Culturally appropriate screening and assessment

People experiencing abuse are likely to be physically, emotionally and spiritually vulnerable.

The first point of contact is important in building trust, together with an atmosphere that conveys openness, caring and a non-judgmental attitude. It is important to provide sufficient time to respond and to explore options. A positive encounter for the person includes being asked what plan of action they would like to take as well as being offered resources, support and guidance. (Glasgow & Fanslow, 2006).

Click here for The Ministry of Health (2007) Family Violence Intervention Guidelines: Elder Abuse and Neglect.

Interviewing older people where abuse is suspected

When working with CALD older people, be mindful that there may be cultural variations in definitions and in ways of addressing abuse. Cultural differences in communication styles also need to be considered. When conducting elder abuse and neglect screening interviews with older people it is important to:

• Make sure that assessment and intervention are part of a face-to-face health care encounter.
• Use open-ended and non-judgmental questions.
• Use professional interpreters where required, rather than a person’s friend or family member.
• Ensure that privacy is considered. Unless the older person specifically requests the presence of a friend or family member for support, the person should be interviewed away from relatives or caregivers. If feasible talk to the person in their own home, as most older people feel safer in familiar surroundings, and the living situation can also be observed.
• If there is a suspicion of abuse or neglect, ensure that the older person’s caregivers are interviewed separately from the older person.
• Be alert to financial abuse of the older person. Examples of this include the older person not being allowed to buy what they need; their bank accounts being accessed without consent; and Enduring Power of Attorney (EPA) being used for the personal gain of the person holding the EPA (Age Concern New Zealand, 2009).
• Comply with organisational policies for elder abuse and neglect screening interviews when cognitive impairment is suspected or when the older person does not have mental capacity.

Here are additional issues to consider when asking about possible abuse and/or neglect

The health provider’s ability to engage the older person in the questioning process is a critical factor for obtaining accurate and relevant information. Consider the following:

• Does the older person have sensory deficits? Ensure glasses and hearing aids are used and eliminate background noises. Ensure the area is well lit. Arrange seating face-to-face, use familiar words and repeat questions.
• Are reactions slowed? Allow extra time for responding and pace questions. Where English is a second language offer the use of professional interpreters. Ensure that you speak clearly and avoid jargon.
• It is common for people who have been abused to deny that abuse has taken place. Talking about abuse can be very difficult.
• Maintaining privacy about what goes on in the home can be highly valued, while a sense of duty or desire to protect their carer or family members can deter the person from speaking out against their abuser.
• The abused person may feel ashamed, frightened or intimidated, or may fear being placed into care or being labelled with dementia. The person being abused may be resigned to or accepting of long-standing abuse and may blame themselves or feel it is their duty not to complain and to accept what life deals out. There may also be a concern that revealing the abuse could result in losing contact with an abuser who is a vital source of social contact or care.