Health Essentials
Is abuse of the elderly real?
The elderly are at risk of various forms of abuse
“This week, we are charting a path that we do not often do. An area that people too often gloss over but it is one that is becoming increasingly troubling. Guess who delivered this apt, informative, and thought-provoking piece?
The one and only Dr. Yaw Berko aka Yaw B who is my akonta, friend and colleague. Do not just enjoy reading but also let us all take the necessary steps to protect our priceless men and women in their golden years.”
As a child, I used to live in a compound house at Adabraka. My understanding at the time was that the complex was built by an old lady who had turned over the management of the buildings to her son who collected rent!
Looking back, I believe the old lady had dementia and sometimes soiled herself! This action was met with emotional and physical abuse at the hands of the son! I feel so bad I could not do anything about it, but I was a child at that time.
With the advent of this unfortunate pandemic and its resultant shutdown of the economy and social distancing, depression and other psychiatric illnesses have increased in incidence!
In fact, emotional and physical abuses have been rampant in this pandemic! I can imagine that our elders are not exempt from abuse in this perilous time!
I would like to bring to the fore what elder abuse is and how to prevent or report it when you witness one.
To grasp how the elderly can easily be abused, it is imperative to consider some of the physiological changes that occur as we all age. Our skin loses thickness and elasticity which makes it more prone to bruising!
The elderly lose muscle mass and have generalised reduction in hormone production and activity.
This results in easy bruising, poor bone formation, and increased risk for falls leading to trauma and fractures! The loss of neurons and brain mass causes dementia. Urinary and fecal incontinence can lead to offensive smell and pressure ulcers.
What exactly is elder abuse? Up-to-date, an electronic clinical resource tool for physicians and patients that provides information on adult primary care and internal medicine defines it as any action taken by a person who has an ongoing relationship with an older person that harms the older person and is done with the intent to harm.
Abuse could be physical, emotional, financial, and even sexual abuse.
Physical abuse causes physical pain or injury to the older adult. Emotional abuse entails verbal assaults, threats of abuse, harassment, and intimidation.
Financial abuse leads to misuse or withholding of an older adult’s resources by another. Sexual abuse involves forcing the older person to remove clothing or do any sex act or downright rape!
Statistics are hard to come by in Ghana but in America, it is believed that approximately one in 10 elders experience some form of abuse! I suspect the incidence in Ghana is about the same or higher but will not be known because it is a taboo to talk about such.
The elderly who are at risk of the various forms of abuse are women, those older than 80 years, older people with dementia, and those with less social connections and have trouble paying bills!
Unfortunately, abusers are both women and men and in most cases are family members! Two-thirds of perpetrators are adult children (as I witnessed as a child) or even spouses! In some instances, the abuser may be someone who cares for older people, maybe a house help hired by family members to take care of their loved ones.
It is very easy to suspect abuse in the elderly. Things to look for are cuts and bruises. Pain, soreness, and bleeding in the anal or genital area are some indicators.
Pressure ulcer on the buttocks that develop when a person sits in one position for too long must arouse your antennae for elder abuse!
Elders with a strong smell of urine or faeces suggest poor hygiene and lack of proper care. Emotional abuse sometimes leads to withdrawal from normal activities, unusual depression, and frequent arguments between the caregiver and the older adult.
The effects of elder abuse are daunting. Abuse in the elderly population causes a 300 per cent higher risk of death as compared to those who have not been mistreated.
So how does one prevent elder abuse? The most important thing to do is to keep in touch with him or her. You can also ask the elderly direct questions if you suspect abuse or neglect!
I always suggest paying unexpected visits to their homes if they are under the supervision of a caregiver!
Some countries have adult protective services that seek the interest of the elderly population! If none of that exists in Ghana, I strongly urge the Social Welfare Department to set up one and educate the general population about the existence of elder abuse and how it can be reported.
