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A Global Response to Elder Abuse - page 36 / 149

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1. Have you relied on people for any of the following: bathing, dressing, shop- ping, banking or meals?

p Yes

p No

p Did not answer

If Yes: Have problems been common be- tween those people and you?

p Yes

p No

p Did not answer

2. Has anyone prevented you or tried to prevent you from getting food, clothes, medication, glasses, hearing aides or medical care, or from being with people you wanted to be with?

p Yes

p No

p Did not answer

If Yes: Has this happened more than once?

p Yes

p No

p Did not answer

3. Have you been upset because someone talked to you in a way that made you feel shamed or threatened?

p Yes

p No

p Did not answer

If Yes: Has this happened more than once?

p Yes

p No

p Did not answer

4. Has anyone tried to force you to sign papers or to use your money or your be- longings against your will?

p Yes

p No

p Did not answer

If Yes: Has this happened more than once?

p Yes

p No

p Did not answer

A GLOBAL RESPONSE TO ELDER ABUSE AND NEGLECT

5. Has anyone made you afraid, touched you in ways that you did not want, or hurt you physically?

p Yes

p No

p Did not answer

If Yes: Has this happened more than once?

p Yes

p No

p Did not answer

Doctor: Do not ask this next question to the patient. It is for you only to respond to.

6a. Elder abuse may be associated with findings such as: poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts, bruises, inappropri- ate clothing, or medication compliance issues. Did you notice any of these today or within the last 12 months?

p Yes

p No

p Not sure

6b. Doctor: Aside from you and the pa- tient, is anyone else in this room during this questioning?

p Yes

p No

  • M.

    J. Yaffe, MD mark.yaffe@mcgill.ca

  • M.

    Lithwick, MSW mlithwick@ssss.gouv.qc.ca

  • C.

    Wolfson, PhD tinaw@epid.jgh.mcgill.ca

PAGE 21

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