when the blessing of advancing in age becomes a curse.

According to the World Health Organisation (chapter 5) abuse of the elderly tracks back since early days but has always received less attention. Literature highlights four main types of elderly abuse Physical abuse, sexual abuse, psychological abuse and economical or financial abuse (Bigala & Ayiga, 2014). For the purposes of this reflection i will only focus on elderly abuse as I experienced it as a contributing factor in barriers with establishing rapport with elderly patients. Elderly are vulnerable to abuse because as they grow frail they lose the ability to physically function independently and sometimes get affected cognitively as well. Abuse can be inflicted by family members, care-givers, members of the community or even health care professionals. In the black communities it is very common to have elderly being killed because of accusations of practising witch-craft, as much as such incidents happen in our country elderly abuse is still a private matter.

Healthcare professionals are in a unique position to identify abuse and help their clients, but often patients do not disclose due to reasons such as family loyalty, shame and low self-esteem (Rodriguez, Craig, Mooney & Bauer, 1998).

In one of my clinical rotations last year I met a patient who was just above 65 years of age. It took me about 3 sessions to establish rapport with this particular patient she was constantly refusing to cooperate during treatments sessions and would just not respond at times.I tried to establish a relationship with her and asked her what time would she prefer for physio sessions, so she told me I should see her in the morning and that is when we started working well together. This particular patient always referred to me as a Doctor and always begged me not to send her home. She never disclosed what the matter was at home but she was also diagnosed with dementia which made it difficult to communicate with her because she gave random answers mostly. I had a routine of first seeing her in the morning until I had a patient with respiratory problems that needed to get priority on my list, so that meant seeing the old lady late, when I got to her she asked why I came late that day, she was worried I wouldn’t come. What I noticed during our interactions was that the patient was socially isolated even in the ward because she was the only old person and she had no one visiting her, which was probably one of the reasons why she did not want to go back home. until I read this topic of abuse I didn’t really consider the social isolation observation and the repetitive request not to send her home as an indicator of possible elderly abuse and find out more about the patient’s family , however I was aware that the doctor that referred the patient was arranging a government institution/ home for further care after discharge.  I learnt that it is important to look out for any cues of abuse and listen to the patient in order to be able to refer to relevant health professional in trying to manage the patient holistically.

References

Bigala, P & Ayiga, N ,2014; Prevalence and predictors of elderly abuse in Mafikeng local municipality in South Africa, 463-474

Rodriguez, M A , Craig, A M, Mooney, D R & Bauer,  H M , 1998; Patient attitude about mandatory reporting of domestic violence implications for health care professionals, 337-34

World health organisation, 2009 ; Charpter 5. Abuse of elderly ,125-145

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