It was stressed that a health professional first needed to determine whether or not there is cognitive deterioration in the older person, which would affect the ability to ask any of these questions directly. A related issue was the ethical application of such a questionnaire. Should it be used only for older patients who have ongoing contact with the same practitioner? Is it dangerous to use the questionnaire in older people who are seen only once, such as in a hospital emergency ward or an outpatient clinic? What are the next steps for medical practitioners and nurses if they establish a suspicion of abuse? Which referral agencies are most appropriate?
Several practitioners were concerned about asking these questions in front of a carer who might be the abuser. A related issue was that carers might be being abused by the older people.
Some of the questions are phrased in the present tense (“Do you ... ?”) and some in the past tense (“Has anyone ever ... ?”). Some consistency concerning the time frame would be useful here. Should the main focus be on the present or recent situ- ation rather than on something that may have happened 10 or 20 years ago?
A GLOBAL RESPONSE TO ELDER ABUSE AND NEGLECT
Workshop with social workers
All six participants (five females, one male) were experienced social workers, working in urban and suburban public hospitals, local government, health and community services, and dealing with patients aged 65 years and older.
Several participants were concerned that, despite elder abuse being recognized as an important community issue in the past, both government interest and pub- lic consciousness of it tends to wax and wane. Others mentioned their awareness of increasing expectations on caregivers and consequent increased caregiver stress.
In addition to the abuse categories given in the definition used within the WHO-CIG project, specific examples of abuse from their social work experience are:
Decision-making by family members on behalf of older people. is includes, for example, subtle pressure not to sell the family home.
Use of cultural expectations and accept- ed ways of doing things to justify taking control and making it “acceptable” to hit or push an older person.
Fear of abuse can be a potent controlling force, not only when there have been actual threats but also when there is the perception of threat from others.
Withholding of information, either to punish or to take advantage of an older person.