Step of trust which causes harm or distress

Step 1: Gathering information (Case scenario) :

Mr. A.M. is an 84 year old Emirate male who presented to the clinic
with multiple joint pain that has been there for the past 4 weeks. The pain is
always there and he can’t move his knee with full range of motion. When he was
asked whether he fell before or got exposed to any sort of trauma he denied
both.

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His medical history shows that he has Hypertension for 30 years and
is taking amlodipine. He also has diabetes for 20 years and is on metformin and
gliclazide.

He hasn’t done any surgeries before. As for his family history, his
father has hypertension other than that everything is normal.

He lives with his son and his wife who have 4 children. They all
live in a five room flat and he has his own room. His caregiver is his son and
his wife but since they both work then he stays with a nurse in the morning.

On physical examination, the patient was reluctant to be examined
and when asked for the reason he claimed to be shy. After insisting on physical
examination, multiple bruises on both forearms and legs were found. He was also
dehydrated and was noticed to be underweight with a BMI of 18.

 

Upon questioning regarding the bruises, he said that he often feels
dizzy and fell several times. The story didn’t match the bruises so upon
further questioning and counseling he admitted that he was getting beaten up by
his son’s wife.

 

What are the
red flags in this case?

First of all, the patient was reluctant to be examined which means
that he must be hiding something. Another thing was that the bruises on his
forearms and legs didn’t match his story where he claimed he had fallen several
times. Falls would show bruises on the bony prominences and not the extensor
surfaces. He has a BMI of 18, which is low, and he is dehydrated which
indicates neglect.

 

 

 

How is elder
abuse defined?

According to the WHO, “Elder abuse is a single or repeated act, or
lack of appropriate action, occurring within any relationship where there is an
expectation of trust which causes harm or distress to an older person.”

 

Step 2: Identifying the ethical problem?

Our patient was very reluctant and disagreed to discuss his case or
even record it. We faced here a confliction between autonomy, confidentiality
and beneficence. Autonomy
encourages to accept his will to keep his case for himself, refusing to record
it, and keep it confidential. However, in the other hand beneficence, goes with
taking the best option for the patient’s health and break confidentiality of
the fact that he was abused. The dilemma
here is between going with the patient will to keep everything confidential. Or
take an action and report his case to the social worker in health center.

 

Step 3: Identifying the relevant factors and analyzing the problem.

 What are the Types of Elderly Abuse?

Several types
of elderly abuse have been established by the “National Center on Elder Abuse”,
these types include:

1.     
Physical
abuse: in which they can be attacked by
physical force (ex. Beating) ending up with injuries and bruises

2.     
Sexual
abuse

3.     
Emotional
abuse: whether it is through verbal or
non-verbal acts.

4.     
Financial
abuse/ Material exploitation: and that is by
taking an advantage of the elderly’s money and properties.

5.     
Neglect: by not completing all the duties that a person should be
responsible on towards their elderly.

6.     
Abandonment: complete desertion of the elderly person by someone who is
supposed to take full responsibility to provide the needed care to the elder.

According to an
article published in “The Lancet” journal in 2017 which included around 28
countries, it showed that the most common type of elderly abuse was
physiological abuse with a percentage of 11.6%, while the least common type was
sexual abuse with 0.90%.

 

Who are more at risk for elderly abuse?

The risk
factors for elderly abuse can be divided into several levels:

1.     
At
the individual level:

a.      
the
elder person have a generally poor mental and physical health

b.     
the
abuser may be suffering from some mental disorders or is addicted to some
substance

2.     
Relationship

a.      
Those
elderly people who live with their family members are at a higher risk of being
abused especially if there is poor family connection/ relationship.

3.     
Community-wise

a.      
elderly
people who are socially isolated and those who are deficit of any social
support have a higher risk

4.     
Socio-cultural

a.      
Some
people see the elderly generation as weak and fragile

b.     
Lack
of financial support to provide care to the elder.

c.      
Those
who live in institutions are also not safe from elderly abuse either. The
reasons behind this may be a result of the unavailability of well-trained
staff, and the poor environment that they may be living in.

 

Step 4: What
are the available options in this case?

1- Go with the patient wish and keep his case confidential.

2- Accept his will to keep this for
himself and refusing to keep them in his medical record.

3-Call the patient’s family and discuss it with them.

4- Take an action by informing the social worker in the health center
and record the
            incidence.

 

Step 5: Testing
the options:

Option 1:

1-     
Harm
test: This option will do the most harm to the patient. The abuse can recur
again.

2-     
Reversibility
test: I would not ethically choose this option again, as the patient can be
adversely affected by it. There is a chance if abuse has recurred he might be
severely injured and present with more severe symptoms and complications.

Option 4:

1-     
Harm
test: This option will do the least harm for the patient. It will help us to
confirm that abuse has happened, identify the possible causes that led to this
issue, and try to find the possible solutions for his case.

