如何在急診室發現虐待和忽視老年人:事情並不總是眼見為憑

How to spot elder abuse and neglect in the ER: Things are not always as they seem

From MNT(Medical News Today) Published: Wednesday 23 March 2016

When older adults in severely debilitated states show up for treatment in the emergency department, emergency physicians and staff must be able to identify and document their symptoms and decide whether to report their concerns to adult protective services. This is a difficult decision as the patient’s symptoms may stem from willful neglect, unintentional neglect or sub-acute symptoms caused by an underlying illness than manifest as neglect. Two papers published online recently in Annals of Emergency Medicine highlight a problem that promises to grow rapidly with the aging of the Baby Boom generation.

當嚴重衰弱狀態的老年人在急診科就診,急診醫生和工作人員必須能識別並記錄他們的症狀,並決定是否向成人保護服務報告。因為病人的症狀可能因無意的疏忽或故意忽視潛在的疾病表現或亞急性症狀而讓決定變得困難。最近在急診醫學年鑑網上發表的兩篇論文凸顯嬰兒潮世代的老齡化快速增長問題。

"Given the aging of the population, emergency physicians need to be prepared to balance their obligations to the patient by documenting findings, reporting suspicions and referring patients to appropriate agencies," said Marguerite DeLiema, Ph.D, of the Stanford University Center on Longevity in Stanford, Calif., the lead study author of "The Forensic Lens: Bringing Elder Neglect into Focus in the Emergency Department." "Emergency physicians can also help prevent misunderstandings about elder neglect by encouraging patients to document care preferences, involve others in care planning and communicate with their caregivers about how to fulfill their wishes."

“由於人口老齡化,急診醫生需要藉由文件調查,報告懷疑處和病人轉介到相應的機構權衡履行對病人的義務”加利福尼亞州斯坦福大學長壽中心的 Marguerite DeLiema 博士,“法醫鏡頭:的指導研究作者,聚焦在急診室對長者的忽視。” “急救醫生還可以幫助預防忽略老年者的誤解,鼓勵患者偏好的護理記錄,涉及他人護理計劃,並與他們的照顧者溝通如何滿足他們的願望。”obligation義務;責任合約,契約

Ms. DeLiema’s team documented two case studies in which seemingly similar symptoms of elder neglect (severe malnutrition, skin ulcers and other physical problems), resulted from very different caregiving situations. In one instance, the patient’s daughter had become frustrated with medical providers after a home health care agency refused to care for him when his condition deteriorated. The daughter believed she could provide better care on her own and brought her father home from the hospital against medical advice. In the other case, the patient’s son intentionally neglected his father for his own financial gain. He reported that he refused to provide medical care because his father didn’t "need to see a doctor or take medicine because he is dying."

DeLiema 女士的團隊記錄的兩個案例研究中,忽視老人看似相似的症狀(重度營養不良,皮膚潰瘍和其他身體的問題),起因於非常不同的護理情況。一個情況是,患者的病情惡化家庭醫療保健機構拒絕照顧他的病人,患者的女兒變得沮喪。女兒認為,她自己可以提供更好的照顧而拒絕醫生的建議將父親從醫院帶回家。另一個情況,患者的兒子為了自己的經濟利益故意忽視他父親。他報告說,他拒絕提供醫療服務,因為他的父親快死了所以不需要看醫生或吃藥。”

The second paper ("Identifying Elder Abuse in the Emergency Department: Towards a Multi-Disciplinary Team-Based Approach") recommends a team-based approach across disciplines to identify elder abuse, including emergency medical providers, triage providers, nurses, radiologists and technicians, social workers and case managers. Opportunities to detect abuse occur throughout the episode of emergency care, from when paramedics and EMTs enter a patient’s home to the clinical exam in the emergency department through intervention by social workers and/or law enforcement.

"Currently, most victims of elder abuse and neglect pass through our emergency departments with a life-threatening condition unidentified," said the latter paper’s lead study author, Tony Rosen, MD, MPH, of Weill Cornell Medical College in New York, N.Y. "A multi-disciplinary, team-based approach supported by additional research and funding has the potential to improve the identification of elder abuse and improve the health and safety of our most vulnerable patients."

   第二篇論文(“識別急診處虐待老人:建立一個多學科團隊為基礎的方法”),建議跨學科團隊為基礎的方式來確定 
   虐待老人,包括緊急醫療機構提供者 ,區分提供商,護士,放射科醫生和技師,社會工作者和個案經理。在整個急救
的情節來時的機會檢測虐待發生。由社會工作者和/或執法部門介入從醫護人員和急救人員進入家裡到在急診的臨床
檢查。

“目前,很多老人虐待和忽視的受害者在急診室處於一個危及生命不明的情況,說:”後者論文的研究主要作者,托
尼·羅森博士,公共衛生碩士,紐約威爾康乃爾醫學院,“通過進一步的研究和資金支持的多學科,以團隊為基
礎的方法提高對虐待老人的識別和促進我們最脆弱的病人健康和安全的潛力。“

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