{"id":439,"date":"2022-10-08T09:49:55","date_gmt":"2022-10-08T06:49:55","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=439"},"modified":"2022-10-08T09:49:55","modified_gmt":"2022-10-08T06:49:55","slug":"yasli-istismari-ve-ihmali","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yasli-istismari-ve-ihmali\/","title":{"rendered":"Ya\u015fl\u0131 \u0130stismar\u0131 ve \u0130hmali"},"content":{"rendered":"<p style=\"font-weight: 400\">Uluslararas\u0131 Ya\u015fl\u0131 \u0130stismar\u0131n\u0131n \u00d6nlenmesi ve D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) Toronto Deklarasyonu\u2019na g\u00f6re ya\u015fl\u0131 istismar\u0131; \u201cYa\u015fl\u0131 insanlara kar\u015f\u0131, herhangi bir g\u00fcven beklentisi i\u00e7inde ger\u00e7ekle\u015fen, s\u0131k\u0131nt\u0131 ve zarara neden olabilecek bir kez veya tekrarlanan hareket ve davran\u0131\u015f eksikli\u011fi\u201d olarak tan\u0131mlanmaktad\u0131r (1). G\u00fcn\u00fcm\u00fczde artan ya\u015fl\u0131 n\u00fcfusla birlikte, ya\u015fl\u0131 istismar\u0131 ve ihmali yayg\u0131n bir sorun olarak kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r. Ya\u015fl\u0131 bak\u0131m\u0131n\u0131 yapan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 b\u00f6yle bir durumdan \u015f\u00fcphelendi\u011finde, yasal olarak bildirimini yapmakla y\u00fck\u00fcml\u00fcd\u00fcr (2). Sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 bu t\u00fcr olgularla acil servis, bak\u0131mevleri, klinik ve polikliniklerde kar\u015f\u0131la\u015fabilir ve bu konuda fark\u0131ndal\u0131klar\u0131n\u0131n y\u00fcksek olmas\u0131 gereklidir.<\/p>\n<p style=\"font-weight: 400\">Ya\u015fl\u0131 istismar\u0131; fiziksel, ekonomik, cinsel ve duygusal olarak 4 gruba ayr\u0131l\u0131rken, ya\u015fl\u0131 ihmali; ya\u015fl\u0131n\u0131n kendini ihmali ve \u00e7evresindekilerin ya\u015fl\u0131y\u0131 ihmali \u015feklinde 2 t\u00fcrl\u00fc olabilir (2-5).<\/p>\n<ul>\n<li><em>Fiziksel istismar: <\/em>Ya\u015fl\u0131 bak\u0131m\u0131ndan sorumlu ki\u015filerce bilin\u00e7li olarak yap\u0131lan a\u011fr\u0131\/ac\u0131 verecek fiziksel \u015fiddet ile v\u00fccuda zarara vermedir. Tokat atma, vurma, yakma, ba\u011flama, y\u00fcksek dozda ya da yanl\u0131\u015f ila\u00e7 verme gibi y\u00f6ntemler olabilir. Nedeni a\u00e7\u0131klanamayan yaralanmalar, v\u00fccutta morluklar, k\u0131r\u0131klar, \u0131s\u0131r\u0131k\/sopa\/kam\u00e7\u0131 izleri, v\u00fccutta yan\u0131k b\u00f6lgelerin olmas\u0131, sa\u00e7l\u0131 deride kanama ya da sa\u00e7s\u0131z bir b\u00f6lge olmas\u0131 gibi fiziksel bulgular\u0131n varl\u0131\u011f\u0131 bu tarz bir istismar\u0131 d\u00fc\u015f\u00fcnd\u00fcr\u00fcr.<\/li>\n<li><em>Ekonomik istismar: <\/em>Ya\u015fl\u0131n\u0131n sivil ve hukuki haklar\u0131n\u0131n ihlal edilmesi, yasal veya yasal olmayan \u015fekilde paras\u0131n\u0131n, mallar\u0131n\u0131n al\u0131nmas\u0131, banka hesab\u0131n\u0131n kullan\u0131lmas\u0131, hile ile vekaletname al\u0131nmas\u0131 gibi yollarla yap\u0131lan hak istismarlar\u0131 \u015feklinde olabilmektedir.<\/li>\n<li><em>Cinsel istismar:<\/em> Ya\u015fl\u0131n\u0131n kendi r\u0131zas\u0131 olmadan herhangi bir cinsel aktiviteye zorlanmas\u0131 olup, en \u00e7ok gizlenen istismar t\u00fcr\u00fcd\u00fcr. Ba\u015fl\u0131ca cinsel istismar belirtileri; a\u00e7\u0131klanamayan anal ve vajinal kanama, kanl\u0131, y\u0131rt\u0131k giysiler, memelerde \u00e7\u00fcr\u00fck ve morluklar say\u0131labilir. Cinsel istismar ma\u011fdurlar\u0131 daha \u00e7ok kad\u0131nlard\u0131r ve eylemi ger\u00e7ekle\u015ftirenler ise tan\u0131d\u0131k ya da akrabalard\u0131r.<\/li>\n<li><em>Duygusal istismar:<\/em> Ya\u015fl\u0131n\u0131n g\u00fcvendi\u011fi konumda olan birisi taraf\u0131ndan s\u00f6zel ya da s\u00f6zel olmayan duygusal a\u00e7\u0131dan ac\u0131 veren ya da strese sokan davran\u0131\u015flar olup; s\u00f6zel sald\u0131r\u0131, k\u00fc\u00e7\u00fcmseme, a\u015fa\u011f\u0131lama, g\u00f6zda\u011f\u0131 verme, tehdit etme, utand\u0131rma, s\u00fcrekli ele\u015ftirme, korkutma ve zorla \u00e7evresinden ay\u0131rma gibi \u00f6rnekler \u015feklindedir. Duygusal istismar belirtileri aras\u0131nda; sorulan sorulara cevap vermemesi, ileti\u015fim kurmamas\u0131, \u015f\u00fcpheli ve mant\u0131ks\u0131z korku ya\u015famas\u0131, sosyal ili\u015fkilerde eksiklik olmas\u0131, kronik fiziksel ve psikolojik sa\u011fl\u0131k problemlerinin olmas\u0131 say\u0131labilir. Duygusal istismar t\u00fcr\u00fc tek ba\u015f\u0131na olabilece\u011fi gibi fiziksel ve\/veya cinsel istismarla birlikte g\u00f6r\u00fclebilir.<\/li>\n<li><em>\u0130hmal: <\/em>Ya\u015fl\u0131larda, istismara g\u00f6re daha fazla g\u00f6r\u00fcl\u00fcr, \u00e7\u00fcnk\u00fc aile \u00fcyeleri \u00e7o\u011fu kez bunun fark\u0131nda de\u011fillerdir. Ya\u015fl\u0131n\u0131n yiyecek, giyecek, \u0131s\u0131nma, t\u0131bbi tedavi, hijyen gibi ihtiya\u00e7lar\u0131n\u0131 yerine getirmeme ya da yerine getirme konusunda isteksiz davranmalar \u015feklinde g\u00f6r\u00fclebilir. Ya\u015fl\u0131n\u0131n kendini ihmal etmesi ise, \u00f6z bak\u0131m\u0131 ve kendini korumas\u0131 konusunda yetersizlik ya da isteksizlik \u015feklinde olabilmektedir. Ya\u015fl\u0131n\u0131n k\u00f6t\u00fc kokmas\u0131, derisinde k\u0131zar\u0131kl\u0131k ve yaralar\u0131n olmas\u0131, beslenme bozuklu\u011funun bulunmas\u0131, elbiselerinin kirli olmas\u0131, mevsime uygun giyinmemesi, hasta oldu\u011fu halde yak\u0131nlar\u0131n\u0131n hastaneye g\u00f6t\u00fcrmemesi gibi durumlar ya\u015fl\u0131 ihmalinin belirtileridir.<\/li>\n<\/ul>\n<p style=\"font-weight: 400\">Ya\u015fl\u0131 istismar\u0131 en y\u00fcksek oranlarda kad\u0131nlarda ve 80 ya\u015f ve \u00fczerinde g\u00f6r\u00fclmektedir. \u0130stismarc\u0131, olgular\u0131n yakla\u015f\u0131k %90&#8217;\u0131nda bir aile \u00fcyesidir (2). Ya\u015fl\u0131 istismar\u0131na ili\u015fkin yap\u0131lan sistematik bir incelemede, istismar yayg\u0131nl\u0131\u011f\u0131n\u0131n bili\u015fsel olarak sa\u011flam ya\u015fl\u0131 yeti\u015fkinlerde %10 iken, demans\u0131 olanlarda bu oran\u0131n %47&#8217;ye kadar \u00e7\u0131kt\u0131\u011f\u0131 bildirilmi\u015ftir (6).