The Psychological Abuse of the Elderly - a Silent Factor of Cardiac Decompensation.

Abuse of the elderly is a major issue debated worldwide. The most commonly identified form of abuse is the physical abuse. It is also the most frequently studied in the medical literature. However, at least six types of elder abuse are identified, and physical abuse is found in a small proportion of the cases. The consequences of abuse are frequent and, by prolonging hospitalizations, they will be associated with high costs of medical services, and patient's lack of self-confidence which, in time, may lead to social isolation, somatization, anxiety, depression, and suicide attempts. In this context, the identification and correction of psychological abuse becomes a desideratum of utmost importance for ensuring an optimal therapeutic response. This should be done by using a simple method that does not require qualified personnel, but allows the patient to be guided towards psychological consultation; this study was carried out with the help of the EASI EASI (The Elder Abuse Suspicion Index) questionnaire. We present the case of an 80-year old patient in a rural area, who has been hospitalized several times, admitted for numerous episodes of global cardiac decompensation (about four over the last year). The causes of cardiac decompensation were, systematically, non-compliance with treatment, regardless of all attempts to readjust and simplify the therapeutic schemes. The dynamic geriatric assessment showed a deterioration of the patient's mental and nutritional status and an accentuation of depression. The EASI questionnaire used during the last admission corroborated with the psychological consultation and detected several types of abuse: abandonment, negligence and financial abuse. Given that the complexity of care, the frequency of hospitalizations and the length of stay were reduced, therapeutic compliance increased and the mental and nutritional status improved after correcting the abuse.

Complementary Multidisciplinary Elder Abuse Service in A Geriatric Clinic.

Aim: To describe a pilot, innovative intervention project combining the adoption and adaptation for hospital use of a screening instrument designed for use in primary health care settings in Canada (and translated into 6 other languages) and a dialogical narrative therapeutic approach. The development of a complementary multidisciplinary elder abuse service (CMEAS) in a private-public partnership. Material and Methods: Between June 2015 ­ March 2016 elderly hospitalized in Iasi town, Geriatric Clinic and suspected of being abused had the benefit of a complementary multidisciplinary elder abuse service (CMEAS) after being screened for abuse, neglect or abandonment experiences. Results: A total of 450 patients admitted to the Geriatric Clinic were invited for the study and 152 raised suspicion of abuse experiences and were screened with EASI. Of these patients, 132 where found positive and were invited to participate in CMEAS. Conclusions: Such a multidisciplinary service requires the collaboration between the geriatric team (medical service), psychologist, social worker, legal advisor, and psychiatrist, referral of cases to relevant public and private community services and their monitoring after hospital discharge throughout project duration.