Emotional abuse could be separated from psychological abuse. Emotional abuse definitions should focus more on the outcomes for the victim, such as anxiety, depression, sadness and loneli- ness; psychological abuse should also in- clude “limiting the resources of a person (money, housing, etc.)”.
Basis of the diagnostic
of their practice settings, and a reluctance to get involved. Contact points would be local government, district nursing and aged care services.
Diagram 1.1: diagnostic guideline on elder abuse or neglect
is “diagnostic guideline” flowchart had a
number of limitations and legal problems that would make it largely unworkable in Australia:
• It assumes the older person will have physical symptoms of abuse, which is often not the case.
It assumes knowledge and history of the patient by a doctor, whereas people often see a range of doctors and visit hospital emergency wards.
It assumes that a conflictual relationship with the family member/caregiver is evident, which is often not the case.
ere is no mention of cultural differ- ences or a need for a translator to be present.
Under “Risk factors in the family”, it was suggested that one main set of factors missing were various types of vulnerabil- ity in the older person, such as disability, dementia, illness and frailty. Another was failings in caregiver behaviour, such as lack of responsibility or greed.
Under “Risk factors in institutions and community homes”, there were concerns regarding staff/patient ratios, as these were mandated only for medical staff but not for other ancillary staff in accredited facilities. Overcrowding and lack of community and social interactions could also apply.
Diagnosis of the problem
e general suggestion in the PAHO manu-
al is that “the doctor undertakes a thorough examination of the patient, both through a physical exam and private interview”, fol- lowed by the detailed “indications” of abuse in Table 1.2. is approach was thought to be largely unworkable, because general practitioners were not considered the “first port of call” for issues of elder abuse, due to their lack of time and training, the nature
ere is no procedure whereby doctors
must ask permission before touching older patients. is is especially im- portant in cases of the sexual assault of older women.
3. Basis for treatment
Diagram 1.2: treatment guidelines
ere were similar reservations about the
usefulness of this flowchart: