Why do we miss elder abuse?
There are similarities between child abuse and elder abuse in relation to failure to diagnose. Both children and the aged may be unable to articulate that abuse has occurred. If they are able to report abuse, they may be too afraid of the consequences to report it. Those consequences may be punishment of some form including ongoing and perhaps even more severe abuse. They may not be believed perhaps due to concurrent mental health issues and/or senility (real or perceived). It may be because it is too inconvenient for the receiver of the report to action the report particularly where mandatory reporting (with associated penalties for not reporting) is not in existence or applicable. Also, the aged person may be so isolated that the only person that they may report to is, in fact, the perpetrator of the abuse.
For health professionals, there may be additional barriers for failing to report and acting upon perceived elder abuse. The first of these is not considering abuse as part of the differential diagnosis. In other words, being unsuspecting of abuse. If it is not a consideration when making an assessment of injuries, it will never form a diagnosis. Denial is another barrier where there is knowledge of the family and a belief that the professional carer, facility, employee, family or a family member could not possibly engage in abuse. Even if abuse is considered, there may be a reluctance by the health professional to become involved for a variety of reasons. Finally, there may be a failure to act due to the perceived futility of reporting based on past experiences. The end result of this is that the aged person remains at the mercy of the perpetrator of abuse.
There is one factor that usually doesn’t feature in child abuse but may in elder abuse: that reporting abuse does not matter. In this instance, a diagnosis is considered immaterial. People become old and their contribution to society is deemed to be less with increasing age to a point where they become totally dependent upon family, relatives, friends and society. Their death becomes beneficial, a convenience and financial gain both for the estate and the state.
John Gall, President