Some participants were concerned about the effects of addictive gambling, since this is a major issue in Melbourne and can lead to financial, psychological and physi- cal abuse. e consensus was that it would be good to cover all three risk elements
alcohol, illegal drugs and gambling – in
e wording of this question should be
more comprehensive. Suggestions made were:
“Do you live with (have contact with) some- one who drinks alcohol or uses drugs in ways that cause problems for you?”
“Is there anyone you know who drinks alcohol, uses drugs or gambles in a way that causes problems for you?”
Question 11: is was considered a very important question. ere were, however, some concerns about how the question was written. Some doctors felt they would be reluctant to ask this question unless they could observe some physical evidence of abuse or symptoms of anxiety or depres- sion. Important issues of threatened physi- cal abuse and use of chemical restraint were missing from this question.
Participants also noted that this question was somewhat ambiguous because it could include both accidental harm (such as a fall or bruise when transferring someone into a wheelchair or bath) and intentional harm (being intentionally rough or violent).
Research findings were also quoted to the effect that older people feel ashamed and make excuses for relatives’ behaviour. e experience of abuse influences how people define their experiences.
A GLOBAL RESPONSE TO ELDER ABUSE AND NEGLECT
On the other hand, visiting nurses had seen instances where older women who have suffered physical abuse for much of their lives then seek retribution in a caregiv- ing role. Dilemmas of this nature could be understood only if the doctor or other health professional knew something about the present domestic circumstances as well as the history of both the patient and the caregiver.
e question was felt to be overly complex
and there was some redundancy. e ele- ment of “impeded your free movement” was felt to have been covered in Question 6, regarding stopping someone from doing things or being with people. If retained, however, it would need to be rephrased as “restrained you in any way” or “stopped you from moving around” or “locked you in”.
ere were also suggestions for an overall
“Have you (recently) been physically hurt by
someone you have trusted?”
“Has anyone recently hit you, pushed you or stopped you from moving around?”
Question 12: All agreed that this was a very important question. It could be associ- ated with physical abuse, but having it as a separate question was more appropriate.
As with most of the discussed questions, however, a level of trust in the practitioner is needed, and there is the issue of possible cognitive impairment of either the older person or the abuser, or both.