Adopted by the 41st World Medical Assembly,
Hong Kong, September 1989
and editorially revised at the 126th Council Session, Jerusalem,
Israel, May 1990
and at the 170th Council Session, Divonne-les-Bains, France, May
2005
Elderly people may suffer pathological problems such as motor
disturbances and psychic and orientation disorders. As a result
of such problems, elderly patients may require assistance with
their daily activities that can lead to a state of dependence.
This may cause their families and the community to consider them
to be a burden and to subsequently limit or deny care and services.
Abuse or neglect of the elderly can be manifested in a variety
of ways: physical, psychological, financial and/or material, and
medical. Variations in the definition of elder abuse present difficulties
in comparing findings on the nature and causes of the problem.
A number of preliminary hypotheses have been proposed on the etiology
of elder abuse including: dependency on others to provide services;
lack of close family ties; family violence; lack of financial
resources; psychopathology of the abuser; lack of community support,
and institutional factors such as low pay and poor working conditions
that contribute to pessimistic attitudes of caretakers.
The phenomenon of elder abuse is becoming increasingly recognized
by both medical facilities and social agencies. The first step
in preventing elder abuse and neglect is to increase levels of
awareness and knowledge among physicians and other health professionals.
Once high-risk individuals and families have been identified,
physicians can participate in the primary prevention of maltreatment
by making referrals to appropriate community and social service
centres. Physicians may also participate by providing support
and information on high-risk situations directly to patients and
their families. At the same time, physicians should employ care
and sensitivity to preserve patient trust and confidentiality,
particularly in the case of competent patients.
The World Medical Association therefore adopts the following
general principles relating to abuse of the elderly.
GENERAL PRINCIPLES
- The elderly have the same rights to care, welfare and respect
as other human beings.
- Physicians have a responsibility to help prevent the physical
and psychological abuse of elderly patients.
- Whether consulted by an aged person directly, a nursing home
or the family, physicians should see that the patient receives
the best possible care.
- If physicians verify or suspect ill treatment, as defined
in this statement, they should discuss the situation with those
in charge, be it the nursing home or the family. If ill treatment
is confirmed, or if death is considered to be suspicious, they
should report the findings to the appropriate authorities.
- To guarantee protection of the elderly in any environment
there should be no restrictions on their right of free choice
of a physician. National Medical Associations should strive
to make certain that such free choice is preserved within the
socio-medical system.
The World Medical Association also makes the following recommendations
to physicians involved in treating the elderly, and urges all
National Medical Associations to publicize this Declaration to
their members and the public.
RECOMMENDATIONS
Physicians involved in treating the elderly should:
- make increased attempts to establish an atmosphere of trust
with elderly patients in order to encourage them to seek medical
care when necessary and to feel comfortable confiding in the physician;
- provide medical evaluation and treatment for injuries resulting
from abuse and/or neglect;
- attempt to establish or maintain a therapeutic alliance with
the family (often the physician is the only professional who maintains
long-term contact with the patient and the family), while preserving
to the greatest extent possible the confidentiality of the patient;
- report all suspected cases of elder abuse and/or neglect in
accordance with local legislation;
- utilize a multidisciplinary team of caretakers from the medical,
social service, mental health, and legal professions, whenever
possible; and
- encourage the development and utilization of supportive community
resources that provide in-home services, respite care, and stress
reduction with high-risk families.
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