Prevention and detection of elderly abuse
Introduction.
The increase in life expectancy and population aging world. Population aging arises following the transition of the demographic process and the epidemiological process of populations.
Characterized by the decrease in fertility rate, mortality and increased life expectancy. In addition, the appearance of chronic and degenerative and disabling diseases is increasing. The United Nations Organization and WHO predict that the volume of world population over 60 years in 2050 will be 2.000 million people compared to the 900 million in 2015. In Spain in particular, at the end of 2019 there were already more than 8.9 million people exceed 65 years of age, of which 25% exceed 80.
Developing.
All age groups are susceptible to abuse, although the elderly form an especially vulnerable group given their dependence on third parties to satisfy the basic activities of daily life (ABVD) or the instrumental activities of daily life. The abuse in the old man has become a reality that health professionals are increasingly faced. This fact creates the need for health teams, in a multidisciplinary way and based on the closest possible attention to the humanization of care, they have the necessary competences to guarantee the well -being and quality of life of our greatest 3.4.
Primary care professionals have a unique opportunity to prevent, identify and inform the elderly;arising the need to properly design and use prevention, early detection and approach and intervention tools against abuses against the elderly .
The United States Medical Association considers the elderly;Any act or omission that gives rise to damage or threat of damage against the health or well -being of an elderly person ”. The Council of Europe considers abuse “any act or omission committed against an elderly person in the painting of family life, economic security, physical-psychic integrity, their freedom or that seriously compromises the development of their personality.
In 1982 the basic human rights of the old man were approved for the first time in the first international action plan on the aging presented in Vienna, but the concept of abuse of the old man is not defined until 1988 by the British Society of Geriatrics. In 2002, the elder’s abuse is recognized as a global public health problem through the Toronto Declaration for the Global Prevention of the Elderly of the Elderly .
WHO in 2002 publishes the current definition of the abuse of the elderly in their work active aging: a political framework such as: “a unique or repeated act that causes damage or suffering to the elderly, or the lack of appropriate measures to avoid it, thanIt occurs in a relationship based on trust. This type of violence constitutes a violation of human rights and includes physical, sexual, psychological or emotional abuse;violence for economic or material reasons;abandonment;negligence;and the serious impairment of dignity and lack of respect ”6.
It should be added that abuse can occur in the context of the family, community or institutional sphere and can also be considered as an act that produces damage either intentionally or not.
Epidemiology and types of abuse
The latest data published by WHO. The abuse rates to the elderly are high in institutions such as nursing homes and long -term care centers: two out of three workers of these institutions indicate having inflicted ill -treatment in the last year 9.
According to another 2017 WHO study, based on the best available evidence of 52 investigations carried out in 28 countries in various regions, including 12 low and medium -sized income countries, during the last year 15.7% of 60 -year -old peopleor more were subject to some form of abuse.This percentage probably represents an underestimation, since only one in 24 cases of abuse to the elderly is denounced. Therefore, prevalence rates are likely to be underestimated.
In Spain there are few studies on the incidence of the abuse of the elderfor both and the rate of psychological abuse and negligence of 0.3%. The types of ill -treatment can be divided into physical, psychological, sexual abuse, financial abuse, negligence and abandonment. – Physical abuse is characterized by any type of physical aggression that produces damage either, blows, burns, beating, fractures or abusive drug administration.
- The emotional or psychological abuse that both verbal and offensive silences, the social isolation caused, threats of abandonment or institutionalization, manipulation, humiliations, emotional blackmail, intimidation, etc.
- Any form of sexual activity without consent from the person both by denial or as inability to express the will is considered as sexual abuse.
- Financial abuse or economic abuse occurs when the person is deprived of the use and control of their own money or goods, being able to appear in the form of blackmail and includes thefts or robberies and the concealment of material goods.
- Negligence abuse appears when the basic needs of the person are not met, whether hygiene, food, dehydration, medical treatment, etc.
- When signs of affection are denied or the person is deprived of communicating with others, there is talk of the case of emotional abandonment or abuse.
The lack of respect for the intimacy of the old man and his personal space can also occur as mistreatment.
Risk factor’s
The risk factors that can increase the possibility that an older person suffers from ill -treatment are located individual, relational, community and sociocultural. We find a great connection with the level of dependence, the lack of autonomy either due to mental or physical disability, the level of knowledge of the rights, the character and personality of the old man, its cultural level, the economic resources of whichIt provides, the skills to establish personal relationships and the existence of family support, among others, such as social isolation, advanced age, history of domestic abuse, widowhood, dementia, etc.
