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The lowest quartile of psychosocial function (GAF <
35) showed a trend toward association with abuse (OR 2.0). Although
again possibly due to chance, it is consistent with studies reporting
an association of elder abuse with functional disability and cognitive
impairment (11,22,26).
The highest quartile of age ( > 83 years) showed a trend toward
inverse association with abuse (OR 0.29). Once more, this may be
due to chance or to age-related factors that our model did not capture
fully, such as institutionalization, hospitalization, legal protection,
and transience of abuse or survival bias.
The practical implications of our study are that elder abuse is
common among patients referred to geriatric psychiatry services,
that such services should have multidisciplinary expertise and resources
available for dealing with abuse, and that certain situations may
signal higher risk. Nevertheless, we caution against oversimplification
of abuse as a unitary problem; risk is mediated not only by patient
variables but by caregiver or abuser variables. The familiar classification
of physical, psychological, and material abuse, neglect, and violation
of rights is phenomenologically based and has face validity but
does not address causes or abuse mechanisms. For example, treating
teams must routinely assess whether the abuse is associated with
a caregiver influenced by exhaustion, mental illness, substance
abuse, lack of resources, financial hardship, or abuse from the
care receiver. They must also assess whether it is associated with
opportunistic or predatory behaviour of more distant individuals
or strangers. This has implications for the selection of social,
psychiatric, environmental, and judicial interventions.
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Manuscript received April 2001, revised December 2001, and accepted
April 2002.
1 Director, Division of Geriatric Psychiatry, Montreal General
Hospital, Montreal, QC; Director, Division of Geriatric Psychiatry,
McGill University, Montreal, QC; Assistant Professor, Department
of Psychiatry, McGill University, Montreal, QC.
2 Clinical Asssociate Professor, Department of Psychiatry, University
of British Columbia, Vancouver, BC.
3 Assistant Professor, Department of Psychiatry, McGill University,
Montreal, QC.
Address for correspondence: Dr S Vida, Montreal General Hospital,
McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC
H3G 1A4
e-mail: stephen.vida@mcgill.ca
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