Elder abuse - The approach in primary health care

Abstract

Elder mistreatment Goals: Progress in medicine has enabled the rise of life expectancy and quality. Meanwhile, changes in social and family contexts changed the social status of the elderly. Recent studies show that violence against elderly people is increasing in Portugal (data from the Portuguese Association for Victim Support - APAV, indicating an increase of 20.4% of the total elderly victims of crime, from 2006 to 2007). For many elderly, the consultation of the Family Physician (FP) is the only opportunity to detect mistreatment. This article aims to review strategies for the prevention, identification and intervention in cases of elder mistreatment in primary care (PC). Data Sources: Medline and evidence-based medicine sites. Review methods: A search was done of review articles and guidelines in Medline and evidence-based medicine sites (National Clearinghouse, The Cochrane Library, Bandolier), published between 1998 and 2008, in Portuguese, English and Spanish, with the keywords: "Elder abuse" and "primary care". Results: 13 articles were found, 7 of which were selected: 3 systematic reviews, 3 randomized controlled trials and 1 guideline. There are several types of mistreatment: physical, psychological, neglect, economic abuse and self-neglect. Primary prevention is made through identification of risk factors (RF) in the elderly (comorbidities, cognitive deterioration, social isolation,...) and the caregiver (physical and emotional overload, drug addiction,...). Secondary prevention is the identification of mistreatment asking key questions, detection of signs of mistreatment signs and evaluation of the relationship between elder and care provider) and the implementation of measures to prevent its perpetuation. The FP, with the help of nurses, social workers and psychologists, may intervene in several ways: advising day care center, home support, Continuous Care Units, etc. Conclusions: The FP´s have the privileged opportunity to recognize elder abuse and to act preventively, identifying elderly in need of protection or families unable to care. Because of the lack of guidelines and specific legislation, it is important to develop protocols that could enhance the ability to deal with this issue, in PC.