The emergency must be trained in the detection and management of abuse

It is imperative to train emergency diagnosis and management of elder abuse and give them tools for screening, pleaded various experts at Nantes in the 11th consensus conference organized by the French Society of Emergency Medicine (SFMU).
The elder abuse is characterized by physical abuse (assault and battery), active and passive neglect (deprivation of assistance with daily living, retirement, exclusion), and the violation of human deprivation choices explained in the preamble Dr. Jerome Pellerin, gerontologist psychiatrist in the University Hospital East Group in Ivry-sur-Seine (Val-de-Marne).

But if it is often defined by the acts, it must also be the existence of a pathological relationship between the victim and the aggressor, which is manifested in the form of a hold or litigation.

In most cases, it is the fact of the victim's family or institutional staff, as evidenced by the data network Alma (hello Abuse of the Elderly), which received more than 7,000 calls in 2003, most of the share of women over 80 years.

Few epidemiological studies have been conducted on the subject, but the prevalence of elderly victims of abuse in France is estimated between 3 and 8%. According to these sources, abuse causes significant mortality, with only 9% of abused older people survive 13 years, against 40% of the same age not abused.

As for the child, signs of abuse of the elderly are not very specific. If the observation of bruises, fractures, head trauma or unexplained injury may suggest physical abuse, other forms of abuse are much more difficult to characterize.

Somatic symptoms, relatively rare, are more evocative. However, the increase in the elderly with chronic diseases, repeated dehydration, untreated sores, drug overdose, physical neglect and lack of equipment despite a high economic level, are all signs that should alert the emergency, according to Professor Panteleimon Giannakopoulos, psychiatrist gerontologist in Geneva

Unfortunately, these "lack of time, training, are isolated and afraid of doing wrong and finally ask the question: what are we gonna do, then?" Said Dr. Pellerin, pleading for training teams and collaboration between medical, social and legal.

Unlike screening, whose relevance has divided experts, the development of diagnostic tools appeared essential to all of them. They have especially emphasized the importance of systematically annotate all observations to the patient's arrival and its accompanying emergency, citing as examples "the general appearance, physical indicators, indicators of neglect, possible neglect or exploitation. "

Key partners, the social worker, psychiatrist and nursing staff (nurses, caregivers) must be requested at any time.

If the abuse is no doubt, the emergency physician must report to the administrative or judicial authorities, said Prof. Gilles Potel, UAS Nantes. Otherwise, it must offer the patient's hospitalization, ideally versatile middle, leaving him time to get in touch with the family, the doctor, the nurse at home or social services, and to confirm or invalidate his suspicions.