So just as the Bible says in Exodus 20:12, “honour your father and mother so that you may live long in the land the Lord your God is giving you.” This is the time to take care of our elders who nourished us from the womb to who we are today.
Good luck!
Source:
Dr. Yaw Berko
(yawberko2001@gmail.com)
References
● Ref National Council on Aging NCOA
● National institute on aging
● Uptodate
By Dr. Kojo Cobba Essel
This week I bumped into Deborah, one of my avid readers and I promised her I will be writing this weekend. So Deborah, this is for your reading pleasure and to pick some golden nuggets for the future.
The quest to find the best way to make one’s golden years, happy, exciting, healthy and a time most people look forward to continues unabated. One factor that keeps popping up is the need to grow friendships with people more than 20 years younger than yourself.
Do not take this for granted. It is a form of “social security” since these close friends who are much younger than you will step in to support you in more ways than you can ever imagine.
Some conditions may make life challenging for older adults but knowing these Geriatric Giants helps us to take the necessary steps to reduce our risk.
“Geriatric Giants” refers to a group of chronic health conditions that are common in the elderly, typically 65-year-olds and older.
These conditions quite often co-occur and can impact on the independence, dignity and overall wellbeing and quality of life of an elderly person.
These Geriatric Giants include:
- Impaired Intellect/ Memory (e.g. Dementia)
- one of the major battles we need to deal with is challenges with memory
- Exercise, adopt the Mind Diet, build a great social network and enjoy time outdoors
- Keep reading and solving puzzles for as long as possible
- Instability – leading to much feared falls
- A good reason to indulge in Balance Training and Core Strengthening exercises from today
- Ensure your home is safe; avoid clutter such as cables crisscrossing floors, toys etc. These are all trip hazards and should be avoided
- Many healthy, happy and fun-loving older adults have died soon after a fall with its attendant complications.
- Do whatever it takes to avoid falling
- Immobility (opening the doors to pressure sores, joint stiffness)
- Even when you are unable to move about on your own it is important to get support to change positions as often as possible or get an appropriate mattress or bed that prevents prolonged pressure over any single point.
- Make sure you passively or actively move joints daily.
- Incontinence (urine, faeces or both)
- This is one of the reasons older adults prefer to stay at home and avoid going out to meet friends etc.
- Iatrogenic Disorders – adverse effect of medication
- Quite often most older adults are on several medications and some side effects such as drowsiness may seem to cause more unhappiness and may even lead to falls.
- Inappetite – this may result in poor nutrition
- This may also be linked to loss of teeth thus making chewing very difficult or limited.
- The loss of smell and taste may also reduce the amount of food one may willingly eat.
The power to reduce the impact of the Geriatric Giants starts now and should be a lifetime commitment. It is never too early to start making the appropriate lifestyle modifications, nor is it too late to reduce the impact of the giants on one’s life.
Other conditions that significantly impact on the lives especially of the elderly are:
- Sleep Disorders
- Good sleep has the power to give us energy, improve our thought pattern and even helps us to make good choices.
- Good sleep sets the tone for a healthy life
- Constipation
- This is a challenge that confronts quite a number of older adults.
- Movement, fibre and lots of water go a long way to reduce the stress that frequent constipation generates.
- Fraility
- Muscle loss is real and as we age, we lose a significant percentage of our muscle plus our bones also become brittle.
- Make sure strength training is part of your exercise schedule
- Polypharmacy
- Another headache that needs to be confronted head-on
- Everyone especially older adults need a good primary care physician or a general practitioner who can coordinate all medicines from the different Specialists who may be attending to an elderly person. This ensures that unnecessary medicines are dropped
The goal of care at all times is to optimise the quality of life. As family, professional caregivers and friends we should always show respect so that the dignity of the elderly is preserved at all times. For those of us who are not yet in the age group with such challenges, we need to start the conversation about the type of care we will prefer and take steps to stay healthy and independent for as long as possible. The goal should be a long Healthspan and not just a long Lifespan.
