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Elder mistreatment is common and often overlooked by health-care providers. It may include physical abuse, psychological and emotional abuse, sexual abuse, financial exploitation, and neglect. While any older adult may be susceptible, particular mitigating factors discussed in this chapter include cognitive impairment and dementia, multimorbidity, substance use, socioeconomics and culture, and social isolation. Strategies for approaching clinical cases, identifying signs and symptoms, and developing interventions are explored using illustrative cases and selected findings from the growing literature on elder mistreatment across care settings.
This chapter presents reflections on next-generation ethical issues by four deans at the University of Southern California: Public Policy, Medicine, Business, and Engineering. Each of the deans was asked to reflect on some of the important ethical issues that they believe we face today or that we will face in the near future. Their responses follow.
Elder mistreatment is a surprisingly common and often misunderstood phenomenon. It causes significant pain and suffering and is especially prevalent among those who have a dementing illness. Financial abuse is one of the most common types of mistreatment and often co-exists with other types (such as emotional and/or physical abuse). Sometimes the clinician is called upon to assess capacity for financial transactions. The implications and consequences of such an assessment are significant, and it is often helpful to engage a geropsychologist or neuropsychologist to assist with an accurate determination. It is critically important for the clinician to ask about abuse and to identify high-risk situations. Once abuse is suspected, the clinician must know what the reporting requirements and options are, as these vary among states. In general, suspected abuse in licensed facilities is reported to the Long-Term Care Ombudsman, and suspected abuse in community settings is reported to Adult Protective Services. Health practitioners have an opportunity to prevent and detect abuse at early stages, thus improving the quality of life for their patients and those who love them.
This fully updated seventh edition remains the pioneering text for practicing physicians and allied health staff confronted with the unique problems of an increasing elderly population. Dr Reichel's formative text is designed as a practical and useful guide for all health specialists. Emphasizing the clinical management of the elderly patient with simple to complex problems, this is a must-read for all practitioners who need practical and relevant information in a comprehensive format. Chapters have been updated and re-organized to reflect the clinical approach to aging, beginning with a general approach to the management of older adults, followed by a review of common geriatric syndromes, and proceeding to an organ-based review of care. The final section addresses principles of care, including care in special situations, psychosocial aspects of our aging society, and organization of care. Particular emphasis is placed on cost-effective, patient-centered care, including a discussion of the Choosing Wisely campaign.
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