Clinical Implications

Elder abuse is a pervasive phenomenon which results in significant adverse health, social justice and financial consequences for its victims. Difficulties with defining the concept of elder abuse as well as difficulties with underreporting of abuse have resulted in uncertainty about its true causes and prevalence. As an alternative to mandatory reporting policies, which

have been unsuccessfully trialled in various countries overseas, and the limitations of screening tools, the present study used a risk factor approach to studying elder abuse.

In terms of utility in practice, the findings from the present study can be used to educate and raise awareness about risk factors which make older adults more vulnerable to experiencing elder abuse. Potential observers or sources of support include individuals in regular face-to-face contact with older adults. This group includes professionals such as counsellors and psychologists, social workers, dentists, general practitioners, gerontologists and other health professionals. It also includes public servants from government agencies, lawyers, bankers, neighbours, religious group elders/leaders and other community organisation leaders.

As Johannesen and Logiudice (2013) state, health practitioners are privy to the most intimate details of patients’ lives and are therefore in a unique position to identify high-risk situations. Their limited knowledge of risk factors can result in poor detection of elder abuse. The findings from the present study may potentially be used by care professionals who are regularly in contact with older adults to assess for elder abuse risk. Care professionals in regular contact with older adults often have some idea of their patients’ living and social situations. Awareness of these social aspects of their patients’ lives may be one way to discretely assess for potential elder abuse, which is important given the problem of underreporting by victims, and to encourage and facilitate social lifestyle changes which may reduce the risk of elder abuse.

There is a tension between the profession’s ethical obligations to report suspected abuse to the appropriate agencies/authorities and the bulk of the elder abuse research literature which warns against mandatory reporting approaches due to its unintended adverse consequences

include potential damage to rapport, potential backlash from suspected victims and/or their abusers, risk of liability and conflicts of interest between maintaining patient confidentiality and advocating for their wellbeing (Payne, 2008; Schmeidel, Daly, Rosenbaum, Schmuch & Jogerst, 2012). There may also be problems with time restraints, inadequate reporting procedures, unwillingness to interfere with private family matters and scepticism about being able to effect helpful changes (Cohen, 2011) which mean that mandatory reporting is not sufficient to address elder abuse.

The Code of Ethics, adopted by both the New Zealand Psychological Society and the New Zealand College of Clinical Psychologists in 2002, guides those working in the profession to give due regard to the ethical principle of ‘responsible caring’ and its associated value of ‘promotion of wellbeing’. Subsumed under this ethical principle is the explicit practice implication 2.1.12 which charges psychologists to

do everything reasonable to stop or offset the consequences of actions by others when these actions are likely to result in serious physical harm or death. This may include reporting to appropriate authorities (e.g. the police) or an intended victim or other relevant people, and would be done even when a confidential relationship is involved.

While not mandatory in the sense of being a legal obligation, abiding by the Code of Ethics is strongly encouraged by the profession and taught at the outset of most postgraduate psychology professional training courses in New Zealand. Further evidence of the importance placed on the Code’s ethics and practice guidelines is its incorporation into many workplace codes of conduct. Such workplaces include many District Health Board community mental health services in New Zealand.

The findings of the present study suggest that enquiring about loneliness and social support in particular, is important for identifying vulnerability to elder abuse. This is consistent with the research literature (Schiamberg & Gans, 2000; Pillemer et al., 2016). Enquiring about these contextual factors as well as other elder abuse correlates, in a sensitive and respectful manner, is an important component to include during the assessment stage of therapy. Identifying the likelihood of victimhood to elder abuse provides a background context within which psychological disorders or their symptoms are experienced, providing valuable insight about reasons for emotional distress and informing appropriateness of approach to therapeutic intervention. It is also a necessary component to assess the individual’s risk of harm to self, to others or from others.

Making the assessment of elder abuse more commonplace or even necessary in assessment ‘checklists’ enables community care providers to take a preventative approach to ensuring good health outcomes for their clients; to check for potential elder abuse and to take measures to intervene if necessary. Such interventions might include providing contact details of helplines or helpful agencies as well as basic psychoeducation for the client (and/or their families), enabling the older adult to strengthen their financial/living/social circumstances to reduce their vulnerability to elder abuse. However, it is acknowledged that in reality, issues such as patient workload and limited availability of professional time are often obstacles to conducting thorough assessment. It may be more practical to include one or two main questions about elder abuse and to continue further questioning if any red flags are raised.