AS ALWAYS LAUGH OFTEN, ENSURE HYGIENE, WALK AND PRAY EVERYDAY AND REMEMBER IT’S A PRICELESS GIFT TO KNOW YOUR NUMBERS (blood sugar, blood pressure, blood cholesterol, BMI)
Dr. Kojo Cobba Essel
Health Essentials Ltd (HE&W Group)
(dressel@healthessentialsgh.com)
*Dr. Essel is a Medical Doctor with a keen interest in Lifestyle Medicine, He holds an MBA and is an ISSA Specialist in Exercise Therapy, Fitness Nutrition and Corrective Exercise. He is the author of the award-winning book, ‘Unravelling The Essentials of Health & Wealth.’
Thought for the week – “There is no magic formula to being happy but making a conscious effort to be happy goes a long way.” – Dr. Kojo Cobba Essel
By Dr. Kojo Cobba Esse
The call to action
We must move beyond the cycle of temporary outrage. I propose a four-point blueprint for the Ministry of Health and the government:
1. A Digital Bed-Tracking Command Centre: Legally mandate all public and major private hospitals to update a live, digital bed-registry every hour. The NAS must be able to see a vacancy before they move. This must be matched with the available resources and services so that the right patient will be sent to the right facility.
2. Strategic Capacity Expansion: We must stop building “prestige projects” and start building high-volume stabilisation centres. We need a targeted investment to triple the ER bed count in Accra and Kumasi within 24 months. This should then be extended to other regional capitals.
3. Specialised Emergency Hubs: Designate specific hospitals as “Centres of Excellence” for Cardiac and Stroke care (and for other health emergencies), ensuring they have 24/7 imaging and intervention capabilities as well as the requisite expertise to manage these conditions. Policy makers must incentivise public-private partnerships to ensure that a heart attack in Accra or Kumasi can be treated with the same urgency as one in New York.
4. Develop a nationwide trauma system: This is extremely important because trauma is a major cause of deaths in Ghana. In the US, each state has a statewide trauma system with three levels. Level 1 trauma centres are usually University Teaching hospitals that provide comprehensive trauma care and also play an important role in local trauma system development, regional disaster planning, increasing capacity and advancing trauma care through research. Level II trauma centres are expected to provide initial definitive trauma care for a wide range of injuries and injury severity.
Level III centres provide definitive care to patients with mild trauma. Having such systems is imperative to ensure proper treatment of trauma patients.
Even for those who survive trauma, disability is a major assault on economic potential and viability. Importantly all this cannot happen with a cash and carry system. Emergencies should be managed under a different model to save life and limb first. Obviously, there is a need to ensure that healthcare facilities will be able to recover their investments in emergency care, and that balancing act needs careful consideration.
Frontline clinicians are often forced to bear the public’s anger for infrastructure deficits they did not create and cannot fix. This is a failure of governance, not a lack of clinical care. Responsibility lies with the policy makers who manage the nation’s resources.
The “No Bed Syndrome” is a systemic disease. It cannot be cured with a directive from the Ministry of Health, parliament or a lecture on ethics. It requires a blueprint, a budget, and the political will to treat this like the menacing threat it is.
It is safe to say that non-emergent healthcare is excellent in Ghana for the most part if you can afford it. However, emergency care is suboptimal. We had a sitting president die from an emergency health issue and a former vice president also die from an emergency. If that is not enough warning, it is clear that anyone can be a victim of an emergency.
If we do not act, the next ambulance driving aimlessly through the streets of Accra could be carrying anyone, including the very people who have the power to fix this issue.
Prof. Jonathan Laryea is a Professor of Surgery at the University of Arkansas for Medical Sciences in Little Rock. Arkansas. He is board certified in General Surgery, Colorectal Surgery and Clinic Informatics.
He is a graduate of the University of Ghana Medical School (Class of 1997)
