was failings in caregiver behaviour (e.g. lack of responsibility and greed), history of long-term conflicted relationships and mental illness/personality disorders in the perpetrator and/or the victim.
Under “Risk factors in institutions and community homes”, staff-to-patient ratios, overcrowding and lack of com- munity and social interactions might also apply.
General practitioners are not the “first port of call” in all countries for issues of elder abuse, due to their lack of time and training, e.g. Australia. erefore, the suggested approach in Diagram 1.1 needs context-specific adaptation.
It is assumed in the manual that the older person will have physical symp- toms of abuse, which is often not the case.
A physician is not necessarily familiar with the patient’s history, since some pa- tients change their doctors with a high frequency and the same doctor may not always be available to see an individual.
It is implied that conflicts with a family member/caregiver is evident, but stress- ful relationships are often well hidden or denied.
ere is no mention of cultural differ- ences or likely needs for translators or interpreters to be present.
A GLOBAL RESPONSE TO ELDER ABUSE AND NEGLECT
h. ere is no procedure whereby physi- cians must ask consent before touching or physically examining older patients; this is especially important in cases of sexual assault.
e risk indicators are considered as a useful list, but for physicians it would be adequate to call it a “diagnostic guide”, as the indicators were not specific enough. Greater preference was given for a checklist that could be used at the end of the assessment.
General practitioners and social workers recommend an adoption of a sociomedi- cal diagnosis in Table 1.2.
Basis for treatment
e approach of the flowchart is too medicalized. Using the word “treat- ment” makes elder abuse sound like a disease. e focus should be on remov- ing or lessening the harm caused to the older person by the perpetrators of abuse.
In some countries “adult protective ser- vices” and mandatory reporting do not exist; nor are there specific intervention orders.
Referral options vary from country to country and need to be adapted accord- ingly within specific contexts.
d. A focus on the rehabilitation and educa- tion of the perpetrator often seems to be more appropriate than strategies being directed only at the education of the older person.