Elder Abuse

Patient Barriers to Disclosure

There are a wide variety of reasons why an elder or dependent adult patient may not tell you about abuse or neglect:

  • not cognitively aware
  • denial
  • afraid that by telling, the abuse will escalate (this may happen with destruction of personal property, injury to pets, or increased physical harm, even death)
  • they don't think people will believe them
  • pride - they want to maintain autonomy and not admit vulnerability
  • fear of dependency and poor care
  • shame, embarrassment - especially if sexual abuse is involved, or they have been a victim of a monetary scam
  • wanting to protect relatives, usually abusive children, from possible prosecution or public censure
  • cultural boundaries prohibit talking about this situation outside of the family
  • feeling disgraced that children/relatives would treat them this way
  • not wanting to initiate legal action
  • belief they are being "paid back" for their earlier behavior in life
  • may believe institutionalization is the only other option, and want to avoid (solution to the problem worse than the problem)
  • cycle of isolation and intimidation -> learned helplessness, resignation, hopelessness
  • depression, psychological decline
  • grief over loss of physical function and loss of role in family
  • sense of worthlessness that they are a burden to others and can't expect any better

 

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