Elder Abuse: The Enemy Within…

The greatest threat to residents in long-term care is ... other residents, a new review points out. That means staff will have to be well-trained to look for the insidious signs of elder abuse. (Picture courtesy the fine folks at Wiki Media Commons.)

The greatest threat to residents in long term care is … other residents, a new review points out.  (Picture courtesy the fine folks at Wiki Media Commons.)

Bill Myers

Good morning, ProviderNation. Elder abuse may be more common than previously thought—or more common than is really tolerable—but those who guard against abuse in care centers ought to be looking for an enemy within, a new piece in the New England Journal of Medicine argues.

Arguing that around 10 percent of elders are physically, emotionally or financially abused every year—a “major public health problem”—researchers from the Cornell’s medical school say that “abuse of older residents by other residents in long term care facilities is now recognized as a problem that is more common than physical abuse by staff.”

“Physicians,” lead researcher Mark S. Lachs writes for his colleagues, “should be alert to this possibility when examining and treating nursing home residents, because clinically significant injuries have been found to result from resident-to-resident aggression.”

Context Matters

(Context is precious here: By the numbers, long term care residents are much less likely to be abused, for instance, than poor sixty-something women who live in large households, Lachs points out. Still, there’s no level of abuse that’s really tolerable, and dementia is another risk factor for victimhood.)

Among the difficulties, of course, is that elder abuse is particularly insidious, Lachs notes.

“First, victims may conceal their circumstances or be unable to articulate them owing to cognitive impairment. Second, the high burden of chronic illness in older people creates both false negative findings … and false positive findings,” Lachs says.

Most Depressing Sentence Ever

“Thus,” Lachs and his colleagues say in what may well be the most depressing sentence ever published in a peer-reviewed journal, “a busy physician caring for older adults will encounter a victim of such abuse on a frequent basis, regardless of whether the physician recognizes the abuse.”

Doctors, the researchers conclude, have “an important role” to play in preventing elder abuse, but not the only one. Docs’ efforts “must include connecting with specialists in other disciplines, including social work, law enforcement, and protective services, ideally in the context of an interprofessional-team approach,” Lachs says.

Enter the Great Dayne DuVall, chief operating officer of the National Certification Board for Alzheimer Care. Reading Lachs’ study, he says that, if care centers are serious about stopping abuse, they’ll start with careful training for front-line staff.

“You have situations in our homes and centers where residents have trouble communicating, and staff is expected to interpret their wants and needs,” he tells me. “As a profession, though, the data shows we don’t even do a good job interpreting pain in that population. If you can’t figure out that someone is in pain, how can we expect staff to take the next, great leap, and understand that the pain is being caused by another resident?”

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

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