When the Elderly Have No One to Tell : AMA reminds doctors of their special responsibility to detect abuse of those so vulnerable

The elderly make up the fastest-growing segment of the U.S. population. Like the very young, the old are especially vulnerable to abuse and manipulation. Pediatricians are trained to look for and report suspected mistreatment of children. Nearly all states also require physicians to report suspected neglect or abuse of the elderly. But guidelines for doctors in such cases have largely been lacking. The American Medical Assn. has now proposed such guidelines as part of its Physicians’ Campaign Against Family Violence.

The AMA’s recommendations are sound and the need they address is serious. A congressional report last year estimated that between 1.5 million and 2 million Americans 60 or older annually suffer abuse. Only about 7% of such cases are reported to authorities. Some abuse occurs in caregiving institutions. Some--more than is commonly or willingly recognized--takes place in the home.

The AMA says that abuse occurs in all racial, ethnic and socioeconomic groups. It is not limited to such physical mistreatment as violence, force feeding, improper use of restraints or withholding food, drink, medicine or hygiene. It can also be psychological, including harassment, threats, intimidation, isolation from friends, family and activities and failure to provide changes in routine. Or it can be financial, the AMA says, such as misuse of an elderly person’s resources for a caretaker’s personal gain, using coercion to gain power of attorney or forcing an aged person to alter a will.

“Physicians,� say the guidelines, “are ideally situated to play a significant role in the detection, management and prevention of elder abuse and neglect. A physician may be the only person outside the family who sees the older adult on a regular basis, and he or she is uniquely qualified to order confirmatory diagnostic tests . . . to recommend hospital admission or to authorize services such as home health care.�

The AMA recommends that the elderly be examined and interviewed away from their caregivers, and be asked questions aimed at determining whether and how mistreatment may have occurred. No doubt some of the elderly abused will be afraid of being honest. No doubt, too, that physicians will be able to identify and report a lot of cases of possible abuse that would otherwise have continued undetected.

The frequent heavy dependency of older people on caregivers unhappily exposes far too many to deliberate ill-treatment. The AMA’s guidelines, endorsed by the federal Administration on Aging, the American Geriatrics Assn. and the American Assn. of Retired Persons, could be an important aid in extending necessary and even vital protections to millions of older people.