteristics of carers, dementia sufferers and the caring situation and the presence of abuse that was acknowledged by carers.

METHODS

Eighty-two carers of dementia sufferers were interviewed in their homes about three types of abuse (verbal abuse, physical abuse and neglect) using a structured questionnaire.

RESULTS

Fifty-two percent (n = 43) carers admitted to having carried out some form of abuse. Verbal abuse was the most common form (n = 42, 51%), while 20% (n = 16) of carers admitted to physical abuse and 4% (n = 3) to neglect abuse. Significant associations were found between verbal abuse and psychological ill health in the carer and behavioural problems in the dementia sufferer. Physical abuse was significantly associated with higher levels of self-reported good health by the carer. High expressed emotion measured in carers was highly correlated with all types of abuse.

CONCLUSION

It is possible to identify situations where people with dementia may be at high risk of abuse from their carers. Any effective intervention strategy should address psychological health problems in the carer, behavioural problems in the dementia sufferer and a strategy to manage high levels of expressed emotion in these situations.

Prevalencia y factores de riesgo de sospecha de maltrato en población anciana

BACKGROUND AND OBJECTIVE

We determined the prevalence and associated risk factors in the suspicion of elder abuse in the old population.

PATIENTS AND METHOD

We included a total of 209 patients > or = 72 years of age without cognitive deterioration (score in test of Pfeiffer (3/4) 4 points). The questionnaire of suspicion of elder abuse used was one recommended by the Canadian Task Force and the American Medical Association; it consists of 9 questions and the presence of a positive answer is considered as indicative of suspicion of abuse.

RESULTS

The prevalence of suspicion of elder abuse was 52.6% (at least one positive answer to the questionnaire). 8.6% affirmatively responded to 2 questions and 2% to 3. Female gender, widowhood, deficiency of studies, living alone or in institutions and having exerted a remunerated work were the associated variables in the bivariant analysis with regard to the suspicion of abuse. In the model of logistic regression, there was a significant association with the civil status and the coexistence of the familiar nucleus, with a greater risk of elder abuse in unmarried and/or widowers (p < 0.001) and in those living alone (p < 0.0001).

CONCLUSIONS

There is a high prevalence of suspicion of elder abuse in the old population.

Medical Implications of Elder Abuse and Neglect

Recognition of elder abuse and neglect among health care professionals has been a relatively recent phenomenon. Each year, millions of elderly persons suffer as the result of abuse and neglect. Their quality of life is severely jeopardized in the form of worsened functional status and progressive dependency, poorly rated self-health, feelings of helplessness, and from the vicious cycle of social isolation, stress and further psychologic decline. Other medical implications of abuse and neglect include higher health systems use in the form of frequent ER visits, higher hospitalization, and higher nursing home placement; most importantly, it is an independent predictor for higher mortality. Physicians are well situated in detecting and reporting suspected cases and taking care of the frail elders who are victims of abuse and neglect, but there are barriers on the individual level, and there is a broader need for system change. Through education, training, and reinforcement, there are strategies to get health care professionals more involved and provide effective management protocols and guidelines for us to advocate for our patients in the current epidemic of elder abuse and neglect.

Elder abuse

Elder abuse has received increasing attention over the past decade as a common problem with serious consequences for the health and wellbeing of old people. Our aim is to assist clinicians by summarising recent international research and clinical findings about elder abuse, and to assess their quality, relevance, and feasibility for health-care providers in clinical practice. This seminar includes issues of definition and frequency of elder abuse and a summary of major known risk factors. The advantages and disadvantages of screening for elder abuse are discussed. We review clinical manifestations and diagnosis of elder abuse, and propose a protocol for medical assessment of a patient with confirmed or suspected abuse. Suggestions for treatment are offered on the basis that elder abuse is multifactorial and needs individual medical and social intervention strategies, preferably in the context of a multidisciplinary team.

Advancing the Field of Elder Mistreatment: A New Model for Integration of Social and Medical Services

PURPOSE

The purpose of this work is to describe the development and operation of a new model for integration of medical and social services. The Vulnerable Adult Specialist Team (VAST) provides Adult Protective Services (APS) and criminal justice agencies with access to medical experts who examine medical and psychological injuries of victims of elder abuse.

DESIGN AND METHODS

This retrospective, descriptive analysis included community-dwelling elders and adults with disabilities who were reported for mistreatment and referred to VAST (n = 269).

RESULTS

Most cases came from APS for mental status and physical examination for evidence of abuse. Cases referred to a medical response team (n = 269) were significantly different from cases that were not referred (n = 9,505).