<\/p>\n<p style=\"font-weight: 400\">Ya\u015fl\u0131 istismar\u0131 ve ihmalinin tan\u0131nmas\u0131 konusunda e\u011fitim eksikli\u011fi, istismarc\u0131y\u0131 koruma arzusu veya istismarc\u0131y\u0131 bildirme konusunda bili\u015fsel eksiklik nedeniyle bildirilen olgu say\u0131s\u0131 beklenenden az olmaktad\u0131r (7). Genel olarak istismar ve kendini ihmal olgular\u0131 eksik bildirilmekte ve bildirilen olgular aras\u0131nda kendini ihmal en yayg\u0131n olarak g\u00f6r\u00fclmektedir.<\/p>\n<p style=\"font-weight: 400\">Toplumda ya\u015fl\u0131 istismar\u0131n\u0131n yayg\u0131nl\u0131\u011f\u0131 %2-10 aras\u0131nda de\u011fi\u015fmektedir (8). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) verilerine g\u00f6re; 2019 y\u0131l\u0131nda 60 ya\u015f ve \u00fcst\u00fc ki\u015filerin %15.7\u2019sinin istismara maruz kald\u0131\u011f\u0131 tahmin edilmektedir (9). \u00dclkemizde ise yap\u0131lan ara\u015ft\u0131rmalarda ya\u015fl\u0131 istismar\u0131 s\u0131kl\u0131\u011f\u0131 %14.2 ve %18.2 olarak bildirilmi\u015ftir (10,11).<\/p>\n<p style=\"font-weight: 400\">Ya\u015fl\u0131lara bak\u0131m hizmeti veren kurumlarda istismar ve ihmal s\u0131kl\u0131\u011f\u0131na dair veriler ise s\u0131n\u0131rl\u0131 say\u0131dad\u0131r. Muhtemelen bildirimlerle ilgili eksiklikler s\u00f6z konusu olabilmektedir. Bununla birlikte uzun s\u00fcreli bak\u0131m hizmeti veren kurumlarda daha \u00e7ok duygusal istismar\u0131n yap\u0131ld\u0131\u011f\u0131 ve bunu s\u0131ras\u0131yla fiziksel istismar, ekonomik istismar, ihmal ve cinsel istismar\u0131n takip etti\u011fi g\u00f6sterilmi\u015ftir. \u0130stismar kurumlarda \u00e7al\u0131\u015fan g\u00f6revli personeller taraf\u0131ndan da yap\u0131labilmektedir (2). Kurumda \u00e7al\u0131\u015fan personelin d\u00fc\u015f\u00fck \u00fccretli, yetersiz ve a\u015f\u0131r\u0131 \u00e7al\u0131\u015f\u0131yor olabilmesi, kurum y\u00f6neticilerinin ve \u00e7al\u0131\u015fanlar\u0131n\u0131n istismar ve ihmal belirtilerine kar\u015f\u0131 duyars\u0131zl\u0131klar\u0131, de\u011fer ve g\u00f6renekleri, yeti\u015ftirilme \u015fekli ve e\u011fitimleri kurumsal fakt\u00f6rlerin nedenleri aras\u0131nda say\u0131labilir. Sa\u011fl\u0131k personelinin ya\u015fl\u0131 istismar\u0131n\u0131 ortaya \u00e7\u0131karmada hangi sorular\u0131 soraca\u011f\u0131n\u0131 bilmemesi, konu ile ilgili bilgi eksikli\u011finin olmas\u0131 veya sa\u011fl\u0131k personelinin problemi bildirme ve kaydetmede yetersiz\/isteksiz olmas\u0131 ise sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131ndan kaynakl\u0131 zorluklard\u0131r. Kurumsal engeller ise huzurevleri ve bak\u0131mevlerindeki denetim eksikli\u011fi, kurum \u00e7al\u0131\u015fanlar\u0131 ve ya\u015fl\u0131lar\u0131n \u00e7e\u015fitli kayg\u0131lar\u0131 nedeniyle sorunlar\u0131n g\u00f6rmezlikten gelinmesidir (3). Ya\u015fl\u0131 istismar\u0131 ve ihmali; uygun olmayan ila\u00e7lar\u0131n verilmesi, uygun olmayan dozlarda ila\u00e7lar\u0131n verilmesi veya ila\u00e7 tedavisinin izlenmemesi \u015feklinde olabilir ve bu durum kurumsal ortamlarda ortaya \u00e7\u0131kabilir.