The Psychological Abuse of the Elderly - a Silent Factor of Cardiac Decompensation

Abuse of the elderly is a major issue debated worldwide. The most commonly identified form of abuse is the physical abuse. It is also the most frequently studied in the medical literature. However, at least six types of elder abuse are identified, and physical abuse is found in a small proportion of the cases. The consequences of abuse are frequent and, by prolonging hospitalizations, they will be associated with high costs of medical services, and patient's lack of self-confidence which, in time, may lead to social isolation, somatization, anxiety, depression, and suicide attempts. In this context, the identification and correction of psychological abuse becomes a desideratum of utmost importance for ensuring an optimal therapeutic response. This should be done by using a simple method that does not require qualified personnel, but allows the patient to be guided towards psychological consultation; this study was carried out with the help of the EASI EASI (The Elder Abuse Suspicion Index) questionnaire. We present the case of an 80-year old patient in a rural area, who has been hospitalized several times, admitted for numerous episodes of global cardiac decompensation (about four over the last year). The causes of cardiac decompensation were, systematically, non-compliance with treatment, regardless of all attempts to readjust and simplify the therapeutic schemes. The dynamic geriatric assessment showed a deterioration of the patient's mental and nutritional status and an accentuation of depression. The EASI questionnaire used during the last admission corroborated with the psychological consultation and detected several types of abuse: abandonment, negligence and financial abuse. Given that the complexity of care, the frequency of hospitalizations and the length of stay were reduced, therapeutic compliance increased and the mental and nutritional status improved after correcting the abuse.