IMPLICATIONS

Ninety-seven percent of those who referred cases to VAST indicated that the team was helpful in confirming abuse, documenting impaired capacity, reviewing medications and medical conditions, facilitating the conservatorship process, persuading the client or family to take action, and supporting the need for law enforcement involvement. As a result, VAST has become institutionalized in our county. Amenable to replication, medical response teams for elder abuse may be useful in other counties across the nation.

Prevalence and 3-year incidence of abuse among postmenopausal women

OBJECTIVES

We examined prevalence, 3-year incidence, and predictors of physical and verbal abuse among postmenopausal women.

METHODS

We used a cohort of 91,749 women aged 50 to 79 years from the Women's Health Initiative. Outcomes included self-reported physical abuse and verbal abuse.

RESULTS

At baseline, 11.1% reported abuse sometime during the prior year, with 2.1% reporting physical abuse only, 89.1% reporting verbal abuse only, and 8.8% reporting both physical and verbal abuse. Baseline prevalence was associated with service occupations, having lower incomes, and living alone. At 3-year follow-up, 5.0% of women reported new abuse, with 2.8% reporting physical abuse only, 92.6% reporting verbal abuse only, and 4.7% reporting both physical and verbal abuse.

CONCLUSIONS

Postmenopausal women are exposed to abuse at similar rates to younger women; this abuse poses a serious threat to their health.

Prevalence and correlates of elder abuse and neglect in a geriatric psychiatry service

OBJECTIVE

To determine the prevalence and correlates of 4 types of elder abuse and neglect in a geriatric psychiatry service.

METHOD

We conducted a cross-sectional retrospective chart review of new in- and outpatients seen by the Montreal General Hospital Division of Geriatric Psychiatry in one calendar year.

RESULTS

Abuse or neglect was suspected or confirmed in 20 (16%) of 126 patients, comprising financial abuse in 16 (13%), neglect in 7 (6%), emotional abuse in 5 (4%), physical abuse in 3 (2%), and multiple abuse in 7 (6%). On bivariate analysis, patients living with nonspouse family, friends, or other persons were significantly more likely to have suffered abuse than were those living with their spouse or in a supervised setting (OR 10.5; 95%CI, 2.3 to 47.8); widowed, divorced, or separated patients were significantly more likely to have suffered abuse than were married patients (OR 4.7; 95%CI, 1.02 to 22.0). Nonsignificant trends included female sex (OR 4.1; 95%CI, 0.89 to 18.6); alcohol abuse (OR 2.1; 95%CI, 0.71 to 6.2); behaviour problems (OR 1.9; 95%CI, 0.71 to 5.2); and chronic cognitive impairment (OR 1.4; 95%CI, 0.55 to 3.8). Although living situation with nonspouse family, friends, or others and marital status of widowed, divorced, or separated were significantly associated with abuse when examined in separate logistic regression models, both were nonsignificant when examined together, suggesting collinearity. Both were retained in the model because they probably represent different aspects of vulnerability. The final model included living situation with nonspouse family, friends, or others (OR 6.1; 95%CI, 0.75 to 49.5) and widowed, divorced, or separated marital status (OR 2.4; 95%CI, 0.21 to 26.8). Nonsignificant trends included female sex (OR 2.6; 95%CI, 0.45 to 14.4); alcohol abuse (OR 2.2; 95%CI, 0.59 to 7.9); and lowest quartile on the Global Assessment of Functioning (GAF) scale (GAF < 35; OR 2.0; 95%CI, 0.64 to 6.0).

CONCLUSIONS

The practical implications of our study are that elder abuse and neglect are common among patients referred to geriatric psychiatry services, that such services should have access to multidisciplinary expertise and resources to deal with abuse, and that certain situations may signal higher risk. In our setting, the situation of living with nonspouse family, friends, or other persons in a nonsupervised setting and a history of family disruption by widowhood, divorce, or separation were significant correlates of abuse. Suggestive but nonsignificant trends of potential importance (OR > or = 2.0) included female sex, alcohol abuse, and lowest quartile of functional status. Study limitations include a cross-sectional retrospective chart review design, a clinically derived sample, a small sample size, and a lack of structured instruments for several variables.

Physical and sexual abuse against women and children

There is an increasing awareness of physical and sexual abuse against women and children. However, standardization of research is needed in order to facilitate comparison among studies on abuse. Most of the research has focused on prevalence, incidence and causes of domestic violence, family violence, and physical and sexual abuse. There is also a need to evaluate the effect of different intervention programmes. It is important that the education system, the health sector and the judicial system are motivated to recognize that they have not only the opportunity, but also the responsibility to take action against physical and sexual abuse. A multidisciplinary and multiagency perspective is needed in approaching this issue. All of us, especially educators and clinicians, are in a position to address abuse, and ultimately to reduce violence in our society. Abuse is everyone's business.