What is it about ?
In Belgium, mistreatment is defined as a single or repeated act which:
- is committed by a person or a group of persons within the framework of a personal or professional relationship;
- causes physical, moral or material damage;
- is intentional or unintentional.
Abuse can be intentional, but it can also be unintentional, for example as a result of an unconscious act or an absence of acts that results in injury or moral distress for the elderly person.
There are therefore several types of abuse:
- physical abuse : hurt, injure, force medication, tie up or other forms of physical restraint;
- forced treatment : demanding things by hitting the elderly person, knocking them over or tying them up,…;
- psychological or moral abuse : humiliate, belittle, insult, ignore, show indifference,…;
- financial or material abuse : exploit, extort money, mismanage finances, steal,…;
- sexual abuse : any form of unwanted sexual contact;
- negligence : refuse to take on the care of a senior or to pay for this care, not to give him food and drink, to prevent him from practicing his daily activities;
- civic abuse : undermine the dignity of the person, prevent him from exercising his rights (for example the right to vote in elections), prevent him from having social contacts, etc.
What is its frequency?
In Wallonia, 28% of people over 70 have denounced some form of mistreatment. Neglect (21%) and psychological violence (18%) came out on top, followed by financial abuse (8%), physical violence (6%) and, to a lesser extent, sexual violence (1%) .
In Flanders, 32% of women over the age of 60 reported having suffered some form of abuse in the past year. Mental abuse came first (27.5%), followed by financial abuse (6%), neglect (6%), sexual violence (2%) and physical violence (2%).
How to recognize it?
Elder abuse is a very sensitive issue in our society. The facts are most often covered up or simply ignored. Moreover, it is not always easy to define the threshold between what remains acceptable and what is no longer acceptable.
Seniors who present the following risk factors are at greater risk of maltreatment:
- depression;
- dementia;
- lack of communication ;
- social isolation (few contacts);
- dependence on third parties for care;
- financial problems.
The risk of mistreatment is also greater when the caregiver meets a series of criteria. A person who is depressed, dependent on alcohol or dependent on the senior (for example financially) will thus be more inclined to be guilty of acts of mistreatment.
Always be vigilant and think about possible mistreatment of seniors who:
- look neglected;
- had several unexplained falls;
- have injuries;
- suffer from undernutrition;
- decline for no real physical reason;
- exhibit unusual behavior;
- try to end their life.
If you have any doubts, talk to the general practitioner or the home care team.
How does the doctor recognize a case of abuse?
Usually, the general practitioner knows the patient very well. He knows how he usually behaves and is aware of his physical and mental problems. Most of the time, the general practitioner is also in contact with informal caregivers. On this basis, he can quickly make a first estimate of the situation.
If he suspects a case of mistreatment, the doctor can also use a rating scale: the EASI (Elder Abuse Suspicion Index). He will thus try to objectify the situation. The rating scale is based on 6 questions. If the answer is “yes” to 1 or more of these questions, it may be a question of abuse. This instrument should of course be used with all due caution. The interviewee must, for example, not have dementia, and must have a relationship of trust with his doctor. The general practitioner should also take into account that the answers are not always reliable and do not always reflect reality. Shame, guilt, or fear sometimes make things keep quiet.
What can you do ?
If you suspect a case of elder abuse, it is very important to talk about it. Concealment and silence never solved anything. If you find the subject too delicate to discuss with the senior, talk to the general practitioner or someone you trust.
What can your doctor do?
The interest of the senior is always at the center of the care. The doctor will always discuss the situation with him and take his wishes into account. Nor will he take any initiatives without his authorization.
A first step is often to optimize home care. To do this, the doctor will establish a treatment plan. This plan makes it possible to organize the interventions of the home nurse, physiotherapist, housekeeper, meal delivery service, etc. Home care indeed requires multidisciplinary teamwork. Recourse to a mediator and / or a property manager is also one of the possibilities. The more the number of people involved increases, the more the risk of mistreatment decreases.
If it is not possible to optimize home care in this way, a move should be considered, to a child or to a nursing and care home, for example. It is sometimes preferable to remove the victim (briefly) from his environment until the situation normalizes. This removal can be done by hospitalization, in the event of a serious medical problem, or by a short stay for rehabilitation in a care center. If necessary, the person who is guilty of acts of mistreatment may be refused all contact with the elderly person.
In the event of physical abuse, the doctor will always make a statement of assault and battery, which he will add to the medical file. In the presence of serious injuries, the Public Prosecutor will also be informed.
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