In the fight against violence against the elderly. New online education platform launches

The number of seniors and... needs towards them is growing

According to recent sociological studies, Poland is facing a huge challenge: a declining number of births of children and an exponential increase in the elderly. The consequences of this phenomenon will affect Polish society on a variety of levels, not just economic. Based on statistics from the Central Statistical Office, at the end of 2022 the number of people aged 60 and over was 9.8 million, up 0.7 percent from the previous year. According to Eurostat's EURO-POP2019 population projection, in 2050 Poland's population will be 34.1 million, 3.85 million fewer than today, while the number of elderly people will increase to 10.3 million, or by almost 3.3 million people. The aging of the population is also associated with an increase in the needs of this group. In the face of this challenge, it is already necessary to implement multidirectional systemic changes, including against all forms of violence against the elderly.

Elderly victims of violence

A rarely addressed, even neglected and silenced by the public is violence against the elderly in society.

- We doctors are reminded of elder abuse rarely, usually around holidays, May Day and long weekends, when EDs and emergency rooms fill up with people seventy, eighty plus and their relatives. We hear that Mommy hasn't wanted to drink or eat for two days, Daddy has stopped walking for two weeks. For two days, two weeks, two months... (...) then we find that health issues have not been taken care of for years... - with this perspective agrees Agnieszka Skoczylas, a geriatrician, Head of the Geriatric-Intermediate Care Unit of Dr. Anna Gostynskaya Wolski Hospital, an expert of the Elderly Project Foundation.

Surveys conducted in Poland show that one in seven people over the age of 60, experience violence from relatives or caregivers. According to the Polsenior2 survey, this is a woman, in early or late old age (65-69 and 85-89), a poorly educated resident of a small town or village, mainly in the northeastern regions. The perpetrator of violence is usually a family member, usually cohabiting. The most common forms of violence against the elderly include - psychological, economic, neglect, physical and sexual violence. With neglect being the most common form reported by the elderly, according to respondents. The issue of violence is made more difficult by caregivers' low awareness of the reprehensibility of their own behavior. More often than not, they feel isolated and left to their own devices in their caregiving efforts, which drastically increases their psycho-physical burden, directly translating into a lower quality of care offered. As a result, the so-called "caregiver syndrome" develops, characterized by, among other things, secondary entitlement, excessive expectations of the external environment or a constant sense of being wronged, explains Skoczylas.

Violent actions, especially those of immediate family members, directly translate into worse health for the elderly. Hence such an unprecedented and sensitive role for the doctor, who is most likely to recognize violence and act. Indeed, the family doctor is increasingly often the first person an elderly patient chooses to confide in, treating him or her as a kind of confidant.

According to changes in the anti-domestic violence legislation, which take effect on June 22, 2023, no longer only a doctor, but also other medical professionals, so a nurse, midwife or paramedic are authorized to initiate the Blue Card Procedure.

Elder Abuse Risk Assessment Form - a simple diagnostic tool

FORP was developed as part of a 2-year research project (2021-2022) carried out by the Elder Project Foundation in partnership with the research firm Local Social Research, the National Institute of Geriatrics, Rheumatology and Rehabilitation, the Medical and Diagnostic Center in Siedlce and the ZOZ in Lodz.

FORP is a simple tool that allows you to assess the risk of violence in a short conversation with a patient and gives a simple path to follow. It is an answer to the lack of adequate procedures, time and support in social institutions to make an effective intervention. FORP can be used both in primary care facilities and in hospital wards. This type of tool is successfully used in many countries around the world, contributing to proper and systemic care for the elderly. In Poland, as part of their work on the form, violence experts and physicians analyzed more than a dozen different risk assessment forms operating in health care in Europe and around the world. Their work also included an analysis of the literature on the problem, Polish and foreign studies on violence against the elderly, and the specifics of the Polish anti-violence system.

When to use FORP?

The form should be used to diagnose patients against whom - on the basis of conversation, appearance and behavior of the patient or third parties, such as family members - there is suspicion that they may be experiencing violence. Indications for examination may include, among other things, a disturbing manner of behavior, such as an apprehensive person who does not maintain eye contact, clothing that is inappropriate for the situation and season, or marks on the body that may indicate physical violence.

Part of the form is a procedure, which, depending on the result, gives the doctor a simple path to follow. Depending on the patient's response, there are 3 procedures: green, yellow and red. Green is a procedure that did not confirm the doctor's concerns; yellow signals a risk of experiencing violence; and red indicates a situation in which the patient's life or health is at risk. In this case, the doctor should fill out a Blue Card A form, give it to the appropriate person at the medical facility in question, and report the case to the prosecutor's office.

- The Elder Abuse Risk Assessment Form (FORP) has been in operation since January 2023. The project takes time, but we are gradually moving forward. Just as we have given time to the experts invited for substantive cooperation to develop the form, we are now giving the medical community the time they need to implement the procedure in their daily relationship with patients, and we as a Foundation the time for the necessary educational and dissemination activities of FORP in the medical community. The sum of the efforts of the parties involved, and above all, the stakes of the entire project, is to improve the well-being of people in the autumn of life. Now they especially deserve respect, peace of mind and health well-being," argues Magdalena Rutkiewicz, President of the Elder Project Foundation, responsible for the ideas and implementation of FORP towards the elderly.

Physician, (u)cure violence!

With all representatives of the health care system in mind, the Elder Project Foundation has just launched a sub-site(www.projektstarsi.pl, tab: Resources for doctors). It provides an accessible and clear compendium of knowledge about FORP and possible forms of violence against the elderly, while not crossing the time-consuming barrier, which is crucial in the work of medical staff. It includes:

- FORP questionnaire in the active version, which you can attach to the patient's file at your medical facility;

- An instructional video on how to fill out the form and its potential;

- statements from practicing physicians encouraging the use of the form;

- Prevention and information materials for the elderly, such as brochures and leaflets.

In addition, you can sign up for training on elder abuse and the use of FORP through the sub-site.

- Violence against the elderly should be talked about as much as possible! Let it cease to be a taboo subject just because it is not easy, even uncomfortable. We doctors usually like to deal with difficult cases, so let's not run away from this topic as well," Dr. Skoczylas appeals to the medical community and thus encourages the use of materials developed by the Foundation.