Hazzard W R
Department of Internal Medicine, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.
Acad Med. 1995 Nov;70(11):979-81. doi: 10.1097/00001888-199511000-00015.
Elder abuse is a growing problem as the number of dependent older persons increases and the proportions of middle-aged and younger children--who themselves are struggling with problems of their own families and finances--decline. As this occurs, older women increasingly will dominate the ranks of the elderly. These realities make it imperative for medical students to become familiar with the care of older persons, including abused older persons, who, at present, constitute at least 2% of the population over 65. The author outlines the causes of elder abuse (e.g., previous abusive relationships in a family increase the likelihood of elder abuse); lists important barriers to diagnosis and management of the abused (e.g., the physician's uncomfortable position between protecting confidentiality, serving as an advocate for the patient, and needing to collaborate with the family--and often the abuser); and outlines the various forms of intervention that are available (e.g., assistance of adult protection services). Education in elder abuse should be distributed across the entire medical student curriculum (many examples are given) and should be dominated by case-based learning at a variety of sites, such as hospitals, clinics, and subacute care units. The author closes by reiterating the urgent need to prepare physicians now to deal with a problem of increasing magnitude, severity, and ugliness.
随着需要照料的老年人数量增加，而那些自身正为家庭和经济问题所困扰的中年及更年轻子女的比例下降，虐待老年人的问题日益严重。在此情况下，老年女性在老年人中的占比将越来越高。这些现实情况使得医学生必须熟悉对老年人的护理，包括受虐待的老年人，目前这部分人群至少占65岁以上人口的2%。作者概述了虐待老年人的原因（例如，家庭中先前存在的虐待关系会增加虐待老年人的可能性）；列举了诊断和处理受虐者的重要障碍（例如，医生在保护隐私、为患者代言以及需要与家庭——通常还有施虐者——合作之间所处的尴尬境地）；并概述了可用的各种干预形式（例如，成人保护服务机构的协助）。关于虐待老年人的教育应贯穿整个医学生课程（文中给出了许多例子），并且应以在医院、诊所和亚急性护理单元等各种场所开展的基于案例的学习为主。作者在结尾重申，迫切需要现在就培养医生，以应对一个规模、严重程度和恶劣程度都在不断增加的问题。