<\/p>\n<p style=\"font-weight: 400\">Ya\u015fl\u0131lara k\u00f6t\u00fc muamele \u00f6nemli bir halk sa\u011fl\u0131\u011f\u0131 sorunudur. Acil serviste ve di\u011fer ayakta tedavi veren b\u00f6l\u00fcmlerde bir\u00e7ok klinisyen, ya\u015fl\u0131 istismar\u0131 ve ihmal tan\u0131s\u0131nda yetersiz e\u011fitim ald\u0131klar\u0131n\u0131 ve bu t\u00fcr hastalar i\u00e7in uygun m\u00fcdahaleler hakk\u0131nda yetersiz olduklar\u0131n\u0131 belirtmektedir. \u00c7al\u0131\u015fmalar acil servis hekimlerinin bak\u0131m verdikleri ma\u011fdurlar\u0131n b\u00fcy\u00fck \u00e7o\u011funlu\u011funa ya\u015fl\u0131 istismar\u0131 tan\u0131s\u0131 koyamad\u0131klar\u0131n\u0131 g\u00f6stermektedir (12). Oysa acil servisler bu a\u00e7\u0131dan \u00f6nemli bir role sahiptir ve hastalar\u0131n hassas bir \u015fekilde sorgulanmas\u0131 \u00e7\u00f6z\u00fcm i\u00e7in \u00f6nemli bir ad\u0131m olabilir (13). Acil servis hekimlerinin ya\u015fl\u0131 istismar\u0131n\u0131n \u00f6nlenmesi, belirlenmesi ve raporland\u0131r\u0131lmas\u0131 konusunda sorumluluklar\u0131 b\u00fcy\u00fckt\u00fcr ve bu konu hakk\u0131nda fark\u0131ndal\u0131klar\u0131n\u0131n art\u0131r\u0131lmas\u0131 gerekmektedir.<\/p>\n<p style=\"font-weight: 400\"><strong>Kaynaklar<\/strong><\/p>\n<ol>\n<li><a href=\"https:\/\/eapon.ca\/wp-content\/uploads\/2021\/09\/toronto_declaration_en.pdf\">https:\/\/eapon.ca\/wp-content\/uploads\/2021\/09\/toronto_declaration_en.pdf<\/a><\/li>\n<li><a href=\"https:\/\/www.uptodate.com\/contents\/elder-abuse-self-neglect-and-related-phenomena?search=elder%20abuse&amp;source=search_result&amp;selectedTitle=1~15&amp;usage_type=default&amp;display_rank=1\">https:\/\/www.uptodate.com\/contents\/elder-abuse-self-neglect-and-related-phenomena?search=elder%20abuse&amp;source=search_result&amp;selectedTitle=1~15&amp;usage_type=default&amp;display_rank=1<\/a><\/li>\n<li>G\u00fclen M, Akt\u00fcrk A, Acehan S, Se\u011fmen MS, A\u00e7\u0131kal\u0131n A, Bilen A. Ya\u015fl\u0131 \u0130stismar\u0131 ve \u0130hmali (Elder Abuse and Neglect). Ar\u015fiv Kaynak Tarama Dergisi (Archives Medical Review Journal) 2013; 22(3):393-407.<\/li>\n<li>Erden \u015e, Boz H. T\u00fcrkiye\u2019de Ya\u015fl\u0131 \u0130stismar\u0131 ve \u0130hmali. Ankara \u00dcniversitesi T\u0131p Fak\u00fcltesi Mecmuas\u0131 2018;71(3):100-105.<\/li>\n<li>K\u0131ssal A, Be\u015fer A. Ya\u015fl\u0131 istismar ve ihmalinin de\u011ferlendirilmesi. TAF Preventive Medicine Bulletin. 2009;8:357-364.<\/li>\n<li>Dong XQ. Elder Abuse: Systematic Review and Implications for Practice. J Am Geriatr Soc 2015; 63:1214.