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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
occurred (Marshall et al., 2000). Finally, the perpetrator may prevent the professional from spending time alone with the elder individual (Paris et al., 1995).
Health care providers are one professional group whose reluctance to report financial abuse of the elderly has received considerable attention (Kleinschmidt, 1997). Physicians have been found to be most likely to report physical abuse and the least likely to report financial abuse (Rosenblatt et al., 1996). Health care providers may fear that raising concerns will offend or insult the patient, perhaps by impugning their financial competence, or invade the patient’s privacy (Marshall et al., 2000). They may consider it an inappropriate topic for them to raise or believe that it goes beyond the scope of the evaluation provided (Lachs and Pillemer, 1995; Marshall et al., 2000; Tueth, 2000). Also, they may cite their busy schedules, particularly when it requires addressing a relatively complicated topic in a short period of time, or their lack of expertise and the absence of reliable standardized protocols for discerning whether finanancial abuse is present (Marshall et al., 2000; Rosenblatt et al., 1996). Also, they may believe financial abuse of the elderly occurs relatively infrequently among their patients39 or that they are being asked to do too much already within the relatively short time they meet with patients (Rosenblatt et al., 1996; Sugg and Inui, 1992). Furthermore, it has been suggested that health care providers do not report financial abuse because they are uncertain as to where to make a report, believe it will not make a difference, or rationalize away its existence (Beck and Phillips, 1984). Although, as noted, some argue that health care professionals are well situated to detect and report financial abuse (Lachs and Pillemer, 1995; Paris et al., 1995), others argue that considering the many barriers faced, there are better ways by which physicians can serve their patients (e.g., by recommending the establishment of a guardianship or power-of-attorney when they identify that funds are being misappropriated) (Tueth, 2000).
Reliability of Reports
At the same time, studies have indicated that a relatively high percentage of elder abuse reports in general and reports of financial abuse of the elderly in particular are not substantiated following investigation (i.e., they
This may be the case for emergency rooms. Fulmer and colleagues (1992), in a sixmonth study of the charts of elders seen in a hospital emergency department, found 3.4 percent of the patients suffered from neglect, 2.3 percent from abuse, 0.4 percent from violent crime, 0.2 percent from abandonment, and only 0.05 percent from exploitation. Arguably, however, this may be an unlikely setting for detecting financial abuse in elders and if relevant questions were not asked such charts are unlikely to reflect its occurrence.