With the elderly community set to be celebrated on International Day of Older Persons (1 October), a leading professional indemnity provider is urging its members to remain alert to potential indicators that senior citizens have been abused.

The Medical Protection Society (MPS) says it is issuing the advice partly because there is a greater tendency in the media, and society generally, to focus on abuse of children, rather than that of older people, which often remains invisible.

Despite this relative lack of awareness, MPS draws attention to claims from the charity Action on Elder Abuse, that 4% of old people in the UK have been abused. Figures from the Office for National Statistics, issued last month, have confirmed that, for the first time, there are now more people of state pensionable age in the UK than under-16s, with the over-80s being the fastest-growing age group of all.*

Dr Stephanie Bown, MPS director of communications and policy, said: "Elder abuse can take various forms; physical and financial abuse is probably the most common, but abuse can also be psychological or sexual.

"Statistics suggest a clinician could encounter at least one victim of elder abuse for every 20 to 40 older people they see.**

"Elder abuse can be difficult to recognise. There is no universally agreed test as to what constitutes elder abuse and there are no exclusive diagnostic signs. Elements of abuse can easily be attributed to other common problems in elderly people's lives: accidental falls cause fractures, bruises, head injuries and lacerations, and weight loss can also be a sign of cancer or chronic diseases.

"Many victims of abuse are socially isolated, cognitively impaired and detached from their care. They may be brought to the consultation by their abuser, acutely aware of what's happening to them, but not wanting to let the clinician know.

"Abuse is sometimes a sign that carers are not coping and need help themselves, and the medical profession could do more to identify the needs of carers."

Dr Bown said the indicators of abuse could be subtle and doctors often faced an unenviable task in trying to uncover and deal with it.

She said: "Background indicators can include delays in seeking medical attention, inconsistent or even contradictory histories being delivered by patients and carers, and a disparity between assets and living conditions. They can also include extreme withdrawal, agitation, or depression and repeated admissions.

"Physical injuries signifying possible abuse include bruises and lacerations on certain parts of the body - the palms, soles, inner thighs and upper arm. Also, multiple injuries at different stages of healing, malnutrition, dehydration, occult fractures and poor personal hygiene."

Dr Bown said if doctors suspected abuse, they have a responsibility to act promptly.

"Follow the adult protection policy in the area," she added. "Ensure immediately that the patient is made safe and receives medical attention. Make careful and comprehensive records of the history, examination and conversations with other health professionals.

"Take advice from a senior colleague or your medical defence organisation about other steps, which might include informing the police or the Adult Protection Enquiry Co-ordinator."

Dr Bown also said: "The International Day of Older Persons is a particularly appropriate time to remind all doctors and healthcare workers about this widespread, but often concealed problem. Signs of elder abuse can be subtle and clinicians are understandably reluctant to raise concerns which may prove to be unfounded.

"However, doctors have a key role in both identifying and preventing abuse, and a responsibility to protect vulnerable patients from harm. The patient's interests must always be the doctor's primary concern and, sometimes, this will mean probing more deeply to explore whether the patient's symptoms are a manifestation of abuse.

Medical Protection Society

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