<\/li>\n<li>National Center on Elder Abuse. Statistics and data: What is known about the incidence and prevalence of elder abuse in the community setting? Available at: https:\/\/ncea.acl.gov\/What-We-Do\/Research\/Statistics-and-Data.aspx#prevalence (Accessed on August 14, 2020).<\/li>\n<li>Lachs MS, Pillemer K. Elder abuse. Lancet 2004; 364:1263.<\/li>\n<li><a href=\"https:\/\/www.who.int\/health-topics\/abuse-of-older-people#tab=tab_1\">https:\/\/www.who.int\/health-topics\/abuse-of-older-people#tab=tab_1<\/a><\/li>\n<li>YA\u015eLILARDA \u0130HMAL VE \u0130ST\u0130SMAR \u0130LE \u0130L\u0130\u015eK\u0130L\u0130 FAKT\u00d6RLER\u0130ZM\u0130R \u0130L\u0130NDEN B\u0130R \u00d6RNEK, S \u00c7 ERY\u0130\u011e\u0130T DOKTORA TEZ\u0130, DANI\u015eMAN Prof. Dr. G\u00fczel D\u0130\u015e\u00c7\u0130G\u0130L. AYDIN ADNAN MENDERES \u00dcN\u0130VERS\u0130TES\u0130 SA\u011eLIK B\u0130L\u0130MLER\u0130 ENST\u0130T\u00dcS\u00dc YA\u015eLI SA\u011eLI\u011eI ANAB\u0130L\u0130M DALI YA\u015eLI SA\u011eLI\u011eI VE BAKIMI D\u0130S\u0130PL\u0130NLERARASI DOKTORA PROGRAM, AYDIN-2022. <a href=\"http:\/\/adudspace.adu.edu.tr:8080\/xmlui\/bitstream\/handle\/11607\/4652\/Saadet%C3%87isenEryi%C4%9FitDRTez.pdf?sequence=3&amp;isAllowed=y\">http:\/\/adudspace.adu.edu.tr:8080\/xmlui\/bitstream\/handle\/11607\/4652\/Saadet%C3%87isenEryi%C4%9FitDRTez.pdf?sequence=3&amp;isAllowed=y<\/a><\/li>\n<li>\u00c7ift\u00e7i H, Bostanc\u0131 Da\u015ftan N, Kaya F. Acil Servisin Bilinmeyen-G\u00f6r\u00fclmeyeni: Ya\u015fl\u0131 \u0130stismar\u0131. Sted, 2020, cilt: 29, say\u0131: 3, S:213-220.<\/li>\n<li>Evans CS, Hunold KM, Rosen T, Platts\u2010Mills TF. Diagnosis of elder abuse in US emergency departments. J American Geriatr Soc. 2017; 65(1): 91-7.<\/li>\n<li>K\u0131l\u0131\u00e7 \u00d6zt\u00fcrk Y, D\u00fczenli E, Karaali C, \u00d6zt\u00fcrk F. Physical violence among elderly: analysis of admissions to an emergency department. Ulusal Travma ve Acil Cerrahi Derg., 2017; 23(1): 56-60.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Uluslararas\u0131 Ya\u015fl\u0131 \u0130stismar\u0131n\u0131n \u00d6nlenmesi ve D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) Toronto Deklarasyonu\u2019na g\u00f6re ya\u015fl\u0131 istismar\u0131; \u201cYa\u015fl\u0131 insanlara kar\u015f\u0131, herhangi bir g\u00fcven beklentisi i\u00e7inde&hellip;<\/p>\n","protected":false},"author":1185,"featured_media":440,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10018,10028,10027],"class_list":["post-439","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-geriatri","tag-ihmal","tag-istismar"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/439","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=439"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/439\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/440"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=439"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=439"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=439"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}