2-     
Reversibility
test: I would choose this option again as it help in patient’s protection and
benefit.

3-  Publicity test: I would
like this option to be well known and published as it helps in
            highlighting this issue in
the committee and raise awareness about it.

Step 6: What is
the option that you consider is the best?

   Option 4.

 

Step 7:

 

 

 

Laws and regulations in the UAE.

The life expectancy
of the UAE’s population is estimated to be around 77. 1 years. This shows that
the elderly population is an influential part on the structure of the UAE’s
community. That being said the UAE has provided lots of services for old people
such as elderly homes. There are 5 elderly homes in the UAE supervised by the
government distributed in the emirates of Sharjah Dubai, Ajman, Umm Al Quwain and
Ras Al Khaimah. However, in the UAE there is no law yet that protects the
elderly population against domestic abuse nor help the healthcare providers to
report such incidences. Yet on 2014 the authorities started to pay attention to
such events and thus started working on a law that would protect elderly people
against physical, financial, psychological abuse and neglect. (Mbrsg.ae, 2017)

The government
have a vision that by 2025 there will be no elderly emeriti citizen who is
subjected to abuse or neglect.

 

How can elderly abuse be prevented?

The abuse of
older adults is everyone’s business. Seniors and community members need to be
educated about elder abuse, be able to identify the signs and be engaged in
taking steps to prevent it. It’s vital to remember that everyone can help and
has a part to play to stop elder abuse.

Knowledge is
the key to prevention and it is promising to prevent elder abuse. Specific
prevention approaches may be required depending on the situation and type of
abuse occurring.

There are many
activities elders and community members can take to prevent elderly abuse. The
following are some actions that can help in the prevention of elderly abuse.

 

Preventative
actions elderly can take

 

Protecting
Finances/ Belongings

·        
Do not give your bank card or give your PIN
number to anyone.

·        
Have bills paid automatically from your bank
account as your telephone or utilities bills

·        
Do not sign any documents you do not understand
or if you are under pressure to sign from any person

·        
Do not be guilt-tripped into doing something
you don’t agree with

·        
Write into your Continuing Power of Attorney
for Property instructions regarding when it is to come into effect

·        
Ask for independent advice from someone you
trust before signing any papers.

·        
Read all legal documents carefully, including
the fine print

·        
Do not lend money without a formal payback plan

·        
Be careful when co-signing loans or signing
over ownership of your home

·        
Be informed about financial affairs.

 

Health and
Safety

·        
Think cautiously before making changes to your
living condition such as moving in with family or friends or having someone
move into your home, expressly if they promise to take care of you

·        
Design your future while you are still
independent and mentally capable.

·        
Have a Power of Attorney or a written Living
Will to express how you want to address your finances and health care decisions
to avoid mistakes and family problems later

·        
Maintain contact with loved ones and
connections with friends.

·        
Seek another options for care, do not only rely
only on family members for your care and daily life

·        
Take control of your decisions and health care

·        
Educate yourself about your rights and the
signs to recognize elder abuse

·        
Have your own phone and open your own mail

·        
Become educated about services for elders,
attend local health fairs.

 

 

 

Supporting Your
Rights: Shared Wishes and Planning

·        
Which person do you want to create health
care/monetary decisions for you when you can’t?

·        
What type of medical treatment do you want?

·        
How do you want people to treat you and behave
around you?

 

Preventative
Actions Caregivers Can Take

Caregiving can
be demanding although caring for seniors is a rewarding experience but when a
caregiver becomes overwhelmed and does not have the coping skills and supports
to care for their loved one, they may behave in an abusive manner (most often
not purposely).

·        
Learn about the signs of elder abuse and
inattention

·        
Treat all elders with respect and dignity

·        
Ask for help from friends , relatives, or
local agencies, so you can take a break.

·        
If the older adult has dementia or cognitive
impairments, inquire about adult day programs or respite care services

·        
Seek medical care or psychotherapy to deal with
tension, anxiety and depression when necessary

·        
Join and engage in support group for
caregivers, such as the Alzheimer Society

·        
If you think you need help to care for your
loved one, call to arrange for additional care services.

 

Preventative
Actions Community Members and Organizations Can Take

Educating
seniors, professionals, caregivers, and the public on abuse is critical to
senior abuse prevention. The community engage in taking active phases to assist
seniors who are suffering from abuse or who are at-risk of abuse.

·        
Become involved in your local elder abuse
prevention committee or network

·        
Acquire when, where and how to report abuse

·        
Involve in the planning of educational sessions,
prevention and seniors rights.

·        
Learn about Elderly’s rights and update them of
their rights

·        
Train to teams and volunteers to distinguish
the signs of abuse and neglect.

·        
Sponsor for seniors and their families when
necessary