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Romance Scam Research Center

2015: CA: Elder abuse: an approach to identification, assessment and intervention

Wang, Xuyi Mimi, MD; Brisbin, Sarah, MSc; Loo, Tenneille, MSc; Straus, Sharon, MD MSc.  Canadian Medical Association. Journal: CMAJ; Ottawa Vol. 187, Iss. 8, (May 19, 2015): 575-581.


"In December 2012, the Canadian Parliament passed Bill C-36, the Protecting Canada's Seniors Act, which aims to protect older adults through amendments to the Criminal Code. This bill makes elder abuse an aggravating factor for sentencing purposes, such that criminal acts of elder abuse might be subject to maximal sentencing. There is, however, a substantial discrepancy between prevalence estimates of elder abuse and the number of cases reported to police. In 2009, for example, Canadian police reported 7871 cases of violent crime against people 65 years of age or older6 (relative to a total population of over 4 million in that age group7). Justice Canada researchers have found that charges were laid in only 17% of cases of alleged elder abuse handled by Ottawa police between 2005 and 2010.8 These data suggest that many cases of elder abuse do not reach the criminal justice system and that physicians may be among the first who can intervene.

The complexity of the issue, however, means that research into elder abuse is inherently challenging. For example, elder abuse is defined in various ways. The term encompasses multiple types of abuse, including physical, psychological, sexual and financial abuse, as well as neglect, each of which may be associated with different risk factors, mechanisms of causality and optimal interventional approaches.9-11 Moreover, many older adults who experience abuse are cognitively impaired, socially isolated and frail, and they may have complicated and dependent relationships with their abusers.12-14 Furthermore, the collection of sensitive information about abuse could have negative emotional, social, financial or legal consequences for multiple parties, leading both the abused older person and the abuser to actively try to hide the abuse. This raises ethical concerns about conducting research on a vulnerable population.13,15,16

Assessment of suspected elder abuse should begin with an assessment of capacity. We believe that management strategies for elder abuse should be handled similarly to other medi cal treatment decisions with regard to capacity, namely whether the patient is able to understand and appreciate the consequences of the proposed treatment. If it is determined that the abused older person is capable, we suggest that the physi cian present his or her concerns about abuse to the patient, educate the patient about elder abuse and the tendency for it to increase in frequency and severity, and direct the patient to local resources, including day programs, home care, respite care, legal services, shelters and government-supported elder abuse consultants. In Canada, additional resources include the Advocacy Centre for the Elderly (, the Canadian Network for Prevention of Elder Abuse (, the Seniors Issues Unit of the Ontario Provincial Police ( /index.php?id=151) and the Royal Canadian Mounted Police (www.rcmp-grc. /elder-aine-eng.htm). Imminent safety should be assessed and any concerns clearly communicated to the patient, including creation of an emergency safety plan. Respecting the capable older person's autonomy should be a priority, however, and explicit permission should be sought before discussing any concerns with family members or caregivers who may be able to offer support to the older person."

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