Individuals: The risks of the individual sphere include the poor physical and mental health of the victim, mental disorders and sex. While men run the same risk of ill -treatment as women, in some cultures in which women have a lower social status, they have a greater risk of negligence and economic abuse (such as seizing their properties) when they send 9.
Relationships: Sharing housing is a risk factor for the abuse of the elderly. It is yet to determine whether they are spouses or adult children who are most likely to perpetrate ill -treatment. When the aggressor depends on the elderly (often economically) the risk of ill -treatment is also greater. In addition, with the incorporation of women into the world of work and the reduction of the time they have available, attending to the major relatives can become a heavier load that increases the risk of abuse, appearing the burn caregiver syndrome 9. According to the data obtained in 2014 by the Imserso, the profile of the aggressor was in 50% of the cases the main caregiver, which in 37% was> 65 years.
Community: the social isolation of caregivers and the elderly, and the consequent lack of social support, is an important risk factor for the abuse of the elderly by their caregivers. Many older people are isolated by the loss of physical or mental abilities, or for the loss of friends and family.
Sociocultural: Among the sociocultural factors that can affect the risk of abuse of the elderly, the following are included:
- Age -based stereotypes according to which older people are represented as fragile, weak and dependent.
- The weakening of the links between the generations of the same family.
- The migration of young couples, which leave the elderly parents in societies in which the children have traditionally taken care of the elderly.
- The lack of funds to pay care .
In institutional establishments, abuse is more likely:
- The levels of health care, social services and care centers for older people are not adequate.
- The staff is poorly formed and paid, and supports an excessive workload.
- The norms favor the interests of the institutional center than those of residents 9.
Prevention and interventions before MA by WHO
There are many strategies that have been applied to prevent the abuse of the elderly, adopt measures to combat it and mitigate their consequences. Among the interventions that have been implemented to prevent abuse, the following can be cited:
- Awareness campaigns for the public and professionals
- Detection (of possible victims and aggressors)
- Intergenerational programs in schools
- Caregivers support interventions (for example, stress management, relief assistance);
- Policies on Residences to Define and improve the level of care;
- Training on dementia aimed at caregivers 9.
Among the efforts to respond to abuse and prevent the following interventions from being included:
- Compulsory notification of abuse to the authorities
- self-help groups;
- Casas Refugio and Emergency Centers
- Psychological help programs aimed at people who inflict ill -treatment
- Assistance Telephones that provide information and derivation 9
At the moment there are not too many evidence of the effectiveness of most interventions. However, support for caregivers after a case of abuse reduces the probability of repeated and intergenerational programs in schools (to reduce negative social attitudes and stereotypes towards the elderly) have yield promising results along with sensitizationof health professionals before abuse.
The Primary Care Service is the population entrance door to the health system of health. The detection of cases of abuse to major constitutes a complicated task being most of the cases diagnosed when these are hospitalized. AP professionals have a privileged position to carry out prevention interventions, as well as early detection of abuses to the elderly. Being necessary for this a specific training in this aspect and the provision of reliable tools that allow them to develop a good diagnosis of detection of risk factors in a possible situation of suspicion.
For their part, Nursing professionals in AP have an important role due to the proximity they establish with users and their families. The observation by the nursing team and the integral assessment, both of the possible victim, as well as its main caregiver and the environment in which the old man lives are decisive to identify possible risk factors and/or to detect cases of abuse.
BIBLIOGRAPHY
- Cano SM, Garzón Mo, Segura Am, Cardona D. Factors associated with the abuse of the elderly of Antioquia, 2012. Rev. Fac. Nac. Public health.
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- World Health Organization (WHO). Toronto declaration for global abuse prevention of the elderly. 2002.
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- Mistrate of the elderly: WHO [Internet]. quien.int. 2018.
- IBORRA I. Abuse of older people in the family in Spain. Valencian Community Foundation for the Study of Violence (Reina Sofía Center) [Internet] 2008.
- Fernández Núñez D, Gallardo Sánchez and, Hadad Rodríguez D, Paz Castillo Kl, Gallardo Arzuaga RL. Violence to the elderly a problem in a Granmense health area. Faculty of Medical Sciences Celia Sánchez Manduley. III Regional Congress of Family Medicine WONCA IBEROAMERICANA CIMF.
- Ministry of Health, Consumption and Social Welfare. Institute of Seniors and Social Services (Imserso) [Web headquarters]. 2015.
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