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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.

  • b.

    Under “Risk factors in institutions and community homes”, staff-to-patient ratios, overcrowding and lack of com- munity and social interactions might also apply.

  • c.

    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.

  • d.

    It is assumed in the manual that the older person will have physical symp- toms of abuse, which is often not the case.

  • e.

    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.

  • f.

    It is implied that conflicts with a family member/caregiver is evident, but stress- ful relationships are often well hidden or denied.

  • g.

    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.

  • i.

    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.

  • j.

    General practitioners and social workers recommend an adoption of a sociomedi- cal diagnosis in Table 1.2.

  • 3.

    Basis for treatment

    • a.

      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.

  • b.

    In some countries “adult protective ser- vices” and mandatory reporting do not exist; nor are there specific intervention orders.

  • c.

    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.

PAGE 27

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