WMA Declaration of Hong Kong on the Abuse of Older People

Adopted by the 41^st World Medical Assembly, Hong Kong, September 1989,
editorially revised by the 126^th WMA Council Session, Jerusalem, Israel, May 1990,
and by the 170^th WMA Council Session, Divonne-les-Bains, France,May 2005,
reaffirmed the 200^th WMA Council Session, Oslo, Norway, April 2015 and
with minor revisions by the 227^th WMA Council, Helsinki, Finland, October 2024

PREAMBLE

Older people may suffer pathological problems such as motor disturbances and psychic and orientation disorders. As a result of such problems, older patients may require assistance with their daily activities that can lead to a state of dependence. This may cause their families and the community to consider them to be a burden and to subsequently limit or deny care and services.

Abuse or neglect of older people can manifest in a variety of ways: physical, psychological, emotional, financial and/or material, and medical. Variations in the definition of elder abuse present difficulties in comparing findings on the nature and causes of the problem. A number of preliminary hypotheses have been proposed on the etiology of elder abuse including: dependency on others to provide care and services; lack of close family ties; family violence; lack of financial resources; psychopathology of the abuser; lack of community support, and institutional factors such as low pay and poor working conditions that contribute to pessimistic attitudes of caretakers.

The phenomenon of elder abuse is becoming increasingly recognized by both medical facilities and social agencies. The first step in preventing elder abuse and neglect is to increase levels of awareness and knowledge among physicians and other health professionals. Once high-risk individuals and families have been identified, physicians can participate in the primary prevention of maltreatment by making referrals to appropriate community and social service centres. Physicians may also participate by providing support and information on high-risk situations directly to patients and their families. At the same time, physicians should employ care and sensitivity to preserve patient trust and confidentiality, particularly in the case of competent patients.

The World Medical Association therefore adopts the following general principles relating to abuse of older people.

General principles

1. Older people have the same rights to care, welfare and respect as other human beings.
2. Physicians have a responsibility to help prevent all forms of abuse of older patients.
3. Whether consulted by an older person directly, a nursing home or the family, physicians should see that the patient receives the best possible care.
4. If physicians verify or suspect ill treatment, as defined in this declaration, they should discuss the situation with those in charge, be it the nursing home or the family. If ill treatment is confirmed, or if death is suspicious, they should report the findings to the appropriate authorities.
5. To guarantee protection of older people in any environment, there should be no restrictions on their right of free choice of a physician. Medical Associations should strive to make certain that such free choice is preserved within the socio-medical system.
6. The World Medical Association also makes the following recommendations to physicians involved in treating older people, and urges all its constituent members to publicize this declaration to their members and the public.

RECOMMENDATIONS

Physicians involved in treating older people should:

1. make increased attempts to establish an atmosphere of trust with their patients in order to encourage them to seek medical care when necessary and to feel comfortable confiding in the physician;
2. provide medical evaluation and treatment for injuries resulting from abuse and/or neglect;
3. attempt to establish or maintain a therapeutic alliance with the family (often the physician is the only professional who maintains long-term contact with the patient and the family), while preserving to the greatest extent possible the confidentiality of the patient;
4. report all suspected cases of elder abuse and/or neglect in accordance with local legislation;
5. utilize a multidisciplinary team of caretakers from the medical, social service, mental health, and legal professions, whenever possible, and
6. encourage the development and utilization of supportive community resources that provide in-home services, respite care, and stress reduction for high-risk families.