A challenge to public health and social cohesion
Council of Europe, Strasbourg, June 23 2016
The 2003 heatwave was a wake-up call for France
"During the 2003 heatwave, France suddenly realized it was old and that it was failing its most vulnerable elderly citizens.” This is how Dominique Prédali started her presentation.
Contrary to what the government first announced, she said, the majority of these elderly victims did not die at home. Studies proved they died at hospitals and nursing homes, mainly of dehydration and hypothermia. This came as a shock to most people, remarked Mrs. Prédali, and raised the question: How could this possibly happen in a so-called civilized country?
She was then asked to investigate on the medical and medico-social care of old people in France and abroad. She found the same shocking and “horrible” situation everywhere.
Constants in all countries:
• ER waiting time longer for old people. Younger people are a priority even though the frail elderly are at higher risk of becoming rapidly dehydrated and dying.
• Failure to send them to the right hospital ward because of the lack of geriatric beds or a misdiagnosis due to unfavorable conditions on arrival: i.e. dehydration rapidly leading to mental confusion leading to misdiagnosis of dementia.
• malnutrition: an old person hospitalized for a hip fracture, for example, but with no other health issues, can rapidly end up undernourished after a short stay.
• Overmedication especially tranquilizers or antidepressants such as benzodiazepines which cause dehydration, even when the patient is given enough to drink. The situation is the same in Australia, Canada or the US.
• Understaffing, qualified or not. A care assistant can find herself or himself alone at night with 80 dependent residents to look after. A situation that makes it impossible for them to deal with two simultaneous emergencies. Which one should she or her address first?
• Industrialization of care which leads to budget cuts in heating, staffing or food resulting in what Mrs. Prédali calls the "top three" causes of preventable deaths which are malnutrition, dehydration and pressure sores, closely followed by overmedication, falls and urinary infections. According to US and Canada studies, the higher the profit of the nursing home, the higher the rate of abuse.
• The lack of studies on elder abuse in Europe
Abuse or neglect? A well-kept secret
Everywhere, says Dominique Prédali, there are double standards when dealing with a child or an old person.
For the first one, it is “abuse“, condemned by law, and for the second one it is "neglect" or "structural dysfunction"
Quoting Alexandre KALACHE, former head of the Health and Ageing World Program at the WHO, and John BEARD’s predecessor, Dominique PRÉDALi finishes with these words: "elder abuse is the world’s best kept secret and also the last taboo of the 21st century"!