Download Elder Mistreatment - Academy on Violence and Abuse

April 20, 2018 | Author: Anonymous | Category: , Science, Health Science, Geriatrics
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Elder Mistreatment Laura Mosqueda, M.D. Director of Geriatrics Interim Chair & Professor of Family Medicine University of California, Irvine

Think about our expectations and perceptions of aging. How do these expectations and perceptions influence our interest in elder abuse? How do these expectations and perceptions influence our understanding of elder abuse?

Child & Elder Differences • Death – Unusual/unexpected in kids – Common/expected in older adults

• Autonomy – Not recognized in children – Assumed in older adults

• Social networks – Almost all children are in schools and in some contact with people other than their parents – An elder may easily remain isolated

Child & Elder Differences • Training – Most police officers, health care providers, social workers have received specific training in child abuse – Most police officers, health care providers, social workers have received NO training in elder abuse

• Vulnerability – Will likely decrease over time for children – Will likely increase over time for elders

Why is understanding elder abuse important?

“People with dementia don’t feel pain.” E.R. nurse

“She did the best she could.”

Primary Care Doctor

“I see old people who die in this condition all the time.” Coroner Investigator

“He was just doing it to annoy me so I finally hit him - it’s not my fault.” Daughter

Normal & Common Changes • Renal: decrease in creatinine clearance • Integument – thinner epidermis – capillary fragility – Less elasticity

• Sensory system – presbycussis – slower reaction time – macular degeneration, cataracts

Normal & Common Changes • Musculoskeletal – sarcopenia – osteopenia/osteoporosis

• Cardiovascular – orthostatic hypotension – congestive heart failure

• Function – gait/falls – ADLs

Effects of Decrease in Reserve • Greater susceptibility to illness • More difficulty in recovering from illness • Sensitivity to side effects of medication

• Vulnerability to abuse

Vulnerability • Emotional: fear of losing independence, more susceptible to threats • Physical: more difficult to defend oneself • Cognitive • More assistance is required – Change in dynamics of relationships – More people involved in intimate aspects

Research Markers Instruments Models

Technical Assistance

Forensic Center

CoE EAN

Training Institute Conferences Products Pocket Doc FC manual

OCEAPC VAST EDRT

Policy

Objective To summarize the occurrence, progression, and resolution of accidentally acquired bruises in a sample of adults aged 65 and older. The systematic documentation of accidentally occurring bruises in older adults could provide a foundation for comparison when considering suspicious bruising in older adults.

Design Between April 2002 and August 2003, a convenience sample of 101 seniors was examined daily at home (up to 6 weeks) to document the occurrence, progression and resolution of accidental bruises that occurred during the observation period.

Setting and Participants Three community-based settings and two skilled nursing facilities in Orange County, California. One hundred and one adults over the age of 65.

Measures Age, gender, ethnicity, functional status, handedness, medical conditions, medications, cognitive status, depression, history of falls, bruise size, bruise location, initial bruise color, color change over time. Each day, bruises were visually inspected, recorded in subject files, and digitally photographed.

Bruising II • To document the bruises of elders who have been physically abused and compare them with ‘normal’ bruising • Worked in partnership with Adult Protective Services to gain access to physical abuse cases

Bruising Associated With Physical Elder Abuse

• Subjects: 67 older adult APS clients seen within 30 days of a physical abuse incident • Compared with 101 older adults from the earlier accidental bruising study

Findings • (At least) 72% of physically abused older adults had bruises • Of 155 bruises found, they reported that (at least) 89 were inflicted, 26 accidental and 40 unknown

Findings & Clinical Significance 

Inflicted bruises are larger.  Be suspicious if >5 cm.



Abused elders are more likely to have bruises on head, neck, lateral right arm.  Pay attention to the location.



People who were abused are more likely to remember the cause of the bruise.  Ask.

Caregiver Research Study • Can we predict who is at risk? • Interviewed 140 dyads at home • Incidence of abuse by caregiver – Psychological 42% – Physical 9% – Neglect 17% – Any 47%

Care Recipient Characteristics • • • •

Dependent Dementia Physically aggressive Verbally abusive

Caregiver Characteristics • Mental Illness • Substance Abuse • Perceived stress

Physical Abuse Predictors • Caregiver Characteristics: – Depressive symptoms – Felt they had a poor emotional status and had role limitations in activities and/or work as a result of caregiving role • Patient Characteristics: – Physical assault toward caregiver – Psychological aggression toward caregiver

Predictors statistically significant at p < .05

High Risk Caregiving Situations • People with inadequately treated mental health and/or substance abuse problems are more likely to be abusive • People who feel stressed/burdened are more likely to be abusive • Providing care for an older adult who is physically combative and/or verbally abusive

Medical Education

Medical Education: Students • MS IIIs: one week geriatrics (required) • at APS headquarters to learn about calls, triage • half day at the EAFC – Video – Meet with gerontologist coordinator – Attend IDT meeting – Debrief after meeting

Medical Education: PGs • Geriatrics rotation (required) for all FM and IM residents • half-day with APS in the field • half day at the EAFC – Video – Meet with gerontologist coordinator – Attend IDT meeting – Debrief after meeting

Medical Education: electives • Medical students • Residents • Fellows • Opportunities for combined elective in family violence being explored

The Importance of Good Science • To understand the issues and generate appropriate hypotheses • To study outcomes • To evaluate effectiveness of interventions • To avoid costly, albeit well-intentioned, mistakes • To understand consequences of elder abuse

Sherrie’s Mom

To promote aging with joy and eliminate aging in fear www.centeronelderabuse.org

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