Elderly people should not be seen as marginalised victims in society

A seminar in this week’s issue of THE LANCET discusses the under-reported and complex subject of elder abuse. The topic is also covered by an editorial in this week’s issue (p 1192) which concludes that ‘elderly people should not be seen as marginalised victims in society but as fully participating and valuable citizens. Anything less is inhumane and unsustainable’.

Mark S Lachs (The Weill Medical College of Cornell University, New York City, USA) and Karl Pillemer (Cornell University, Ithaca, New York USA) highlight the lack of quality research concerning the abuse, physical and mental, of elderly people. Restricting their review of what data exists to domestic abuse, they highlight two startling statistics: the rate of elder abuse is probably between 2% and 10%; and people who have been mistreated are over three times more likely to die within 3 years compared with those not abused, even when corrected for comorbidities and other confounding factors.

The authors also discuss possible approaches for screening programmes to identify elder abuse, but state that clinician’s awareness of the phenomenon is more of a priority to enhance the detection of abuse. The difficulties of accurate diagnosis given the high risk of false positive and false negative judgements is also highlighted. Emphasis is given to the importance of a multidisciplinary approach—with a role for professions including nursing, social workers, advocacy organisations, and the police—in addition to family physicians.

Dr Lachs comments: “Although there are gaps in knowledge with respect to the clinical manifestations and treatment of elder abuse, they should not prevent clinicians from taking an active role in identification and management. Family violence directly affects quality of life, and removal of a patient from an abusive situation is one of the most gratifying experiences for physicians and other health-care professionals. Despite the need for more data on interventions, a reasonable approach is a multidisciplinary one, specifically tailored to the situation, ideally involving multiple team members with varied expertise (the model used in other geriatric syndromes). Future research should focus on the creation of clinically useful screening techniques and evidence-based assessments of replicable interventions.”