Child Abuse Medical Focus Discussion
Child Abuse Medical Focus Discussion
Description
Despite the medical profession’s focus during the last few decades on child abuse and intimate partner violence, there has been relatively little attention to elder abuse. Elder abuse is associated with physical and mental health problems, including physical injuries, depression, poor control of chronic diseases, and functional disability. Results of elder abuse can be devastating. During a 5-year period, nearly 114 elderly patients accounted for 628 emergency department visits seeking treatment for physical abuse. Mortality rates between 1992 and 2001 show that of 74 postmortem cases, 52 deaths were attributed to a homicidal act, and in 22 deaths neglect was suspected. Primary care may be a first response to abuse. In 2001, adults aged 65 years and older averaged 13.7 physician visits in the year. This level of interaction puts primary care physicians, who account for most visits, in a unique position to identify abuse and intervene.
Parental problems are commonly considered to be the main contributor to neglect. Certainly, parental factors, such as mental health issues, intellectual deficits and substance abuse, have been associated with neglect (6,7). Developmental-ecological theory, however, suggests that child, parental, parent-child, family, community and society factors may all contribute to neglect. Often, several factors interact and play a role in the occurrence of neglect (eg, a single parent experiencing depression and substance abuse in a community with few resources) (8).
Younger children, children with complex medical problems, and children with developmental disabilities are at an increased risk for neglect (9,10) due to the heightened challenge of meeting the basic needs of these populations. However, while less often recognized, older children and adolescents with emotional and behavioural problems are also at risk. Consider, for example, the adolescent with type 1 diabetes presenting with recurrent diabetic ketoacidosis whose unmet mental health issues are a contributor to poor adherence to the insulin treatment regimen.
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Family factors and characteristics of the parent-child relationship associated with neglect include less positive engagement between the parent and child, inappropriate parental expectations, chaotic family environments, increased family stress (8) and intimate partner violence (11–13).
The community and society in which the child lives may also contribute to the occurrence of neglect. Communities without community centres and other supportive resources and communities in which caregivers are socially isolated often have a higher prevalence of neglect (8). Although it is important to note that many impoverished families provide safe and nurturing environments for their children, poverty has consistently been found to contribute to neglect (14,15). A negative or dismissive view of children in society may result in fewer resources focused on children’s needs and thus foster neglect (8). Hence, a developed and prosperous society may be neglectful of children by not making available resources that meet the needs of its children.